Using Data to Keep Vaccines Cold in Kenya: Remote Temperature Monitoring with Data Review Teams for Vaccine Management.

BACKGROUND: Global vaccination coverage rates have remained around 85% for the past several years. Increasing immunization coverage rates requires an effective cold chain to maintain vaccine potency. Remote temperature monitoring (RTM) technology for vaccine refrigerators has shown promise for improving the ability of supply systems to maintain optimal temperature conditions to ensure potent vaccines reach the end users. METHODS: A pilot study of RTM technology and data use teams was implemented in 36 study sites in Kenya. Data were collected at baseline and endline points over a 3-month baseline and 7-month implementation period. Data included 44 qualitative interviews, process logs, meeting minutes from data use team meetings, and quantitative temperature and power data from the RTM devices. RESULTS: The ability of cold chain equipment to maintain World Health Organization-recommended temperatures in study sites improved markedly between the baseline and implementation periods, resulting in an improvement in total time spent in the correct range from 83.9% in the baseline period to 90.9% in the intervention period and an improvement in time spent in the too cold range from 6.5% to 1.5%. Friedman tests revealed that differences in time spent in the correct range and time spent in the too cold range during the course of the study were statistically significant (P<.001 and P=.04, respectively). Qualitative and quantitative data suggest that this improvement was due to a combination of improved responsiveness to temperature excursions at the facility level, resulting from SMS alarms for temperature excursion periods, and improved ability at the management level to recognize and address recurring problems. CONCLUSION: The combination of using RTM technology with a structured data review process by a management team is a promising approach for improving cold chain outcomes. Future research examining the added value of each of the technological and behavioral components separately is needed.

Root cause analysis underscores the importance of understanding, addressing, and communicating cold chain equipment failures to improve equipment performance.

Vaccine cold chain equipment (CCE) in developing countries is often exposed to harsh environmental conditions, such as extreme temperatures and humidity, and is subject to many additional challenges, including intermittent power supply, insufficient maintenance capacity, and a scarcity of replacement parts. Together, these challenges lead to high failure rates for refrigerators, potentially damaging vaccines and adversely affecting immunization coverage. Providing a sustainable solution for improving CCE performance requires an understanding of the root causes of failure. Project teams conducted small-scale studies to determine the root causes of CCE failure in selected locations in Uganda and Mozambique. The evaluations covered 59 failed refrigerators and freezers in Uganda and 27 refrigerators in Mozambique. In Uganda, the vast majority of failures were due to a cooling unit fault in one widely used refrigerator model. In Mozambique, 11 of the 27 problems were attributable to solar refrigerators with batteries that were unable to hold a charge, and another eight problems were associated with a need to adjust thermostat settings. The studies showed that tracking and evaluation of equipment performance and failure can yield important, actionable information for a range of stakeholders, including local CCE technicians, the ministry of health, equipment manufacturers, and international partners such as the United Nations Children's Fund, World Health Organization, and Gavi, the Vaccine Alliance. Collaborative efforts to systematically collect and communicate data on CCE performance and causes of failure will help to improve the efficiency and reach of immunization programs in low- and middle-income countries.