COVID-19 vaccine uptake and associated factors among individuals living in a peri-urban area in Uganda: A cross-sectional study

Mary Bridget Nanteza; Gertrude Nanyonjo; Nasimu Kyakuwa; Flavia Nakanjako; Hamza Kalute; Christine Atuhairwe; Christine Watera; Deogratius Ssemwanga

doi:10.1371/journal.pone.0312377

Abstract

Introduction

The Corona virus disease (COVID-19) is a respiratory illness that is caused by SARS-CoV-2 virus. This virus was first reported in China in December 2019. It then spread to all countries and from March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In Uganda, the disease was first reported in March 2020 and COVID-19 vaccines became available by January 2021. Although COVID-19 vaccines were available in Uganda, uptake remained low. The aim of this study was to establish COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda.

Methods

This was a cross-sectional study conducted among 127 men and 263 women who reside in Entebbe City, Uganda. Data was collected on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine using interviewer administered questionnaires. Uptake of COVID-19 vaccine was defined as the proportion of participants who had received at least one dose of the COVID-19 vaccine. We used descriptive statistics to estimate awareness of COVID-19 vaccines. The ‘chi-square test’ and ‘modified Poisson regression’ were used to assess variations in uptake of COVID-19 vaccines among respondents and their socio-demographics as well as other characteristics.

Results

Ninety-nine percent (388 out of 390) of the study population were aware of at least one brand of COVID-19 vaccines in the country. Thirty-five percent (138 out of 390) knew that the vaccine immunity was achieved 14 days after the 2^nd dose and 98.7% (385 out of 390) admitted that observing the standard operating procedure for COVID-19 infection prevention was necessary after vaccination. There was a gap in knowledge on vaccine safety reported by 74.6% (291 out of 390) participants. Some participants 37.2% (145 out of 390) had concerns about the vaccine. Of these, 57.9% (84 out of 145) believed that the vaccines were not helpful; and 30.3% (44 out of 145) feared serious side effects. Sixty-six percent (257 out of 390) believed that vaccines were not working and 79.0% (308 out of 390) admitted that vaccines were promoted for financial gain. At the time of performing the study, 36.2% and 22.3% had received the 1^st and 2^nd dose respectively. The main sources of information on COVID-19 vaccine were television (TV) and social media (p-value 0.001). In a multivariate model, COVID-19 vaccine acceptability was associated with salaried and self-employment (p-value 0.046). The other predicative factors were awareness of the COVID-19 vaccine (p-value <0.001) and having vaccine concerns (p-value 0.013).

Conclusion

Uptake of COVID-19 vaccination in Entebbe community was low, partly attributed to knowledge gaps and concerns about vaccine safety and effectiveness. This highlights the need to enhance dissemination of information about COVID-19 vaccine. The lessons learnt in this study would be relevant for other emerging infections by informing vaccination implementation programs in similar settings.

Citation: Nanteza MB, Nanyonjo G, Kyakuwa N, Nakanjako F, Kalute H, Atuhairwe C, et al. (2024) COVID-19 vaccine uptake and associated factors among individuals living in a peri-urban area in Uganda: A cross-sectional study. PLoS ONE 19(11): e0312377. https://doi.org/10.1371/journal.pone.0312377

Editor: Frank Kyei-Arthur, University of Environment and Sustainable Development, GHANA

Received: November 1, 2023; Accepted: October 6, 2024; Published: November 4, 2024

Copyright: © 2024 Nanteza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

SARS COV-2 transmission and the fulminating COVID-19 disease can be prevented by SARS-COV-2 vaccines that became globally available in December 2020 [1–3]. In 2021, a cross-sectional study in Africa showed vaccine acceptance levels of 48.93% (95% CI [39.49, 58.37] [4]. However, in April 2022, vaccine coverage of only 12% was reported for Eastern and Southern Africa [5]. By September 2022, the vaccine uptake in Africa was 22.2% still below the WHO target of 70% of the total population who had been fully immunised [6]. As of December 2022, COVID-19 vaccine coverage barely increased and was estimated at 26.4% [7]. Overall, vaccination success has been hindered by negative perception about the COVID-19 disease and vaccines [8–10]; in addition to the absence of vaccines which was initially a challenge for Africa. The situation in Africa poses a challenge to the success of future vaccination programmes [11, 12].

In Uganda, the government secured COVID-19 vaccines with the support from UNICEF and GAVI Alliance [13, 14]. Vaccination began in March 2021. Despite availability of free vaccines, vaccination uptake in Uganda remained low. It was rated at 40–50% for those who received the 1^st dose and 30–40% for those who received the 2^nd dose as of December 2022 [15]. From a recent study, vaccine uptake that was observed in estate and slum communities in Uganda was reported at 43.8% and 39.9% respectively [16]. These communities were in Kampala and Wakiso districts; the slum and estate communities were not specified. Another study performed in a rural setting of Uganda described low education level and misconceptions about the disease and vaccines as obstacles to vaccine uptake [10]. The low incidence of COVID-19 disease in the country was also associated with poor compliance to vaccine uptake [17, 18]. Others believed in divine intervention for a break-through [19]; and persons from malaria endemic areas were believed to be protected from the virus [20, 21]. A study conducted among Ugandan women reported an erroneous belief that COVID-19 infection was believed to be a disease of the white race manifesting with high morbidity and mortality [22]. Uptake of COVID-19 vaccine was also reported to be affected by the level of civilization, societal factors and age [23–25]. Contrary, studies performed among the literate Ugandans aged >18 years displayed good attitudes and prevention approaches estimated at 72.4% and 85.3% respectively [26]. Numerous factors have been shown to contribute to the low COVID-19 vaccine uptake in Uganda. This study aimed to determine COVID-19 vaccine uptake awareness and the associated positive and negative factors that could be promoted or discouraged to enhance vaccine uptake in the country. The study was conducted at a clinic in the peri-urban area because it was a catchment site in the proximity of the investigating institution, Uganda Virus Research Institution (UVRI).

