COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021
Abstract
:1. Introduction
2. Materials and Methods
2.1. Survey Design, Population, and Setting
2.1.1. Selection of CMs
2.1.2. Selection of HCWs
2.2. Survey Development and Implementation
2.3. Data Collection
2.4. Outcome and Explanatory Variables
2.5. Data Analysis
2.6. Ethical Considerations
3. Results
3.1. Respondent Characteristics
3.2. COVID-19 Knowledge and Awareness
3.3. COVID-19 Vaccine Perceptions
3.4. Intention to Receive the COVID-19 Vaccine
3.5. General Vaccine Confidence and Vaccine Decision-Making
3.6. Vaccine-Related Communication Preferences
3.7. Correlates of COVID-19 Vaccine Acceptance
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | CMs (N = 631) n (%) | HCWs (N = 438) n (%) | |
---|---|---|---|
Age (years), median (IQR) 1 | 31 (22–42) | 35 (29–42) | |
Sex | |||
Male | 208 (33.0) | 203 (46.4) | |
Female | 423 (67.0) | 235 (53.7) | |
Health Zone | |||
Beni | 239 (37.9) | 167 (38.1) | |
Butembo | 250 (39.6) | 172 (39.3) | |
Mabalako | 142 (22.5) | 99 (22.6) | |
Highest Education Level | |||
None | 72 (11.4) | 10 (2.3) | |
Primary school | 175 (27.7) | 33 (7.5) | |
Secondary school | 324 (51.3) | 178 (40.6) | |
University or higher institute | 56 (8.9) | 215 (49.1) | |
Do not know/declined | 4 (0.6) | 2 (0.5) | |
Religion | |||
Catholic | 352 (55.8) | 227 (51.8) | |
Protestant/Evangelical/Pentecostal/Revival | 250 (39.6) | 196 (44.7) | |
Muslim | 17 (2.7) | 1 (0.2) | |
Other 2 | 12 (1.9) | 14 (3.2) | |
Influence of Faith on Decisions Including Health | |||
No influence | 213 (33.8) | 152 (34.7) | |
Influences some decisions | 205 (32.5) | 170 (38.8) | |
Influences all decisions | 207 (32.8) | 114 (26.0) | |
Declined to respond | 6 (1.0) | 2 (0.5) | |
Ebola Vaccination Status | |||
Received vaccine | 397 (62.9) | 416 (95.0) | |
Declined vaccine | 77 (12.2) | 4 (0.9) | |
Ineligible or not offered vaccine | 157 (24.9) | 18 (4.1) | |
Primary Occupation | |||
Community Members | n (%) | Healthcare Workers | n (%) |
Farmer | 181 (28.7) | Nurse | 209 (47.7) |
Unemployed | 113 (17.9) | Doctor | 20 (4.6) |
Homemaker | 93 (14.7) | Administrator | 46 (10.5) |
Student | 68 (10.8) | Hygienist | 76 (17.4) |
Trader/businessperson | 69 (10.9) | Midwife | 14 (3.2) |
Healthcare worker | 24 (3.8) | Lab Technician | 25 (5.7) |
Work from home | 21 (3.3) | Physiotherapist | 3 (0.7) |
Teacher | 9 (1.4) | Medical/Nursing Student | 19 (4.3) |
Other 3 | 53 (8.4) | Data Manager | 10 (2.3) |
Pharmacist | 4 (0.9) | ||
Other 3 | 12 (2.7) |
Questionnaire Item | CMs (N = 631) | HCWs (N = 438) | ||
---|---|---|---|---|
n | % | n | % (95% CI) 1 | |
