Acceptance and Risk Perception of COVID-19 Vaccination among Pregnant and Non Pregnant Women in Sub-Saharan Africa: A Cross-Sectional Matched-Sample Study.

This study aims to evaluate the acceptance and risk perception of pregnant and non pregnant women towards COVID-19 vaccines using a cross-sectional matched-sample study approach. A web-based questionnaire with closed- and open-ended questions was administered to adults older than 18 years in the sub-Saharan African (SSA) region. Respondents (n = 131) were grouped based on their pregnancy status (54 pregnant and 77 non pregnant women) and matched for comparison by age. The matched groups were compared using the chi-square test and the t-test where appropriate. Compared to non pregnant women, pregnant women reported significantly lower risk perception scores of COVID-19 infection (3.74 vs. 5.78, p < 0.001) and were less likely to take the COVID-19 vaccine (odds ratio = 0.12, 95% confidence interval (CI) 0.06-0.27, p < 0.001). A similar proportion of pregnant and non pregnant women believed in false information about the COVID-19 vaccine, and 40% of unvaccinated pregnant women (n = 40) were concerned about the safety of the vaccine. After adjustment, women's education, marital status, belief in misconceptions and risk perception were associated with non-vaccination among pregnant women. The content analysis revealed that pregnant women refused the vaccine due to mistrust of their countries' health systems, concerns about the country where the vaccines were manufactured and a lack of confidence in the production process of the vaccines. This study shows the poor acceptance of COVID-19 vaccines among pregnant women in SSA, who perceived a lower risk of COVID-19 infection. Understanding the reasons for non-acceptance and the motivation to accept the COVID-19 vaccine could guide the development of health education and promotion programmes, and aid governments and policymakers in implementing targeted policy changes.

The impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa.

BACKGROUND: Vaccination remains the most powerful weapon against the emergence of new variants of coronavirus (COVID-19). However, false information about COVID-19 vaccines through various platforms including social media remains a major threat to global public health. This study examined the impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa (SSA). METHODS: A validated web-based cross-sectional study was conducted from 14 March to 16 May 2021, and was administered in both French and English to 2572 participants aged 18 years and over. Data on sociodemographic characteristics, medical and vaccination history, and the information sources (mainstream media and social media) used by the participants during the pandemic were obtained. There were three main outcomes: The vaccinated group were those who responded in the affirmation (Yes) to the question of whether they have been vaccinated against COVID-19. Those who responded 'not sure' or 'no' to the question were then asked if they were willing to be vaccinated when the vaccine became available in their home countries. The responses to this follow-up question were used to derive the second and third outcome variables of 'vaccine hesitancy' and 'vaccine resistance', respectively. A series of logistic regression analyses were used to examine the impact of information sources on the three main outcomes. RESULTS: The prevalence of COVID-19 vaccine hesitancy among the participants was lowest among newspaper readers (42%) and highest among TV (72%) and social media users (73%). The prevalence of COVID-19 vaccine-resistance was also lowest among newspaper readers (37%) but highest among social media users (87%). Multivariate analyses revealed that compared to those who did not use these information sources, SSA participants who relied on the radio (aOR 0.83, 95%CI = 0.70, 0.99), TV (aOR 0.80, 95%CI = 0.65, 0.97) and social media (aOR 0.79, 95%CI = 0.65, 0.97) for information during the pandemic were less likely to be hesitant towards taking the vaccines. However, social media users (aOR 2.13, 95%CI = 1.62, 2.80), those who watched TV (aOR 1.40, 95%CI =1.08, 1.80), relied on healthcare workers (HCWs: aOR 1.32, 95%CI = 1.07, 1.63) and families/friends (aOR 1.31, 95%CI = 1.06, 1.61) for COVID-19 related information during the pandemic were more likely to resist taking the COVID vaccines in this study. Participants who relied on the newspaper for information during the pandemic were less likely to resist the vaccines (aOR 0.77, 95%CI = 0.62, 0.95) compared to non-readers of a newspaper. CONCLUSION: We found that all six information sources except radio were strong predictors of the resistance towards COVID-19 vaccination. Further research on how these channels can be used to improve the availability of reliable healthcare information is needed. Investments in these resources will protect people and empower them to make appropriate choices about their health.