Materials and methods

Study design

This was a cross-sectional study conducted among 390 individuals (263 female) between 10^th November 2021 and 2^nd February 2022. An interviewer administered questionnaire was used to collect data on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine.

Sampling procedure

Selection of respondents was by convenience sampling. All people who came to the clinic during the study period were given information about the study. Those who fulfilled the eligibility criteria and were willing to participate in the study were recruited.

Study setting

The study was conducted in peri-urban communities of Entebbe City in Uganda. Entebbe is a small city of around 70,000 people located on the shores of Lake Victoria, 40 km south of Kampala, the capital city of Uganda. The study included two main communities Katabi town council and Entebbe Central division. Selection of participants was open to those who came to seek health services and vaccination at the UVRI Clinic.

Data collection procedures

Individuals who visited the clinic were briefed about the study and those who were interested in participating were grouped and given further details about the study. After obtaining informed consent, they were asked to respond to a set of questions administered by trained research assistants. Each participant was interviewed for 30 to 40 minutes. The recruitment exercise started on 10^th November 2021 and was concluded on 2^nd February 2022.

Description and conceptualization of variables

The independent variables for knowledge included whether the participant had ever heard about COVID-19 vaccines, and the source of information. The independent variables for practices included willingness to take COVID-19 vaccines, willingness to pay for the vaccines, and whether they would recommend the vaccine to a friend or family. The independent variables for attitude included having received adequate information on the COVID-19 vaccine safety, satisfaction with the health professional/health worker’s responses on COVID-19 vaccine, having concerns about the COVID-19 vaccine, taking precautions after vaccination, requirement for other information/messages on the coronavirus, and the level of trust of COVID-19 information. Finally, the independent variables for perceptions included concerns about the efficacy of the vaccines, and whether taking precaution after vaccination was still important and whether one needed more information.

Study variables

Our outcome variable was uptake of any type of COVID-19 vaccine measured basing on whether the study participant managed to receive the COVID-19 vaccine using a binary scale of yes or no. We defined COVID-19 vaccine uptake as the proportion of participants who had received at least one dose of any COVID-19 vaccine at the time of performing the study.

The independent variables included socio-demographics such as age (measured in years); sex (male and female); marital status (married/cohabiting, single, separated/divorced, widowed); level of education completed (none, primary, secondary, tertiary/vocational); religious affiliation (Christian, Moslem); and occupation (formal-also described as salaried, both salaried and self-employed, informal, self-employed).

Trusted sources (newspapers, social media, radio, internet or church); trusted information about COVID-19 vaccines (very trusted, moderately, somewhat, not trusted); mandatory vaccination (no or yes); trusted that the vaccine protects against COVID-19 disease (disagree, agree, neutral); immunity against corona virus achieved (after first dose, second dose, 14 days after first dose, 14 days after second dose, or don’t know); vaccine eligibility (no or yes); source of COVID-19 vaccine information (doctor, nurse, social media, radios, television shows); practices for COVID-19 vaccine uptake (willingness to take, pay, and recommend vaccination to others); motivation, and hindering factors. The key questions were borrowed from a validated questionnaire [27]. These have been provided in S1 Appendix.

Quantitative data

We double-entered quantitative data using Epi-Data version 3.1 and merged the files to ensure precision, concurrently ensuring quality control measures and then exported the data to Stata version 15 for analysis.

Statistical methods

In the first stage of analysis, descriptive statistics were used to estimate uptake of COVID-19 vaccines. The chi-square test was used to compare the uptake of COVID-19 vaccines of the study participants with their socio-demographics and other characteristics. For variables with an expected cell frequency count less than 5, we reported the Fisher’s exact test p-value but not the p-value for the Chi-square test. Variables found significant at p≤0.05 in the bivariate analyses were further modelled into the modified Poisson regression analysis to determine those independently associated with the outcome.

Ethical approval

The study was approved by the Uganda Virus Research Institute, Research and Ethics Committee (UVRI REC) Reference GC/127840 and the Uganda National Council for Science and Technology (UNCST) Reference HS1660ES. Participants were given detailed information about the study through an information sheet read to them in the language they understood best that was either English or Luganda. Documented informed consent was sought from all study participants. The participants were reimbursed $ 3.00 for their time and transport.

Results

A total of 390 participants consented and were included in the analysis. Of these 67.4% were females. The median age was 26 years [interquartile range (IQR) 21–32] and the majority were aged 21–30 years. Half (51.0%) were married, 63.3% had attained secondary education, 89.7% were Christians and 52.8% were self-employed. Ninety-nine percent (99.5%) had heard of the COVID-19 vaccine, of whom 34.9% and 27.2% heard it from television (TV) shows and social media respectively. Table 1 below shows more details on the socio-demographic characteristics.

Download:

Table 1. Socio-demographic characteristics of the study participants.

https://doi.org/10.1371/journal.pone.0312377.t001

Overall, 74.6% of the study participants reported that they had not received adequate information on COVID-19 vaccine safety. Approximately thirty-seven percent, 37.7%, had concerns about the COVID-19 vaccines, 30.3% of whom had fears of the side effects and 57.9% believed the vaccines were not helpful. Interestingly, 98.7% admitted that observing standard operating procedures for COVID-19 infection prevention was still necessary irrespective of having received the vaccine. Only 36.2% and 22.3% had received the 1^st and 2^nd dose of the vaccine respectively. Thirty-five (35.4%) reported that the immunity of COVID-19 vaccine was achieved 14 days after the 2^nd dose. Table 2 shows additional information on the knowledge, attitudes, and perceptions on the vaccine.