Have you heard of COVID-19? | ||||
Yes | 618 | 97.9 | 434 | 99.1 (98.6, 99.4) |
No | 7 | 1.1 | 1 | 0.2 (0.0, 0.6) |
Unsure/declined | 6 | 1.0 | 3 | 0.7 (0.4, 1.2) |
Do you think you are at risk of contracting COVID-19? | ||||
Yes | 338 | 53.6 | 358 | 81.7 (79.4, 83.9) |
No | 199 | 31.5 | 55 | 12.6 (10.9, 14.5) |
Unsure/declined | 94 | 14.9 | 25 | 5.7 (4.6, 7.1) |
COVID-19 Transmission: COVID-19 is spread… | ||||
From person-to-person | 392 | 62.1 | 304 | 69.4 (66.2, 72.4) |
Through coughs and sneezes | 403 | 63.9 | 336 | 76.7 (74.1, 79.1) |
From animals | 66 | 10.5 | 46 | 10.5 (8.6, 12.7) |
COVID-19 Prevention: COVID-19 can be prevented by… | ||||
Wearing a mask | 540 | 85.6 | 420 | 95.9 (94.6, 96.9) |
Washing hands regularly | 492 | 78.0 | 366 | 83.6 (81.2, 85.7) |
Staying at least 1 m from others | 383 | 60.7 | 346 | 79.0 (76.6, 81.2) |
Avoiding crowds | 178 | 28.2 | 183 | 41.8 (38.6, 45.1) |
Going out only when necessary | 39 | 6.2 | 45 | 10.3 (8.5, 12.3) |
Questionnaire Item | CMs (N = 631) | HCWs (N = 438) | ||
---|---|---|---|---|
n | % | n | % (95% CI) 1 | |
Would you receive a COVID-19 vaccine if offered? | ||||
Yes | 174 | 27.6 | 174 | 39.7 (37.0, 42.5) |
Unsure | 142 | 22.5 | 116 | 26.5 (23.7, 29.5) |
No | 304 | 48.2 | 142 | 32.4 (29.8, 35.1) |
Declined to respond | 11 | 1.7 | 6 | 1.4 (9.4, 2.0) |
Reasons I would accept a COVID-19 vaccine 2 | n (N = 316) | % | n (N = 290) | % (95% CI) 1 |
To protect myself and my family | 242 | 76.6 | 216 | 74.5 (70.6, 78.0) |
To protect other people in my community | 166 (52.5) | 52.5 | 138 | 47.6 (43.4, 51.8) |
To stop the spread of COVID-19 in my community | 126 (39.9) | 39.9 | 112 | 38.6 (35.2, 42.2) |
Reasons I would not accept a COVID-19 vaccine 3 | n (N = 304) | % | n (N = 142) | % (95% CI) 1 |
I do not have enough information about the vaccine | 161 | 53.0 | 94 | 66.2 (62.0, 70.1) |
I am worried that the vaccine is not safe | 113 | 37.2 | 52 | 36.6 (32.0, 41.6) |
I am worried that the vaccine does not prevent COVID-19 | 41 | 13.5 | 12 | 8.5 (6.4, 11.1) |
I do not trust the local vaccination team | 29 | 9.5 | 5 | 3.5 (2.2, 5.6) |
I do not trust the manufacturer of the vaccine | 82 | 27.0 | 39 | 27.5 (23.3, 32.1) |
I do not trust the government | 51 | 16.8 | 21 | 14.8 (11.3, 19.2) |
Fear of getting COVID-19 while getting vaccinated (e.g., exposure to vaccinators, etc.) | 39 | 12.8 | 20 | 14.1 (11.2, 17.6) |
Fear of getting COVID-19 from the vaccine itself | 39 | 12.8 | 16 | 11.3 (8.9, 14.1) |
Would you recommend a COVID-19 vaccine to patients? | n (N = 438) | % (95% CI) 1 | ||
Yes | n/a | 239 | 54.6 (51.5, 57.6) | |
Unsure | 99 | 22.6 (20.1, 25.3) | ||
