COVID-19 Vaccine Acceptance and its Predictors among College Students in Addis Ababa, Ethiopia, 2021: A Cross-Sectional Survey

Introduction

The Coronavirus disease (COVID-19) pandemic disrupted the normal social and economic activities of the world^1–5 and continued to havoc the globe.⁵ However, the African continent recorded fewer proportion of the COVID-19 infection; the disease caused over 3 million deaths worldwide.⁶

Numerous biologic and chemotherapeutic therapies such as convalescent plasma, tocilizumab, remdesivir and hydroxylchloroquine were applied for the treatment of COVID-19 patients^7,8 with no conclusive evidence on its cure rate.

Nevertheless, it was a recent experience that most of the world practiced different public health measures, such as social distancing, lockdowns, respiratory hygiene, and hand hygiene for the prevention of COVID-19 disease, a little role was recorded;⁹ rather, an effective vaccine as a standing solution was recommended during the crises.^10,11

Vaccine hesitancy is a delay in acceptance or refusal of vaccine despite the availability of vaccination service.¹² When safe and efficacious vaccines become available, governors could ensure a successful, large-scale uptake of COVID-19 vaccines to the attainment of community immunization.

Existing studies on COVID-19 vaccine uptake revealed that a considerable proportion of people are careless of taking the vaccine. A representative study from 19 countries revealed, 71.5% were likely to take the COVID-19 vaccine.¹³ Perhaps; the evidence from 20 nations representative studies revealed the level of COVID-19 acceptance to be under 67%.¹⁴

The predictors of vaccine acceptance are complex, multiple, and vary depending on the type of vaccine involved.^15–17 The level of trustworthiness of the source information determines the likelihood of vaccine acceptance,¹⁸ but trust in COVID-19 vaccination varies widely between different groups of people.¹⁹ It is reasonable to think more people trust vaccines, the more they will take the COVID-19 vaccine. However, the infodemic that inundated the world during the COVID-19 has changed vaccine acceptance,^20–23 – which directly shows that media sensationalism is linked to distrust in COVID and COVID-19 vaccines appear to have different predictors of acceptance than previous vaccine.²⁴

To the best knowledge of the researchers, there was a limited evidence regarding the acceptance of COVID-19 vaccine by college students in Ethiopia. Informed by the above statement, this study assessed the acceptance and predictors of COVID-19 vaccine by college students in Addis Ababa, Ethiopia.

Methods

Participants and Study Design

A multi-center-institutional-based cross-sectional study design was conducted among 407 participants from the selected colleges in Addis Ababa from May 01 to July 30, 2021. The study received ethical approval from Universal Medical and Business College, a research review ethics committee and applied to the respective colleges. All the participants were provided written informed consent. The source population was all regular students of the selected colleges; namely, Universal Medical and Business College, Kea Med Medical and Business College, and Africa Health Science College. The study population was all the 407 participants from the selected colleges available during the study period. Students who registered in the stated colleges, available during data collection, and those free from severe medical conditions were included in the study. A simple random sampling technique was employed to select the participants after their lists were once identified from the registrar of the respective colleges.

The sample size was determined based on a single population proportion, with the premise that the magnitude of vaccine acceptance among college students taken at 50%, since there was no prior study among the particular study group, 95% confidence interval 1.96 and 5% margin of error. The final sample was 422 inclusive of a 10% non-response rate.

Data were gathered with a pre-tested self-administered questionnaire. The questionnaire was developed by reviewing related pieces of literature^25–29 then given to three senior researchers working in academic institutions, and their inputs were incorporated in the final tool.

Definitions of Concepts

The outcome variable (COVID-19 vaccine acceptance) was measured as yes and no question.^1,27 Knowledge was measured as true and false questions and categorized as poor versus good knowledge based on median score after constructs forming knowledge were once computed.

Statistical Analysis

Descriptive statistics were used for the summarization of data. For the identification predictors of COVID-19 acceptance, binary (bi-variable and multivariable) logistic regression was used, with their respective 95% Confidence Interval (CI) and p-value of less than 0.05 as a statistically significant level.

Result

Socio-Demographic Characteristics

Of 422 students approached, 407 respondents completed the questionnaire, with a response rate of 96%. The majority (82.8%) and (68%) of the participants were single and females consecutively. The mean age of the participants was 21.9 years with a standard deviation of ±3.43. Most (63.4%) of the study participants had children living with them (Table 1).

Table 1 Socio-Demographic Characteristics of Participants in Selected Colleges of Addis Ababa, Ethiopia, May, 2021

Knowledge About COVID-19 Vaccination

This study reported that about 57.5% (95% CI: 52.5–62.3%) of the study participants had poor knowledge regarding COVID-19 disease. More than half (53%) of the study participants had heard of COVID-19 disease at first from social media. From all the WHO-recommended preventive protocols, most (80.6%), (81.8%), and (74.2%) of the study participants practiced hand washing, used antibiotics, and wore face masks consecutively. Most (69%) of the study participants knew that only AstraZeneca was given in Ethiopia (Table 2).

