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Table of Contents
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 7-11

“Evaluation of Non-electrical cold chain equipments of all urban health centers (UHCs) of Ahmedabad Municipal Corporation (AMC) area.”


1 Assistant Professor, Dept. of Community Medicine, GMERS Medical College, Valsad, Gujarat, India
2 Assistant Professor, Dept. of Community Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India

Date of Web Publication24-Aug-2018

Correspondence Address:
J K Govani
Assistant Professor, Dept. of Community Medicine, GMERS Medical College, Valsad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.239549

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  Abstract 


Introduction: Cold chain is important elements of immunization programme.
Aims & objectives: 1) To evaluated the status of Non electrical equipments. 2) To take necessary corrective measures whenever required and give relevant advices to handlers for improving the system.
Methodology: A cross sectional study was conducted at all the 56 UHCs of AMC area during May 2012 to January 2013. Pretested check list was used having details of various cold chain elements.
Results & discussion: Majority (55.4%) of the UHCs had no cold boxes. Majority (92.9%) of the UHC had adequate stock of vaccine carriers. Mean of broken vaccine carriers was 5.9 ± 8.2. Vaccine carrier were properly closed at 47 (83.9%) & secured with belt at 14 (25%) sites. Only 10(18.5%) DFs showed criss-cross icepacks arrangement. Significantly higher number of icepacks had leakage at the session site (38.1%) than at UHCs (14.6%)
Conclusion: The practice of using thermocol box instead of cold box needs to be stopped. Effective monitoring & logistic management for all non electrical cold chain equipments are required.

Keywords: Cold chain, Vaccine carrier, Cold box, Ice packs.


How to cite this article:
Govani J K, Sheth J K. “Evaluation of Non-electrical cold chain equipments of all urban health centers (UHCs) of Ahmedabad Municipal Corporation (AMC) area.”. J Integr Health Sci 2014;2:7-11

How to cite this URL:
Govani J K, Sheth J K. “Evaluation of Non-electrical cold chain equipments of all urban health centers (UHCs) of Ahmedabad Municipal Corporation (AMC) area.”. J Integr Health Sci [serial online] 2014 [cited 2022 May 29];2:7-11. Available from: https://www.jihs.in/text.asp?2014/2/2/7/239549




  Introduction: Top


Cold chain is a system of storing and transporting vaccine at the recommended temperature range from the point of manufacture to point of use.[1],[2],[3] Non-electrical cold chain equipments were one of the very important component to avoid cold chain failure at field level or during the vaccine transport. Mainly there are three types of Non-electrical cold chain equipments.[4] (1) Cold Box: Cold boxes are big insulated boxes. These are of different sizes- 5, 8, 20 and 22 liters with requisite number of ice packs. 20-22 liters cold box has enough space to transport about 6000 – 6600 doses of mixed antigen vaccines. Vials of freeze sensitive vaccines like Hepatitis B, DPT, TT should never place in direct contact with the icepacks and they should be surrounded by OPV, BCG and

Measles vaccines.[3],[4],[6] Cold Boxes are mainly used for transportation of vaccines. In emergency they can also be used to store vaccines as well as frozen ice packs.[7] (2) Vaccine Carriers: Vaccine carriers are used for carrying small quantities of vaccines (16-20 vials) to the sub-centres or session sites. The vaccine carriers are made of insulated material, the quality of which determines the cold life of the carrier. Four ice packs are laid in the vaccine carrier as per manufacturer's guidelines.[2],[8] (3) Ice packs: Ice packs are key component of the cold chain. The ice packs are frozen inside the deep freezer and used with cold box and vaccine carrier. In DF arrangement of icepacks should be criss-cross pattern to maintain air circulation in between icepacks.[9] To deal with larger number of vaccine stocks in major cities are also increasing the chance of cold chain failure. The Ahmedabad Municipal Corporation (AMC) is urban area are equally challenging so far as maintaining cold chain is concerned. Thus, looking in details of cold chain system in an urban area is very much required. So study was conducted at all UHCs of AMC with following objectives.


  Aims & Objectives: Top


  1. To evaluated the status of Non electrical equipments.
  2. To take necessary corrective measures whenever required and give relevant advices to handlers for improving the system.



