COVID-19 vaccine hesitancy and its determinants among sub-Saharan African adolescents

  1. Dongqing Wang
  2. Angela Chukwu
  3. Mary Mwanyika-Sando
  4. Sulemana Watara Abubakari
  5. Nega Assefa
  6. Isabel Madzorera
  7. Elena C. Hemler
  8. Abbas Ismail
  9. Bruno Lankoande
  10. Frank Mapendo
  11. Ourohiré Millogo
  12. Firehiwot Workneh
  13. Temesgen Azemraw
  14. Lawrence Gyabaa Febir
  15. Christabel James
  16. Amani Tinkasimile
  17. Kwaku Poku Asante
  18. Till Baernighausen
  19. Yemane Berhane
  20. Japhet Killewo
  21. Ayoade M. J. Oduola
  22. Ali Sie
  23. Emily R. Smith
  24. Abdramane Bassiahi Soura
  25. Tajudeen Raji
  26. Said Vuai
  27. Wafaie W. Fawzi

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Abstract

COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the prevalence and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2662 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between potential determinants and COVID-19 vaccine hesitancy. The percentage of COVID-19 vaccine hesitancy was 14% in rural Kersa, 23% in rural Ibadan, 31% in rural Nouna, 32% in urban Ouagadougou, 37% in urban Addis Ababa, 48% in rural Kintampo, 65% in urban Lagos, 76% in urban Dar es Salaam, and 88% in rural Dodoma. Perceived low necessity, concerns about vaccine safety, and concerns about vaccine effectiveness were the leading reasons for hesitancy. Healthcare workers, parents or family members, and schoolteachers had the greatest impacts on vaccine willingness. Perceived lack of safety (aPR: 3.52; 95% CI: 3.00, 4.13) and lack of effectiveness (aPR: 3.46; 95% CI: 2.97, 4.03) were associated with greater vaccine hesitancy. The prevalence of COVID-19 vaccine hesitancy among adolescents is alarmingly high across the five sub-Saharan African countries, especially in Tanzania. COVID-19 vaccination campaigns among sub-Saharan African adolescents should address their concerns and misconceptions about vaccine safety and effectiveness.

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  1. Version published to 10.1371/journal.pgph.0000611
  2. ScreenIT

    SciScore for 10.1101/2022.05.18.22275274: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Verbal parental consent and adolescent assent were obtained for adolescents younger than 18 years of age, and oral informed consent was obtained from adolescents aged 18 years and older.
    IRB: This study was approved by the Institutional Review Board at Harvard T.H.
    Sex as a biological variablenot detected.
    RandomizationWithin the sampling frame in each area, we interviewed approximately 300 randomly selected households with adolescents between the ages of 10 to 19 years residing in the household.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We conducted all analyses using SAS 9.4 (SAS Institute Inc., Cary, North Carolina) at a two-sided α level of 0.05.
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A potential limitation of the study was that the study areas were selected based on existing connections and infrastructure, and the adolescents in each area were not selected probabilistically. Therefore, the results from this study are not expected to be representative of all adolescents in the country. Nevertheless, we increased the representativeness of the study population by including countries and areas geographically spread across sub-Saharan Africa. Therefore, the results provide important insights into the levels of determinants of COVID-19 vaccine hesitancy in sub-Saharan Africa. Another limitation is that, due to the nature of phone-based interviews, the adolescents included in most areas were those who resided in households with access to a mobile phone. Consequently, the sample might underrepresent adolescents from under-resourced households, which may affect generalizability. The presence of unreachable phone numbers and failures to pick up phone calls may also have impacts on the generalizability of the findings. In conclusion, we show that COVID-19 vaccine hesitancy among adolescents is high across the five sub-Saharan African countries, especially in Tanzania. COVID-19 vaccination campaigns among sub-Saharan African adolescents must address adolescents’ concerns and misconceptions about COVID-19 vaccines, especially regarding vaccination safety and effectiveness. It is unfortunate that, at the time of this survey, a considerable proportion of adolescents in ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.05.18.22275274v1 on medRxiv