Table 2 Knowledge of the Study Participants About COVID-19 Vaccination in Selected Colleges of Addis Ababa, Ethiopia, May, 2021

Perceptions About COVID-19 Vaccination

Less than half (43%) of the study participants were afraid the first time they heard about COVID-19 disease. Less than half (44.2%) of the study participants perceived the importance of taking COVID-19 vaccination. Most (64%) of the study participants perceived that they would not get infected with COVID-19 (Table 3).

Table 3 Attitude About COVID-19 Disease and Vaccination Among Participants in Selected Colleges of Addis Ababa, Ethiopia, May, 2021

COVID-19 Vaccine Acceptance

The level of COVID-19 vaccine acceptance was 39.8% (95% CI: 35.0–44.7%). A quarter (25%) of the study participants thought it was the best preventive mechanism to prevent COVID-19. One-tenth (11%) of the study participants did not want to take the vaccine, worrying about the possible side effects (Table 4).

Table 4 COVID-19 Vaccination Acceptance of Participants in Selected Medical Colleges of Addis Ababa, Ethiopia, May, 2021

Predictors of COVID-19 Vaccine Acceptance

The bivariate logistic regression identified candidate variables for the multivariate logistic regression, at the p-value of 0.25 set as a cut-off point. Accordingly, nine variables fulfilled the candidacy for the multivariate logistic regression. After-effects of confounders were controlled in multivariate logistic regression, sex, living with an elderly person who was elder than 50 years old, and knowledge about the COVID-19 vaccine was statistically associated with COVID-19 vaccine acceptance.

The odds of vaccine acceptance was 53.7% higher among male participants as compared to the females (AOR: 0.463, 95% CI: 0.284–0.755, P<0.001). The odds of having had vaccine acceptance was 2.295 times higher among participants who lived with under-five years old children (AOR: 2.295; 95CI:1.416–3.721, P<0.05) and was 1.609 times higher among participants who lived with an elderly person (AOR: 1.609, 95% CI: 1.016–2.548, P<0.05). Similarly, the odds of vaccine acceptance was two folds higher among those participants with poor knowledge of COVID-19 compared to those with good knowledge (AOR: 2.187, 95% CI: 1.391–3.438, P < 0.001) (Table 5).

Table 5 Predictors of COVID-19 Vaccine Acceptance of in Selected Colleges Students of Addis Ababa, Ethiopia 2021

Discussions

In this study, the level of vaccine acceptance was 39.8%, which was consistent with the findings from 37.3% in Uganda,²⁷ 37.4% in Jordan,²⁸ 47% in Bangladesh³⁰ and 47% in France.³¹

The current finding was lower than the reports of 54.8% in Russia,¹³ 88.6% in China,¹³ 64.7% in Saudi Arabia,³² 67% in Indonesia,¹¹ 75% in US²⁴ and 83% in Denmark.³¹ Such variations might be attributed to the variations in the type of vaccine across the different countries and perception differences across the communities. Thus, the lower acceptance level in Ethiopia might be due to a limited option was available at the time of the investigation.

The level of vaccine acceptance in this study was higher than the finding from Republic of Congo that was 27.7%.³³ This variation might be linked to differences in study participant type across the studies.

In this study, being a male had a higher level of vaccine acceptance. The same was reported by a study from Uganda that being a male was associated with an increased level of vaccine acceptance.²⁷ A study from US college students reported that worrying about unknown side effects and unforeseen problems, vaccine cynicism, under evaluation for safety and political conservativeness to be predictors of vaccine hesitancy.³⁴

In this study, the level of vaccine acceptance was higher among participants who lived with the elderly and children of under-five years old. This was supported by another study.³⁵

The likelihood of vaccine acceptance was two folds higher among participants with poor knowledge about the COVID-19. Probably, participants with good knowledge of COVID-19 might have fear associated with vaccine type, efficacy, and fear associated with AstraZeneca. However, source of the information matters, participants with good knowledge had a higher tendency to vaccine acceptance.^36,37

Conclusion and Recommendation

The level of vaccine acceptance among college students in Ethiopia was lower than necessary to achieve herd immunity. Sex, living with under-five children and elderly, knowledge were predictors of vaccine acceptance in the study settings. Policymakers, stakeholders, and concerned bodies were recommended to work on the identified predictors of COVID-19 vaccine acceptance.

Limitation of the Study

The study was a cross-sectional study, which had a nature of point observation and difficult to establish the temporal association between variables. The other limitation was difficulty of inferring to the community at large, as it was an institution-based study.