No | 90 | 20.5 (18.3, 23.0) | ||
Declined to respond | 10 | 2.3 (1.6, 3.2) |
Questionnaire Item | CMs (N = 631) | HCWs (N = 438) | ||
---|---|---|---|---|
n | % | n | % (95% CI) 1 | |
How would you/your community prefer to receive communication on vaccinations and health services in the future? 2 | ||||
Radio | 461 | 73.1 | 353 | 80.6 (78.1, 82.9) |
Healthcare workers | 356 | 56.4 | 313 | 71.5 (68.5, 72.3) |
Religious venues (church, mosque, or other) | 311 | 49.3 | 271 | 61.9 (58.5, 65.1) |
Megaphone announcements | 269 | 42.6 | 192 | 43.8 (40.5, 47.2) |
Community leaders (chief or village headman) | 157 | 24.9 | 162 | 37.0 (33.7, 40.4) |
Other community settings | 123 | 19.5 | 159 | 36.3 (33.2, 39.5) |
Print materials/flyers | 89 | 14.1 | 147 | 33.6 (30.4, 36.9) |
Television | 104 | 16.5 | 111 | 25.4 (22.2, 28.7) |
Outbreak response workers | 100 | 15.9 | 81 | 18.5 (16.2, 21.1) |
Mobile phone/text message | 49 | 7.8 | 72 | 16.4 (14.3, 18.9) |
Ministry of health/governmental authority | 73 | 11.6 | 68 | 15.5 (11.6, 18.0) |
Internet/social media/Facebook/blogs | 25 | 4.0 | 42 | 9.6 (7.9, 11.6) |
Other | 41 | 6.5 | 18 | 4.1 (3.2, 5.3) |
What communication methods would you recommend for sharing information on vaccinations to HCW in the future? 2 | ||||
Meetings/workshops | n/a | 375 | 85.6 (83.3, 87.7) | |
Posters | 227 | 51.8 (48.8, 54.9) | ||
Pamphlets/handouts | 184 | 42.0 (38.7, 45.3) | ||
Memory aids | 108 | 24.7 (22.0, 27.5) | ||
Mobile phone/text message/Whatsapp | 72 | 16.4 (14.5, 18.6) | ||
Internet/social media/Facebook/Twitter | 49 | 11.2 (9.5, 13.2) | ||
Other | 63 | 14.4 (12.3, 16.8) |
Vaccine Acceptant n (%) N = 174 | Vaccine Hesitant n (%) N = 444 | RR (95% CI) | aRR (95% CI) | |
---|---|---|---|---|
Sex | ||||
Male | 68 (39.1) | 135 (30.4) | Reference | Reference |
Female | 106 (60.9) | 309 (69.6) | 0.77 (0.58–1.03) | 0.78 (0.63, 0.96) |
Age (years), median (IQR) | 31 (22.75, 42.25) | 30 (22, 42) | 1.00 (0.98, 1.01) | 1.00 (0.99, 1.01) |
Highest Education Attained | ||||
None | 17 (9.8) | 55 (12.4) | Reference | Reference |
Primary | 49 (28.2) | 124 (27.9) | 1.17 (0.76, 1.80) | 1.13 (0.75, 1.72) |
Secondary | 82 (47.1) | 234 (52.7) | 1.22 (0.79, 1.89) | 1.07 (0.72, 1.60) |
University or higher | 25 (14.4) | 28 (6.3) | 2.34 (1.34, 4.08) | 1.45 (0.86, 2.44) |
Declined to respond | 1 (0.6) | 3 (0.7) | n/a | |
Religion Influence | ||||
No influence | 66 (37.9) | 144 (32.4) | Reference | Reference |
Influences some decisions | 53 (30.5) | 146 (32.9) | 0.80 (0.56, 1.15) | 0.73 (0.52, 1.04) |
Influences all decisions | 55 (31.6) | 148 (33.3) | 0.80 (0.51, 1.24) | 0.70 (0.47, 1.06) |