Acceptance of COVID-19 vaccine among sub-Saharan Africans (SSA): a comparative study of residents and diasporan dwellers.

BACKGROUND: The COVID-19 vaccines are being rolled out across all the sub-Saharan Africa (SSA) countries, with countries setting targets for achieving full vaccination rates. The aim of this study was to compare the uptake of, resistance and hesitancy to the COVID-19 vaccine between SSA locally residents and in the diasporan dwellers. METHODS: This was a cross-sectional study conducted using a web and paper-based questionnaire to obtain relevant information on COVID-19 vaccine acceptance. The survey items included questions on demography, uptake and planned acceptance or non-acceptance of the COVID-19 vaccines among SSAs. Multinomial logistic regression was used to determine probabilities of outcomes for factors associated with COVID-19 vaccination resistance and hesitancy among SSA respondents residing within and outside Africa. RESULTS: Uptake of COVID-19 vaccines varied among the local (14.2%) and diasporan (25.3%) dwellers. There were more locals (68.1%) who were resistant to COVID-19 vaccine. Participants' sex [adjusted relative risk (ARR) = 0.73, 95% CI: 0.58 - 0.93], education [primary/less: ARR = 0.22, CI:0.12 - 0.40, and bachelor's degree: ARR = 0.58, CI: 0.43 - 0.77]), occupation [ARR = 0.32, CI: 0.25-0.40] and working status [ARR = 1.40, CI: 1.06-1.84] were associated with COVID-19 vaccine resistance among locals. Similar proportion of local and diasporan dwellers (~ 18% each) were hesitant to COVID-19 vaccine, and this was higher among health care workers [ARR = 0.25, CI: 0.10 - 0.62 and ARR = 0.24, CI:0.18-0.32, diaspora and locals respectively]. After adjusting for the potential confounders, local residents aged 29-38 years [ARR = 1.89, CI: 1.26-2.84] and lived in East Africa [ARR = 4.64, CI: 1.84-11.70] were more likely to report vaccine hesitancy. Knowledge of COVID vaccines was associated with hesitancy among local and diasporan dwellers, but perception was associated with vaccine resistance [ARR = 0.86,CI: 0.82 - 0.90] and hesitancy [ARR = 0.85, CI: 0.80 - 0.90], only among the local residents. CONCLUSIONS: Differences exist in the factors that influence COVID-19 vaccine acceptance between local SSA residents and thediasporan dwellers. Knowledge about COVID-19 vaccines affects the uptake, resistance, and hesitancy to the COVID-19 vaccine. Information campaigns focusing on the efficacy and safety of vaccines could lead to improved acceptance of COVID-19 vaccines.

Public awareness and perception towards COVID-19 in Sub-Saharan African countries during the lockdown.

