EFFECTS OF INADEQUATE COLD CHAINMANAGEMENT ON VACCINE EFFICACY IN NIGERIA IMMUNIZATION PROGRAMS
DOI:
https://doi.org/10.71396/p668qn80Keywords:
cold chain, vaccines, vaccine potency, Nigeria, immunization, supply chain, vaccine wastage, VVM, refrigerationAbstract
Background: Vaccination is among the most cost-effective public health interventions globally, yet its impact depends entirely on the potency of vaccines at the point of administration. In Nigeria, inadequate cold chain management—characterized by erratic electricity supply, aging equipment, and variable health worker practices—threatens vaccine integrity and undermines immunization program outcomes. Objective: This study aims to (1) assess cold chain infrastructure status and equipment functionality in health facilities in Kano, Lagos, and Enugu States; (2) evaluate health worker knowledge, attitudes, and practices (KAP) regarding cold chain management; (3) examine associations between cold chain management practices, vaccine potency indicators, and immunization coverage; and (4) identify contextual factors and stakeholder perspectives that inform strategies for cold chain system strengthening.Methodology: A convergent parallel mixed-methods design with an embedded proxy sub-study will be employed. Quantitative data will be collected from 384 health workers across 48 facilities in three purposively selected states (Kano, Lagos, Enugu) using validated structured questionnaires and facility observation checklists. Vaccine potency will be assessed using validated proxy measures including Vaccine Vial Monitor (VVM) staging and digital temperature logger data (LogTag TRID30-7R). Qualitative data will be gathered through 24 key informant interviews. Data integration will employ joint display tables and mixed-methods framework analysis. Results: Findings will provide multi-state empirical evidence linking cold chain management to vaccine potency outcomes, inform national policy on immunization logistics, and guide strategic investment in infrastructure, training, and monitoring systems across Nigeria’s geopolitical zones.Conclusion: The study revealed that mobile phones of healthcare providers have high bacterial contamination and can harbor varied bacterial species and serve as a fomite in self- and cross- patient transmission of hospital acquired infections. Guidelines on standard precautions must be instituted in various healthcare settings as a way to curb the high prevalence of nosocomial infections
References
References
Adebimpe, W. O., & Adeoye, O. A. (2021). Knowledge and practice of vaccination logistics management among primary health care workers in Nigeria. Human Vaccines & Immunotherapeutics, 17(5), 1490–1495. https://doi.org/10.1080/21645515.2020.1827609
Adu, F. D., Oladipo, A. R., & Onwuasoigwe, C. (2021). Challenges of vaccine storage and distribution in sub-Saharan Africa: A review. African Journal of Public Health, 15(2), 78–86.
Afolabi, M. O., et al. (2017). Challenges of vaccine storage and handling in Nigeria. Journal of Vaccines and Vaccination, 8(3), 1-6.
Akanbi, O. O., Olowokere, S., & Akinloye, O. M. (2021). Cold chain management challenges in Nigerian immunization programs: Implications for vaccine efficacy. Journal of Public Health Research, 10(2), 145-160.
Anyene, B. C., Eze, U. C., & Adebayo, A. (2020). Cold chain management and immunization services in Nigeria: A review of challenges and prospects. Nigerian Journal of Paediatrics, 47(1), 12–20.
Babalola, D. A., & Odeyemi, A. O. (2020). Impact of power supply on vaccine preservation in Nigeria: A case study of selected primary healthcare centers. African Journal of Health Sciences, 17(3), 75-89.
Babalola, S., et al. (2018). Factors influencing vaccine uptake in Nigeria: A systematic review. Journal of Vaccines and Vaccination, 9(2), 1-11.
Babatunde, O. A., Olatunji, M. B., Omotajo, O. R., Ikwunne, O. I., Hamzat, Z., & Sola, S. T. (2020). A comparative assessment of cold chain management using the outbreak of circulating vaccine-derived poliovirus type 2 as a surrogate marker in Oyo State, Nigeria-2019. Pan African Medical Journal, 37, Article 313. https://doi.org/10.11604/pamj.2020.37.313.26152
Brown, S. T., et al. (2014). Analysis of the vaccine cold chain in Nigeria. Vaccine, 32(41), 5285-5291.
