A Descriptive-Multivariate Analysis of Community Knowledge, Confidence, and Trust in COVID-19 Clinical Trials among Healthcare Workers in Uganda

Keneth Iceland Kasozi^{1

2}, Anne Laudisoit³, Lawrence Obado Osuwat⁴, Gaber El-Saber Batiha⁵, Naif E Al Omairi⁶, Eric Aigbogun⁷, Herbert Izo Ninsiima², Ibe Michael Usman⁷, Lisa M DeTora⁸, Ewan Thomas MacLeod¹, Halima Nalugo⁹, Francis P Crawley¹⁰, Barbara E Bierer¹¹, Daniel Chans Mwandah¹², Charles Drago Kato¹³, Kenedy Kiyimba¹⁴, Emmanuel Tiyo Ayikobua⁴, Linda Lillian¹⁵, Kevin Matama⁷, Shui Ching Nelly Mak¹, David Onanyang¹⁶, Theophilus Pius⁷, David Paul Nalumenya¹³, Robinson Ssebuufu⁷, Nina Olivia Rugambwa¹⁷, Grace Henry Musoke¹⁸, Kevin Bardosh¹⁹, Juma John Ochieng⁷, Fred Ssempijja⁷, Patrick Kyamanywa⁷, Gabriel Tumwine¹³, Khalid J Alzahrani²⁰, Susan Christina Welburn^{1

21}

Affiliations

¹ Infection Medicine, Deanery of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh EH8 9JZ, UK.
² School of Medicine, Kabale University, P.O. Box 317 Kabale, Uganda.
³ EcoHealth Alliance, 520 Eighth Ave, Suite 1201, New York, NY 10018, USA.
⁴ School of Health Sciences, Soroti University, P.O. Box 211 Soroti, Uganda.
⁵ Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, AlBeheira, Egypt.
⁶ Department of Internal Medicine, College of Medicine, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
⁷ Kampala International University Western Campus, P.O. Box 71 Bushenyi, Uganda.
⁸ Department of Writing Studies and Rhetoric, Hofstra University, Hempstead, NY 11549, USA.
⁹ Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara, Uganda.
¹⁰ Good Clinical Practice Alliance-Europe and Strategic Initiative for Developing Capacity in Ethical Review, BE-1050 Brussels, Belgium.
¹¹ Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
¹² Faculty of Science, Muni University, P.O. Box 725 Arua, Uganda.
¹³ College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O. Box 7062 Kampala, Uganda.
¹⁴ Department of Pharmacology and Therapeutics, Faculty of Health sciences, Busitema University, P.O. Box 206 Mbale, Uganda.
¹⁵ Uganda National Health Laboratory Services, Ministry of Health, P.O. Box 7272 Kampala, Uganda.
¹⁶ Department of biology, Faculty of Science, Gulu University, P.O. Box 166 Gulu, Uganda.
¹⁷ Department of Library and Information Science, Faculty of Computing, Library and Information Science, P.O. Box 317 Kabale, Uganda.
¹⁸ Faculty of Science and Technology, Cavendish University, P.O. Box 33145 Kampala, Uganda.
¹⁹ Center for One Health Research, School of Public Health, University of Washington, Seattle, WA 98195, USA.
²⁰ Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
²¹ Zhejiang University-University of Edinburgh Joint Institute, Zhejiang University, International Campus, 718 East Haizhou Road, Haining 314400, China.

PMID: 33809269
PMCID: PMC8000597
DOI: 10.3390/vaccines9030253

A Descriptive-Multivariate Analysis of Community Knowledge, Confidence, and Trust in COVID-19 Clinical Trials among Healthcare Workers in Uganda

Keneth Iceland Kasozi et al. Vaccines (Basel). 2021.

. 2021 Mar 12;9(3):253.

doi: 10.3390/vaccines9030253.

