CHAPTER ONE

INTRODUCTION

The cold chain is a science, a technology and a process. It is a science since it requires the understanding of the chemical and biological processes linked with perishability. It is a technology since it relies on physical means to insure appropriate temperature conditions along the supply chain. It is a process since a series of tasks must be performed to manufacture, prepare, store, transport and monitor temperature sensitive products. From a geographical perspective, the cold chain has global, regional and local impacts respectively. Global, Specialization enable the distribution of vaccines and other pharmaceutical or biological temperature sensitive products to large facilities. Agricultural functions permitting the transport of temperature sensitive food products to distant markets. Regional. Can support the specialization of production and economies of scale in distribution. This could involve large cold storage facilities servicing regional grocery markets or specialized laboratories exchanging temperature sensitive components. Local Timely distribution to the final consumer like vaccine to beneficiaries in an immunization session. The cold chain involves the transportation of temperature sensitive products along a supply chain through thermal and refrigerated packaging methods and the logistical planning to protect the integrity of these shipments. (Cyril Chaput PhD 2000) There are several means in which cold chain products can be transported, including refrigerated trucks and railcars, refrigerated cargo ships as well as by air cargo.

“Cold chain” in health care service refers to the process to maintain optimum recommended temperature from the manufacturer, during transportation, storage, and handling of vaccines, starting at the manufacturing and ending with the administration of the vaccine to the client. It is used to help extend and ensure the shelf life of products. The optimum temperature for refrigerated vaccines is between +2°C and +8°C. In addition, protection from light is a necessary condition for some vaccines.

Cold chain and logistics refer to the system of people, policies, procedures, vehicles, fuel, equipment, and technologies that work together to make sure that vaccines given to people are safe and effective. Because most vaccines have specific temperature requirements, an effective cold chain and logistics management system prevents both excessive heat and cold from damaging the vaccines from the time of manufacturing until they are used (WHO Feb.2008).

A decade ago, the vaccines used in most developing countries cost only about one us dollar per child. Today with the addition of combination vaccines against hepatitis b and hemophilia’s influenza type b, and other newly introduced vaccines and increase in the rate per dollar,it now cost as fifteen dollars or more per a fully immunized child (UNICEF 2013).

BACKGROUND OF THE STUDY

Ushongo local government area is one of the 23 local government areas in Benue state which was created in may1989 from Kwande Local Government Area by the then Head of state General Ibrahim Badamosi Babangida. It is located between latitude 70 in the eastern part of Benue state with a total population of 268529 projected from 2006 population census. It bound with Gboko Local Government Area to the North and North-West, Buruku local government area to the north—east, Kwande local government area to the east, Vandeikya local government area to the south and Konshisha Local Government Area to the west. The local government headquarter is Lessel town situated along Gboko-to-Ihugh road, about 135km away from Makurdi her state capital. Her land area is 1228km.2 the postal code of the area is 982. The name of the local government is derived from Ushongo hill located at Ushongo town in Mbayegh council ward.

It is significant to understand that Ushongo local government area was privileged to be a UNICEF assisted local government between 2006 to 2015.within this time it receive tremendous supports from UNICEF, NPHCDA, WHO and BSMH to national program on immunization (NPI). The cold chain system of Ushongo local government was boosted with the capacity of 13 solar and 9 refreegilators.2 in stored in LGA cold store, and one in each comprehensive health center across the eleven council wards in the local government area. This is to serve a total population of children 0-11mths 10742 which constitutes 4% of the total population, children 0-59mths 53706 which constitute 20% of the total population, pregnant women 13426 which is 17% of the total population and women of child bearing age 59068 which constitute 22% of the total population. Also, considering the high cost of vaccines with the nature of the sensitivity to heat which need to have a smooth and effective cold chain system.Furthermore, NGOs (GAVI), Government at various levels, donor agencies like WHO, UNICEF, stakeholders and all the concern bodies are putting in the best for children health care most especially in term of immunization services. Nevertheless, the cold chain status of Ushongo Local Government Area according to 2018 cold chain inventory out of 14 solar refrigerators, ten (10) are no longer functional, the four (4) are partially functional. Another thing is that shortly after 2015 measles campaign there was an outbreak of measles in four council wards which 47 children within the age range were affected, 32 (68%) with record of been vaccinated with measles but there was no sera conversion which means the vaccine was not potent in 2016. Similarly, 59 children across the local government have BCG failure when post program evaluation was carried out as a result of vaccine failure due to lack of potency as of 2018. The last stroke that Brock the female camel’s back was the implementation of measles vaccination campaign in December 2017 that was pros ponded and shifted to February 2018 because there was no good and adequate icepacks to implement the program, until icepacks were borrowed from a neighboring local government area. Another problem was that, in August 2018 a WHO consultant on his supervision discovered thousands of doses of different vaccines that has been kept wasted over time due to lack of functional storage facility as said by the routine immunization officer and confirmed by the supervisor.