Download:

Table 2. Knowledge, attitude, perception and concerns about the COVID-19 vaccine.

https://doi.org/10.1371/journal.pone.0312377.t002

Fifty-two percent of the study participants knew the vaccine eligibility status for patients with chronic infection and those with immune suppression states (52.6% and 73.6%). Regarding the significance or impact of the vaccine information source, social media ranked high with 68.7% and the impact of religious leaders was low with 24.9%. News from the national radio/TV ranked least at 8.5%. When participants were asked about their willingness to accept the COVID-19 vaccine, majority (95.9%) were unwilling with only 9.5% willing to pay for the vaccine. Unforeseen future effects of COVID-19 vaccine were a concern for 60.0% of participants. Table 3 below elaborates on the practices and concern for COVID-19 vaccine.

Download:

Table 3. Practices and concerns regarding the COVID-19 vaccine.

https://doi.org/10.1371/journal.pone.0312377.t003

At bivariate analysis, the socio-demographic factors associated with vaccine acceptability were age (p-value 0.041), occupation (p-value 0.003) and sources of COVID-19 vaccine information (p-value 0.001). Other socio-demographic variables were insignificant (Table 4).

Download:

Table 4. Bivariate analysis of COVID-19 vaccine acceptability by socio-demographic factors.

https://doi.org/10.1371/journal.pone.0312377.t004

The other factors associated with vaccine acceptability were participant’s concerns on the COVID-19 vaccine (p-value 0.006); trusted sources of COVID-19 information (p-value 0.023); and willingness to being vaccinated (p-value 0.003). Participants who had no concerns about the COVID-19 vaccine (63.8%) accepted the vaccine. The church contributed to the dissemination of COVID-19 vaccine information by 54.2%, and radio 61.2%. Fifty-seven percent (57.2%) of participants who had disagreed that the vaccines were protective against severe disease did accept the vaccine though the finding was not statistically significant. Many participants admitted that immunity to the COVID-19 vaccine was achieved 14 days after the second dose (60.1%) whereas 50.6% had no idea about it. Again, this was not statistically significant p-value 0.309. Surprisingly, unwillingness to take the vaccine did not result in refusal to take the vaccine (25.0%) compared to the 60.2% who agreed and took the vaccine p-value 0.003 (Table 5).

Download:

Table 5. Bivariate analysis of COVID-19 vaccine acceptability by knowledge, attitude, and concerns.

https://doi.org/10.1371/journal.pone.0312377.t005

In the multivariate model, the factors associated with COVID-19 vaccine acceptability were salaried and self-employment (cPR1.30; 95% CI:1.00–1.68, p-value 0.046), hearing of the COVID-19 vaccine (cPR0.914; 95% CI: 0.87–0.95, p-value <0.001), and having vaccine concerns (cPR 0.78; 95% CI: 0.65–0.95, p-value 0.013) (Table 6).

Download:

Table 6. Model summary.

https://doi.org/10.1371/journal.pone.0312377.t006

Discussion

This study assessed COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda. In Entebbe community, 36.2% and 22.3% of the population received the 1^st and 2^nd dose of COVID-19 vaccine respectively from November 2021 to December 2021. By June 2022, the vaccine uptake of the first dose had increased to 42% [28]. However, this was below the WHO target for the first dose set at 70% for the eligible population. As of October 2023, 26,406,936 doses of the vaccine had been administered. These were inadequate for the ≥ 24.7 million eligible population considering the two doses recommended for most COVID-19 vaccines used in Uganda [29]. Due to a difference in the data computing for year 2023, it was not possible to track and monitor the vaccine coverage levels. Ninety-nine percent (99%) of the individuals were aware of at least one brand of COVID-19 vaccines.

From this study, the major hindrance to COVID-19 vaccine uptake was misconception about the vaccine (p-value 0.006), which has been a common finding in related studies [9, 10]. Misconceptions included beliefs that vaccines were not effective and were promoted for financial gain. In addition, many participants had a concern about the possible short-term and long-term side effects of the vaccines. Many participants did not know that COVID-19 vaccine protects from severe COVID-19 disease. The gaps observed in the setting should be addressed and communicated to the public using impactful information transfer platforms. Other modes of communication should also be promoted since dissemination tools target different population groups.

In this study, females were more willing to receive the vaccine. In Uganda, females reportedly have a better health seeking behavior than males [30]: females have a better opportunity to receive health education as they attend antenatal and immunization care clinics [31] and thus, are more empowered and would make positive decisions on health issues easily. However, in a systematic review and meta-analysis performed among studies conducted in high-income countries, men had a higher intention to receive the vaccines. The difference in acceptance was more observed among the health care workers compared to the general population [32]; thus, the difference observed could be linked to health promotion sensitization. In another study, gender difference did not influence the perception on COVID-19 vaccination [33]. As mentioned, additional factors seem to play a role for the gender differences observed.

The young adults aged 21 to 30 years constituted 51% of the study population and were more likely to receive the vaccine (p<0.041). This group is highly steered, by social media in Uganda [34], which contributes to rapid data sharing among the peers. The data however, cannot be generalized to the country because other studies have reported high vaccine uptake in older age groups [35, 36]. Nevertheless, it is encouraging to report that the majority group displayed a positive perception towards COVID-19 vaccination.

