Abimbola Odumosu 1 ,Patrick Obi 2 , Bayero Farah 3 , Ado Z. Mohammed 4 and Okeke, O. F. I 5 International Conference on Transport and Health 2016 San Jose California
Presentation Outline 1. Introduction 2. Problem Identification 3. Objectives 4. Study Area 5. Methodology 6. Findings 7. Recommendations 8. Conclusions
1. Introduction A vaccine is a biological preparation that improves immunity to a particular disease. A cold chain is a temperature-controlled supply chain system of storage and distribution activities. However, Cold chain logistics refer to the system of people, policies, procedures, vehicles, fuel, equipment, and technologies that work together to make sure that vaccines given to people are available, safe and effective. Vaccines are temperature sensitive and is susceptible to damage as a result of exposure to excessive heat or freezing temperatures
Introduction Cont’d Most vaccines have specific requirements for their optimal efficacy. Cold chain logistics management system ensures that the integrity of these vaccines are maintained That little or no damage affects them from the time of their manufacture until they are used. Thus, logistics support is critical to immunization services This is to ensure the availability of appropriate equipment and adequate supply of high-quality vaccines for immunization at all levels.
2. Problem Identification Five million children die in the developing world each year. Another five million are mentally or physically disabled due to the six vaccine preventable diseases namely diphtheria, pertussis, tetanus, measles, poliomyelitis and tuberculosis. The annual death rate from these diseases is approximately 220,000 with 10-26% of these occurring in infancy and early childhood.
Problem Identification Cont’d Most vaccines have specific requirements for their optimal efficacy. An effective cold chain logistics management system ensures that the integrity of these vaccines is maintained That little or no damage affects them from the time of their manufacture until they are used. However, certain factors can affect the cold chain logistics management system of vaccines. These critical factors are: Transportation, Distribution and Storage conditions.
3. Objectives The objectives of this study are: Examine the structure of the supply chain system for the vaccines from point of manufacture to point of usage (end use) Assess the cold chain logistics management effect on vaccines used in Childhood Routine Immunization Programs
4. The Study Area Kaduna state in North west Nigeria is the study area. Kaduna State occupies part of the Central position of the Northern part of Nigeria It shares common borders with Zamfara, Katsina, Niger, Kano, Bauchi and Plateau States. To the South-West, the State shares a border with the Federal Capital Territory, Abuja. The global location of the State is between longitude of 30’’ east of the Greenwich meridian and also between latitude 0900 and 11 30’’ North of the equator. It occupies an area of approximately 48,473.2 square kilometers and has a population of more than 6 million .
Fig 1 Map of Nigeria showing different States of the Federation
The Study Area Cont’d For the purpose of vaccine distribution, Nigeria is divided into four (4) zones. Kaduna state falls under the Kano zone. KSPHCA receives vaccines from the Kano Zonal cold store on a quarterly basis. After the vaccines arrive KSPHCA cold store, they are off loaded and neatly arranged inside the cold room; Other vaccine consumables are also well arranged within the cold store. Subsequently, the Local Government [LG] receive vaccines based on their requisition forms, vaccines utilization reporting form and monthly immunization summary report submitted to KSPHCA.
5. Methodology Data needed were sourced from available records from the Kaduna state Ministry of Health (MOH) through the Kaduna State Primary Health Care Agency (KSPHCA) The local governments. Observational Survey, documents sourcing and group and individual interviews were also performed. These include administered questionnaire and observation check lists.
Methodology Cont’d Multistage Sampling Technique was employed in selecting the primary health care facilities for the study. The various stages involved were as follows: Stage 1 Kaduna state comprises of three (3) senatorial districts and twenty three (23) local government areas (LGAs). All local governments (LGs) were grouped according to their senatorial districts. Stage 2 Using simple random sampling technique by balloting without replacement, one-third from the 23local governments (LGs) was selected (that is eight (8) LGs). However, nine (9) LGs were finally selected to ensure that all three senatorial districts were equally represented by three LGs respectively.
Methodology Cont’d Stage 3 LGs were further grouped into urban and rural LGs according to their senatorial districts. Stage 4 Using simple random sampling technique by balloting, urban LGs were selected. Stage 5 Using simple random sampling technique by balloting without replacement, rural LGs were selected.
6. Findings Analysis showed that poorly managed logistics systems can lead to high and unnecessary vaccine wastage rates, stock outs, or improper management of waste, resulting in significant operational program costs, as well as a negative impact on public health. For the purpose of vaccine distribution, Nigeria is divided into four (4) zones. Kaduna state falls under the Kano zone. The vaccines allocated to the zone leave the national cold store in tempertature-regulated trucks to Kaduna state and makes it stop at the KSPHCA cold store. The vaccines are subsequently off loaded and properly stored in the cold store.
Findings Cont’d From this point, the local governments come to pick up their vaccines using public transport system (pick-up van, station wagon, car or bus). All nine LGs used public transport for vaccine pick up. 44.4% used buses; 22.2% used car and station wagon respectively; while only one LG (11.1%) used a pick-up van. Although the vehicles for transport are not temperature- controlled, storage system is still effectively maintained as the vaccines are transported to the LGs in vaccine boxes lined with conditioned ice packs.
Findings Cont’d The transportation time for the vaccines from KSPHCA to LGs ranged from 30 minutes to three (3) hours. This length of time had no adverse effect on the integrity of vaccines as they were transported in vaccine cold boxes with conditioned ice packs. Thus the cold chain for maintaining the vaccines was intact. However, in Kaduna state, there is lack of an efficient transport system for the distribution of vaccines. The study revealed that, there were vehicles for transportation before which were provided by International donor funds. HILUX vans were available at the LGAs to facilitate transportation of vaccines after collection from the state. Over time however, these vehicles broke down due to lack of adequate maintenance. Thus, LGs now have to pick up vaccine consignments from the state through private and public transport arrangement
Table 1: Transportation time from KSPHCA cold store to LGs S/no LG Average time in hours 1. Igabi 1hour 2. Kachia 1hour, 30mins 3. Kaduna South 30mins 30mins – 1hour 4. Kajuru 5. Kaura 2½ - 3hours 6. Kubau 2½ - 3hours 7. Kudan 2½ hours 8. SabonGari 1hour 9. Sanga 3hours
Findings Cont’d Table 1 shows the transportation time in hours for vaccine transport from the KSPHCA cold store to the various LGs. The journey to Kaduna South is shortest at 30minutes while Sanga is the farthest distance with 3hours.
Table 2: Target population for childhood immunization S/no LG Target population % 1. Igabi 548,182 20.59 2. Kachia 311,245 11.69 3. Kaduna South * 285,960 10.74 4. Kajuru 141,265 5.30 5. Kaura 283,602 10.65 6. Kubau 359,372 13.50 7. Kudan 177,099 6.65 8. SabonGari 365,520 13.73 9. Sanga 190,274 7.15 Total 2,662,519 100
7. Recommendations The gap in information technology and management information systems should be properly addressed. This can be achieved by: Putting in place a method for vaccine inventory management using the appropriate soft ware tools . Supervision and monitoring of vaccine management should also be stepped up. Provision of internet facilities. Provision of office computers, printers, scanners and photocopiers. Automatically-regulated inverters should be procured and installed to ensure that power supply is constant round the clock.
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