|Year : 2020 | Volume
| Issue : 3 | Page : 220-223
A cross-sectional survey on awareness, practice of vaccine administration, and cold chain management in a tertiary health center of Western Maharashtra
Prabhakar T Teli1, Renuka Kunte1, Arun Kumar Yadav1, Prafull Mohan2
1 Department of Community Medicine, AFMC, Pune, Maharashtra, India
2 Department of Pharmacology, AFMC, Pune, Maharashtra, India
|Date of Submission||16-Dec-2019|
|Date of Decision||26-Mar-2020|
|Date of Acceptance||26-Mar-2020|
|Date of Web Publication||3-Jun-2020|
Arun Kumar Yadav
Department of Community Medicine, Armed Forces Medical College, Sholapur Road, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: The potency of vaccines depends on maintaining the cold chain, that is, a prescribed temperature range during distribution from manufacture to use. The paramedical staff of any hospital plays a pivotal role in cold chain maintenance. Hence, the study aims to assess knowledge and practice of cold chain maintenance of vaccines by paramedical staff. Materials and Methods: A cross-sectional questionnaire-based study was conducted among paramedical staff in a tertiary health care of western Maharashtra, from June 15, 2019, to August 30, 2019. The data were collected using interview schedule. Results:A total of 115 paramedics were enrolled. The final data analysis was done on 91 respondents. Participants' knowledge about maintenance of refrigerators with respect to place of vaccine storage (54; 59.34%), temperature recording in a day (54; 59.34%), and preferable place of deep freezer (62; 68.13%) was satisfactory. A total of 42 (46.15%) participants had knowledge about shake test; however, only 38 (41.75%) participants knew about demonstration of shake test, suggesting that awareness about testing the frozen vaccine was poor among paramedical staff. Full form and use of vaccine vial monitor (VVM) in participants were satisfactory, being 70 (76.92%) and 59 (64.83%), respectively. Participant's knowledge about correct site and route of administration of vaccines were satisfactory. Conclusion: The study demonstrates the gap in knowledge in cold chain maintenance of the paramedical workers. Regular training may be conducted for the paramedical workers to improve their understanding of the cold chain management.
Keywords: Cold chain, KAP, Paramedical staff, Vaccine Administration
|How to cite this article:|
Teli PT, Kunte R, Yadav AK, Mohan P. A cross-sectional survey on awareness, practice of vaccine administration, and cold chain management in a tertiary health center of Western Maharashtra. Med J DY Patil Vidyapeeth 2020;13:220-3
|How to cite this URL:|
Teli PT, Kunte R, Yadav AK, Mohan P. A cross-sectional survey on awareness, practice of vaccine administration, and cold chain management in a tertiary health center of Western Maharashtra. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Oct 22];13:220-3. Available from: https://www.mjdrdypv.org/text.asp?2020/13/3/220/285770
| Introduction|| |
Proper maintenance of cold chain is one of the most essential parts for making any immunizations program a success. The potency of vaccines depends on maintaining the cold chain, that is, a prescribed temperature range during distribution from manufacture to use. A proper storage of vaccines at the recommended temperature conditions is vital so that vaccine's potency is retained up to the moment of administration. Any loss of potency in a vaccine is permanent and irreversible. Hence, immunization supply chain system is one of the important elements for improving the immunization coverage with quality. It deals with cold chain and vaccine logistics. The vaccine and cold chain handler (pharmacist or health supervisor or other paramedical staff) is a key person for the management of cold chain and vaccine logistics and also responsible for safe storage of vaccine under UIP.
There are various studies for assessing awareness and practice of paramedical workers at primary and secondary care levels.,,,,,, However, we could not find any study carried out at a tertiary care level. In our setup, all the paramedical workers are put in the management of vaccine cold chain management on a rotational basis. Hence, the study was conducted with the aim to assess awareness, practice of vaccine administration, and the status of vaccine cold chain management by paramedical staff of a tertiary health-care center.
| Materials and Methods|| |
The study was conducted in a tertiary care center in western Maharashtra from June 15, 2019, to August 30, 2019. It was a cross-sectional study. Ethical approval for the study was obtained from the Institutional Ethical Committee of Armed Forces Medical College, Pune (IECS. No. IEC/2019/183 dated 25 April 2019).
The study population was paramedical staff of a tertiary health center. The tertiary care hospital has 115 paramedical staff, which includes pharmacists, health assistants, nursing assistants, and lab assistants. In our setup, all paramedical staff were male. All were approached for the study, but only 91 (79.1%) gave consent. Inclusion criteria were permanent paramedical staff working in the tertiary care hospital.