Authors

Affiliations

¹ Infection Medicine, Deanery of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh EH8 9JZ, UK.
² School of Medicine, Kabale University, P.O. Box 317 Kabale, Uganda.
³ EcoHealth Alliance, 520 Eighth Ave, Suite 1201, New York, NY 10018, USA.
⁴ School of Health Sciences, Soroti University, P.O. Box 211 Soroti, Uganda.
⁵ Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, AlBeheira, Egypt.
⁶ Department of Internal Medicine, College of Medicine, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
⁷ Kampala International University Western Campus, P.O. Box 71 Bushenyi, Uganda.
⁸ Department of Writing Studies and Rhetoric, Hofstra University, Hempstead, NY 11549, USA.
⁹ Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara, Uganda.
¹⁰ Good Clinical Practice Alliance-Europe and Strategic Initiative for Developing Capacity in Ethical Review, BE-1050 Brussels, Belgium.
¹¹ Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
¹² Faculty of Science, Muni University, P.O. Box 725 Arua, Uganda.
¹³ College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O. Box 7062 Kampala, Uganda.
¹⁴ Department of Pharmacology and Therapeutics, Faculty of Health sciences, Busitema University, P.O. Box 206 Mbale, Uganda.
¹⁵ Uganda National Health Laboratory Services, Ministry of Health, P.O. Box 7272 Kampala, Uganda.
¹⁶ Department of biology, Faculty of Science, Gulu University, P.O. Box 166 Gulu, Uganda.
¹⁷ Department of Library and Information Science, Faculty of Computing, Library and Information Science, P.O. Box 317 Kabale, Uganda.
¹⁸ Faculty of Science and Technology, Cavendish University, P.O. Box 33145 Kampala, Uganda.
¹⁹ Center for One Health Research, School of Public Health, University of Washington, Seattle, WA 98195, USA.
²⁰ Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
²¹ Zhejiang University-University of Edinburgh Joint Institute, Zhejiang University, International Campus, 718 East Haizhou Road, Haining 314400, China.

PMID: 33809269
PMCID: PMC8000597
DOI: 10.3390/vaccines9030253

Abstract

Background-misinformation and mistrust often undermines community vaccine uptake, yet information in rural communities, especially of developing countries, is scarce. This study aimed to identify major challenges associated with coronavirus disease 2019 (COVID-19) vaccine clinical trials among healthcare workers and staff in Uganda. Methods-a rapid exploratory survey was conducted over 5 weeks among 260 respondents (66% male) from healthcare centers across the country using an online questionnaire. Twenty-seven questions assessed knowledge, confidence, and trust scores on COVID-19 vaccine clinical trials from participants in 46 districts in Uganda. Results-we found low levels of knowledge (i.e., confusing COVID-19 with Ebola) with males being more informed than females (OR = 1.5, 95% CI: 0.7-3.0), and mistrust associated with policy decisions to promote herbal treatments in Uganda and the rushed international clinical trials, highlighting challenges for the upcoming Oxford-AstraZeneca vaccinations. Knowledge, confidence and trust scores were higher among the least educated (certificate vs. bachelor degree holders). We also found a high level of skepticism and possible community resistance to DNA recombinant vaccines, such as the Oxford-AstraZeneca vaccine. Preference for herbal treatments (38/260; 14.6%, 95% CI: 10.7-19.3) currently being promoted by the Ugandan government raises major policy concerns. High fear and mistrust for COVID-19 vaccine clinical trials was more common among wealthier participants and more affluent regions of the country. Conclusion-our study found that knowledge, confidence, and trust in COVID-19 vaccines was low among healthcare workers in Uganda, especially those with higher wealth and educational status. There is a need to increase transparency and inclusive participation to address these issues before new trials of COVID-19 vaccines are initiated.

Keywords: COVAX; COVID-19; COVID-19 and medical workers; COVID-19 clinical trials in resource poor countries; clinical trials in Africa; vaccines.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Location of healthcare centers surveyed in the study area by region. In total, participants were based at medical facilities in 46 districts. In particular, 39% of participants came from the central region (101/260), 28% eastern region (72/260), 10% northern region (25/260), and 24% from the western region (62/260). Further individual district demographics indicated more males participated in the study (Supplement File S1).

**Figure 2**
Factor loading components and correlation of variables. The strongest correlation was observed between confidence and trust with factor 2.

See this image and copyright information in PMC

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A Descriptive-Multivariate Analysis of Community Knowledge, Confidence, and Trust in COVID-19 Clinical Trials among Healthcare Workers in Uganda

Affiliations

A Descriptive-Multivariate Analysis of Community Knowledge, Confidence, and Trust in COVID-19 Clinical Trials among Healthcare Workers in Uganda

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources