key: cord-0874203-2142aa63 authors: Ojewale, L. Y.; Afolabi, R. F.; Ogunniyi, A. title: COVID-19 vaccine attitude and its predictors among people living with chronic health conditions in Ibadan, Nigeria date: 2022-01-28 journal: nan DOI: 10.1101/2022.01.27.22269947 sha: cbd4fbc3238eb4f20b970d20ffa348ca3aedb5ca doc_id: 874203 cord_uid: 2142aa63 Background: Globally COVID-19 has caused death among millions of people and new cases continue to be reported daily, including in Nigeria. With the efforts of the Nigerian government to ensure everyone gets vaccinated, the vaccination attitude and its predictors among persons with chronic health conditions remains unclear. The study was therefore conducted to assess vaccination attitude and determine its associated factors among people living with chronic health conditions. Methods: A descriptive cross-sectional study was conducted among 423 patients attending the medical outpatient clinic of University College Hospital, Ibadan, Oyo State, Nigeria; before COVID-19 vaccination commencement. Data were collected on socio-demographic and COVID-19 related characteristics, via Open Data Kit (ODK) software. The Vaccine Attitude Examination (Vax) Scale including its four subscales was adopted to assess attitude towards COVID-19 vaccine uptake. The main outcome was vaccine attitude status defined as positive if a VAX sum score was above the median value; otherwise, non-positive. Data were analysed using Chi-square and multivariate logistic regression analyses at a 5% significance level. Results: Hypertension (27.4%), diabetes mellitus (22.0%) and heart conditions/diseases (19.6%) were the top three conditions being managed by the participants. The overall proportion of patients with a positive attitude towards the uptake of COVID-19 vaccination was 46.6%; while 29.6% trusted the vaccine benefit, 46.6% were not worried about the aftermath effect of the vaccine and 11.1% were not concerned about the vaccine commercial profiteering. Factors associated with overall vaccine attitude were level of education, income, knowledge of COVID-19, living room arrangement, and confidence in government (p<0.05). The main influential factor on general vaccine positive attitude and the four subscales was confidence in the government. Conclusion: Less than half of people living with a chronic medical condition had a positive attitude towards the COVID vaccine. The attitudes are mediated strongly by confidence in the government and several sociodemographic and COVID related characteristics. A lot still needs to be done to achieve the prescribed herd immunity. Introduction the UK had a high level of mistrust, towards the vaccine, [10] . Also, 69% of adult participants 67 were willing to get vaccinated in a study among over 2000 adults in US [11] . The proportion 68 of people intending to get vaccinated is similar to that reported among about a thousand Hong 69 Kong nurses, [1] . 70 It was opined that the proportion of vaccinated people should be greater than two-thirds to 71 achieve 'herd' OR public immunity, [1] . Literature has shown that reasons for unwillingness 72 to vaccinate, mistrust of vaccines and poor vaccine intention include low socioeconomic status, 73 lower education, older age, concerns about the unforeseen side effects, mistrust of Government, 74 and poor adherence to COVID-19 prevention guidelines, [1, 5, 10] . 75 Addressing the aforementioned factors may promote a positive attitude and high intention to 76 be vaccinated. Besides, COVID-19 vaccine recommendation by health care providers was a 77 positive mediating factor towards its uptake among US adults, [11] . Adequate understanding 78 of clients by health care professionals is thus crucial before they can effectively communicate 79 the need for vaccines [12] . Nurses, physicians and other health care workers can thus 80 effectively improve the attitude and uptake of the vaccine among their clients. 81 Generally, the population at higher risk of death or complications should be vaccinated first 82 due to inadequate supply of COVID-19 vaccine. Many countries have therefore adopted the 83 WHO vaccination guideline of prioritizing people at higher risk of mortality from the disease 84 including older adults and those with chronic conditions like diabetes and chronic kidney 85 disease [13] . 86 Specifically, adults with chronic condition are more likely to be hospitalized due to 19 infection compared to healthy individuals in a study conducted in the United States, [14] . 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 January 28, 2022. ; https://doi.org/10.1101/2022.01.27.22269947 doi: medRxiv preprint also corroborated the claim that people who have co-morbidities such as diabetes and 91 hypertension are more likely to suffer fatality from COVID-19 infection, [16] . 92 Apart from the vulnerability of people with chronic conditions being reported, the patients 93 themselves are aware of this fact. In a study conducted among Ethiopian living with diabetes 94 and hypertension. many (79%) participants felt that they were more susceptible to COVID-19 95 death, yet only 10% were involved in a good level of COVID-19 prevention measures, [17] . 96 The poor attitude towards COVID-19 prevention could be carried over to the reception of the 97 vaccine. Hence, the need to assess vaccination attitude. 98 Many studies have examined the COVID-19 vaccination attitude but few of such were 99 conducted in Nigeria. The 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 January 28, 2022. Based on the assumptions of a 50% prevalence of positive attitude towards the uptake of 120 COVID-19 vaccination among the patients and a 5% desired level of precision, the required 121 minimum sample size was estimated. A total of 423 sample size was estimated for the study 122 after adjusting for a 10% non-response rate. At every clinic visit, eligible consenting 123 participants were selected using a simple random sampling (balloting approach). Daily 124 attendance register at the Record section of the clinic served as the sampling frame. There were 125 20 "yes" of the total prepared secret ballot-papers, labelled "yes" or "no" for eligible patients 126 who registered on a clinic day. Patient who selected a "yes" was enrolled into the study after 127 written informed consent was obtained, while excluding patient who was very ill and 128 cognitively impaired. 