  Materials and Methods: Top


Ahmedabad Corporation is divided in 6 zones and has total 57 wards with a city population of 5,570,585.[10] Zone wise distribution of fifty seven UHCs shoes that West Zone (WZ), New west Zone (Nwz), East Zone (Ez) and North Zone (Nz) having 10 UHCs in each zone. While Central Zone (Cz) having 09 UHCs and South Zone (Sz) having 08 UHCs. The present cross sectional study was conducted at all 56 UHCs of AMC area during May2012 to January2013. As far as the cold chain system of UHC is concern, there are fifty six UHCs, because 2 UHCs of East zones (Rajpur and Rakhiyal) are working as a single unit for immunization coverage and there is single set of all cold chain equipments for both UHCs. In AMC area Responsibility of cold chain and vaccine management at all UHCs is under RBD department. Due permission was taken from Registrar of birth & death department (RBD department), Health sector, AMC. Institutional Review Board (IRB) of Smt. N.H.L. Municipal Medical College, Ahmedabad approved the study and gave ethical clearance. Fully structured checklist, which was specially designed and pre-tested, was used for data collection purpose at all UHCs. The check list contains details of various components of cold chain. Among them one of the important components is availability and condition of Non electrical equipments. e.g. Cold boxes, Vaccine carrier and Ice packs. At each UHC this check list was filled and corrective measures were taken wherever necessary. Data entry was carried out and data analysis was done by using appropriate statistical software and applying suitable statistical tests.


  Results: Top


Cold box, Vaccine carrier and Ice pack are the three non-electrical cold chain equipments available at UHCs. Majority (55.4%) of the UHCs had no cold boxes. They were using thermocol box instead of cold box. 19 (76%) out of 25 UHCs who had cold boxes were found in usable condition [Table 1].
Table 1: Status of Cold box at UHC level.

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Vaccine carrier is main part of cold chain maintenance at field level. Majority (52, 92.9%) of the UHC had adequate stock of vaccine carriers. 4 (7.1%) UHCs staff expressed that there is shortage of vaccine carriers during the National Polio rounds and they had to borrow it from the other UHCs. Routinely used vaccine carriers were proper and usable at all the UHCs. Broken vaccine carriers were not found/reported at 23 (41.0%) UHCs, whereas at other UHCs (33, 59%) there were few to many broken vaccine carriers [Table 2]. Mean of broken vaccine carriers was 5.9 ± 8.2 (SD). Findings of Vaccine carrier at field session sites were evaluated externally as well as internally [Table 3]. Vaccine carriers were satisfactorily cleaned. Vaccine carrier were properly closed at 47 (83.9%) & secured with belt at 14 (25%) sites. Foam pads were uniformly absent as they are not supplied as a standard set of vaccine carrier. Zip pouches were available and used at majority of session sites. Ice packs are one the key component of cold chain system. All UHCs had sufficient number of icepacks for routine immunization purpose. But only 8 (14.3%) UHC fulfill the criteria of having a minimum of 60 frozen ice packs. Out of 54 DFs, only 10 (18.5%) DFs showed criss-cross icepacks arrangement. No session site had all the icepacks in fully melted condition. Majority of the icepacks (49.3%) were found in Semi Frozen (SF) condition at session site. Freeze sensitive vaccines observed in wells of ice packs and observed in direct contact with ice packs at 19.6% and 58.9% accordingly at field sessions [Table 3]. Significantly less (28.5%) icepacks were properly filled up to mark level in the field as compared to UHCs (48.9%). Significantly higher number of icepacks had leakage (and thus was incompletely filled) at the session site (38.1%) than at UHCs (14.6%) [Table 4].
Table 2: Status of broken vaccine carriers at UHC level.

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Table 3: Status of Vaccine carrier at field session site of each UHC.

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Table 4: Comparison of Fully Melted (FM) ice packs status between UHC and Field level.

