Assessment of factors affecting quality of vaccine cold chain management in health facilities in Kabale District, Western Uganda

Abstract

Background: Effective immunization relies heavily on a well-managed vaccine cold chain to ensure the potency and efficacy of vaccines from production to administration. In Uganda vaccine cold chain management is compromised by inadequate infrastructure and transportation. In Kabale district, these challenges, along with the poor terrain, hinder effective immunization. Methodology: The cross-sectional study employed a convergent parallel mixed- methods approach. Data was collected between 4th and 24th May, 2024, from 40 health facilities in Kabale district using a non-probability consecutive sampling. Quantitative data was collected using a semi-structured questionnaire administered to cold chain focal persons, while qualitative data was obtained through key informant interviews. The sample size was determined using the Kish-Leslie formula and facilities stratified by level of care and ownership. Analysis was done on 41 health facilities using STATA 14 and deductive thematic analysis was done for qualitative data. Results: Only 10 (24.4%) facilities had adequate quality of vaccine cold chain management. Temperature monitoring was satisfactory in 34 (82.9%) facilities, cold storage in 35 (85.4%), infrastructure in 13 (31.1%), and stock management in 35 (85.4%). Associations were found between quality of vaccine cold chain management and the level of healthcare, storage of non-vaccine items, and the availability of functional thermometers. Key informants identified staff turnover, lack of vaccine carriers and worker facilitation as critical challenges affecting the quality of vaccine cold chain management. Conclusion: The study highlights significant shortcomings in vaccine cold chain management across health facilities in Kabale district, with only 24% of the facilities achieving adequate quality of vaccine cold chain management. Higher-level facilities, such as Hospitals and HCIV’s, generally performed better than lower-level health facilities, indicating that resource availability and infrastructure significantly impact the quality vaccine cold chain management. Major challenges include unstable power supply, insufficient cold boxes, vaccine carriers and high turnover rates. To address these issues, there is a need for reliable power solutions, installation of better refrigeration facilities, and supervision. Keywords: Quality of Vaccine cold chain management; Health facilities.