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Primary vaccine failures can occur after high immunization coverage has been achieved. Healthcare workers' knowledge and practices are influential factors in preventing vaccine failures. Adequate knowledge and practices in the cold chain system are important to keep potency of vaccines and effectiveness of immunization. This cross-sectional study w...
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Context 1
... to collect data for this study was approved by the Kalasin provincial chief medical officer who was the chief executive officer of the MoPH, Thailand at the provincial level. Table 1 shows the characteristics of the 117 respondents, 90.6% of whom had a bachelor degree level of education and the rest had master degree level. 78.6% of respondents were nurses and 61.5% of respondents had work experience in EPI services of less than 2 years. ...
Citations
... A structured self-administered questionnaire was developed as per the Pakistan national EPI policy and strategic guidelines 2022 and WHO guidelines (21), as well as from earlier studies (19,22,23). The questionnaire was prepared in both English and Urdu (the official language of Pakistan) for the ease of understanding. ...
Introduction
The periodic evaluation of knowledge, attitudes, and practices (KAP) of healthcare workers, including vaccinators, concerning expanded programs on immunization (EPI) is very crucial for a better healthcare system. This study was carried out to assess the KAP of vaccinators about the EPI, including cold storage of vaccines and their practices related to vaccine cold chain management.
Method
A cross-sectional study was conducted from January 2022 to June 2022 among registered vaccinators in the twin cities (Islamabad and Rawalpindi) of Pakistan. A structured self-administered questionnaire (English and Urdu) was developed as per the Pakistan national EPI policy and strategic guidelines 2022 and World Health Organization (WHO) guidelines, as well as from earlier studies (Cronbach's alpha value of 0.734). The final questionnaire consisted of closed-ended questions in four sections, including sociodemographic information, knowledge (with dichotomous variables of yes/no), attitudes (with a 5-point Likert scale ranging from strongly agree to strongly disagree), and handling of vaccines and cold chain management. Completed questionnaires were entered into Microsoft Excel and then imported into SPSS version 25 for statistical analysis.
Results
A total of 186 vaccinators completely filled out their questionnaires, with a 97.9% response rate. More than half of the participants (57.5%) had no training related to EPI. Most of the respondents had a moderate to poor level of knowledge regarding EPI. The overall attitude was positive, and 57% of the participants strongly agreed that the national immunization programs can significantly contribute to the decrease in morbidity and mortality rates among children. In the current study, participants showed good practices toward EPI, vaccine storage, and cold chain management. The majority (93.5%) of the participants checked the expiry of vaccines at regular intervals to maintain the first expiry first out (FEFO) in their healthcare setting.
Discussion
In conclusion, most of the vaccinators had moderate to poor knowledge, a positive attitude, and good practices toward EPI, vaccine cold storage, and cold chain management. Lack of training among vaccinators on EPI was also observed. These findings have suggested that continuous training, education, and regular supervision of vaccinators in EPI are important for maximum immunization effectiveness and coverage.
... However, the findings are comparable with those of earlier studies (19,29,30,43). But this is much lower than other findings (20,44,45). The discrepancies might be because of differences in the availability of supplies and materials, as well as participant differences in terms of their knowledge, skills, and commitments. ...
Background
Vaccines are vital health commodities that need an appropriate supply chain system. They could be transported, stored, and used at appropriate temperatures. The purpose of this study was to assess vaccine cold chain management practices in primary health centers offering an expanded program of immunization (EPI) in Bahir Dar, Northwest Ethiopia.
Methods
A self-reported and actual practice observational cross-sectional study was conducted at primary public health centers in the Bahir Dar city administration from August 15 to 30, 2021. A simple random sampling method was used to select study participants. An interview-administered questionnaire and direct actual practice observation were used to collect data. The data was entered into the Epi-data 4.6 program and analyzed using SPSS version 25. Participants’ knowledge, storage and transport conditions, IPLS management, and vaccine cold chain management practices were examined using independent samples t-tests and one-way ANOVA tests.
Findings
A total of 50 respondents from ten health centers were enrolled in the study. Most of the EPI service providers had good knowledge (60%) and good practice in vaccine storage and transport (74%). However, more than two-thirds (68%) of EPI service providers had poor integrated pharmaceutical logistics system (IPLS) management. Only half (50%) of the health centers had good actual vaccine cold chain management practices. Higher educational background, longer work experience, and receiving training and supervision in EPI services, IPLS management, and vaccine inventory management resulted in higher knowledge, storage and transport management, IPLS management, and vaccine cold chain management practices.
Conclusion
Although most EPI service providers in an interview assessment reported having good knowledge and good vaccine storage and transport management, only half of the health facilities followed the standard. Stakeholders are recommended to play a vital role in improving practices related to EPI services.
... The fact that three-quarters of the respondents had never managed at least one case of an NTD might be either due to a weak knowledge base or misdiagnosis. 18 One-quarter of health workers either received a referred case of an NTD or referred a case of an NTD to another facility. The structure of healthcare delivery in Nigeria supports the referral of cases from clinics or hospitals with limited capacity to facilities of higher capacity. ...
... The structure of healthcare delivery in Nigeria supports the referral of cases from clinics or hospitals with limited capacity to facilities of higher capacity. 18 However, the referral practice and culture in Nigeria is quite weak, resulting in some health workers managing cases well beyond the capacity of their centres and their professional competence. Measures should therefore be put in place to strengthen the referral system for NTDs and possibly integrate the management of NTDs into the mainstream healthcare system in order to improve the quality of care for NTDs. ...
Background:
The public health impact of neglected tropical diseases (NTDs) is quite substantial. The objective of this study was to assess the knowledge and response capability of health professionals regarding NTDs in Kaduna State, Nigeria.
Methods:
A pre-tested questionnaire with a Cronbach's α coefficient of 0.716 was administered to 350 health professionals. The questionnaire assessed the knowledge, resource availability and capacity to handle NTD cases.
Results:
Only 38 (12.6%) respondents were familiar with the World Health Organization's definition of NTDs. Although self-reported knowledge was highest for physicians (37 [82.2%]), there was no statistically significant knowledge disparity between cadres of health professionals. Only 12 (46.2%) practitioners in private health facilities reported adequate knowledge. The tier of practice was significantly associated with management of NTDs (χ2 = 10.545; df 2; p = 0.005). Only 24 (47.1%) medical laboratory scientists and 18 (40.0%) physicians had adequate clinical resources for management of NTDs. Nearly three-quarters (211 (70.1%)] of respondents had never been trained in the management of NTDs. More than half (177 [58.8%]) of facilities lacked pharmaceuticals or standard operating procedures for management of NTDs.
Conclusions:
Self-reported knowledge of NTDs was suboptimal. Physical and clinical resources for the diagnosis and treatment of NTDs were inadequate. Targeted training, increased funding and provision of adequate resources are needed in order to ameliorate the situation.
... Low levels of knowledge may also relate to the different trainings the HCWs had received that might not have dovetailed neatly with their everyday work responsibilities. The finding of low levels of pentavalent vaccination knowledge differs from other studies in Egypt [17] and Thailand [22]. One explanation for this differnce may be due to the general low level of edcuation of participants, with just one third of the participants having completed an associate diploma.As with our study, other studies, have reported higher educationlevels is acssociated with higher levels of knowedge related to vaccination [23,24]. ...
... The reasons might be that most participants were HCWs responsible for the vaccination. 62.7% had previously received training in immunization, so they had gained practical knowledge in the administration of vaccinations from experts or from those that were qualified in this field, and then they passed on their own expertise [2725].It is also likely that through their work, HCWs gain practical knowledge and learn from colleagues, helping them to integrate formal knowledge with their practical experience [22].The findings also highlighted however, some gaps in good practice, some of which were related to health service factors such as incorrect arrangement of the vaccines in the refrigeration units,no recording of the refrigeration temperature on the weekends, and no instruments prepared to provide first-aid in the event of undesirable symptoms following immunization [2826]. ...
... This also underscores the importance of training in supporting good practice. This finding is similar to other studies for example research done in Egypt and Thailand showed that the knowledge score was significantly higher in HCWs who had training courses compared to those who did not [17,22]. In contrast, research by Swamkar et al found a nonsignificant (P=-.095) ...