Sixty-three percent of the population had attained secondary education and 50% on average were self-employed. The level of education did not differ in individuals who accepted and those who did not accept the vaccine. Similarly, in resource-advantaged countries, high education level was not exclusively linked to better vaccine acceptance [37]. Those with salaried and self-employed jobs were more likely to accept the vaccine. This group of people are moderately exposed to stable jobs and tend to be less vulnerable a factor which has been linked a better COVID-19 vaccine uptake [38].

Married participants were more likely to be vaccinated. Couples have been reported to be less vulnerable as well and demonstrated an improved COVID-19 vaccine uptake when compared to divorced and separated participants [39]. The study, however, was performed among participants of an older age group. Acceptance of COVID-19 vaccines by Christians and Moslems did not differ and was not statistically significant. Thus, it would not give a valid comparison to other studies. Other studies have linked Christian patriotism and Islamic faith to reduced COVID-19 vaccine uptake [40, 41].

Thankfully, Uganda has been endowed with good political will and the President of the Republic of Uganda fostered COVID-19 vaccine development within the country [42]. The study was conducted in a peri-urban community at a time when the public had just been invited to receive the vaccine after vaccinating the priority high-risk groups and hence, the 1^st dose of COVID-19 vaccine receipt has been considered. The ‘studied practices’ hardly influenced the participants’ choices to take up the COVID-19 vaccine. The practices included willingness to accept and pay for the vaccine; and recommending COVID-19 vaccination to the close social support groups.

Limitations

The study was conducted during early vaccine roll out and thus, the index vaccine uptake could not be predicted accurately. Secondly, it was a cross-sectional study and evaluation of the second dose of COVID-19 vaccine uptake was harder to estimate than the first dose. Since some participants had come to attend the clinic, these are likely to have a health care seeking behavior which might bias the results. This, however, would depend on the size of the group in question. The study was furthermore performed in a peri-urban setting and the results obtained would only be inferred to similar settings in the country.

Conclusion and recommendation

Overall, COVID-19 vaccine uptake was low in the study population. This was attributed to negative beliefs in addition to the information gap on vaccine safety and related side effects. Sensitization campaigns that simultaneously address vaccine safety need to be considered to improve vaccine uptake in future.

Supporting information

S1 Appendix.

https://doi.org/10.1371/journal.pone.0312377.s001

(DOCX)

Acknowledgments

We are very grateful to Dr. Alice Stella Namale for her critical review and proofreading of the manuscript. We acknowledge the study team and Uganda Virus Research Institute for the institutional support. Special thanks go to the Government of the Republic of Uganda for the financial support. We are also greatly indebted to the study participants who have made it possible to perform this study.

