Availability of cold chain products and systems, and factors associated with adherence to essential cold chain requirements among community pharmacies in Kampala and Gulu districts

Abstract

Background: Ensuring effectiveness of vaccines and other cold chain items, requires appropriate storage from the manufacturing process to their administration. Cold chain systems maintain the potency of cold chain items that could be lost during storage, transportation or at point of use. Despite continuous supply of the cold chain products in community pharmacies, there is inadequate information on their adherence to essential cold chain system requirements in Uganda and worldwide. This raises concerns on the efficacy and safety of the cold chain products purchased from these facilities which can result into product wastage and failure in effectiveness.

Objectives: To assess the availability of cold chain products and systems, and factors associated with adherence to essential cold chain requirements among community pharmacies in Kampala and Gulu districts.

Methods: A cross sectional survey on 193 retail pharmacies was conducted using a structured self-administered questionnaires and direct observation of cold chain management practices. Data was fed into Epi database software version 3.1, then converted into SPSS version 24 and analysed by descriptive statistics and logistic regression. A threshold score of 75.0% from a similar study in Ethiopia was used to determine adherence as low or high.

Results: Ninety-seven pharmacies (50.3%) had cold chain systems. Similarly, 97 pharmacies had cold chain pharmaceutical products with insulin being the most (37.8%) stocked. The mean adherence score on cold chain system requirements was 77.0% (SD=15.1%). The mean knowledge level about cold chain systems was 82.7% (SD=20.1%). Of the pharmacies that had cold chain systems and products, 60.8% lacked backup generators, 8.2% had current refrigerator temperature readings out of range, 44.3% did not do regular thermometer calibration, and 70.1% were not performing regular equipment maintenance. Personnel working experience (AOR = 0.18; 95%CI: 0.07-0.51; p = 0.001), functional backup generator availability (AOR = 5.21; 95%CI: 1.61-16.89; p = 0.006), and existence of SOPs (AOR = 3.08; 95%CI: 1.03-9.21; p = 0.044) were significantly associated with adherence to cold chain temperature requirements.

Conclusions: Relatively high number of community pharmacies in Uganda’s cities of Kampala and Gulu sell a variety of cold chain pharmaceutical products. However, there is a low adherence to cold chain requirements which raises concerns on the safety and efficacy of the products.

Recommendations: National Drug Authority should carry out frequent inspections and sensitization on cold chain system management in community pharmacies in Uganda.