Knowledge and practice regarding the administration of the pentavalent vaccine among health care workers in Vientiane Capital, Lao PDR: A mixed method approach Abstract Background: The pentavalent vaccine is an essential, cost-effective public health measure to reduce preventable premature child mortality and childhood mobility and contributes to lowering the spread of vaccine-preventable diseases. The aim of this study is to assess the knowledge and practice of providing pentavalent vaccines and its related factors among health care workers (HCWs). Method: This was a cross-sectional analytical study, using the qualitative and quantitative methods. The study was conducted in nine district hospitals and 33 health centers in Vientiane Capital. In total, 184 health care workers were involved in the study and in-depth interviews were conducted with 12 HCWs. Descriptive and inferential statistics were applied to determine the factors associated with the knowledge and the practice of pentavalent vaccines. A thematic analysis was applied to the qualitative data. Results: The results showed that more than half (63.3%) had poor knowledge of the pentavalent vaccine, while about two thirds (65.7%) reported good practices for delivering the pentavalent vaccine. In the multiple logistic regression, significant factors associated with the knowledge of the pentavalent vaccine were the qualification of HCWs (AOR=2.6, 95% CI=1.1 – 6.3, p=0.030), receiving training on vaccines (AOR=3.4, 95% CI=1.7 – 6.8, p<0.001), and incentives of working for vaccination programmes (AOR=2.7, 95% CI=1.2 – 6.1, p=0.020). The qualitative study revealed the need to improve supply-side determinants including increased training to improve the health staff’s competency, knowledge and practice of immunization. Conclusion: The data from this research indicated that more than half of the HCWs had poor knowledge about the pentavalent vaccine, despite vaccination practice being relatively good. There was a correlation between improved knowledge, with those HCWs who had higher education, and received training and incentives. These findings demonstrate there is a need for more efficient training and the continuous education of HCWs in the field of immunization. Keywords: Pentavalent vaccine, health care workers, knowledge and practice, Lao PDR.
... This finding is lower than reported from Bale, Gojam and Gurage zone of Ethiopia (57.1%,58.3% and 85.7% respectively), Thailand (61.1%) and India (95%) of health facilities had recorded temperature twice daily [22,23,26,29,30]. However, our finding on proper temperature recording practice is higher than the reported in Bale, in which none of health facilities had complete and update temperature recording practice [22], but it is lower than the reported from Cameroon, in which 49% of health facilities had completed and up-to-dated temperature recording practice [18]. ...
... In the current study, receiving training on cold chain and vaccine management was the only significantly associated factor with knowledge of vaccine handlers. This finding is supported with previous studies which revealed that vaccine handlers who had received training had better knowledge than vaccine handlers who had not received training [20,23,30,33]. Training could increase the vaccine handlers' curiosity and attention to apply the principles obtained from the training. ...
Background
Ethiopia federal ministry of health has been working on increasing access to immunization service by deploying solar refrigerators to primary health care facilities. However, there is limited evidence on cold chain and vaccine management status. Therefore, the objective of this study was to assess knowledge of vaccine handlers and status of cold chain and vaccine management and their associated factors in primary health care facilities of Tigray region Northern Ethiopia.
Methods
Institutional based cross-sectional study was conducted in four randomly selected districts of Tigray region, Northern Ethiopia. In each selected district, all primary health care facilities with functional vaccine refrigerators were included in the study. Data were collected using a pre-tested semi-structured questionnaire. The collected data were entered into Epi-data version 3.1 and then exported to Statistical Package for Social Sciences (SPSS) version 21 for analysis. All variables with p-value of < 0.25 in bivariate logistic regression analysis were included in multi-variable model to identify predictors of the dependent variables.
Results
In this study, fifty Primary Health Care Facilities (PHCFs) were included with a response rate of 94.4%. The overall level of good knowledge of vaccine handlers and good status of cold chain and vaccine management were 48% (95% CI; 30.7%-62%) and 46% (95%CI; 26.1%-61.3%) respectively. Receiving training on cold chain and vaccine management (AOR = 5.18; 95%CI: 1.48–18.18) was significantly associated with knowledge of vaccine handlers. Furthermore, receiving supportive supervision (AOR = 4.58; 95%CI: 1.04–20.17) and good knowledge of vaccine handlers (AOR = 10.97; 95%CI: 2.67–45.07) were significant associated with cold chain and vaccine management.
Conclusions
This study showed that knowledge of vaccine handlers on cold chain and vaccine management was poor. Similarly, the cold chain and vaccine management status was also poor. Therefore, on-site training should be provided to vaccine handlers to increase their knowledge, so as to improve their practices on cold chain and vaccine management. In addition, Programme based supportive supervision is needed to improve cold chain and vaccine management.
