1. EFFECT OF COLD CHAIN FACILITY STATUS ON VACCINE DISTRIBUTION AND INFANT IMMUNIZATION COVERAGE IN GADA LOCAL GOVERNMENT OF SOKOTO STATE NIGERIA.
A.A. ADEIGA1, S. AHMAD2
1 NIGERIAN INSTITUTE OF MEDICAL RESEARCH,YABA, LAGOS, NIGERIA SOKOTO STATE MINISTRY OF HEALTH, SOKOTO, NIGERIA. THIRD ANNUAL CONFERENCE ON ‘VACCINES ALL THINGS CONSIDERED ‘ AT SHERATON PENTAGON SOUTH , ALEXANDRA VIRGINIA. USA 3RD -4TH NOV

2. BACKGROUND
History of Immunization in Nigeria
Immunization activities started in 1956 prior to eradication of small pox.
Expanded Programme on Immunization (EPI) was introduced in 1978 and implemented in 1979.
Objective was to protect children against Tuberculosis, whooping cough, poliomyelitis, tetanus, diphtheria and measles.
Evaluation after 1st five years in 1983 showed:
low immunization coverage of 10%
high infant mortality rate from vaccine preventable diseases.

3. a. lack of political will
Background contd.
The programme was revised and relaunched in There is still no progress.
In 1988, National Immunization Days (NID) was introduced and conducted.
In 1990, Nigeria attained Universal Childhood Immunization with coverage of 81.5% for all vaccine antigens.
Thereafter, routine immunization suffered a setback due to
a. lack of political will
b. creation of more LGAs
c. low demand for immunization
Consequently The Federal Government relaunched EPI as National Programme on Immunization (NPI) in July 1996 to reflect national committment.
It became an agency in 1998 to take charge of all immunization activities.
Background contd

4. SPECIFIC OBJECTIVES OF IMMUNIZATION
promoting child health
reducing vaccine preventable childhood diseases
reducing mortality of children from deadly diseases
preventing and controlling epidemics
STATE OF THE PROGRAMME SO FAR
Low immunization coverage is frequently reported.
Reasons
poor knowledge of immunization
long distance to site of immunization centers
long waiting for health care providers
poor medical facilities
poor motivation
bad terrains of communities

5. EXPERIENCE OF GADA LOCAL GOVERNMENT:
Gada LGA is in Sokoto state with the capital in Gada town.
- LGA Population = 226,525
- Population children < 5yrs = 62,000
It has 4 health districts:
Gada A
Gada B
Kaffe
Wauru
Terrain of the Health Districts is shown in Table 1.

6. TYPE OF TRANSPORTATION
TABLE 1: TERRAIN OF DISTRICTS
DISTRICTS
TERRAIN
TYPE OF TRANSPORTATION
Gada “A”
PLAIN, EASY TO REACH
MOTORABLE WITH ANY VEHICLE
Gada “B”
HILLY AND DIFFICULT TO REACH
LAND ROVER, MOTOR CYCLE, DONKEYS
Kaffe
SANDY TERRAIN AND DIFFICULT TO REACH
DONKEYS AND MOTOR CYCLE
Wauru
PLAIN AND EASY TO REACH
MOTORABLE WITH ANY VEHICLE

7. Report on state of health in the LGA
Uneven distribution of health and cold chain facilities
Health districts with bad terrains suffer neglect in distribution of facilities
High morbidity and mortality rates are frequently reported in disease outbreaks especially measles
This history informed the need to conduct a survey of Cold chain facilities and capacity to contain vaccines in the health districts
Aim of the study
to establish status of cold –chain facilities in each health districts
to assess quantity and type of vaccines available in the facilities of each district
to determine how this and other factors affect infant immunization coverage for BCG, DPT, OPV, and measles vaccinations.
Report on state of health in the LGA

8. METHOD The survey conducted addressed, the following:-
Existence and number of cold chain facilities such as freezers, fridges, cold boxes in each health district;
Power source to each health district
Types and number of doses of vaccines contained in the facilities
Infant Immunization coverage of children under 2 years of age using EPI cluster method.
Questionnaires were administered with WHO cluster form for infant Immunization. Recall history and Immunization Cards were used as tools .

9. RESULT AND DISCUSSION SITUATION OF FACILITIES AT GADA TOWN LGA HQS
1. Cold Chain facilities
Freezer
Fridge
Cold boxes with
Ice packs
Working condition 6 4 26
All working well
2. Power Source
Electric Power from National Grid
Alternative Power Supply
Connected
2 big generators plus Solar Power Plant
3. Vaccine Holdings
Vaccine in the facilities
Vaccine Preservation
20,000 doses of BCG
15,000 doses of DPT
40,000 doses of OPV
10,000 doses of Measles vaccine
All preserved at – 20 ◦C

10. RESULT AND DISCUSSION(CONTD)
STATUS OF COLD CHAIN FACILITIES AT DISTRICTS
3 health districts are inadequate
Gada A ( partially)
Gada B ( no working facility)
Kaffe ( no working facility)
Wauru has adequate facilities (Table 2)
POWER SOURCE TO THE DISTRICTS (Table 3)
VACCINE HOLDING FACILITIES IN THE DISTRICTS (Table 4)

11. TABLE 2: STATUS OF COLD-CHAIN FACILITIES IN THE HEALTH DISTRICTS .
WORKING CONDITION
FREEZER
FRIDGE
COLD BOXES
Gada “A” 1 3
Fridge partially working. Cold boxes functional when ice packs are available.
Gada”B” 4
Cold boxes functional when ice packs are available.
Kaffe
Fridge not functioning. Cold boxes functional when ice packs are available.
Wauru 2 5
All facilities are functioning.

