Introducing auto-disable syringes to the national immunization programme in Madagascar
Drain, P.K.; Ralaivao, J.S.; Rakotonandrasana, A.; Carnell, M.A.
Bulletin of the World Health Organization 81(8): 553-560
2003
ISSN/ISBN: 0042-9686 PMID: 14576886 Document Number: 265375
Objective: To evaluate the safety and coverage benefits of auto-disable (AD) syringes, weighed against the financial and logistical costs, and to create appropriate health policies in Madagascar. Methods: Fifteen clinics in Madagascar, trained to use AD syringes, were randomized to implement an AD syringe only (for administering diphtheria tetanus pertussis vaccines, measles vaccines, and anti-tetanus toxoid vaccines), mixed (AD syringes used for administering the 3 vaccines, only on non-routine immunization days), or sterilizable syringe only (control) programme between September to December 2000. During a five-week period, data on administered vaccinations were collected, interviews were conducted, and observations were recorded. Findings: 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%, and 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%. Conclusion: 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.