Assessment of vaccine wastage rates, missed opportunities, and related knowledge, attitudes and practices during introduction of a second dose of measles-containing vaccine into Cambodia’s national immunization program

• Published in: Vaccine 2018-07, Vol.36 (30), p.4517-4524
• Main Authors: Wallace, Aaron S., Krey, Kong, Hustedt, John, Burnett, Eleanor, Choun, Narin, Daniels, Danni, Watkins, Margaret L., Soeung, Sann Chan, Duncan, Richard
• Format: Article
• Language: English
• Subjects: Attitudes; Cambodia; Children; Children & youth; Diphtheria; Dosage; Health care; Health care facilities; Health facilities; Hepatitis; Hepatitis B; Humans; Immunization; Immunization Programs - methods; Immunization Schedule; Knowledge; Measles; Measles Vaccine - therapeutic use; Pertussis; Poliomyelitis; Public health; Supervisors; Tetanus; Vaccination; Vaccines; Wastage
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2018.06.009

•In Cambodia, we assessed vaccine wastage-related vaccinator knowledge and practices.•Mean vaccine wastage rates were between 4 and 81%, varying substantially by vaccine type.•17% of providers administered measles-containing vaccine less frequently than other vaccines.•Vaccinators wait for at least 2 children before opening measles-containing vaccine.•Too much focus on reducing wastage leads to missed opportunities for vaccination. Missed opportunities for vaccination (MOV) can result in inadequate protection against disease. Although healthcare provider reluctance to open multi-dose, lyophilized vaccine vials (particularly the measles-containing vaccine [MCV]) for every eligible child due to concerns about wasting vaccine is a known reason for MOV, little is known about providers’ related attitudes and practices. In 100 randomly selected health facilities and 24 districts of Cambodia, we surveyed healthcare providers and their district supervisors regarding routine vaccine administration and wastage knowledge and practices, and child caregivers (five per facility) regarding MOV. Vaccine stock management data covering six months were reviewed to calculate facility and district level wastage rates and vaccine usage patterns for six vaccines, including a recently introduced second dose of MCV (MCV2). Response rates were 100/100 (100%) among facility staff, 48/48 (100%) among district staff, and 436/500 (87%) among caregivers. Mean facility-level wastage rates varied from 4% for single-dose diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine to 60% for 10-dose MCV; district-level wastage rates for all vaccines were 0%. Some vaccines had lower wastage rates in large facilities compared to small facilities. The mean MCV wastage rate was the same before and immediately after MCV2 introduction. Providers reported waiting for a mean of two children prior to opening an MCV vial, and 71% of providers reported offering MCV vaccination less frequently during scheduled vaccination sessions than other vaccines. Less than 5% of caregivers reported that their child had been turned away for vaccination, most frequently (65%) for MCV. Although the MCV wastage rate in our study was in line with national targets, providers reported waiting for more than one child before opening an MCV vial, contrary to vaccine management guidelines. Future research should explore the causal links between provider practices related to vaccine wastage and their impact