Vaccine wastage at primary, secondary, and tertiary level of healthcare system—A study from Northern India

BACKGROUND: High vaccine wastage results in escalation of budget of immunization program. OBJECTIVE: To analyze vaccine wastage at three levels of service delivery under public sector, such as at district level, community health Centre (CHC), and sub center (SC). STUDY DESIGN: A retrospective cross-sectional record based study in a north Indian state. MATERIALS AND METHODS: The record from January to June 2016 was taken from randomly selected 5 districts of the state at 3 levels; for number of doses of vaccine used and number of children vaccinated for BCG, OPV, Hepatitis B, Pentavalent, DPT, IPV, Measles, and TT (vaccines being given in state in the study year). A total of 67,550 vaccine doses in routine immunization were studied. STATISTICAL ANALYSIS USED: Data were presented in mean ± standard deviation. One-way ANOVA test was used to compare the means among three levels. RESULTS: Vaccine wastage for Pentavalent was remarkably low (4.86% at district level, 8.35% at CHC and 11.50% at SC) in contrast to other similar 10 dose vials of vaccines like DPT, TT, Hep B. For both the lyophilized vaccines, interestingly BCG wastage was not only significant but over the permissible levels at 60.39%, whereas it is not so for measles. Result indicated that mean difference of the vaccine wastage among three levels was significant for the BCG, OPV, Hepatitis B, Pentavalent, and TT (P < 0.05); while insignificant for the DPT, IPV, and Measles (P > 0.05). CONCLUSIONS: Not all vaccine wastage is preventable, but pruning the corners where feasible and allowing where it is desirable should depend on prioritizing stakeholders at the receiving end.