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 January 28, 2022. ; https://doi.org/10.1101/2022.01.27.22269947 doi: medRxiv preprint employment classification, history of children's vaccination, daily exposure to news, and self-140 rated adherence to the COVID-19 guidelines, among others. The analysis started with data cleaning to ensure completeness and consistency. The main 155 outcome variable was a positive attitude towards the uptake of the COVID-19 vaccine. The 156 response to the attitude questions was summed together to generate an attitude score ranging 157 from 0 to 60. Similar scores (ranged 0-15 scores) were generated for each of the four subscales 158 of attitude towards COVID-19 vaccine uptake. Having confirmed the nonnormality of the 159 outcome variable including its subscales' scores using the Shapiro Wilk normality test (p< 160 0.05), an overall score above the median value was coded "1" as positive attitude; otherwise, 161 coded "0" as non-positive(20). Independent variables considered were socio-demographics, 162 contextual and COVID-19 related characteristics, see Table 1 . 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 January 28, 2022. Patient total asset grouped into single (only one asset declared) or multiple (two or more assets declared) Media exposure Exposure to media is grouped into not exposed and exposed. Cooking fuel Type of cooking fuel categorised as clean and unclean Drinking water source Source of drinking water grouped as improved and unimproved Descriptive statistics such as percentages were used to report the frequency distribution and 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 January 28, 2022. 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 January 28, 2022. 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 January 28, 2022. 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 January 28, 2022. 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 January 28, 2022. 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 January 28, 2022. Table 5 . In the overall model, the likelihood of having a positive attitude 245 towards COVID-19 vaccine uptake was higher among patients living in a house with more than 246 two rooms (3-4 rooms -aOR=3.16, CI: 1.52,6.57; >4 rooms -aOR=4.29, CI: 1.87,9.87) and 247 those who rated government high (aOR=15.78, CI:6.52,38.16) at handling the pandemic. The 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 January 28, 2022. 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 January 28, 2022. ; 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 January 28, 2022. Arabs [26] . In contrast, studies have shown that participants in high income countries had a The most influential factor to having a positive attitude towards the COVID vaccine among the 280 study participants was trust in the government's ability to handle the pandemic. Those who 281 trusted the government were sixteen times more likely to take the vaccine. This element of trust 282 in the government was much stronger than the influence of confidence in health professionals. Generally, many people think, justifiably so, that the government has a lot to do in helping to . This finding corroborates recent study conducted among US, Australian and 290 UK citizens, [30] 291 Trust in the government and its influence on vaccination attitude does appear to be common 292 phenomenon among people irrespective of their race. This was the case in a large 293 intercontinental study involving twenty-six adults, [24] . Likewise, another study [31] reported 294 the influence of mistrust of the government on vaccine attitude. There is currently no health 295 condition that has generated so much media attention, controversy/strongly polarised opinion 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 January 28, 2022. The study further showed that participants who did not complete their children's immunization 319 showed a preponderance for natural immunity. This, however, poses a question of how far a 320 person's natural immunity can protect against the COVID virus. This is an aspect that requires 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 January 28, 2022. ; https://doi.org/10.1101/2022.01.27.22269947 doi: medRxiv preprint Immunology in collaboration with the UK Coronavirus Immunology Consortium (UK-CIC) 323 has stated that vaccination against COVID-19 is likely to lead to a more effective and longer-324 lasting immunity than that prompted by natural infection with the virus. The vaccine is also 325 said to be five times more protective against the virus compared to natural immunity following 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 January 28, 2022. The percentage of those with a positive attitude needs to be upped to achieve herd immunity. Since people with chronic conditions are more susceptible to morbidity and mortality from 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 January 28, 2022. ; https://doi.org/10.1101/2022.01.27.22269947 doi: medRxiv preprint Suggestions for further study 370 A qualitative study on the reason for poor vaccine attitude or vaccine hesitancy. 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 January 28, 2022. ; https://doi.org/10.1101/2022.01.27.22269947 doi: medRxiv preprint COVID-19 vaccination intention and vaccine hesitancy among nurses: A survey Costs of Using Social Distancing to Flatten the Curve for COVID-19 A sharp 382 increase in the number of COVID-19 cases and case fatality rates after lifting the 383 lockdown in Kurdistan region of Iraq. 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