key: cord-0801477-u4p23gmt
authors: Miner, C. A.; Timothy, C. G.; Mashige, K. P.; Osuagwu, U. L.; Envuladu, E. A.; Amiebenomo, O. M.-A.; Ovenseri-Ogbomo, G.; Charwe, D. D.; Goson, P. C.; Ekpenyong, B. N.; Abu, E. K.; Langsi, R.; Oloruntoba, R.; Ishaya, T.; Agho, K. E.
title: Acceptance of COVID 19 vaccine among sub-Sahara African (SSA): a comparative study of residents and diaspora dwellers
date: 2022-03-18
journal: nan
DOI: 10.1101/2022.03.16.22272510
sha: 8b370ead29af6cfaab1a265f38b885fe898e2737
doc_id: 801477
cord_uid: u4p23gmt

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 diaspora. 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. Uptake of COVID-19 vaccines varied among the local (14.2%) and diaspora (25.3%) residents. There was more resistance to COVID-19 vaccine among locals (68.1%) and across the sociodemographic variables of sex [ adjusted Relative Risk (ARR) =0.73, 95% CI; 0.58 - 0.93], primary/less [ARR =0.22, 95% CI; 0.12 - 0.40] and bachelors degree [ARR =0.58, 95% CI; 0.43 - 0.77] educational levels, occupation [ARR =0.32, 95% CI; 0.25 - 0.40] and working status [ARR =1.40, 95%CI; 1.06 - 1.84]. COVID-19 vaccine hesitancy was almost similar between locals and diasporas (17.7% and 17.8% respectively) significant only among healthcare workers [ARR =0.46, 95% CI; 0.16 - 1.35] in the diaspora after adjusting for the variables. Similarly, knowledge and perception of COVID-19 vaccine among locals were substantial, but only perception was remarkable to resistance [ARR =0.86, 95% CI; 0.82 - 0.90] and hesitancy [ARR =0.85, 95% CI; 0.80 - 0.90] of the vaccine. Differences exist in the factors that influence COVID-19 vaccine acceptance between local SSA residents and those in the diaspora. 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.

Africans living locally and those in the diaspora (mostly living in Western countries) during 144 the lockdown, [37] suggests there could be similarities in their acceptance of the COVID-19 145 vaccination. This study, therefore, sought to investigate the differences in the acceptance of Study setting and population 164 The study population included adults who were 18 years and older and were of sub- 165 Saharan Africans residing locally (in Africa) and in diaspora (outside of Africa). Respondents 166 from several countries in SSA, mostly from Cameroun, Ghana, Nigeria, South Africa, 167 Tanzania, and those in diaspora mostly living in Australia, United Kingdom, United States, 168 Saudi Arabia, Canada, China, and India took part in this study. 169 Sample size determination 170 The sample size was determined using Cochran's formulae (n = z 2 pq/d 2 ) with the 171 assumption of a proportion of 50% at a confidence level of 95% with an error margin of 172 2.5%. A 20% non-response rate was assumed, and a minimum sample size of 2401 was 173 obtained. 175 This was a web-based cross-sectional survey carried out between 14 th of March and 176 17 th of May 2021. Due to the continued COVID-19 lockdowns in many of the target 177 countries at the time of this study, web-based study was most appropriate even though it may 178 have excluded some participants with no access to internet-based phone/computer services.

The survey instrument and data collection 180 Data was collected using a validated self-administered questionnaire adapted from a 181 previous study.

[39] The survey tool was tested for the internal validity of the items, and is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint 19 (S1 Table) . The exposure variable was the 'place of residence' (local or diaspora).

The COVID-19 vaccine knowledge items had 10 questions on a Likert scale with five 199 levels as indicated in SI Table 1 . The scores for nine of the items ranged from 0 (lowest) to 4 200 (highest) while, for one item, it was coded as 1 for Yes and 0 for No. The overall knowledge 201 towards COVID-19 vaccination score ranged from 0 -37 points, with a higher knowledge 202 score indicating a better knowledge towards COVID-19 vaccination.

The attitude towards the COVID-19 vaccine items included four items with each 204 assigned 2 points for 'yes', 1 point for 'unsure' and 0 point for 'No'. The total attitude score 205 ranged from 0 to 8, with a higher score denoting a better attitude towards COVID-19 206 vaccination.

The risk perception for contracting the disease after vaccination included questions on 208 how the participants rate their risk of becoming infected with the virus and risk of dying from 209 the infection. The responses were structured using a Likert scale with five levels (S1 Table) , 210 with scores for each item ranging from 0 (lowest) to 4 (highest). The total perception score . CC-BY 4.0 International license It is made available under a perpetuity.

is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint and charts using frequencies, percentages, mean and standard deviations as required. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint 