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  Discussion: Top


Cold box is mainly used for transportation of vaccines.[5] Each PHC/UHC should have one cold box.[1] Only 25(44.6%) of UHC had cold box with 6 (24%) of them had an unusable cold box. As transportation is not a major issue in urban area and power failure is rare in AMC, situation of cold box seems to be ignored. Vaccine carrier is main part of cold chain maintenance at field level. Vaccine carriers are used for carrying small quantities of vaccines (16-20 vials) to the sub-centres or session sites for maintaining the cold chain.[3],[4] All the UHCs had multiple vaccine carriers for their need of routine immunization & special campaigns (National Polio rounds). Study reveals that there was satisfactory (92.9%) stock of vaccine carriers at majority of the UHCs. Vaccine carrier should keep away from direct sunlight and no heavy materials should put over the carrier.[2],[3] External condition & cleanliness of the vaccine carrier and its placement were satisfactory at all the field session sites [Table 3]. Ice packs are key component of cold chain. They are frozen inside the DF before use. All UHC have sufficient number of icepacks for their routine need. Additional frozen icepacks are required as buffer & emergency needs.[5],[6] But very few (14.3%) UHCs fulfilled the criteria of having a minimum of 60 frozen ice packs. This low number of frozen icepacks may be due to rare power cut situation in AMC. Icepack status was found to be satisfactory condition at all the session sites. Fully melted icepacks were seen depending on time of visit after starting the session, duration of session & distance from the UHC. The study showed very few of fully melted icepacks (18.5%) at session level. T series vaccines should not be kept in wells of ice packs or in direct contact of the icepack as per the guideline.[6] however, such false practices were found during the session [Table 3]. At each UHC, five fully frozen icepacks were randomly selected and kept at room temperature. Completely melted icepacks were then weighed with a standard electronic weighing scale and checked for their water level. Any leakage was also noted along with its reasons. Even for field sessions similar assessment of icepack was done for already melted icepacks [Table 4]. The study reveals satisfactory icepacks condition at UHC level as compare to field sessions. This highlights the importance of regular checking of icepacks after each session to avoid cold chain failure at field level.[3]


  Conclusion and Recommendations: Top


Only 25 (44.6%) of UHC had cold box with 6 (24%) of them in unusable condition. The practice of using thermocol box instead of cold box needs to be stopped. Satisfactory stock of vaccine carriers was found at majority (92.9%) of the UHCs for. Appropriate actions are also required for broken cold boxes and vaccine carriers. Significantly less (28.5%) icepacks were properly filled up to mark level in the field sessions as compared to UHCs level (48.9%).

Significantly higher number of icepacks had leakage at the session site (38.1%) than at UHCs (14.6%). Effective monitoring, logistic management and supportive supervision for all non electrical cold chain equipments are required for better cold chain system. Regular cold chain training for handlers at UHC level should be organized by the health authority of the AMC area.



 
  References Top

1.
Park's text book of Preventive and Social medicine, K. PARK, 21st edition, M/s Banarsidas Bhanot,1167-prem nagar, Jabalpur-482001(M.P.), India.  Back to cited text no. 1
    
2.
Handbook for Vaccine & Cold Chain Handlers 2010, Department of Health & Family Welfare Ministry of Health and Family Welfare Government of India.  Back to cited text no. 2
    
3.
Ministry of Health & Family Welfare, Government of India. Immunization Handbook for Medical Officers. New Delhi: Dept. Health & Family Welfare, Govt. of India, 2009.  Back to cited text no. 3
    
4.
Ministry of Health & Family Welfare, Government of India. Cold Chain: Management for Vaccine Handler. New Delhi: Dept. Health & Family Welfare, Govt. of India, 2003.  Back to cited text no. 4
    
5.
Immunization In Practice: A Practical Resource Guide for Health Workers, Geneva, World Health Organization, 2004, (WHO/IVB/04.06),  Back to cited text no. 5
    
6.
India National Universal Immunization Programme Review, New Delhi, United nations children's fund-World Health Organization , 2004,  Back to cited text no. 6
    
7.
National Family Health Survey (NFHS-3), 2005-06: India, Mumbai, International Institute of Population Sciences and Macro International, 2007  Back to cited text no. 7
    
8.
Immunization Essentials: A Practical Field Guide, Washington, D.C., United States Agency for International Development, 2003, Immunization Handbook for Health Workers, New Delhi, Government of India, 2006  Back to cited text no. 8
    
9.
Reproductive and Child Health Programme, Immunization Strengthening Project: Training Module for Mid-level Managers, New Delhi, Government of India, 2001  Back to cited text no. 9
    
10.
http://www.censusindia.gov.in/2011 (accessed on December 30, 2011)  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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