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    Strengthening the vaccine cold chain.

    Cheyne J

    WORLD HEALTH FORUM. 1982; 3(4):436-40.

    In this discussion of strengthening the vaccine cold chain, attention is directed to the following: preventing breakdowns (ensuring good performace, delivery and installation, and training users in maintenance) and repairing equipment (planning a maintenace system and suppliers of spare parts). Keeping vaccines continuously cold as they travel from the factory to the place where they are used calls for a "cold chain" of referigerators and cold boxes. In tropical countries with unreliable electricity supplies and without vehicles to carry the vaccines, this cold chain is highly vulnerable to interruption, with consequent loss of vaccine potency. Although the UN International Chilren's Emergency Fund, the World Health Organization, and many other agencies have spent hundreds of thousands of dollars in the past few years on equipment and training, vaccines continue to be damaged. Refrigeration engineers have produced many new ideas for keeping vaccines cold, including: refrigerators that regquire only 8 hours of electricity per day; an almost unbreakale lamp glass for use in kerosene refrigerator; freezers that can produce 40 kgof ice per day for cold boxes; and freezers that use bottled gas as fuel and are specially designed for making ice packs for cold boxes. Yet, the cold chain still fails. In a typical vaccine cold chain, between 30-50% of refrigerators and freezers are not working, due in part to refrigerators have a very short working life in tropical climates. The following recommendations should be followed whien buying and installing refrigerators or freezers for cold chain: mmake sure their performace is good enough; make sure the equipment is delivered and installed in good condition; and train users to look after the equipment properly. Even a perfectly maintained refrigerator or freezer eventually wiull break down. In a properly orgaized cold chain, the individual resonaible should then contact a repair workshop. Refrigerator and freezer repairs can be done in developing countries. The guidelines for ensuring prompt repairs consider both planning a maintenance system and storing the spare parts where they will be used. There are 2 options for ministries of health who want to improve their cold chain repair work: they can award a contract for the work to a private compan; they can do the work themselves. All the work that has been done on training, tool kit design, and spare parts is based on the assumption that countries have a national policy on maintenace and repair of cold chain rquipment. This is the responsibility of the ministry of health, and there must be a commiTMENT TO THIS POLICY IN THE HIGHEST LEVELS OF THE MINISTRY.
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