Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices

Abstract

Introduction The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. Methods We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns. Results Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Discussion Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system’s contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials.

Documentation of vaccine wastage in two different geographic contexts under the universal immunization program in India

“…The vaccine wastage rates from Bangladesh (34.8 to 84.4%) are comparable to Indian figures [16].. The wastage rates in Nigeria were in the range of 21-35% at outreach sessions and 18-27% at the stores [17]. The wastage rates were lower in Gambia for most of the vaccines, except the BCG (54.9%) [18].…”

Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilities

“…Understaffing also resulted in turning children away or scheduling fewer vaccination days, further limiting the opportunities to vaccinate children. Other studies have shown that health workers might only offer certain vaccines at certain vaccination sessions and wait for a minimum number of children before opening a multi-dose vial [36,37]. Children who are unable to visit health facilities on scheduled vaccination days can be automatically excluded [13,38,39].…”

Small Session Size and Big Vial Size: Operational Research Assessing Open Vial Vaccine Wastage at the Service Delivery Points in the Mandalay Region of Myanmar During 2018

“…Globally, observed wastage rates range between 15% to 50% for lyophilized vaccines and 5% to 25% for liquid vaccines [6]. However, studies from various low-and middle-income countries have reported high rates of vaccine wastage [7][8][9][10]. As vaccine wastage rate depends on session size, vial size, and formulation, it varies across the countries and even within the countries [7,8,10].…”

“…However, studies from various low-and middle-income countries have reported high rates of vaccine wastage [7][8][9][10]. As vaccine wastage rate depends on session size, vial size, and formulation, it varies across the countries and even within the countries [7,8,10]. The systematic assessment of vaccine wastage and session size during immunization can help in deciding on optimal vial size to be procured under the immunization programme, in order to limit vaccine wastage [10].…”