Declined to respond | 0 (0) | 6 (1.4) | n/a | n/a |
Perceived Risk of Contracting COVID-19 | ||||
No/unsure | 44 (25.3) | 241 (54.3) | Reference | Reference |
Yes | 130 (74.7) | 203 (45.7) | 2.74 (1.92, 3.90) | 2.17 (1.54, 3.07) |
Vaccine Side Effects Important | ||||
No/unsure | 91 (52.3) | 249 (56.1) | Reference | Reference |
Yes | 83 (47.7) | 195 (43.9) | 1.09 (0.76, 1.58) | 0.82 (0.60, 1.12) |
Vaccine Efficacy Important | ||||
No/unsure | 44 (25.3) | 175 (39.4) | Reference | Reference |
Yes | 130 (74.7) | 269 (60.6) | 1.62 (1.17, 2.26) | 1.13 (0.89, 1.44) |
New Vaccines Pose More Risks 1 | ||||
No/unsure | 128 (73.6) | 225 (50.7) | Reference | Reference |
Yes | 46 (26.4) | 219 (49.3) | 0.46 (0.34, 0.61) | 0.63 (0.45, 0.86) |
Distrust Government for Vaccine Decisions | ||||
No/unsure | 140 (80.5) | 274 (61.7) | Reference | Reference |
Yes | 34 (19.5) | 170 (38.3) | 0.52 (0.35, 0.77) | 0.80 (0.55, 1.15) |
Security Concerns Prevent Access to Vaccines and Health Services | ||||
No/unsure | 1411 (81.0) | 309 (69.6) | Reference | Reference |
Yes | 33 (19.0) | 135 (30.4) | 0.69 (0.48, 1.01) | 0.70 (0.51, 0.96) |
Received Ebola Vaccine | ||||
No | 16 (9.2) | 59 (13.3) | Reference | Reference |
Yes | 130 (74.7) | 257 (57.9) | 1.92 (1.40, 2.62) | 1.43 (1.05, 1.94) |
Ineligible/not offered | 28 (16.1) | 128 (28.8) | n/a | n/a |
COVID-19 Knowledge Score | ||||
Low | 27 (15.5) | 78 (17.6) | Reference | Reference |
Medium | 111 (63.8) | 302 (68.0) | 1.11 (0.75, 1.64) | 0.69 (0.50, 0.96) |
High | 36 (20.7) | 64 (14.4) | 1.49 (0.98, 2.28) | 0.80 (0.52, 1.23) |
General Vaccine Confidence 2 | ||||
Low | 9 (5.2) | 72 (16.2) | Reference | Reference |
Medium | 51 (29.3) | 200 (45.1) | 1.96 (0.94, 4.08) | 2.06 (1.08, 3.90) |
High | 114 (65.5) | 172 (38.7) | 3.80 (1.75, 8.26) | 3.01 (1.51, 5.99) |
Vaccine Acceptant n (%) N = 174 | Vaccine Hesitant n (%) N = 258 | OR (95% CI) | aOR (95% CI) | |
---|---|---|---|---|
Sex | ||||
Male | 91 (52.3) | 107 (41.5) | Reference | Reference |
Female | 83 (47.7) | 151 (58.5) | 0.65 (0.54, 0.77) | 0.60 (0.46, 0.80) |
Age (years), median (IQR) | 35.5 [20–44.25] | 35 [29–40.25] | 1.01 (1.00, 1.02) | 0.98 (0.96, 0.99) |
Highest Education Attained | ||||
None | 4 (2.3) | 6 (2.3) | Reference | Reference |
Primary | 17 (9.9) | 16 (6.2) | 1.59 (0.79, 3.20) | 1.43 (0.35, 4.75) |
Secondary | 67 (38.5) | 108 (41.9) | 0.93 (0.49, 1.77) | 0.47 (0.13, 1.62) |
University or higher | 84 (48.3) | 128 (49.6) | 0.98 (0.51, 1.90) | 0.37 (0.11, 1.22) |
Religion Influence | 0 (0) | 2 (1.2) | ||
No influence | 68 (39.1) | 81 (31.6) | Reference | Reference |
Influences some decisions | 55 (31.6) | 115 (44.9) | 0.57 (0.44, 0.73) | 0.45 (0.34, 0.61) |
