Factors influencing COVID-19 vaccine acceptability among household heads in northern Nigeria: a community-based cross-sectional study

Abstract

Objectives: COVID-19 vaccine was rolled out for the public in August 2021 in Zamfara state, Northen Nigeria. We determined the factors influencing COVID-19 vaccine acceptance.

Settings: We executed a community-based analytical cross-sectional study during the first 4 months of the second phase of the COVID-19 (Oxford/AstraZeneca) mass vaccination campaign in Zamfara state.

Participants: We used multistage sampling to select 910 household heads.

Outcome measures: We used a semistructured electronic questionnaire to collect data on sociodemographic characteristics, uptake and acceptance of COVID-19 vaccine between 12 October and 20 December 2021. We calculated frequencies, proportions, adjusted ORs and 95% CIs for factors influencing COVID-19 vaccine acceptance using logistic regression.

Results: Our respondents had a median age of 48 years (IQR: 37-55), 78.1% (711) were men, a majority more than 30 years, and only 8.9% (81) had received COVID-19 vaccine. Of the 829 unvaccinated respondents, 10.1% (84) accepted to take the vaccine, the current week of the interview while 12.2% (101) rejected the vaccine. Individuals aged 30 years and older (adjusted OR (aOR)=2.39, 95% CI 1.16 to 4.94, p=0.018), who owned a mobile phone (aOR=25.35, 95% CI 11.23 to 57.23, p<0.001) and a television (aOR=3.72, 95% CI 1.09 to 12.69, p=0.036), with medium-high levels of trust (aOR=7.41, 95% CI 3.10 to 17.74, p<0.001), and those with a medium-high (positive) levels of attitude (aOR=1.82, 95% CI 1.06 to 3.11, p=0.029) were more likely to accept the COVID-19 vaccine. Also, those who had been vaccinated with other vaccines (aOR=2.2, 95% CI 1.09 to 4.43, p=0.027) and those previously tested for COVID-19 (aOR=2.0, 95% CI 1.10 to 3.66, p=0.023) were also more likely to accept it.

Conclusion: COVID-19 vaccine had a poor uptake and acceptance. Factors such as age, awareness, trust and previous vaccination experience played a significant role in COVID-19 vaccine acceptance. We recommended targeted public health campaigns, improving community engagement and building trust in community leaders, healthcare providers and public health institutions.

Keywords: COVID-19; Community-Based Participatory Research; Immunization Programs; SARS-CoV-2 Infection; Vaccination.

Figure 1. The level of confidence in individuals and government bodies (N=910) shows the confidence rankings assigned by respondents to various individuals and government bodies regarding health-related advice or decisions. The bars represent the percentage of respondents selecting each rank, colour-coded as follows: dark green for first choice, light green for second, pale green for third, yellow for fourth, blue for fifth, peach for sixth, pink for seventh and red for eighth choice. Entities ranked include ‘Your own doctor’, ‘Traditional Leaders’, ‘State Health Department’, ‘Religious Leaders’, ‘Presidential Task Force’, ‘Patent Drug Seller’, ‘Nigeria Centre for Disease Control (NCDC)’ and ‘National Primary Healthcare Development Agency (NPHCDA)’. The figure highlights that respondents show the highest confidence in their own doctors, with 37% ranking them as their first choice, while traditional and religious leaders were ranked lower, indicating less trust.