Quality Assessment of Immunization Practice at Clinics in 2006

Abstract

The objective of this cross sectional survey was to assess the quality of immunization practice at immunization clinics of government hospitals and at health centers in Thailand. The study population were health officers who worked in immunization clinics. The number of provinces was randomly selected in proportion to the number of provinces in each of the 4 regions. The total of 25 provinces were finally selected. In each province, 2 clinics in hospitals (hos) and 2 clinics in health centers (hc) were chosen at random. The assessment was conducted by experienced personnel of the Bureau of General Communicable Diseases, by face-to-face interview on health officers conduct about vaccine management using questionnaire and by observation. The survey showed that most of the clinics, both in hospitals and health centers, met the standard for immunization clinic operation eg. provide regular monthly vaccination service, maintain standard cold chain equipments (refrigerator specific for vaccine, vaccine carriage, and ice peck),carry out service procedure with low risk for contamination. However, detail information which is essential for surveillance and investigation of Adverse Events Following Immunization : AEFIs is not available. For example, there was no record of vaccine lot number (at hos and at hc : 32% and 56% respectively),the thermometer was inaccurate (at hos and at hc : 27% and 19% respectively), cold chain temperature was out of recommended range (at hos and at hc : 19% and 21% respectively), There were expired vaccines kept in the refrigerator (at hos and at hc : 25% and 25% respectively). For registration and record of the vaccinees, the name list was available for children under 5 year old in most places (at hos and at hc : 96% and 100% respectively), but the list for vaccines was present at lower rate in antenatal clinic (at hos and at hc : 88% and 89% respectively) and school-based immunization (at hos and at hc : 49% and 60% respectively). To further improvement of the program, the immunization management training need to be strengthened with emphasis on detail and quality of work. Staff responsible for immunization at the provincial and district levels should provide close supervision, systematically and regularly, to increase the capacity of staff at service level.