Vaccine Cold ChainManagement Practice and Its Associated factors in Public Health Facilities Supplied by Ethiopian Pharmaceutical Supply ServiceNekemteHub:AMixedMethod Stud

Abstracts Background: Globally, one of the main challenges facing vaccination programs is maintaining an effective vaccine cold chain. In Ethiopia, only 50% of health centers in the northwest region have demonstrated effective cold chain management. However, studies assessing vaccine management practices and contributing factors—especially in western Ethiopia—remain limited. Objectives: This study aimed to assess the practices of vaccine cold chain management and identify the associated factors among public health facilities supplied by the Ethiopian Pharmaceutical Supply Service (EPSS) Nekemte Hub in Western Ethiopia in 2025. Methods: A facility-based analytical cross-sectional study employing both quantitative and qualitative methods was carried out from February 28 to March 31, 2025, across 73 public health facilities. Zones were selected using a stratified sampling technique. Quantitative data were entered into EpiData version 4.6.0 and analyzed with SPSS version 26.0. Bi-variable and multivariable logistic regression analyses were conducted to examine the relationship between explanatory variables and cold chain management practices. Variables with a p-value less than 0.25 in the bi-variable analysis were included in the multivariable model, and statistical significance was determined at p < 0.05. For the qualitative component, transcripts from in-depth interviews were thematically analyzed using ATLAS.ti version 8.4, and the results were triangulated with the quantitative findings. Results: Among the 73 health facilities surveyed, 58.9% (95% CI: 47%–70%) exhibited good practices in vaccine cold chain management. The average age of participants was 35.58 ± 7.26 years, with males comprising 54.8% of the respondents. Key factors significantly associated with good cold chain management practices included holding a degree-level education (AOR = 6.288, p = 0.009), having received job-related training (AOR = 1.932, p = 0.024), and possessing good knowledge of vaccine cold chain management (AOR = 0.047, p = 0.002). Key informant interviews also highlighted various challenges encountered, along with strategies proposed to address them. Conclusions and Recommendations: Most facilities exhibited good vaccine cold chain management. Enhancing staff education, training, and knowledge is essential. Assigning clear roles and responsibilities can further strengthen accountability and ownership. Keywords: Vaccine Cold Chain Management, Associated factors, Ethiopian Pharmaceutical Supply Service, Nekemte Hub