Centre for Disease Control (CDC) (2017). Vaccine storage and handling. Centers for Disease Control and Prevention.
Cochran, W.G.(1977). Sampling Techniques. 3rd ed, Wiley.
Chen, D., Kristensen, D., & Chanthap, L. (2020). Ensuring vaccine quality in the field: Cold chain monitoring and evaluation. Vaccine, 38(9), 2043–2050. https://doi.org/10.1016/j.vaccine.2019.12.001
DCVMN (Developing Countries Vaccine Manufacturers Network). (2024). Nigeria country profile (2024). https://dcvmn.org/wp-content/uploads/2025/01/Nigeria-Country-Profile-2024-vf.pdf
Fadare, J. O., & Okeke, I. N. (2019). Poor vaccine storage and handling practices: A potential threat to immunization programs in Nigeria. Journal of Public Health in Africa, 10(2), 112–119. https://doi.org/10.4081/jphia.2019.112
Gavi. (2021). Strengthening immunization supply chains during emergencies.
Gavi. (2021). Vaccine wastage and cold chain inefficiencies in low-income countries. Retrieved from https://www.gavi.org
Gavi. (2022). The role of healthcare worker training in vaccine efficacy. Retrieved from https://www.gavi.org
Kahn, A.-L., Kristensen, D., & Rao, R. (2017). Extending supply chains and improving immunization coverage and equity through controlled temperature chain use of vaccines. Vaccine, 35(17), 2214–2216. https://doi.org/10.1016/j.vaccine.2016.10.091
Kartoglu, U., et al. (2010). Impact of temperature excursions on vaccine potency. Vaccine, 28(34), 5497-5505.
Kilian, M., et al. (2010). Vaccine storage and handling practices in developing countries. Vaccine, 28(46), 7259-7266.
Matthias, D. M., Robertson, J., Garrison, M. M., Newland, S., & Nelson, C. (2007). Freezing temperatures in the vaccine cold chain: A systematic literature review. Vaccine, 25(20), 3980–3986. https://doi.org/10.1016/j.vaccine.2007.02.052
Mutua, E., Maina, G., & Kimani, J. (2022). The impact of cold chain failures on immunization outcomes in sub-Saharan Africa. Vaccine and Immunization Journal, 15(1), 89-103.
National Bureau of Statistics & UNICEF. (2022). 2021 Multiple Indicator Cluster Survey (MICS) / National Immunization Coverage Survey (NICS) Report. National Bureau of Statistics & UNICEF. https://www.unicef.org/nigeria/reports/2021-multiple-indicator-cluster-survey-national-immunization-coverage-survey-report
National Primary Health Care Development Agency (NPHCDA). (2021). Nigeria’s immunization coverage survey report. Abuja: Federal Ministry of Health.
Nelson, C. M., Wibisono, H., Purwanto, H., Mansyur, I., Moniaga, V., & Widjaya, A. (2019). Monitoring vaccine cold chain in low-resource settings: Lessons from Indonesia. Vaccine, 37(45), 6727–6734. https://doi.org/10.1016/j.vaccine.2019.09.044
Ogboghodo, E. O., Omuemu, V. O., Odijie, O., & Odaman, O. J. (2017). Cold chain management practices of health care workers in primary health care facilities in Southern Nigeria. Pan African Medical Journal, 27, Article 34. https://doi.org/10.11604/pamj.2017.27.34.11946
Ojo, T. O., Ijadunola, M. Y., Adeyemi, E. O., Adetunji, O. O., Adurosakin, F. O., Adeyinka, A. M., & Adeyelu, C. O. (2019). Challenges in the logistics management of vaccine cold chain system in Ile-Ife, Osun State, Nigeria. Journal of Community Medicine and Primary Health Care, 31(2), 1–12.
