Assessment of Vaccine Distribution Management Practice at Health Facilities in Burji Zone Southern Ethiopia Region, Ethiopia: Mixed Methods Study

Abstract

Background: Around 25% of vaccines reach their destination in a degraded state due to failure within the cold chains, and more broadly, about 20% of temperature-sensitive pharmaceutical products are damaged due to broken cold chains. Due to poor management of the vaccine cold chain, 29% of all child deaths worldwide occur in developing countries. The Ethiopian national EVM survey report showed that health facilities achieved only 59% in vaccine distribution, below the 80% target. Objective: To assess vaccine distribution management practices at health facilities in Burji Zone, Southern Ethiopia Region. Methods: A facility-based cross-sectional mixed study design was conducted from January11 to February25, 2025. From a total of 32 health facilities serving the current study area, all 16 Health facilities that managed vaccine inventories within their storage facilities and met the inclusion criteria were selected, and all 43 vaccine cold chain handlers working in the eligible Health facilities were included using a census method. Vaccine distribution practices were measured based on three components: vaccine transportation, vaccine receiving, and inventory management practices at health facilities. Data were collected using a self administered structured questionnaire, interviews, document review, and an observational checklist. Quantitative data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 27. The Fisher‘s exact test was conducted to determine the association at a p-value <0.05 as a significant level. For the qualitative study, 9 key informants were purposively selected from the Ethiopian pharmaceutical supply service Arba Mich hub and Burji Zone health facilities to supplementing the quantitative finding. Data were analyzed using inductive thematic analysis. Finally, triangulation of the qualitative findings with quantitative data was carried out. Results: In this study, 42 vaccine cold chain handlers from 16 selected health facilities were included, with a response rate of 97.7%. Of 16 health facilities assessed, half 8(50%) of them demonstrated good vaccine transportation practice. Regarding vaccine receiving practices, 5(31%) of the health facilities had good vaccine receiving practices. In addition to that, more than half 9(56%) of healthcare facilities have experienced good vaccine inventory management practices. Overall, the study indicated that 44% of the health facilities had good vaccine distribution management practices. Vaccine cold chain handlers‘ gender (p=0.021), profession (p=0.021), training (p=0.005), supportive supervision (p=0.030), and knowledge I of vaccine handlers (p=0.029) were significantly associated with vaccine distribution practices. Limited cold chain capacity, lack of maintenance supplies and transportation, high turnover, poor data quality, and absence of digital inventory systems were the major challenges contributing to poor vaccine distribution practices. Conclusion: The study revealed that vaccine distribution practices are poor at lower levels of the health facilities. Ensuring effective vaccine distribution through continuous professional training, regular supervision, and provision of cold chain equipment, with coordinated efforts from Regional health bureau, Ethiopian pharmaceutical supply service, Zonal health department, and District health office, may help improve vaccine distribution practices.