The data were collected by a questionnaire using interview schedule. The questionnaire was developed with wide consultation among the stakeholders. It was a structured questionnaire consisting of background information of the respondents and more specific ones related to knowledge, awareness, practice of vaccine administration, and cold chain management. The interviews were taken by a single investigator (PT) to reduce interobserver bias. Interview schedule lasted for an average of 15 min. Every respondent was assured that the information obtained was solely for the purpose of research and would be kept confidential and would not in any way affect future services to that individual. The data were entered into the excel sheet and analysis was done using StataCorp. 2013. Stata Statistical Software: College Station, TX: StataCorp LP. Ethics institutional clearance was taken for the study.
Rao et al.'s study was used as a reference to calculate the sample size. The sample size was calculated for confidence interval of single proportion using the formula n = z  p (1-p)/d  with confidence interval of 95% and 10% absolute error and expected proportion to be 65% total number of sample comes to 86 for this study; however, we included all 115 paramedical staff in the study.
| Results|| |
A total 115 paramedical staff in a tertiary health-care center of western Maharashtra were approached. A total of 91 (79.1%) staff gave consent for the study. They were health assistant (25; 27.47%), nursing assistant (46; 50.55%), laboratory assistant (3; 3.3%), blood technician assistant (12; 13.18%), and dental assistant (5; 5.49%).
The mean age of paramedical staff was 30±4.4 years, with a mean work experience of 10±4.4 years; in our setup, there is multitasking of job, in which all paramedicals are involved in the maintenance of cold chain in rotational basis. All were permanent staff of government hospital trained as per their nature of job, but not received any specific training on cold chain maintenance. They learn mostly by on-the-job-training.
Handling and maintenance of refrigerator
[Table 1] shows various aspects of knowledge about cold chain among paramedical staff of a tertiary health-care center. Participants' knowledge about maintenance about refrigerators assessed was found to be satisfactory as more than 50% of participants answered correctly. It was observed that 54 (59.34%) participants knew about the correct place of vaccine storage in refrigerator (including room refrigerator, ice-lined refrigerator (ILR), and deep freezer) and 54 (59.34%) participants answered correctly about the number of times temperature recording of refrigerator required in a day. A total of 62 (68.13%) paramedical staff knew the preferable place of deep freezer and 64 (70.32%) participants have a correct idea of schedule of defrosting deep freezer. The number of paramedical staff having the correct idea about the action to be taken when power failure or refrigerator failure occurs was 58 (63.73%). The overall knowledge of participants about handling and maintenance of refrigerator was satisfactory.
|Table 1: Correct knowledge and practice about cold chain among paramedical staff of a tertiary health-care center|
Click here to view
Frozen vaccine (shake test) and VVM
Moreover, 42 (46.15%) paramedical staff correctly answered test of frozen vaccine, i.e., shake test; however, 38 (41.75%) participants knew about demonstration of shake test. 69 (75.82%) participants have the knowledge about consequences of frozen vaccine.
Paramedical staff's knowledge about shake test was poor as more than 50% of participants did not know about it.
In examining the paramedical staff's knowledge about VVM, 70 (76.92%) of them knew the full form of VVM, whereas 59 (64.83%) have information about correct use of VVM and its importance. Paramedical staff's knowledge about VVM was satisfactory.
Location and route of administration of vaccines
The correct responses of knowledge about correct site and route of administration of vaccines such as measles, Bacillus Calmette–Guérin (BCG), Diphtheria, Pertussis, and Tetanus (DPT), and Hep B are shown in [Table 2]. It is observed that 84 (92.3%) participants have a correct knowledge about the injection site for BCG; however, correct responses were highest for DPT (74; 81.31%) and Hep B (78; 85.71%) and lowest for measles (57; 62.63%). Furthermore, the correct response for route of administration was maximum for Hep B (82; 90.1%), followed by DPT (79; 86.81%) and BCG (74; 81.32%), and lowest for measles (63; 69.23%). From this, it was observed that the knowledge about correct location and route of administration of vaccines for measles in paramedical staff is less compared to other vaccines. A total of 70 (76.92%) participants have the correct knowledge about site of intramuscular injection in a child.
|Table 2: Knowledge about correct site and route of administration of vaccines|
Click here to view
Adverse events of vaccines
The questionnaire included questions on step following adverse events of vaccines; only 25 (27.47%) paramedical staff answered correctly; this shows that the knowledge about the adverse events of vaccines is low in paramedical staff. A total of 35 (38.46%) participants demonstrated correct action, paramedical staff should undertake before giving BCG vaccines.
| Discussion|| |
Proper maintenance of cold chain is crucial in maintaining efficacy of vaccines in routine immunization. It is important to know the status of knowledge about cold chain maintenance among paramedical staff. In this study, we studied various aspects of knowledge about cold chain among paramedical staff of a tertiary health-care center. The present study was carried out among paramedical staff of a tertiary health center of western Maharashtra. In the present study, all participants were male, whereas in other studies done by various authors, both male and female paramedical workers were included.