Okonkwo, P. O., Eze, C. N., & Ajayi, T. A. (2021). Knowledge and practices of Nigerian healthcare workers in cold chain management: A cross-sectional study. BMC Public Health, 21(4), 234-250.
Oli, A. N., Agu, R. U., Ihekwereme, C. P., & Esimone, C. O. (2017). An evaluation of the cold-chain technology in South-East Nigeria using immunogenicity study on the measles vaccines. Pan African Medical Journal, 27(Suppl 3), Article 28. https://doi.org/10.11604/pamj.supp.2017.27.3.11491
Oluwatosin, A. O., Adejoke, B. T., & Folarin, K. S. (2020). Vaccine logistics and distribution in Nigeria: Challenges and policy recommendations. Global Health Logistics Journal, 8(3), 112-128.
Orenstein, W. A., et al. (2015). Vaccines: A critical component of global health. Vaccine, 33(40), 5211-5217.
Plotkin, S. A. (2014). Correlates of protection induced by vaccination. Clinical and Vaccine
Immunology, 17(7), 1055–1065. https://doi.org/10.1128/CVI.00131-10
Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2018). Exploring challenges and opportunities in ensuring cold chain management in India. International Journal of Preventive Medicine, 9(1), 22–28.
Shuaib, F., Garba, A. B., Meribole, E., Obasi, S., Sule, A., Nnadi, C., & Bloland, P. (2020). Implementing the routine immunisation data module and dashboard of DHIS2 in Nigeria, 2014–2019. BMJ Global Health, 5(7), e002203. https://doi.org/10.1136/bmjgh-2019-002203
Uddin, M. J., Adhikary, G., Ali, M. W., Ahmed, U., & Alam, S. (2017). Evaluation of the EPI cold chain in Bangladesh. Public Health, 148, 16–22. https://doi.org/10.1016/j.puhe.2017.03.006
UNICEF Supply Division. (2020). E003: Solar direct drive refrigerators and freezers (Cold chain support package). UNICEF. https://www.unicef.org/supply/documents/e003-solar-direct-drive-refrigerators-and-freezers
UNICEF. (2021). Cold chain infrastructure and vaccine wastage in West Africa. Retrieved from https://www.unicef.org
World Health Organization (2015). Monitoring vaccine wastage at country level. World Health Organization.
World Health Organization. (2015). Temperature sensitivity of vaccines. Geneva: WHO Press.
World Health Organization. (2018). Controlled temperature chain (CTC). WHO. https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization/supply-chain/controlled-temperature-chain-%28ctc%29
World Health Organization (2019). Vaccines and immunization. World Health Organization.
World Health Organization (2020). Global vaccine wastage and cold chain failures: A review of current challenges. Retrieved from https://www.who.int
World Health Organization (2020). Immunization as an essential health service: guiding principles for immunization activities during the COVID-19 pandemic and other times of severe disruption. ISBN 978-92-4-001469-5.
World Health Organization. (2020). Immunization agenda 2030: A global strategy to leave no one behind. Geneva: WHO.
World Health Organization. (2021). Immunization coverage. WHO. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
World Health Organization (2022). Strengthening vaccine distribution and cold chain systems in developing countries. Retrieved from https://www.who.int
World Health Organization (2025). Vaccine efficacy, effectiveness and protection.
Yakum, M. N., Ateudjieu, J., Walter, E. A., & Watcho, P. (2015). Vaccine storage and cold chain monitoring in the North West region of Cameroon: A cross sectional study. BMC Research Notes, 8, Article 145. https://doi.org/10.1186/s13104-015-1109-9
Zipursky, S., Djingarey, M. H., Lodjo, J. C., Olodo, L., Tiendrebeogo, S., Ronveaux, O., & Clark, T. A. (2017). Benefits of using vaccines out of the cold chain: Delivering meningitis A vaccine in a controlled temperature chain during the mass immunization campaign in Benin. Vaccine, 32(13), 1431–1435. https://doi.org/10.1016/j.vaccine.2014.01.038
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