Cold Chain Management by Healthcare Providers at a District in Ghana: A Mixed Methods Study

Abstract

Background. Despite the relevance of cold chain management in maintaining the potency of vaccines, gaps still exist in the ability of healthcare practitioners to maintain the cold chain system effectively. Thus, the current study sought to assess healthcare providers’ knowledge, attitudes, practices, and challenges regarding cold chain management. Methods. A concurrent mixed methods study was conducted at twelve facilities in the Sekyere Central District of Ghana. Eighty-six (86) participants took part in a survey that assessed their “cold chain management” knowledge and attitudes. Twelve (12) cold chain sites within the district were also observed in respect of their cold chain management practices. Eleven key informants were additionally interviewed to explore their challenges on cold chain management. Quantitative data were analyzed using descriptive (frequencies, percentages, means, standard deviations, ranges) and inferential statistics (Spearman’s rho correlation). Qualitative data were inductively analyzed into themes which described participants’ challenges on cold chain management. Results. Majority of the participants scored ≥70% on knowledge (68.6%) and attitudes (67.4%) toward cold chain management. However, there was a very weak positive and statistically insignificant relationship between participant’s knowledge and attitudes toward cold chain management ( r = 0.109 , p = 0.317 ). Regarding cold chain management practices, majority of the facilities had their vaccine vial monitors attached to the vaccines (8/12, 66.7%), had functional fridge tags (8/12, 66.7%), and an appropriate refrigerator to store vaccines (7/12, 58.3%). However, the study observed that 91.7% (11/12) of the facilities did not have policies and guidelines on cold chain management while all 12 facilities (100%) did not have a contingency plan in place for equipment. With regards to the cold chain management challenges, participants raised concerns about inadequate personnel, erratic power supply, logistical constraints, and transportation difficulties. Conclusion. Although majority of the participants had good knowledge and attitude towards cold chain management, there was a weak association between them. This implies that good knowledge may not necessarily influence good attitudes towards cold chain management and vice versa. The extent to which facilities support cold chain management practices was suboptimal. Participants encountered a number of challenges which prevented them from managing the vaccine cold chain system effectively. We recommend continual professional education for cold chain practitioners, provision of adequate human and material resources for cold chain management, and enhanced monitoring and evaluation of cold chain activities. Future studies should quantitatively measure individual participants’ knowledge, attitudes, practices, and challenges on cold chain management so that we can establish the relationships that exist between these components.

Assessment of medicines cold chain storage conformity with the requirements of the World Health Organization in health facilities of the Eastern Province of Rwanda

“…Facilities used the generator to cater to the power outage. This result differs from the study conducted in Ghana [ 32 ]. However, these results are slightly higher than the study carried out in Nigeria [ 30 ], Ethiopia [ 13 ], and Tanzania [ 25 ].…”

“…In contrast, the EPI Rwanda program monitors vaccines’ transport until the end-users via refrigerated and calibrated vehicles, data loggers, and the cold chain report status of the equipment disseminated countrywide. The use of non-specialized cold chain transportation means was also reported in many other countries, such as Cameroon [ 13 ], Ethiopia [ 32 ], and Kenya [ 11 ].…”

Vaccine cold chain management practice and associated factors among health professionals in Ethiopia: systematic review and meta-analysis

“…On the other end of the spectrum, studies in Oyo state of Nigeria, India and Ghana have reported a higher levels of good vaccine cold chain management practices than the finding of this study [ 35 – 37 ]. The observed difference could be due to the difference in the study population.…”

Knowledge, attitudes, and practices of vaccinators about expanded programs on immunization: a cross-sectional study

“…This shows that the attitude of healthcare workers can be critical in guaranteeing the effectiveness of EPI and improved management of the cold chain. A recent study conducted in Ghana in 2021 has also highlighted the importance of knowledge and attitude of healthcare workers and emphasized pivotal steps such as maintenance of the cold chain and its relation to retaining the potency and efficiency of vaccines; this, without any doubt, can boost the outcomes of the vaccine campaigns and minimize duplication of efforts ( 32 ). Therefore, all vaccinators should have a positive attitude and possess comprehensive knowledge about vaccines, in general, to help build vaccine confidence in the community and respond to any questions ( 33 ).…”