Introducing auto-disable syringes to the national immunization programme in Madagascar

• Published in: Bulletin of the World Health Organization Vol. 81; no. 8; pp. 553 - 560
• Main Authors: DRAIN, Paul K, RALAIVAO, Josoa S, RAKOTONANGRASANA, Alexander, CAMELL, Mary A
• Format: Journal Article
• Language: English
• Published: Genève Organisation mondiale de la santé 01.01.2003; World Health Organization; The World Health Organization
• Subjects: Biological and medical sciences; Child; Child, Preschool; Clinics; Cooperation; Cost estimates; Data collection; Developing countries; Diphtheria-Tetanus-Pertussis Vaccine - administration & dosage; Disposable Equipment - supply & distribution; Disposable equipment/economics; Disposable equipment/standards; Disposable equipment/utilization; Equipment reuse/economics; Female; General populations; Health personnel/education; Health policy; Health Policy & Services; Hepatitis; Humans; Immunization; Immunization - economics; Immunization - instrumentation; Immunization Programs - economics; Immunization Programs - organization & administration; Immunization Programs - utilization; Immunization programs/organization and administration; Infant; Injections; Injections/economics; International cooperation; Interviews; LDCs; Madagascar; Madagascar - epidemiology; Medical instruments and apparatus; Medical sciences; Medical sector; Medical waste disposal; Medical wastes; National Health Programs; Prevention and actions; Product surveillance, Postmarketing; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Randomized controlled trials; Safety measures; Safety/standards; Statistical significance; Sterilization; Sterilization - economics; Syringes - supply & distribution; Syringes/economics; Syringes/standards; Tetanus; Tetanus Toxoid - administration & dosage; Tropical medicine; Vaccination; Vaccination and vaccines; Vaccines; Women; Workers; Malagasy Republic; Africa; Madagascar; Human; Disposable; Sanitary program; Vaccination; Developing countries; Cost benefit analysis; Prevention; Immunoprophylaxis; International cooperation; Health policy; Health economy; Syringe; Female; Child; Public health; Equipment reuse; Países en desarrollo; Jeringas; Cooperación internacional; Vacunación; Sterilization; Femmes; Medical waste disposal; Niño; Pays en développement; Equipos desechables; Esterilización; Vigilance produits de santé; Women; Immunization; Disposición de residuos médicos; Coopération internationale; Health personnel; Programas de inmunización; Injection; Immunization programs; Syringes; Stérilisation; Programmes de vaccination; Immunisation; Entretien; Madagascar; Réutilisation matériel; Inyecciones; Inmunización; Randomized controlled trials; Mujeres; Disposable equipment; Seguridad; Equipo reutilizado; Product surveillance, Postmarketing; Safety; Interviews; Essai clinique randomisé; Personnel sanitaire; Vigilancia de productos comercializados; Entrevistas; Ensayos controlados aleatorios; Matériel usage unique; Injections; Enfant; Sécurité; Traitement déchets médicaux; Personal de salud; Seringues
• ISSN: 0042-9686; 1564-0604
• DOI: 10.1590/S0042-96862003000800004

To evaluate the safety and coverage benefits of auto-disable (AD) syringes, weighed against the financial and logis- tical costs, and to create appropriate health policies in Madagascar. Fifteen clinics in Madagascar, trained to use AD syringes, were randomized to implement an AD syringe only, mixed (AD syringes used only on non-routine immunization days), or sterilizable syringe only (control) programme. During a five-week period, data on administered vaccinations were collected, interviews were conducted, and observations were recorded. The use of AD syringes improved coverage rates by significantly increasing the percentage of vaccines administered on non-routine immunization days (AD-only 4.3%, mixed 5.7%, control 1.1% (P<0.05)). AD-only clinics eliminated sterilization sessions for vaccinations, whereas mixed clinics reduced the number of sterilization sessions by 64%. AD syringes were five times more expensive than sterilizable syringes, which increased AD-only and mixed clinics' projected annual injection costs by 365% and 22%, respectively. However, introducing AD syringes for all vaccinations would only increase the national immunization budget by 2%. The use of AD syringes improved vaccination coverage rates by providing ready-to-use sterile syringes on non-routine immunization days and decreasing the number of sterilization sessions, thereby improving injection safety. The mixed programme was the most beneficial approach to phasing in AD syringes and diminishing logistical complications, and it had minimal costs. AD syringes, although more expensive, can feasibly be introduced into a developing country's immunization programme to improve vaccination safety and coverage.