Vaccine wastage in the littoral region, Cameroon : differences between rural and urban health districts and policy implications

Abstract

Introduction: Vaccination is a major and cost-effective public health intervention in the prevention of infectious diseases, especially in children. Availability of vaccine is a prerequisite for high vaccination coverage and vaccine wastage renders vaccines less available for use. In Cameroon, the Expanded Program of Immunization (EPI) vaccinates all children less than 5 years free of charge but the vaccination coverage has consistently remained below target. Distribution of vaccines are based on the target population size and some ‘wastage norms’ but wastage rates may differ from locality to locality. This study seeks assess vaccine wastage rates and compare it between various settings in the Littoral Region of Cameroon. Methods: This was a record based analytical study carried out in the Littoral Region of Cameroon using the 2016 and 2017 immunization data. Health districts were classified as ‘urban’ or ‘rural’ based on their remoteness. Vaccine wastages and vaccine wastage factor were calculated and compared between the rainy and the dry seasons. Results: A total of 2851527 doses of vaccines were used to vaccinate 2640077 children during the two years. Vaccine wastage was highest in BCG (32.19%), then MR (19.05%) and yellow fever (18.34%). The single-dose vaccine vials had negative vaccine wastage rates (VWR). February and November always experienced a decrease in vaccination coverage and over the months, whenever vaccination coverage decreases VWR increases and vice versa. VWR for all vaccines were higher during the dry season, except in 2016, where the VWR for lyophilized vaccine were higher in the rainy season. VWR were continuously higher in the rural districts. Conclusion: Vaccine wastage greatly differs between rural and urban health districts but also between the dry and the rainy season with most of the wastage occurring in the rural districts and surprisingly during the dry season where climatic conditions are more favourable.