... Our study revealed that (99.3%, 99.3%, 93.3%, 97.3%, 97.3% and 91.3%) of HCPs knew the proper dose and route of (OPV, BCG, DPT, HBV Pentavalent and MMR) vaccines respectively. These results were better than Widsanugorn et al. [16] who assessed the knowledge and practice of 117 health care workers and ninety primary care units regarding expanded program on immunization in Kalasin, Thialand whose study reported that 78.6%, 63.2%, 68.4% and 59% knew the proper dose and route of BCG, DPT, HBV and MMR vaccines respectively [16]. Also, the same result obtained by Al-Ayed. ...
... Our study revealed that (99.3%, 99.3%, 93.3%, 97.3%, 97.3% and 91.3%) of HCPs knew the proper dose and route of (OPV, BCG, DPT, HBV Pentavalent and MMR) vaccines respectively. These results were better than Widsanugorn et al. [16] who assessed the knowledge and practice of 117 health care workers and ninety primary care units regarding expanded program on immunization in Kalasin, Thialand whose study reported that 78.6%, 63.2%, 68.4% and 59% knew the proper dose and route of BCG, DPT, HBV and MMR vaccines respectively [16]. Also, the same result obtained by Al-Ayed. ...
... This study revealed that receiving training courses has significant effect on the total knowledge of health care providers about vaccination with. These results agree with Widsanugorn et al. [16] and El Shazly et al. [9] who mentioned that trained healthcare workers had better knowledge than untrained healthcare workers and to ensure optimal immunization effectiveness, continuous training and regular supervision on EPI and the cold chain system are necessary. ...
Background: Uptake of vaccination services isn’t only dependent on provision of these services, but also in knowledge and practice of health care providers (HCPs), so WHO indicated that training of HCPs is an essential component of all expanded programs on immunization (EPI) activities. The aim of this study is to lower primary vaccine failure, morbidities and mortalities among children. Methods: This cross-sectional study included 150 HCPs and 16 primary healthcare units and one center in Shubra Khit District, Beheira Governorate, Egypt. Predesigned questionnaire and observational checklist were applied to collect data. The questionnaire assessed the knowledge of health care providers about storage, handling, administration, scheduling, doses, routes and contraindications of the different vaccines routinely. The checklist assessed the practice of health care providers regarding cold chain, room layout, preparation for vaccination session, general and specific practice related to each vaccine. Results: The majority of health care providers had adequate level of knowledge about all vaccines except for MMR vaccines & Hib vaccines. There were significant associations between knowledge levels and place of work with (p= <0.001), qualification (P = 0.015), site of task (P =<0.001) and training courses (P = <0.001) among studied health care providers. Conclusions: As regards knowledge levels among studied health care providers, nearly two third had a good knowledge; the same for practice, it was very good in about two thirds of the studied units/center.
... This finding was higher than the study conducted in Thailand to assess health workers knowledge and practice regarding expanded immunization programs, in which 55.6% of the participants had provided the correct answer for immunization schedule. 20 And the study was also conducted in India to assess the mother's knowledge of the immunization schedule of their child and reported 76% of the participants had poor knowledge. 21 The discrepancy might be due to differences in the study unit and sample size. ...
Purpose: To assess health extension workers knowledge of child immunization schedules
and associated factors.
Methods: A cross-sectional study design was conducted among health extension workers working
in Bako Tibe Woreda. The data were collected by using semi-structured questionnaires, and
descriptive statistics were used to summarize the data. Chi-square (χ2) was used to identify factors
associated with the knowledge of health extension workers on the immunization schedules.
Results: The response rate of the study was 92.1% (58/63). All of the health extension
workers included in the study were females. The majority of health extension workers 45
(77.59%) had satisfactory knowledge of the child immunization schedule. Educational status
(χ2 = 11.05; P= 0.001), work experience of as health extension workers (χ2 = 6.22; P= 0.045),
on job training on immunization (χ2 = 11.12; P= 0.002), marital status (χ2 = 6.30; P= 0.019)
were factors associated with health extension workers knowledge.
Conclusion: The majority of health extension workers had satisfactory knowledge of the
child immunization schedule. Educational status, work experience as health extension
worker, on job training on immunization, and marital status were factors associated with
the knowledge of health extension workers on the child immunization schedule.
Keywords: health extension workers, immunization schedule, vaccination, community
health workers
... This finding was higher than the study conducted in Thailand to assess health workers knowledge and practice regarding expanded immunization programs, in which 55.6% of the participants had provided the correct answer for immunization schedule. 20 And the study was also conducted in India to assess the mother's knowledge of the immunization schedule of their child and reported 76% of the participants had poor knowledge. 21 The discrepancy might be due to differences in the study unit and sample size. ...
