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BACKGROUND: Vaccines require cold chain storage conditions, and good distribution practices throughout the supply chain to maintain their quality and potency. However, in the last mile of the vaccines supply chain, these requirements may not be guaranteed resulting in reduced effectiveness which could lead to an upsurge in vaccine preventable morbidity and mortality. The aim of this research was to evaluate vaccine storage and distribution practices in the last mile of vaccine supply chain in Turkana County. METHODS: A descriptive cross-sectional study was conducted from January 2022 to February 2022 across seven sub-counties in Turkana County, Kenya, to assess vaccine storage and distribution practices. The study sample size was 128 county health professionals across 4 hospitals, 9 health centers, and 115 dispensaries. The respondents were selected using simple random sampling within the facilities strata. Data were collected using a structured questionnaire, adapted, and adopted from a standardized WHO questionnaire on effective vaccines management and administered to one healthcare personnel working in the immunization supply chain per facility. Data were analyzed using excel and presented as percentages in table forms. RESULTS: A total of 122 health care workers participated in the study. Most respondents (89%, n = 109) had utilized a vaccine forecasting sheet, but only 81% did have an established maximum-minimum level inventory control system. Many of the respondents had sufficient knowledge of ice pack conditioning although 72% had adequate vaccine carriers and ice packs. Only 67% of respondents had a complete set of twice-daily manual temperature records at the facility. Most refrigerators complied with the WHO specifications but only 80% of them had functional fridge-tags. The number of facilities that had a routine maintenance plan was below average while only 65% had an adequate contingency plan. CONCLUSION: Rural health facilities have suboptimal supply of vaccine carriers and icepacks for effective storage and distribution of vaccines. In addition, some vaccine fridges lack functional fridge-tags for proper temperature monitoring. Routine maintenance and contingency plans remain a challenge to ensure optimal service delivery.
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BACKGROUND: Hypertension (HTN) affects nearly 1 billion people globally and is a major cause of morbidity and mortality. In low- and middle-income countries (LMICs), HTN represents an unmet health care gap that can be addressed by strengthening national health care systems. The National Heart, Lung, and Blood Institute recently funded the T4 Translation Research Capacity Building Initiative in Low Income Countries (TREIN) program to build capacity in dissemination and implementation (D&I) research in HTN in LMICs. The Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO) recently developed a massive open online course (MOOC) to train in D&I. Herein, we report on the use of the TDR WHO MOOC in D&I for the TREIN program in Rwanda, assessing feasibility of the MOOC and D&I competencies after MOOC training. METHODS: Participants in one-group MOOC training completed pre- and post-training questionnaires to assess dissemination and implementation (D&I) competency outcomes and feasibility. D&I competencies were measured by use of a scale developed for a US-based training program, with the change in competency scores assessed by paired t test. Feasibility was measured by completion of homework and final project assignment and analyzed using descriptive statistics. RESULTS: Of the 92 trainees enrolled, 35 (38%) completed all MOOC components. D&I competency scores showed strong evidence of improvements from pre- to post-test. The full-scale average score improved by an average of 1.09 points, representing an effect size of 1.25 (CI 0.48-2.00); all four subscales also showed strong evidence of improvements. Trainees reported challenges to MOOC course completion that included technological issues (i.e., limited internet access) and competing demands (i.e., work, family). CONCLUSIONS: In the context of LMIC training, the MOOC course was feasible and course completion showed improvement in D&I competency scores. While the program was designed with a focus on training for tropical diseases, there is potential for scalability to a wider audience of health care researchers, workers, administrators, and policymakers in LMIC interested in D&I research in non-communicable diseases.
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BACKGROUND: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide and in low- and middle-income countries, and hypertension (HTN) is a major risk factor for CVD. Although effective evidence-based interventions for control of HTN in high-income countries exist, implementation of these in low- and middle-income countries has been challenging due to limited capacity and infrastructure for late-phase translational research. In Rwanda, the 2015 STEPS NCD (STEPwise Approach to Surveillance of Noncommunicable Diseases) risk survey reported an overall prevalence of HTN of 15% (95% confidence interval [CI]: 13.8 to 16.3) for those ages 15 to 64 years; prevalence increased with increasing age to 39% (95% CI: 35.7 to 43.1) for those ages 55 to 64 years; CVD was the third most common cause of mortality (7%). Suboptimal infrastructure and capacity in Rwanda hinders research and community knowledge for HTN control. OBJECTIVES: To address the issue of suboptimal capacity to implement evidence-based interventions in HTN, this project was designed with the following objectives: 1) to develop a regional needs assessment of infrastructure for dissemination and implementation (D & I) strategies for HTN-CVD control; 2) to develop HTN-CVD research capacity through creation of countrywide resources such as core research facilities and training in the fields of HTN-CVD, D & I, and biostatistics; and 3) to engage and train multiple stakeholders in D & I and HTN-CVD evidence-based interventions. METHODS: A weeklong training program in HTN-CVD, biostatistics, and D & I was conducted in Rwanda in August 2018, and pre- and post-D & I training competency questionnaires were administered. RESULTS: Questionnaire results show a statistically significant increase in D & I knowledge and skills as a result of training (full scale pre- to post-test scores: 2.12 ± 0.78 vs. 3.94 ± 0.42; p < 0.0001). CONCLUSIONS: Using principles of community engagement and train-the-trainer methods, we will continue to adapt guidelines and treatments for HTN-CVD developed in high-income countries to the context of Rwanda with the goal of establishing a sustainable platform to address the burden of disease from HTN-CVD.
