Assessing vaccine cold chain storage quality: a cross-sectional study of health facilities in three African countries

Abstract Background Proper refrigeration at health facilities is an essential element in maintaining the integrity of vaccine cold chains. We use vaccine refrigerator and cold box temperature data, recently collected from health facilities in Ghana, Kenya, and Uganda, to assess cold chain quality in these countries. Methods Data were collected from a nationally representative sample of health facilities in Ghana, Kenya, and Uganda from mid-2012 to late 2012. Temperature was recorded from each facility's refrigerator or cold box where pentavalent vaccines were stored. Results were compared to established vaccine storage guidelines, which recommend maintaining a temperature between 2°C and 8°C. We use logistic regression to test the association between proper storage temperature and vaccine storage location, facility characteristics, and availability of a temperature-monitoring chart. Findings Overall, 661 facilities were surveyed and 441 claimed to regularly store vaccines. Only 4% of facilities stored vaccines in cold boxes, while the remainder used refrigerators. In total, we observed storage outside the recommended range in 16·6% (71 of 429) of the sampled facilities, though significant variation was observed between countries (26·2% [34 of 130], 16·3% [26 of 160], and 7·9% [11 of 139] for Ghana, Kenya, and Uganda, respectively). Of those facilities that were not compliant with the guidelines, half were 4°C or more outside the recommended range. While most facility-level characteristics, such as size, management, and location, were not found to be associated with vaccine storage temperature, facilities that had a written chart to monitor their storage equipment were associated with 6·42 (95% CI 3·09–13·32) times higher odds of storing their vaccines within the recommended range compared with those without a chart. Interpretation There remains significant room to improve vaccine storage temperature in Ghana, Kenya, and Uganda. Maintaining a log was associated with appropriate temperature storage, regardless of duration since last check. While more investigation into the nature of this relation is needed, new technologies such as vial monitoring strips may be promising interventions for maintaining cold chain integrity. Funding Bill & Melinda Gates Foundation.