Influences all decisions | 51 (29.3) | 60 (23.4) | 1.01 (0.78, 1.31) | 0.93 (0.68, 1.27) |
Declined to respond | 2 (0.8) | 0 (0) | n/a | n/a |
Perceived Risk of Contracting COVID-19 | ||||
No/unsure | 22 (12.6) | 54 (20.9) | Reference | Reference |
Yes | 152 (87.4) | 204 (79.1) | 1.77 (1.33, 2.36) | 2.23 (1.53, 3.26) |
Vaccine Side Effects Important | ||||
No/unsure | 98 (56.3) | 127 (49.2) | Reference | Reference |
Yes | 76 (43.7) | 131 (50.8) | 1.38 (1.11, 1.72) | 0.72 (0.57, 0.91) |
Vaccine Efficacy Important | ||||
No/unsure | 41 (23.6) | 77 (29.8) | Reference | Reference |
Yes | 133 (76.4) | 181 (70.2) | 1.38 (1.11, 1.72) | 1.30 (0.95, 1.76) |
New Vaccines Pose More Risks 1 | ||||
No/unsure | 148 (85.1) | 147 (57.0) | Reference | Reference |
Yes | 26 (14.9) | 111 (43.0) | 0.17 (0.13, 0.21) | 0.23 (0.17, 0.33) |
Distrust Government for Vaccine Decisions | ||||
No/unsure | 146 (83.9) | 171 (66.3) | Reference | Reference |
Yes | 28 (16.1) | 87 (33.7) | 0.36 (0.28, 0.46) | 0.50 (0.35, 0.70) |
Security Concerns Prevent Access to Vaccines and Health Services | ||||
No/unsure | 141 (81.0) | 170 (65.9) | Reference | Reference |
Yes | 33 (19.0) | 88 (34.1) | 0.45 (0.36, 0.57) | 0.52 (0.37, 0.74) |
COVID-19 Knowledge Score | ||||
Low | 7 (4.0) | 26 (10.1) | Reference | Reference |
Medium | 107 (61.5) | 173 (67.1) | 2.30 (1.59, 3.31) | 1.37 (0.87, 2.16) |
High | 60 (34.5) | 59 (22.9) | 3.78 (2.55, 5.60) | 1.62 (0.97, 2.72) |
General Vaccine Confidence 2 | ||||
Low | 4 (2.3) | 22 (8.5) | Reference | Reference |
Medium | 36 (20.7) | 102 (39.5) | 1.94 (1.14, 3.31) | 3.73 (1.98, 7.01) |
High | 134 (77.0) | 134 (51.9) | 5.5 (3.30, 9.18) | 7.16 (3.89, 3.17) |
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Garbern, S.C.; Perera, S.M.; Mbong, E.N.; Kulkarni, S.; Fleming, M.K.; Ombeni, A.B.; Muhayangabo, R.F.; Tchoualeu, D.D.; Kallay, R.; Song, E.; et al. COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021. Vaccines 2023, 11, 973. https://doi.org/10.3390/vaccines11050973
Garbern SC, Perera SM, Mbong EN, Kulkarni S, Fleming MK, Ombeni AB, Muhayangabo RF, Tchoualeu DD, Kallay R, Song E, et al. COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021. Vaccines. 2023; 11(5):973. https://doi.org/10.3390/vaccines11050973
Chicago/Turabian StyleGarbern, Stephanie Chow, Shiromi M. Perera, Eta Ngole Mbong, Shibani Kulkarni, Monica K. Fleming, Arsene Baleke Ombeni, Rigobert Fraterne Muhayangabo, Dieula Delissaint Tchoualeu, Ruth Kallay, Elizabeth Song, and et al. 2023. "COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021" Vaccines 11, no. 5: 973. https://doi.org/10.3390/vaccines11050973