Characteristics of the respondents 237 There was a total of 2545 SSA respondents [2391 locals (93.9%) and 154 in the 238 diaspora (6.1%)]. Table 1 shows the frequency and percentage distribution of respondents 239 according to their socio-demographic variables. The majority of the SSA local residents 240 (67.8%) were younger than 38 years, while those in the diaspora were older. There were more 241 females than males in both groups, and the majority were originally from West Africa (locals 242 55.6%, diaspora 75.4%). More than half (56.9%) of the locals were not married, and 59.7% 243 from the diaspora were married. Many locals had a bachelors' degree (56.9%), and most 244 diaspora participants were postgraduate degree holders (53.3%). Most respondents from both 245 groups were employed /self-employed were predominantly non-healthcare workers and were 246 of the Christian faith. More than 80% of locals and above 90% of those in the diaspora had 247 been previously vaccinated for one or two other conditions. More than two-thirds of the 248 respondents indicated that they have never smoked. The proportion of respondents with 249 preexisting conditions was high among locals (84.6%) and diaspora (69.5%). is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted March 18, 2022. ; https://doi.org/10.1101/2022.03.16.22272510 doi: medRxiv preprint 292 locals (69.0%) and those in the diaspora (72.2%). The uptake of the vaccine was also higher 293 among those with pre-existing conditions in both local and diaspora respondents.

Higher mean scores for attitude and perception were observed among the COVID-19 295 vaccine uptake respondents for the local residents, while the mean knowledge score was 296 highest for the hesitant group. Among the diasporas, the mean knowledge and perception 297 scores were similarly highest in uptake respondents, but a higher score for attitude was 298 observed in the hesitancy respondents ( is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The purpose of this study was to compare the uptake, resistance and hesitancy of the 374 COVID-19 vaccine between the local residents and diaspora dwellers in SSA region of the 375 African continent. Uptake of the COVID-19 vaccine was found to be twice as high among 376 residents in the diaspora compared to local SSA residents. The WHO and Centers for Disease is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted March 18, 2022. ; is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted March 18, 2022. ; https://doi.org/10.1101/2022.03.16.22272510 doi: medRxiv preprint

The African Diaspora. Introduction 593 to the African Diaspora across the World; c2021

Report of the meeting of experts 597 from members of States on the definition of African Diaspora; c2021

Exploring variation in human papillomavirus vaccination uptake in Switzerland: a 601 multilevel spatial analysis of a national vaccination coverage survey

Inequalities in maternal pertussis 605 vaccination uptake: a cross-sectional survey of maternity units

A global 608 study on the correlates of Gross Domestic Product (GDP) and COVID-19 vaccine 609 distribution

Africa on track to control COVID-19 pandemic 612 in 2022; c2022

Risks and 615 challenges in Africa's COVID-19 vaccine rollout; c2021

COVID-19 vaccine roll

Africa and Zimbabwe: urgent need to address community preparedness, fears and 620 hesitancy

Risk 622 perception of COVID-19 among sub-Sahara Africans: a web-based comparative 623 survey of local and diaspora residents

Principles for Medical Research Involving Human Subjects. c2013

Use of rapid online surveys to assess people's perceptions during 631 infectious disease outbreaks: a cross-sectional survey on COVID-19

Assessing COVID-19 vaccine 635 literacy: a preliminary online survey

World Health Organization Regional Office for Africa [Internet]. Fifteen African 641 countries hit 10% COVID-19 vaccination goal; c2021

Will Africans take COVID-19 vaccination?

COVID 19 vaccine 648 perceptions: A 15 country study; c2021

Racial/ethnic differences in COVID-19 vaccine hesitancy among health care workers 652 in 2 large academic hospitals

Predictors of COVID-19 vaccine hesitancy in the UK household longitudinal study

Hesitant or not? 660 The association of age, gender, and education with potential acceptance of a COVID-661 19 vaccine: a country-level analysis

Misinformation about COVID-19 in sub-Saharan Africa: evidence from a cross-665

Time trends, factors associated with, 668 and reasons for COVID-19 vaccine hesitancy: A massive online survey of US adults 669 from

COVID-19 vaccine hesitation amid 673 surging cases in third wave

COVID-19 vaccination 677 hesitancy among health care workers, communication, and policy-making

COVID-19 vaccine hesitancy among healthcare workers and its socio-demographic 682 determinants in Abia State, Southeastern Nigeria: a cross-sectional study

COVID-19 vaccine hesitancy 686 among health care workers in the Middle East Region

Dachew AM. Health care workers intention to accept 689

COVID-19 vaccine and associated factors in southwestern Ethiopia

Vaccine Hesitancy Among Healthcare Workers: Should Such a Trend Require Closer 694 Attention by Policymakers? Cureus

Vaccine hesitancy among healthcare providers during 698 COVID-19 pandemic

Acceptability of COVID-19 Vaccine in Africa

Religious affiliation 705 and immunization coverage in 15 countries in Sub-Saharan Africa. Vaccine

Intention to vaccinate against the novel 2019 709 coronavirus disease: the role of health locus of control and religiosity

Religious identity cues increase vaccination intentions and 713 trust in medical experts among American Christians

Effects of faith actor engagement in the uptake and coverage of 718 immunization in low-and middle-income countries (LMICs)* Phase 1 Global 719 Landscape : Evidence Summary. c2021

Immunization_Global-Landscape-Analysis_Evidence-Summary-Report_June-722 2021_Sec508comp-low

Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from 725

The willingness to receive COVID-19 vaccine and its associated factors: 729 "Vaccination refusal could prolong the war of this pandemic" -a systematic review

Risk Manag Healthc Policy

COVID-19 vaccine hesitancy over time and association of initial vaccine hesitancy 735 with subsequent vaccination

The arrival of fast internet and employment in Africa