12. TABLE 3: POWER SOURCE TO THE HEALTH DISTRICTS
ELECTRIC POWER
FROM NATIONAL GRID.
A LTERNATIVE POWER SUPPLY
Gada “A”
NOT CONNECTED
SMALL SIZE GENERATOR
Gada “B”
NO GENERATOR
Kaffe
BROKEN DOWN GENERATOR
Wauru
CONNECTED
MEDIUM SIZE GENERATOR

13. TABLE 4: VACCINE DISTRIBUTION IN HEALTH DISTRICTS
VACCINES IN THE FACILITY AT TIME OF VISIT
VACCINE PRESERVATION
Gada”A”
500 doses of DPT
300 doses of tetanus toxoid
Preserved at 150C in the fridge
Gada “B”
No vaccine storage -
Kaffe
Wauru
500 doses of BCG,
1,200 of DPT,
600 of oral polio vaccine
800 measles
Preserved at -200C in freezer and 40C in the fridge

14. RESULT AND DISCUSSION (Contd.)
IMMUNIZATION COVERAGE
low Immunization coverage
many missed opportunities due to:
a low availability of vaccine at health districts
vaccines badly stored where power is epileptic
no vaccine storage at districts with bad terrains
d. seldom presence of health care providers
(Tables 5& 6)

15. TABLE 5: IMMUNIZATION COVERAGE OF CHILDREN UNDER 2 YEARS OF AGE
DISTRICTS
PERCENTAGE OF CHILDREN NOT IMMUNIZED
PERCENTAGE OF CHILDREN PARTIALLY IMMUNIZED
PERCENTAGE OF CHILDREN FULLY IMMUNIZED
COMPLETION OF IMMUNIZATION AT ONE YEAR OF AGE.
Gada”A”
65.2%
28.1%
6.3%
2.4%
Gada”B”
74.2%
19.7%
5.3%
0.8%
Kaffe
72.6%
21.5%
5.4%
0.5%
Wauru
47.4%
23.6%
24.3%
4.7%

16. TABLE 6: IMMUNIZATION COVERAGE BY ANTIGEN RECEIVED IN THE
TABLE 6: IMMUNIZATION COVERAGE BY ANTIGEN RECEIVED IN THE HEALTH DISTRICTS
DISTRICTS
BCG
(%)
DPT
OPV
MEASLES
Gada “A”
21.7
32.3 95
29.4
Gada “B”
3.4
11.7 87
13.3
Kaffe
4.1
9.3
88.3
12.5
Wauru
39.4 52 94
48.1

17. RESULT AND DISCUSSION (Contd.)
REASONS FOR FAILURE TO IMMUNIZE
Lack of transportation
Mothers not informed
Poor advocacy and community mobilization
Lack of motivation
Inadequate vaccine at health districts due to poor vaccine distribution (Table 7)

18. LACK OF VACCINE AT FACILITY
TABLE 7: REASONS FOR FAILURE TO IMMUNIZE OR COMPLETE IMMUNIZATION
DISTRICTS
LACK OF TRANSPORTATION
( %)
LACK OF INFORMATION
LACK OF MOTIVATION
LACK OF VACCINE AT FACILITY
Gada “A”
13.4
35.2
26.8
24.6
Gada “B”
28.5
40.7
9.5
37.7
Kaffe
25.5
24.8
10.2
38.5
Wauru
15.6
48.2
25.8
11.4

19. CONCLUSION
Gada B and Kaffe districts with bad terrains suffered poor vaccine distribution.
Reasons:
Inadequate Cold Chain facilities
No source of power supply
Vaccines provided only on Immunization days.
Low Immunization coverage is generally reported.
3. Missed opportunities (defined as any visit by any eligible child to a health facility, which did not result in his/her vaccination)
Factors attributed are:
Low staff strength in the health districts
Low literacy level of the community
Irregular presence of health care providers causing missed opportunities
Poor advocacy and community mobilization

20. RECOMMENDATIONS 1. Provision of:
sustainable cold chain facilities such as kerosene or gas fridges,
solar power plant as alternative power source.
4-wheel drive vehicles for bad terrains.
2. Increase advocacy and community mobilization
3. Formation of NGO involving the community (including religious leaders) to promote advocacy.
4. Establish community involvement to :
provide people to be trained as health workers
contribute to the provision of facilities
5. Subsidize cost of transportation to Immunization centers

21. REFERENCES:
1.Salamaso et. al., Infant Immunization coverage in Italy, estimated by simultaneous EPI cluster survey regions Bull. WHO (10):
2.Bosu et. al., Factors attendance to Immunization sessions for children in rural districts of Ghana. Acta tropica 1997; 68(3):
3.Amin. R. Immunization coverage and child mortality in two rural districts of Sierra leone. Soc. Sci. Med (11):
4.Gedlu E; Tesema T. Immunization coverage and identification of problems associated with vaccination delivery in Gondar North west of Ethiopia. East Afr. Med. J (4):
5.Sokley J; Jain DC; Harit: A.K. Dhariwal A.C. Moderate Immunization coverage levels in East Delhi: Implications for disease control programmes and introduction of new vaccines J. Trop. Paediatr 2001; 47(4):
6.National Immunization Days reports of National Programme on Immunization for Sokoto State Nigeria 2002.