Assessment of Vaccine Handlers' Knowledge and Cold Chain Management in Primary Health Care Facilities in Tripoli, Libya

Abstract

Vaccination is one of the most effective public health interventions for preventing infectious diseases. In Libya, particularly in Tripoli, challenges related to infrastructure, training, and supervision may affect the effectiveness of vaccine storage and handling practices. The Knowledge, Attitudes, and Practices (KAP) assessment framework provides a structured approach to evaluating provider-level performance in immunization services, yet limited evidence exists from primary health care facilities in Tripoli. A descriptive cross-sectional study was conducted in August 2024 across 65 primary health care vaccination sites in six municipalities of Tripoli, Libya. Using a total population sampling approach, all 65 vaccination providers were assessed. Data were collected using structured questionnaires and observational checklists adapted from WHO Effective Vaccine Management (EVM) guidelines. Standardized categorical scoring thresholds were applied to evaluate provider knowledge, attitude, and practice, alongside overall facility performance. Most facilities possessed functional cold chains with adequate refrigeration (96.9%) and temperature monitoring (98.5%), though operational gaps remained in guideline availability and emergency alarms. While providers overwhelmingly demonstrated positive attitudes (98.5%), good practices (96.9%), and moderate-to-good overall knowledge (93.8%), specific deficiencies were identified regarding mild illness contraindications, vaccine distinctions, batch number recording, and post-vaccination observation times. The study concluded that despite functional cold chains and experienced staff, operational gaps in training, documentation, and emergency preparedness threaten vaccine quality in Tripoli. Addressing these through continuous training, supportive supervision, and enhanced monitoring is essential for safe immunization.