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

Vaccine wastage remains a challenge to effective immunization; especially in low-income countries. We estimated vaccine wastage rates and assessed attributed factors in Mukono and Kalungu districts in Uganda. A mixed methods study design was utilised to estimate vaccine wastage rates for BGC, OPV, IPV, PCV, MR, DPT-HepB-Hib for 6 months prospectively from March-August 2022 and assess attributed factors in 22 health facilities. Mann-Kendall statistical test was used to assess significance of observed trends. We applied Mann Whitney U and Kruskal-Wallis H tests to compare vaccine wastage rates per vaccine by district, ownership, and type of health facility. Additionally, we administered a questionnaire among 57 health workers and conducted 15 Key Informant Interviews to understand reasons for vaccine wastage. 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. Significant variations 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 among health facilities located within urban and rural areas [BCG (p < 0.001), MR (p < 0.001) and OPV (0.003)]. Vaccine wastage rates for BCG and MR vaccines were higher compared to other vaccines because remaining doses in opened vials were discarded within 6 hours of reconstitution, as per the Multi Dose Vial Policy (MDVP). Other contributing factors were low turn up during outreaches, errors and non-completion of vaccine monitoring tools, cold chain failures and inadequate training in vaccine management. 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 reduced-volume multi-dose vials where feasible could minimize vaccine wastage.