References

1. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021;384(5).
- View Article
- Google Scholar
2. Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269). pmid:33306989
- View Article
- PubMed/NCBI
- Google Scholar
3. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27). pmid:33301246
- View Article
- PubMed/NCBI
- Google Scholar
4. Wake AD. The Acceptance Rate Toward COVID-19 Vaccine in Africa: A Systematic Review and Meta-analysis. Vol. 8, Global Pediatric Health. 2021. pmid:34616860
- View Article
- PubMed/NCBI
- Google Scholar
5. Bank TW. Eastern and Southern Africa’s COVID-19 Vaccination Journey Unlocking Supply, Building Capacity, and Overcoming Hesitancy. Available from: https://www.worldbank.org/en/news/immersive-story/2022/06/30/unlocking-supply-and-overcoming-hesitancy-eastern-and-southern-africa-s-covid-19-vaccination-journey
6. CDC A talking points. Talking Points Talking Points, Weekly Press Briefing on COVID-19 in Africa, 22nd September 2022. Available from: https://africacdc.org/speech/talking-points-weekly-press-briefing-on-covid-19-in-africa-22nd-september-2022/
7. Mboussou F, Farham B, Nsasiirwe S, Atagbaza A, Oyaole D, Atuhebwe PL, et al. COVID-19 Vaccination in the WHO African Region: Progress Made in 2022 and Factors Associated. Vaccines. 2023;11(5). pmid:37243114
- View Article
- PubMed/NCBI
- Google Scholar
8. Karlsson LC, Soveri A, Lewandowsky S, Karlsson L, Karlsson H, Nolvi S, et al. Fearing the disease or the vaccine: The case of COVID-19. Pers Individ Dif. 2021;172.
- View Article
- Google Scholar
9. Fisk RJ. Barriers to vaccination for coronavirus disease 2019 (COVID-19) control: experience from the United States. Vol. 5, Global Health Journal. 2021. pmid:33585053
- View Article
- PubMed/NCBI
- Google Scholar
10. Kabagenyi A, Wasswa R, Nannyonga BK, Nyachwo EB, Kagirita A, Nabirye J, et al. Factors Associated with COVID-19 Vaccine Hesitancy in Uganda: A Population-Based Cross-Sectional Survey. Int J Gen Med. 2022;15. pmid:36061966
- View Article
- PubMed/NCBI
- Google Scholar
11. Hakim MS. SARS-CoV-2, Covid-19, and the debunking of conspiracy theories. Vol. 31, Reviews in Medical Virology. 2021. pmid:33586302
- View Article
- PubMed/NCBI
- Google Scholar
12. Mian A, Khan S. Coronavirus: The spread of misinformation. Vol. 18, BMC Medicine. 2020. pmid:32188445
- View Article
- PubMed/NCBI
- Google Scholar
13. Ministry of Health Republic of Uganda. GAVI Proj [Internet]. Available from: https://www.health.go.ug/project/gavi-project/
14. UNICEF supports Government to contain and manage COVID-19 and build back better. Unicef for every child Uganda. Available from: https://www.unicef.org/uganda/press-releases/unicef-supports-government-contain-and-manage-covid-19-and-build-back-better
15. COVID-19 Results briefing Uganda. Available from: https://www.healthdata.org/sites/default/files/covid_briefs/190_briefing_Uganda.pdf
16. Kawuki J, Nambooze J, fong Chan PS, Chen S, Liang X, Mo PKH, et al. Differential COVID-19 Vaccination Uptake and Associated Factors among the Slum and Estate Communities in Uganda: A Cross-Sectional Population-Based Survey. Vaccines. 2023;11(2). pmid:36851317
- View Article
- PubMed/NCBI
- Google Scholar
17. Nshakira-Rukundo E, Whitehead A. Changing perceptions about COVID-19 risk and adherence to preventive strategies in Uganda: Evidence from an online mixed-methods survey. Sci African. 2021;14. pmid:34805650
- View Article
- PubMed/NCBI
- Google Scholar
18. Echoru I, Ajambo PD, Bukenya EM. Acceptance and Risk Perception of COVID-19 Vaccine in Uganda: A Cross Sectional Study in Western Uganda. ResearchSquare. 2020.
- View Article
- Google Scholar
19. Religious leaders gather at Statehouse, Entebbe to pray for divine intervention on combatting the coronavirus pandemic which has put the the whole world on tension. Available from: https://m.facebook.com/NTVUganda/photos/religious-leaders-gather-at-statehouse-entebbe-to-pray-for-divine-intervention-o/2891725720875863/
20. Konozy EHE, Osman ME fadil M, Ghartey-Kwansah G, Abushama HM. The striking mimics between COVID-19 and malaria: A review. Vol. 13, Frontiers in Immunology. 2022. pmid:36081516
- View Article
- PubMed/NCBI
- Google Scholar
21. Anyanwu MU. The association between malaria prevalence and COVID-19 mortality. BMC Infect Dis. 2021;21(1). pmid:34538242
- View Article
- PubMed/NCBI
- Google Scholar
22. Kasozi KI, MacLeod E, Ssempijja F, Mahero MW, Matama K, Musoke GH, et al. Misconceptions on COVID-19 Risk Among Ugandan Men: Results From a Rapid Exploratory Survey, April 2020. Front Public Heal. 2020;8. pmid:32850606
- View Article
- PubMed/NCBI
- Google Scholar
23. Afifi TO, Salmon S, Taillieu T, Stewart-Tufescu A, Fortier J, Driedger SM. Older adolescents and young adults willingness to receive the COVID-19 vaccine: Implications for informing public health strategies. Vaccine. 2021;39(26). pmid:34023134
- View Article
- PubMed/NCBI
- Google Scholar
24. Willis DE, Presley J, Williams M, Zaller N, McElfish PA. COVID-19 vaccine hesitancy among youth. Hum Vaccines Immunother. 2021;17(12). pmid:34715003
- View Article
- PubMed/NCBI
- Google Scholar
25. Ekwebelem OC, Yunusa I, Onyeaka H, Ekwebelem NC, Nnorom-Dike O. COVID-19 vaccine rollout: will it affect the rates of vaccine hesitancy in Africa? Vol. 197, Public Health. 2021. pmid:33714553
- View Article
- PubMed/NCBI
- Google Scholar
26. Ssebuufu R, Sikakulya FK, Binezero SM, Wasingya L, … Awareness, knowledge, attitude and practice towards measures for prevention of the spread of COVID-19 in the Ugandans: A nationwide online cross-sectional …. Medrxiv. 2020;
- View Article
- Google Scholar
27. Kumari A, Ranjan P, Chopra S, Kaur D, Upadhyay AD, Kaur T, et al. Development and validation of a questionnaire to assess knowledge, attitude, practices, and concerns regarding COVID-19 vaccination among the general population. Diabetes Metab Syndr Clin Res Rev. 2021;15(3). pmid:33930855
- View Article
- PubMed/NCBI
- Google Scholar
28. King AP, Wanyana MW, Migisha R, Kadobera D, Claire B, Baganizi M, et al. COVID-19 vaccine uptake and coverage, Uganda, 2021–2022. Uganda Natl Inst Public Heal Q Epidemiol Bull. 2023;8(1):18–29.
- View Article
- Google Scholar
29. Uganda Coronavirus COVID-19 Vaccination Total. Available from: https://tradingeconomics.com/uganda/coronavirus-vaccination-total
30. In Uganda females have better health seeking behaviour than males. Available from: https://www.google.com/search?q=uganda+females+more+health+seeking+behaviour+than+males+in+uganda&client=firefox-b-d&sca_esv=f977441fd745688c&ei=uJczZtqqDL2Exc8P1bS8uA4&oq=uganda+females+more+health+seeking+behaviour+than+males&gs_lp=Egxnd3Mtd2l6LXNlcnAiN
31. UGANDA TRO, HEALTH MO. Essential Maternal and Newborn Clinical Care Guidelines for Uganda REPRODUCTIVE AND CHILD HEALTH DEPARTMENT [Internet]. 2022. Available from: http://library.health.go.ug/sites/default/files/resources/Essential Maternal Newborn Care Guidelines 2022 V3.pdf
32. Zintel S, Flock C, Arbogast AL, Forster A, von Wagner C, Sieverding M. Gender differences in the intention to get vaccinated against COVID-19: a systematic review and meta-analysis. Journal of Public Health (Germany). 2022. pmid:35018277
- View Article
- PubMed/NCBI
- Google Scholar
33. Towar ZA-K, Hussein ZA, Khudair FW. The Distinction Between Male and Female Attitudes Toward COVID-19 Vaccination. J Port Sci Res. 2023;6(1).
- View Article
- Google Scholar
34. Semambo H. Social Media As; an Agent for Behavioral Change among Young People: Case of Facebook Usage among Mass Communication Students of Uganda Martyrs University. Int J Commun Public Relat. 2023;8(1).
- View Article
- Google Scholar
35. Echoru I, Ajambo PD, Keirania E, Bukenya EEM. Sociodemographic factors associated with acceptance of COVID-19 vaccine and clinical trials in Uganda: a cross-sectional study in western Uganda. BMC Public Health. 2021;21(1). pmid:34112143
- View Article
- PubMed/NCBI
- Google Scholar
36. Ndejjo R, Chen N, Kabwama SN, Namale A, Wafula ST, Wanyana I, et al. Uptake of COVID-19 vaccines and associated factors among adults in Uganda: a cross-sectional survey. BMJ Open. 2023;13(3). pmid:36931667
- View Article
- PubMed/NCBI
- Google Scholar
37. Lazarus J V., Wyka K, Rauh L, Rabin K, Ratzan S, Gostin LO, et al. Hesitant or Not? The Association of Age, Gender, and Education with Potential Acceptance of a COVID-19 Vaccine: A Country-level Analysis. J Health Commun. 2020;25(10). pmid:33719881
- View Article
- PubMed/NCBI
- Google Scholar
38. Beale S, Burns R, Braithwaite I, Byrne T, Lam Erica Fong W, Fragaszy E, et al. Occupation, Worker Vulnerability, and COVID-19 Vaccination Uptake: Analysis of the Virus Watch prospective cohort study. Vaccine. 2022;40(52). pmid:36372668
- View Article
- PubMed/NCBI
- Google Scholar
39. Liu H, Nowak GR, Wang J, Luo Z. A National Study of Marital Status Differences in Early Uptake of COVID-19 Vaccine among Older Americans. Geriatr. 2023;8(4). pmid:37489317
- View Article
- PubMed/NCBI
- Google Scholar
40. Alsuwaidi AR, Hammad HAAK, Elbarazi I, Sheek-Hussein M. Vaccine hesitancy within the Muslim community: Islamic faith and public health perspectives. Vol. 19, Human Vaccines and Immunotherapeutics. 2023. pmid:36914409
- View Article
- PubMed/NCBI
- Google Scholar
41. Corcoran KE, Scheitle CP, DiGregorio BD. Christian nationalism and COVID-19 vaccine hesitancy and uptake. Vaccine. 2021;39(45). pmid:34629205
- View Article
- PubMed/NCBI
- Google Scholar
42. Vision N. Uganda making progress on COVID vaccine development. Available from: https://www.newvision.co.ug/category/news/uganda-making-progress-on-covid-vaccine-devel-NV_139563

