Vaccine wastage assessment in a primary care setting in rural India

Abstract

INTRODUCTION Vaccines are one of the most successful health interventions that bring about significant reductions in infectious diseases burden and its sequelae. The world's largest Universal Immunization Programme (UIP) in India targets 27 million infants and 30 million pregnant women every year. The coverage of UIP vaccines is more than 70% in 11 states; 50-70% in 13 states and below 50% in the remaining 8 states. 1 One of the reasons for less coverage may be due to programmatic error in terms of vaccine logistic management. World Health Organization reports over 50% vaccine wastage around the world. 2 Vaccine wastage is a major economic consideration for most developing countries. The Ministry of Health and Family Welfare, Government of India has recommended that wastage rate of all vaccines should not be higher than 25% (Wastage factor of 1.33). 3 However, the policy encourages to open a vial for even single beneficiary to avoid misses opportunities. Wastage is defined as loss by use, decay, erosion or leakage or through wastefulness. Reasons for wastage are due to discarding the remaining doses at the end of session (open vial wastage), not being able to withdraw the number of doses indicated in the label of the vial, poor reconstitution practices, suspected contamination, and expiry, VVM (Vaccine vial monitor) indication, breakage and missing inventory. Knowing the wastage rate helps in assessing vaccine wastage and relative magnitude of its various causes which help to target ABSTRACT Background: Knowing the wastage rate helps in assessing vaccine wastage and relative magnitude of its various causes helps to target efforts in reduce this wastage. Area specific wastage rate is useful in tailoring the vaccine vial size. Research question: What is the vaccine wastage in a primary care setting in rural India? Methods: A record based descriptive study was carried out in an immunization clinic of rural health centre in South India. All childhood vaccinations between 1 st April 2012 and 31 st March 2013 were included in the study. Number of doses issued and number of children vaccinated were obtained from the registers maintained at the rural health centre. Vaccine wastage rates and wastage factor were calculated. Results: A total of 5013 vaccinations (DPT, OPV, measles, MMR, and pentavalent, hep B, TT) were provided. Wastage rate for liquid vaccines was 3.4% and for lyophilized vaccines 28.2% among vaccines provided under national immunization schedule, wastage was highest for measles (46.5%). Conclusions: All vaccines except measles had wastage within the limits proposed by World Health Organization. Wastage rates have to be calculated routinely and considered during vaccine procurement.