Background: The coronavirus disease (COVID-19) outbreak has caused a universal health crisis resulting in significant morbidities and mortalities particularly among high-risk groups. This study sought to determine regional factors associated with knowledge and attitude towards COVID-19 mitigation practices and risk perception of contracting the disease in Sub-Saharan African (SSA) countries. Methods: A cross-sectional anonymous online study was conducted among 1970 participants between April and May 2020, during the lockdown in many SSA countries. Recruitment of participants was via WhatsApp, Facebook and emails using authors' networks. The outcome variables were KAP (knowledge, attitudes and practice) of COVID-19 and analysis of variance (ANOVA) with post hoc test was run to assess the level of KAP by four regions in SSA. Simple and multiple linear regression (MLR) analyses were performed to examine factors associated with the outcome measures in the four SSA regions. Results: Mean knowledge (P=0.707) and risk perception (P=0.904) scores by four regions in SSA did not differ significantly. However, the mean attitude score was higher among West Africans compared with Southern (P=0.019) and Central Africans (P=0.003). MLR analysis revealed that among those living in West (adjusted coefficient ß=-0.83 95% CI: -1.19, -0.48) and Southern Africa (ß=-0.91 95% CI: -1.42, -0.40), having a primary or secondary education was associated with a decrease in knowledge scores while not being worried about COVID-19 decreased risk perception scores across the four SSA regions(West [ß=-6.57, 95% CI: -7.53, -5.62], East [ß=-6.24: 95% CI: -8.34,-4.15], Central [ß=-6.51, 95% CI: -8.70, -4.31], and Southern Africa [ß=-6.06: 95% CI: -7.51, -4.60]). Except among Southern Africans, participants who practiced self-isolation had positive attitude towards COVID-19. Conclusion: Future research on health education regarding COVID-19 or a future related pandemic in SSA should target people with lower education, those who do not self-isolate, those living in Southern and Western Africa and not worried about contracting COVID-19.

Analysis of Perception, Reasons, and Motivations for COVID-19 Vaccination in People with Diabetes across Sub-Saharan Africa: A Mixed-Method Approach.

Diabetes mellitus (DM) is associated with severe COVID-19 infection and complications. This study assesses COVID-19 vaccine acceptance and hesitancy in people with DM, and explores the reasons for not being vaccinated. This was a web-based cross-sectional survey using a mixed-method approach conducted in March-May 2021, corresponding to most Sub-Saharan African (SSA) countries' early vaccine rollout period. Participants were those aged ≥18 years with self-reported DM in 11 Sub-Saharan African (SSA) countries. Responses to comments on the reasons for vaccine hesitancy and facilitators for vaccine uptake were analyzed. Of the 73 participants with DM, 65.8% were males, older than 35 years (86.3%), had postsecondary education (90%), and a significant proportion were from South Africa (39.7%), Nigeria (28.8%) and Ghana (13.7%). At the time of this study, 64.4% experienced COVID-19 symptoms, 46.6% were tested for COVID-19, of which 19.2% tested positive. Few participants (6.8%) had received a COVID-19 vaccination, 65.8% were willing to take the vaccine when it becomes available in their country, while 26.0% either refused or remained hesitant towards taking the vaccine. The main identified reasons for not taking the vaccine were: advice from religious leaders; concerns about the safety, effects, and efficacy of the vaccines; mistrust of the pharmaceutical companies producing the vaccines and the process of production; the conspiracy theories around the vaccines; and the personal belief of the participants regarding vaccination. However, participants stated they would take the vaccine if they were more educated about it, received positive feedback from those vaccinated, were rewarded for taking the vaccine, or if vaccination became a condition for travel and employment. In conclusion, this study shows that the uptake of the COVID-19 vaccine was very low in this high-risk group. Efforts to increase the uptake of COVID-19 vaccines among people with diabetes are imperative, such as the provision of education and relevant information.

Economic, Health and Physical Impacts of COVID-19 Pandemic in Sub-Saharan African Regions: A Cross Sectional Survey.