[ref1] 1. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021;384(5).
View Article
Google Scholar

[2] View Article

[3] Google Scholar

[ref2] 2. Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269). pmid:33306989
View Article
PubMed/NCBI
Google Scholar

[5] View Article

[6] PubMed/NCBI

[7] Google Scholar

[ref3] 3. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27). pmid:33301246
View Article
PubMed/NCBI
Google Scholar

[9] View Article

[10] PubMed/NCBI

[11] Google Scholar

[ref4] 4. Wake AD. The Acceptance Rate Toward COVID-19 Vaccine in Africa: A Systematic Review and Meta-analysis. Vol. 8, Global Pediatric Health. 2021. pmid:34616860
View Article
PubMed/NCBI
Google Scholar

[13] View Article

[14] PubMed/NCBI

[15] Google Scholar

[ref5] 5. Bank TW. Eastern and Southern Africa’s COVID-19 Vaccination Journey Unlocking Supply, Building Capacity, and Overcoming Hesitancy. Available from: https://www.worldbank.org/en/news/immersive-story/2022/06/30/unlocking-supply-and-overcoming-hesitancy-eastern-and-southern-africa-s-covid-19-vaccination-journey

[ref6] 6. CDC A talking points. Talking Points Talking Points, Weekly Press Briefing on COVID-19 in Africa, 22nd September 2022. Available from: https://africacdc.org/speech/talking-points-weekly-press-briefing-on-covid-19-in-africa-22nd-september-2022/

[ref7] 7. Mboussou F, Farham B, Nsasiirwe S, Atagbaza A, Oyaole D, Atuhebwe PL, et al. COVID-19 Vaccination in the WHO African Region: Progress Made in 2022 and Factors Associated. Vaccines. 2023;11(5). pmid:37243114
View Article
PubMed/NCBI
Google Scholar

[19] View Article

[20] PubMed/NCBI

[21] Google Scholar

[ref8] 8. Karlsson LC, Soveri A, Lewandowsky S, Karlsson L, Karlsson H, Nolvi S, et al. Fearing the disease or the vaccine: The case of COVID-19. Pers Individ Dif. 2021;172.
View Article
Google Scholar

[23] View Article

[24] Google Scholar

[ref9] 9. Fisk RJ. Barriers to vaccination for coronavirus disease 2019 (COVID-19) control: experience from the United States. Vol. 5, Global Health Journal. 2021. pmid:33585053
View Article
PubMed/NCBI
Google Scholar

[26] View Article

[27] PubMed/NCBI

[28] Google Scholar

[ref10] 10. Kabagenyi A, Wasswa R, Nannyonga BK, Nyachwo EB, Kagirita A, Nabirye J, et al. Factors Associated with COVID-19 Vaccine Hesitancy in Uganda: A Population-Based Cross-Sectional Survey. Int J Gen Med. 2022;15. pmid:36061966
View Article
PubMed/NCBI
Google Scholar

[30] View Article

[31] PubMed/NCBI

[32] Google Scholar

[ref11] 11. Hakim MS. SARS-CoV-2, Covid-19, and the debunking of conspiracy theories. Vol. 31, Reviews in Medical Virology. 2021. pmid:33586302
View Article
PubMed/NCBI
Google Scholar

