Healthcare workers' knowledge and practices regarding expanded program on immunization in Kalasin, Thailand.

Primary vaccine failures can occur after high immunization coverage has been achieved. Healthcare workers' knowledge and practices are influential factors in preventing vaccine failures. Adequate knowledge and practices in the cold chain system are important to keep potency of vaccines and effectiveness of immunization. This cross-sectional study was performed to assess healthcare workers' knowledge and practices regarding an expanded program on immunization and the cold chain system in Kalasin, Thailand. Data collection methods included interviews, observations and document audit. Ninety primary care units and 117 respondents were selected. Only 55.6% of respondents provided correct answers for questions regarding the immunization schedule of school children and 59.0% of respondents answered correctly for questions about Measles-Mumps-Rubella Vaccine. Healthcare workers in hospitals had better knowledge than healthcare workers in health centers (P < 0.001). Healthcare workers who had sufficient training had better knowledge than healthcare workers who had no training (P < 0.001). Only 61.1% of primary care units recorded the temperature in the vaccine refrigerator twice a day and 63.3% of primary care units had a flowchart regarding what to do when there is an electric power failure. About 13% of vaccine refrigerators had temperatures outside the recommended range of 2 to 8 degrees C. Practices in hospitals were also better than those in health centers (P = 0.001). Knowledge and practices were significantly different between healthcare workers in hospitals and in health centers. Coverage training and regular supervision on vaccine handling and the cold chain system are recommended, especially for health centers in remote areas.