2. VACCINE STORAGE AND ADMINISTRATION AMONG PRIMARY HEALTH CARE WORKERS IN SOUTH-EAST NIGERIA: EFFECT OF EDUCATIONAL INTERVENTION UZOCHUKWU BSC, ONWUJEKWE OE DEPT. OF COMMUNITY MEDICINE, COLLEGE OF MEDICINE, UNIVERSITY OF NIGERIA ENUGU CAMPUS

3. ABSTRACT: VACCINE STORAGE AND ADMINISTRATION AMONG PRIMARY HEALTH CARE WORKERS IN SOUTH-EAST NIGERIA: EFFECT OF EDUCATIONAL INTERVENTION UZOCHUKWU BSC, ONWUJEKWE OE DEPT. OF COMMUNITY MEDICINE, COLLEGE OF MEDICINE, UNIVERSITY OF NIGERIA ENUGU CAMPUS  The aim was to assess health workers’ knowledge about and practice regarding vaccine storage and administration, verify quality of vaccine storage, and evaluate changes in knowledge of vaccine storage and administration after a health education workshop.  75 randomly selected health workers from health centers in 10 local government areas (LGAs) of Anambra state in south-east Nigeria as study groups with 59 health workers from 11 LGAs as controls were interviewed. In addition, the cold chain system of all the 21 LGAs was assessed to verify quality of vaccine storage. An interactive educational workshop was then carried out in the study area and a post intervention evaluation was carried out immediately after in both areas and 18 months after in study area.  Adequate knowledge of vaccine storage and administration was very low. Knowledge increased significantly (p 0.05). Fewer than three-quarters of the LGAs kept records of received and stored doses, and just above half had a functional thermometer. Faulty procedures identified include, storage of vaccines on refrigerator door shelves and storage of food in vaccine refrigerators.  Poor cold chain system in some LGAs; health workers have poor knowledge of vaccine storage and administration. However, it is possible to improve this knowledge through interactive educational strategies.  This type of intervention can be an affordable way of increasing rational vaccine use and thus improving vaccine coverage.

4. INTRODUCTION:  Vaccine preventable diseases are not decreasing and in some cases are increasing in Nigeria despite intensified efforts in improving immunization services  Childhood immunization is a most cost effective public health intervention.  Maintaining adequate vaccine storage and administration is essential to ensure optimal vaccine effectiveness and successful immunization program.  High coverage would have little meaning if the vaccines administered had lost their potency and/or were not properly reconstituted and administered.  An important area that has been constantly neglected is the influence of the health workers’ knowledge about and practice regarding vaccine storage and administration.

5. OBJECTIVES:  To assess health workers’ knowledge about and practice regarding vaccine storage and administration.  To verify quality of vaccine storage.  To evaluate changes in knowledge of vaccine storage and administration after a health education workshop.

6. METHODS:  Study conducted in Anambra State, Southeast Nigeria  Baseline information was collected with self- administered questionnaire from randomly selected health center workers  75 from 10 local government areas (LGAs) as study groups  59 from 11 LGAs as controls  Information gathered were knowledge of  the procedures and implements required for maintaining the cold chain  optimum age bracket for vaccine administration  appropriate routes, site and dose of each vaccine given

7. METHODS:  Assessment of the cold chain system of the 21 LGAs using a check list was done.  Information gathered were availability of:  Refrigerators  Thermometers  Standby generator  Vaccine stock chart and items stored in the refrigerator

8. METHODS CONTD:  A workshop for 3 days in the study area using Lectures, demonstrations, case studies and role- playing  Educational Package used:  Procedures and implements required for maintaining the cold chain  Methods of monitoring the cold chain.  Optimum age bracket for vaccine administration  Routes, site and dose of each vaccine given under the National Programme on Immunization.  Post intervention evaluation with self-administered questionnaire 2 weeks and 18 months after in the study area and 2 weeks after in the control area.

9. RESULTS:  Adequate knowledge of vaccine storage and administration was low (20%-27%).  Knowledge increased significantly (p<0.001) in the study group 2 weeks after the workshop and remained high at 18 months.  In the control group there were no significant changes 2 weeks after (p>0.05 )

10. RESULTS:  All 21 LGAs had at least one functional refrigerator for vaccine storage.  17 (81%) had a functional power source to operate the cold chain system.  11 (52.4%) had a minimum and maximum thermometer.  14 (66.7%) kept records of received and stored doses.  Faulty procedures were:  Storage of vaccines on refrigerator door shelves 13 (61.9%)  Storage of food in vaccine refrigerators 15 (71.4%).

11. Variable Study (n= 75) Control (n= 59) Pre- intervent ion Post-interventionPre- intervention Post-intervention 2 weeks after P-value18 months after P-value2 weeks after P- value Adequate knowledge of vaccine storage 18(24%)65(86.7%) 0.000* 53(70.7%) 0.000* 14(23.7%)15(25.4%) 0.869 Adequate knowledge of vaccine administra tion 15(20%)71(94.7%) 0.000* 56(74.7%) 0.000* 16(27.1%)13(22%) 0.411 MORE RESULTS: Respondents’ distribution of adequate knowledge of vaccine storage and administration * P< 0.001 = Statistically significant

12. IMPLICATIONS/CONCLUSIONS:  Poor cold chain system in some LGAs  Storage of food in vaccine refrigerators means that they are opened frequently.  Health workers have poor knowledge of vaccine storage and administration.  It is possible to improve this knowledge through interactive educational strategies.  This type of intervention can be an affordable way of increasing rational vaccine use and thus improving vaccine coverage.