Purpose
To assess health extension workers knowledge of child immunization schedules and associated factors.
Methods
A cross-sectional study design was conducted among health extension workers working in Bako Tibe Woreda. The data were collected by using semi-structured questionnaires, and descriptive statistics were used to summarize the data. Chi-square (χ²) was used to identify factors associated with the knowledge of health extension workers on the immunization schedules.
Results
The response rate of the study was 92.1% (58/63). All of the health extension workers included in the study were females. The majority of health extension workers 45 (77.59%) had satisfactory knowledge of the child immunization schedule. Educational status (χ² = 11.05; P= 0.001), work experience of as health extension workers (χ² = 6.22; P= 0.045), on job training on immunization (χ² = 11.12; P= 0.002), marital status (χ² = 6.30; P= 0.019) were factors associated with health extension workers knowledge.
Conclusion
The majority of health extension workers had satisfactory knowledge of the child immunization schedule. Educational status, work experience as health extension worker, on job training on immunization, and marital status were factors associated with the knowledge of health extension workers on the child immunization schedule.
... Furthermore, the absence of appropriate cold chain equipment to store and transport vaccines [19], absence of systems to monitor the temperature of thermo sensitive vaccines [11,[20][21][22][23] and insufficient cold chain capacity [24] are common problems associated with vaccine storage. The availability of sufficient storage capacity for existing vaccines in 2014 was 43% in low and lower middle income countries [25], lack of access to generators [26], weak vaccine inventory control and logistics management information system and expiry were also factors responsible for vaccine wastage [27][28][29]. ...
... The presence of a flowchart detailing what to do in case of electrical power outage was available in 14.8% of health centers. In the Bale zone, there were no posted contingency plans [43], while all health facilities in Egypt [46] and 63.3% of primary care units in Thailand had a flowchart [21]. Nearly half (55.6%) health facilities had a function generator for backup services and 14.8% had kerosene in this study. ...
... The finding was slightly lower than studies in Ethiopia: 38 (59.4%) and 37 (57.8%) complete records of the vaccine stock and temperature records, respectively [28], Thailand [21] and Egypt [46]. The discrepancy was due to the knowledge gap, poor attitude, negligence of professional and loose follow up. ...
Background: Effective vaccine cold chain management and well maintained equipment are the keys to safe vaccine storage and delivery.
... Similarly, the study in Thailand identified that healthcare workers who had sufficient training on cold chain handling and management performed better on managing cold chain management than those who had no training (p <0.001). 62 A finding in Ethiopia identified that years of service in the immunization program showed a statistically significant association with the practice of cold chain management (p <0.05). 33 Availability of funds at public health facilities for cold chain maintenance, adherence to cold chain WHO open vial policy, and availability of cold chain equipment were among the factors associated with vaccine cold chain management practices. ...
Background:
Cold chain maintenance is the spine of an immunization program.
Objective:
To examine the status of cold chain maintenance and evaluate knowledge of cold chain handlers and practices of vaccine management at public health centers providing immunization services in Jimma zone.
Methods:
An institutional-based cross-sectional study supplemented with a qualitative method was conducted in 41 randomly selected health centers providing immunization service in districts of Jimma zone from October 31 to November 30, 2019. Pre-tested self-administered questionnaires and observation checklists developed from an effective vaccine management assessment tool (EVMAT) were used to collect quantitative data. Key informants were selected using the purposive sampling technique and an in-depth interview was conducted. Quantifiable data were analyzed using SPSS version 20 and chi-square was used to test the presence of association (p-value <0.05). Qualitative data were analyzed by thematic analysis and triangulated with quantitative findings.
Results:
All public health centers had at least functional ice-lined refrigerators while 28 (68.3%) public health centers had functional deep freezers. Of the cold chain handlers, 120 (82.9%) had fair knowledge. Vaccine storage was appropriate per the World Health Organization's vaccine storage code in ice-lined refrigerators in 11 (24.4%) public health centers. Cold chain handlers' years of service, types of training, availability of funds for cold chain maintenance, and availability of cold chain equipment at public health centers showed the presence of significant association with vaccine cold chain management practice.
Conclusion:
The majority of cold chain handlers showed inadequate knowledge while a significant number showed poor practice of preserving the vaccines' cold chain. Cold chain maintenance was not adequate in public health centers, necessitating attentive efforts of providing proper management of vaccine cold chains at immunization delivery points.