[34] View Article

[35] PubMed/NCBI

[36] Google Scholar

[ref12] 12. Mian A, Khan S. Coronavirus: The spread of misinformation. Vol. 18, BMC Medicine. 2020. pmid:32188445
View Article
PubMed/NCBI
Google Scholar

[38] View Article

[39] PubMed/NCBI

[40] Google Scholar

[ref13] 13. Ministry of Health Republic of Uganda. GAVI Proj [Internet]. Available from: https://www.health.go.ug/project/gavi-project/

[ref14] 14. UNICEF supports Government to contain and manage COVID-19 and build back better. Unicef for every child Uganda. Available from: https://www.unicef.org/uganda/press-releases/unicef-supports-government-contain-and-manage-covid-19-and-build-back-better

[ref15] 15. COVID-19 Results briefing Uganda. Available from: https://www.healthdata.org/sites/default/files/covid_briefs/190_briefing_Uganda.pdf

[ref16] 16. Kawuki J, Nambooze J, fong Chan PS, Chen S, Liang X, Mo PKH, et al. Differential COVID-19 Vaccination Uptake and Associated Factors among the Slum and Estate Communities in Uganda: A Cross-Sectional Population-Based Survey. Vaccines. 2023;11(2). pmid:36851317
View Article
PubMed/NCBI
Google Scholar

[45] View Article

[46] PubMed/NCBI

[47] Google Scholar

[ref17] 17. Nshakira-Rukundo E, Whitehead A. Changing perceptions about COVID-19 risk and adherence to preventive strategies in Uganda: Evidence from an online mixed-methods survey. Sci African. 2021;14. pmid:34805650
View Article
PubMed/NCBI
Google Scholar

[49] View Article

[50] PubMed/NCBI

[51] Google Scholar

[ref18] 18. Echoru I, Ajambo PD, Bukenya EM. Acceptance and Risk Perception of COVID-19 Vaccine in Uganda: A Cross Sectional Study in Western Uganda. ResearchSquare. 2020.
View Article
Google Scholar

[53] View Article

[54] Google Scholar

[ref19] 19. Religious leaders gather at Statehouse, Entebbe to pray for divine intervention on combatting the coronavirus pandemic which has put the the whole world on tension. Available from: https://m.facebook.com/NTVUganda/photos/religious-leaders-gather-at-statehouse-entebbe-to-pray-for-divine-intervention-o/2891725720875863/

[ref20] 20. Konozy EHE, Osman ME fadil M, Ghartey-Kwansah G, Abushama HM. The striking mimics between COVID-19 and malaria: A review. Vol. 13, Frontiers in Immunology. 2022. pmid:36081516
View Article
PubMed/NCBI
Google Scholar

[57] View Article

[58] PubMed/NCBI

[59] Google Scholar

[ref21] 21. Anyanwu MU. The association between malaria prevalence and COVID-19 mortality. BMC Infect Dis. 2021;21(1). pmid:34538242
View Article
PubMed/NCBI
Google Scholar

[61] View Article

[62] PubMed/NCBI

[63] Google Scholar

[ref22] 22. Kasozi KI, MacLeod E, Ssempijja F, Mahero MW, Matama K, Musoke GH, et al. Misconceptions on COVID-19 Risk Among Ugandan Men: Results From a Rapid Exploratory Survey, April 2020. Front Public Heal. 2020;8. pmid:32850606
View Article
PubMed/NCBI
Google Scholar

[65] View Article

[66] PubMed/NCBI

[67] Google Scholar

[ref23] 23. Afifi TO, Salmon S, Taillieu T, Stewart-Tufescu A, Fortier J, Driedger SM. Older adolescents and young adults willingness to receive the COVID-19 vaccine: Implications for informing public health strategies. Vaccine. 2021;39(26). pmid:34023134
View Article
PubMed/NCBI
Google Scholar

[69] View Article

[70] PubMed/NCBI

[71] Google Scholar

[ref24] 24. Willis DE, Presley J, Williams M, Zaller N, McElfish PA. COVID-19 vaccine hesitancy among youth. Hum Vaccines Immunother. 2021;17(12). pmid:34715003
View Article
PubMed/NCBI
Google Scholar

[73] View Article

[74] PubMed/NCBI

[75] Google Scholar

[ref25] 25. Ekwebelem OC, Yunusa I, Onyeaka H, Ekwebelem NC, Nnorom-Dike O. COVID-19 vaccine rollout: will it affect the rates of vaccine hesitancy in Africa? Vol. 197, Public Health. 2021. pmid:33714553
View Article
PubMed/NCBI
Google Scholar

[77] View Article

[78] PubMed/NCBI

[79] Google Scholar

[ref26] 26. Ssebuufu R, Sikakulya FK, Binezero SM, Wasingya L, … Awareness, knowledge, attitude and practice towards measures for prevention of the spread of COVID-19 in the Ugandans: A nationwide online cross-sectional …. Medrxiv. 2020;
View Article
Google Scholar

[81] View Article

[82] Google Scholar

[ref27] 27. Kumari A, Ranjan P, Chopra S, Kaur D, Upadhyay AD, Kaur T, et al. Development and validation of a questionnaire to assess knowledge, attitude, practices, and concerns regarding COVID-19 vaccination among the general population. Diabetes Metab Syndr Clin Res Rev. 2021;15(3). pmid:33930855
View Article
PubMed/NCBI
Google Scholar

