Vaccine wastage rates and attributed factors in rural and urban areas in Uganda: Case of Mukono and Kalungu districts

Abstract Background Vaccine wastage contributes to missed opportunities to vaccinate especially in low-income countries with high vaccine preventable disease burden. We estimated vaccine wastage rates and assessed attributed factors among health workers participating in vaccination activities in Mukono and Kalungu districts in Uganda. Methods A mixed methods study design was utilised to estimate vaccine wastage rates for BGC, OPV, IPV, PCV, MR, DPT–HepB–Hib and assess attributed factors among health workers participating in vaccination activities in randomly selected health facilities in Mukono (urban) and Kalungu (rural) districts. Mann–Kendall statistical test was used to assess significance of observed trends of vaccine wastage rates. We applied Mann Whitney U and Kruskal–Wallis H tests to compare overall average vaccine wastage rates per vaccine by district, ownership, and type of health facility. For purposes of triangulation, we conducted Key informant interviews among immunization focal persons to explore reasons attributed to vaccine wastage. Thematic analysis method using inductive coding was used to analyse qualitative data. Results Overall vaccine wastage rates were BCG (70%), MR (58%), DPT–HepB–Hib (21%), IPV (31%), OPV (28%) and PCV (17%); exceeding accepted vaccine wastage rates in Kalungu and Mukono districts from March–August, 2022. Significant variations in vaccine wastage rates were observed across the different types of health facilities [BCG (p < 0.001), IPV (p = 0.023), MR (p = 0.004) and OPV (0.008)] and further, among health facilities located within urban and rural areas [BCG (p < 0.001), MR (p < 0.001) and OPV (0.003)]. Vaccine wastage rates particularly for BCG and MR vaccines were attributed to compliance with Multi Dose Vial Policy (MDVP). Other contributing factors were low turn up during vaccination outreaches, errors and non–completion of vaccine monitoring tools, failure in maintaining cold chain and lack of training in vaccine management among health workers. Conclusion Vaccine wastage rates for all vaccines were relatively higher than acceptable levels in both districts. Intensified efforts such as regular review of vial opening guidelines, predictive modelling for outreach planning, decentralized vaccination approaches, and availability of vaccines in single-dose presentations where feasible could minimize vaccine wastage especially in multi–dose vials.