Gaps in vaccine management practices during Vaccination outreach sessions in rural settings in southwestern Uganda

Abstract

Background Outreach efforts were developed to bolster people's access to and use of immunization services in underserved populations. However, there have been multiple outbreaks of diseases like measles in Uganda, prompting policy makers and stakeholders to ask many unanswered questions. This research study was created to uncover the discrepancies between vaccine management practices at immunization outreach sessions in rural South Western Uganda compared with existing standards. Methods For this observational descriptive study, qualitative methods were employed in 16 public health facilities across four districts of South Western Uganda (Kasese, Mitooma, Rubirizi and Rwampara). Data was gathered by means of semi-structured in-depth interviews, health facility record reviews, and observation. This enabled us to assess the vaccine management procedures prior to an immunization outreach session, the transportation means used, the set up at the outreach site, vaccine management practices during the outreach session and packing of leftover vaccines - all in relation to World Health Organization immunization practice recommendation. All interview data was transcribed and coded; categories were formed and triangulated with data from observation checklists and record reviews. Themes were generated based on a socio-ecologic framework to gain a better understanding of healthcare provider practices during immunization outreach sessions and so identify any gaps in vaccine management guidelines. Results Overall, 51 individuals were interviewed - including four Assistant District Health Officers in charge of maternal and child health, four cold chain technicians, 15 focal persons for the Expanded Program on Immunization, and 28 health care providers. Data collected identified several main areas of concern: insufficient vaccine integrity monitoring, improper handling and storage practices, deficient documentation, and inadequate vaccine transportation. Issues in vaccine management were similar across immunization outreach sites regardless of whether there had been any vaccine preventable disease outbreaks in the district or not. The majority of these gaps were located at the individual level but were enabled by policy/environmental-level factors. Conclusions The research uncovered poor vaccine management procedures during outreach immunisations sessions, which were contrary to established health worker guidelines. Specific tactics to tackle knowledge deficiencies, health worker attitude, and fewer equipment shortages could significantly improve compliance with vaccine management protocols.