PURPOSE: The key preventive measures adopted to minimise the spread of the coronavirus disease (COVID-19) had significant health, economic and physical impacts mostly in developing countries. This study evaluated the health, economic and physical impacts of COVID-19 lockdown measures among sub-Saharan African (SSA) population and associated demographic variations. METHODS: A total of 1970 respondents took part in this web-based cross-sectional survey during the mandatory lockdown period in most SSA. The dependent variables were health (COVID-19 infection, hospitalisation), socioeconomic (lost job, closed down business) and physical impacts (separated from family) of COVID-19. Univariate and bivariate logistic regression analyses were used to explore the factors associated with each of the dependent variables by the four sub-regions (Southern, Western, Central and East Africa). RESULTS: The respondents were aged 34.1 ± 11.5 years (range: 18-75 years) and mostly men (1099, 55%). 25.9% (n = 511) reported an impact of COVID-19 pandemic with significant regional variations (p < 0.0005, higher proportion were East 36.2% and Southern Africans 30.3%) but no gender (p = 0.334) and age group variations (p > 0.05). Among Central African respondents, more men than women lost their businesses (45.7% versus 14.3%, p = 0.002) and contracted COVID-19 infections (40.0% versus 18.2%, p = 0.024) during the study period. Multivariable analysis revealed that respondents from East (adjusted odds ratio [AOR] 1.95, 95% confidence interval [CI]: 1.42-2.69), Southern (AOR 1.46, 95% CI: 1.09-1.96) and Central Africa (AOR 1.47, 95% CI: 1.06-2.03) reported significantly higher impact of COVID-19. Those who reported family separation during the lockdown were more likely to be older participants (39-48 years, AOR 2.48, 95% CI: 1.11-5.57). CONCLUSION: One in four SSA respondents, mostly East and Southern Africans, were adversely affected by the COVID-19 pandemic during the lockdown. Interventions in high-risk populations are needed to reduce the health, socioeconomic and gender disparities in the impacts of COVID-19.

Differences in Perceived Risk of Contracting SARS-CoV-2 during and after the Lockdown in Sub-Saharan African Countries.

This study investigated risk perception of contracting and dying of SARS-CoV-2 in sub-Sahara Africa during and after the lockdown periods. Two online surveys were conducted one year apart, with participants 18 years and above living in sub-Sahara Africa or the diaspora. Each survey took four weeks. The first survey was taken from 18 April to 16 May 2020, i.e., during the lockdown. The second survey was taken from 14 April to 14 May 2021, i.e., after the lockdown. A cross-sectional study using adopted and modified questionnaires for both surveys were distributed through online platforms. Question about risks perception of contracting and dying of SARS-CoV-2 were asked. The Helsinki declaration was applied, and ethical approvals were obtained. Total responses for both surveys, i.e., both during and after the lockdown, was 4605. The mean age was similar in both surveys (18-28 years). The mean risk perception scores were higher after lockdown by 3.59%. Factors associated with risk perception of COVID-19 were survey period, age group, region of residence, and occupation. Non-health care workers had a lower risk perception of COVID-19. This first comparative study on the level of risk perception of Africans during and after the lockdown shows that one in every three and every four persons in sub-Sahara Africa felt at high risk of contracting COVID-19 and thought they could die from contracting the same, respectively.

Opinion and uptake of chloroquine for treatment of COVID-19 during the mandatory lockdown in the sub-Saharan African region.

BACKGROUND: As the search for effective treatment of coronavirus disease 2019 (COVID-19) infection continues, the public opinion around the potential use of chloroquine (CQ) in treating COVID-19 remains mixed. AIM: To examine opinion and uptake of CQ for treating COVID-19 in the sub-Saharan African (SSA) region. SETTING: This study was conducted through an online survey software titled SurveyMonkey. METHODS: Anonymous online survey of 1829 SSA countries was conducted during the lockdown period using Facebook, WhatsApp and authors' networks. Opinion and uptake of CQ for COVID-19 treatment were assessed using multivariate analyses. RESULTS: About 14% of respondents believed that CQ could treat COVID-19 and of which, 3.2% took CQ for COVID-19 treatment. Multivariate analyses revealed that respondents from Central (adjusted odds ratios [aOR]: 2.54, 95% confidence interval [CI] 1.43, 4.43) and West Africa (aOR: 1.79, 95% CI 1.15, 2.88) had higher odds of believing that CQ could treat COVID-19. Respondents from East Africa reported higher odds for uptake of CQ for COVID-19 than Central, Western and Southern Africans. Knowledge of the disease and compliance with the public health advice were associated with both belief and uptake of CQ for COVID-19 treatment. CONCLUSION: Central and West African respondents were more likely to believe in CQ as a treatment for COVID-19 whilst the uptake of the medication during the pandemic was higher amongst East Africans. Future intervention discouraging the unsupervised use of CQ should target respondents from Central, West and East African regions.