[84] View Article

[85] PubMed/NCBI

[86] Google Scholar

[ref28] 28. King AP, Wanyana MW, Migisha R, Kadobera D, Claire B, Baganizi M, et al. COVID-19 vaccine uptake and coverage, Uganda, 2021–2022. Uganda Natl Inst Public Heal Q Epidemiol Bull. 2023;8(1):18–29.
View Article
Google Scholar

[88] View Article

[89] Google Scholar

[ref29] 29. Uganda Coronavirus COVID-19 Vaccination Total. Available from: https://tradingeconomics.com/uganda/coronavirus-vaccination-total

[ref30] 30. In Uganda females have better health seeking behaviour than males. Available from: https://www.google.com/search?q=uganda+females+more+health+seeking+behaviour+than+males+in+uganda&client=firefox-b-d&sca_esv=f977441fd745688c&ei=uJczZtqqDL2Exc8P1bS8uA4&oq=uganda+females+more+health+seeking+behaviour+than+males&gs_lp=Egxnd3Mtd2l6LXNlcnAiN

[ref31] 31. UGANDA TRO, HEALTH MO. Essential Maternal and Newborn Clinical Care Guidelines for Uganda REPRODUCTIVE AND CHILD HEALTH DEPARTMENT [Internet]. 2022. Available from: http://library.health.go.ug/sites/default/files/resources/Essential Maternal Newborn Care Guidelines 2022 V3.pdf

[ref32] 32. Zintel S, Flock C, Arbogast AL, Forster A, von Wagner C, Sieverding M. Gender differences in the intention to get vaccinated against COVID-19: a systematic review and meta-analysis. Journal of Public Health (Germany). 2022. pmid:35018277
View Article
PubMed/NCBI
Google Scholar

[94] View Article

[95] PubMed/NCBI

[96] Google Scholar

[ref33] 33. Towar ZA-K, Hussein ZA, Khudair FW. The Distinction Between Male and Female Attitudes Toward COVID-19 Vaccination. J Port Sci Res. 2023;6(1).
View Article
Google Scholar

[98] View Article

[99] Google Scholar

[ref34] 34. Semambo H. Social Media As; an Agent for Behavioral Change among Young People: Case of Facebook Usage among Mass Communication Students of Uganda Martyrs University. Int J Commun Public Relat. 2023;8(1).
View Article
Google Scholar

[101] View Article

[102] Google Scholar

[ref35] 35. Echoru I, Ajambo PD, Keirania E, Bukenya EEM. Sociodemographic factors associated with acceptance of COVID-19 vaccine and clinical trials in Uganda: a cross-sectional study in western Uganda. BMC Public Health. 2021;21(1). pmid:34112143
View Article
PubMed/NCBI
Google Scholar

[104] View Article

[105] PubMed/NCBI

[106] Google Scholar

[ref36] 36. Ndejjo R, Chen N, Kabwama SN, Namale A, Wafula ST, Wanyana I, et al. Uptake of COVID-19 vaccines and associated factors among adults in Uganda: a cross-sectional survey. BMJ Open. 2023;13(3). pmid:36931667
View Article
PubMed/NCBI
Google Scholar

[108] View Article

[109] PubMed/NCBI

[110] Google Scholar

[ref37] 37. Lazarus J V., Wyka K, Rauh L, Rabin K, Ratzan S, Gostin LO, et al. Hesitant or Not? The Association of Age, Gender, and Education with Potential Acceptance of a COVID-19 Vaccine: A Country-level Analysis. J Health Commun. 2020;25(10). pmid:33719881
View Article
PubMed/NCBI
Google Scholar

[112] View Article

[113] PubMed/NCBI

[114] Google Scholar

[ref38] 38. Beale S, Burns R, Braithwaite I, Byrne T, Lam Erica Fong W, Fragaszy E, et al. Occupation, Worker Vulnerability, and COVID-19 Vaccination Uptake: Analysis of the Virus Watch prospective cohort study. Vaccine. 2022;40(52). pmid:36372668
View Article
PubMed/NCBI
Google Scholar

[116] View Article

[117] PubMed/NCBI

[118] Google Scholar

[ref39] 39. Liu H, Nowak GR, Wang J, Luo Z. A National Study of Marital Status Differences in Early Uptake of COVID-19 Vaccine among Older Americans. Geriatr. 2023;8(4). pmid:37489317
View Article
PubMed/NCBI
Google Scholar

[120] View Article

[121] PubMed/NCBI

[122] Google Scholar

[ref40] 40. Alsuwaidi AR, Hammad HAAK, Elbarazi I, Sheek-Hussein M. Vaccine hesitancy within the Muslim community: Islamic faith and public health perspectives. Vol. 19, Human Vaccines and Immunotherapeutics. 2023. pmid:36914409
View Article
PubMed/NCBI
Google Scholar

[124] View Article

[125] PubMed/NCBI

[126] Google Scholar

[ref41] 41. Corcoran KE, Scheitle CP, DiGregorio BD. Christian nationalism and COVID-19 vaccine hesitancy and uptake. Vaccine. 2021;39(45). pmid:34629205
View Article
PubMed/NCBI
Google Scholar

[128] View Article

[129] PubMed/NCBI

[130] Google Scholar

[ref42] 42. Vision N. Uganda making progress on COVID vaccine development. Available from: https://www.newvision.co.ug/category/news/uganda-making-progress-on-covid-vaccine-devel-NV_139563

Figures

Abstract

Introduction

Methods

Results

Conclusion

Introduction

Materials and methods

Study design

Sampling procedure

Study setting

Data collection procedures

Description and conceptualization of variables

Study variables

Quantitative data

Statistical methods

Ethical approval

Results

Discussion

Limitations

Conclusion and recommendation

Supporting information

S1 Appendix.

Acknowledgments

References