STATETMENT OF THE PROBLEM

It is significant to understand that Ushongo local government area was privileged to be a UNICEF assisted local government between 2006 to 2015.withing this time she receive tremendous supports from UNICEF, NPHCDA and BSMH to national program on immunization(NPI). The cold chain system of Ushongo local government was boosted with the capacity of 14 solar and 9 refreegilators. Two in LGA cold store and one in each comprehensive health center across the eleven council wards in the local government area. This is to serve a total population of children 9-59mths 10952 as of 2015 out of this there was an outbreak of measles in four council wards which 47 children within the age range of 9-59mths were affected, 32 (68%) with record of been vaccinated with measles but there was no sera convection which means the vaccine was not potent. Similarly, in 2016, out of 11234 children of 0 – 59months, 59 children of 0-11mthsacross the local government have BCG failure when post program evaluation was carried out as a result of vaccine failure and lack of potency. In 2018,11516  the last stroke that Brock the camel’s was the implementation of measles vaccination campaign in December 2017 that was proponed and shifted to February 2018 because there was no good and adequate icepacks to implement the program, until icepacks were borrowed from a neighboring local government area. Another problem was that, in August 2018 a WHO consultant on his supervision discovered thousands of doses of different vaccines that has been kept wasted over time due to lack of functional storage facility as said by the routine immunization officer and confirmed by the supervisor. It was unfortunate to discover that, out of 14 solar refrigerators, only 4 are partially functional including the most recently installed ones. This burden is adversely affecting a large population of children between 0 to 59mounths (53706) who are leaders of tomorrow and pregnant women who may be legible for various schedules of immunization. These amounted to vaccine wastage and shortage resulting to missed opportunity. Also children receiving vaccines that cannot protect them as intended but rather be making children sick. Thus, drown the attention of the researcher to carry out study to assess the responsible factors. There is a need to ensure that an effective product is being used. Vaccine failures caused by administration of compromised vaccine may result in the re-emergence or occurrence of vaccine preventable disease. Careful management of resources is important. Vaccines are expensive and can be in short supply. Loss of vaccines may result in the cancellation of immunization clinics resulting in lost opportunities to immunize.

Revaccination of people who have received an ineffective vaccine is professionally uncomfortable and may cause a loss of public confidence in vaccines and/or the health care system.

OBJECTIVES OF THE STUDY

1.    To assess the knowledge of health workers (routine immunization officers) about cold chain system in Ushongo local government area.

2.    Identify both the general and local factors affecting effective cold chain system in Ushongo Local Government Area of Benue State.

3.    To identify the adverse effects of ineffective cold chain system to communities in Ushongo Local Government Area of Benue State.

4.    To assess the level of importance attached, and commitment and support giving to cold chain system by the Ushongo local government council to ensure effective and sustainable cold chain system  in Ushongo Local Government Area of Benue State.

5.    To identify the availability and function ability of cold chain logistics in Ushongo Local Government Area.

RESEARCH QUESTIONS

1.        Do health workers of Ushongo local government (routine immunization officers) have knowledge on cold chain system and logistics?

2.        Are there general and local factors affecting cold chain system in Ushongo Local Government?

3.        What are the related problems that broken chain or ineffective cold chain system cause to the community and Ushongo Local Government?

4.        How would Ushongo local government council show support and concern to cold chain system for ensuring effective and sustainable cold chain system and logistics?

5.        Are there remedies for broken cold chain system in Ushongo local government area?

SIGNIFICANCE OF THE STUDY

The finding of this study will help health workers (routine immunization officers) in Ushongo local government to be aware of the factors affecting effective cold chain system, and also recognize solutions that can help in addressing the identified problems.

The findings of this study will also be of help to any person that may wish to carry a further research study on this very topic, the donor organizations, stakeholders in the health system.

The findings of this study will help the management of Ushongo Local Government Council to understand the problems of ineffective cold chain system to the communities in the area.

The findings of this study will also help the management of Ushongo Local Government Council to know her responsibility for ensuring an effective cold chain system and breaching the gap between the effective cold chain and ineffective cold chain system.

DELIMITATION OF THE STUDY

This study is limited to Ushongo Local Government Area. It is also limited to 55 health workers in Ushongo Local Government Area (53 routine immunization officers (RIO) in health facilities offering immunization services both privates and publics, one cold chain officer CCO and onelocal immunization officer (LIO). It is also limited to assessment of factors affecting cold chain system in Ushongo local government area, Benue State.