Participants' knowledge about maintenance of refrigerators with respect to place of vaccine storage (59.34%), temperature recording in a day (59.34%), and preferable place of deep freezer (68.13%) was satisfactory. Bhatnagar et al. reported that 100% cold chain handlers had knowledge about place of vaccine storage; however, 61.6% of participants knew about temperature recording in a day and 65% correctly answered about preferable place of deep freezer. Similar findings were observed in a study conducted in Niassa Province of Mozambique. As in our study, all paramedical staff were included as they are put on cold chain management on rotational basis. It points out that a formal training session may be conducted for all paramedical staff centrally before they are detailed for cold chain management.
Defrosting deep freezer is crucial to maintain temperature in the ILR/DF, as any excess layer of ice around the freezer or along the walls and bottom of ILRs will hamper its working condition. Continuous supply of electricity to the refrigerators is required for maintaining prescribed temperature. The correct schedule of defrosting deep freezer and action to be taken when power failure or refrigerator failure occurs or contingency plans for electricity breakdown were observed in 70% and 64% of paramedical staff, respectively. Similar results were seen in the study conducted by Rao et al. on cold chain evaluation.
We observed that only 46% of paramedical staff knew about shake test, done to test whether vaccine is frozen or not; however, only 42% of paramedical staff were able to demonstrate it. Rao et al. (22.4%), Naik et al. (40%), Gupta and Gupta. (66.66%), and Sinha et al. (50%) also reported the same observations.,,, It is interesting to know that majority (76%) of participants knew the consequences of frozen vaccine.
Awareness was satisfactory for VVM, as about 77% of paramedical staff correctly knew the full form of VVM, whereas 65% knew its use. Studies conducted by Vasava at Surat and Chudasama at Valsad observed that 16.5% and 51.6% staff respectively did not heard of VVM., The study suggested that training at regular interval is required to increase awareness among the paramedical worker.
Correct response for knowledge about site and route of administration of vaccines such as measles, BCG, DPT, and Hep B was ranging from 62% to 92% among the paramedical staff. Further training or practice for correct site and route of administration of vaccines can be carried out, as this is important for immunization program.
In the present study, paramedical staff from various categories and only male participants of a single tertiary health-care center in Pune was covered. The findings of the study may be generalizable only to our setup. Further study of paramedical staff working at various levels of health-care system is required to generalize the findings of the study to other health-care setups.
| Conclusion|| |
In the present study, we found that knowledge for cold chain management of paramedical staff of a tertiary health-care center was satisfactory. As there is no specific training for cold chain management, the same was reflected in few participants. Few aspects require regular training to keep knowledge and skills updated, as cold chain management is vital for effective immunization programs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Park K. Park's Textbook of Preventive and Social Medicine. 25th
ed. Jabalpur: M/s Banarsidas Bhanot Publisher; 2019.
Immunization Division Ministry of Health and Family Welfare. Government of India. Handbook for Vaccine and Cold Chain Handlers. 2nd
ed. India: New Delhi; 2016.
Rao S, Naftar S, Baliga S, Unnikrishnana B, et al
. Evaluation, awareness, practice and management of cold chain at the primary health care centers in Coastal South India. J. Nepal Paediatr 2012;32:19-22.
Bhatnagar PK, Chopra H, Garg SK, Bano T, Kumar A, Kumar S, et al
. Status of knowledge and skills of cold chain handlers in district Meerut, Uttar Pradesh, India. IOSR J Dent Med Sci 2018;17:44-8.
Mavimbe JC, Bjune G. Cold chain management: Knowledge and practices in primary health care facilities in Niassa, Mozambique. Ethiop. J. Health Dev 2007;21:130-5.
Patel N, Unadkat S, Sarkar A, Rathod M, Dipesh P, Patel N, et al
. Assessment of cold chain maintenance for routine immunization in Jamnagar district, Gujarat. Int J Med Sci Public Health 2018;7:1-5.
Naik AK, Rupani MP, Bansal RK. Evaluation of vaccine cold chain in urban health centers of municipal corporation of Surat City, Western India. Int J Prev Med 2013;4:1395-401.
Gupta A, Gupta R. Study of cold chain practices at community health centers of Damoh District of Madhya Pradesh. National J Community Med 2015;6:528-32.
Sinha AK, Verma AR, Chandrakar A, Panda PS, Khes SP, Dixit S, et al
. Evaluation of cold chain and logistics management practice in Durg district of Chhattisgarh: Pointer from Central Indiaint. Int J Community Med Public Health 2017;4:390-5.
Vasava B. Awareness about vaccine vial monitor at pulse polio booths, National J Community Med 2010;1:172-3.
Chudasama RK. Awareness about vaccine vial monitor at pulse polio booths. Indian Pediatr 2007;44:919-20.
[Table 1], [Table 2]