Abstract
BackgroundVaccination is a cost-effective and life-saving intervention. Recently several new, but more expensive vaccines have become part of immunization programmes in low and middle income countries (LMIC). Monitoring vaccine wastage helps to improve vaccine forecasting and minimise wastage. As the costs of vaccination increases better vaccine management is essential. Many LMIC however do not consistently monitor vaccine wastage.MethodsWe conducted two surveys in health facilities in rural and urban Gambia; 1) a prospective six months survey in two regions to estimate vaccine wastage rates and type of wastage for each of the vaccines administered by the Expanded programme on Immunization (EPI) and 2) a nationwide cross sectional survey of health workers from randomly selected facilities to assess knowledge, attitude and practice on vaccine waste management. We used WHO recommended forms and standard questionnaires. Wastage rates were compared to EPI targets.ResultsWastage rates for the lyophilised vaccines BCG, Measles and Yellow Fever ranged from 18.5–79.0%, 0–30.9% and 0–55.0% respectively, mainly through unused doses at the end of an immunization session.Wastage from the liquid vaccines multi-dose/ single dose vials were minimal, with peaks due to expiry or breakage of the vaccine diluent.We interviewed 80 health workers and observed good knowledge. Batching children for BCG was uncommon (19%) whereas most health workers (73.4%) will open a vial as needed.ConclusionNational projected wastage targets were met for the multi-dose/single dose vials, but for lyophilised vaccines, the target was only met in the largest major health facility.
Highlights
Vaccination is a cost-effective and life-saving intervention
Data analysis We estimated vaccine wastage rate with 95% confidence interval for each vaccine included in the Gambia Expanded Programme on Immunization (EPI) schedule using the formula; Wastage rate = (Doses used – Children vaccinated)/ Doses used × 100 at the facility level
The health workers in our study reported not to batch children for vaccination, but rather most would ‘open a vial for every child’ which is in keeping with the high national Bacillus Calmette–Guérin (BCG) coverage and the World Health Organisation (WHO) guidelines [6, 11], but contrary to the Nigerian experience where vaccinators batch for a lyophilised vaccine [17]
Summary
But more expensive vaccines have become part of immunization programmes in low and middle income countries (LMIC). In recent years a number of new vaccines have been added to national vaccination programmes and the cost per fully immunised child has increased considerably [2,3,4]. These growing costs make the considerate use of vaccines pressing and interest to minimise vaccine wastage has risen. In the absence of local data, countries use WHO projected wastage rates to estimate their vaccine needs [8]
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