COVID-19 vaccine acceptance and perceived risk among pregnant and non-pregnant adults in Cameroon, Africa

Abstract

Background The public health response to the global COVID-19 pandemic has varied widely by region. In Africa, uptake of effective COVID-19 vaccines has been limited by accessibility and vaccine hesitancy. The aim of this study was to compare perceptions of COVID-19 infection and vaccination between pregnant women and non-pregnant adults in four regions of Cameroon, located in Central Africa. Methods A cross-sectional survey study was conducted at urban and suburban hospital facilities in Cameroon. Participants were randomly selected from a convenience sample of adult pregnant and non-pregnant adults in outpatient clinical settings between June 1st and July 14th, 2021. A confidential survey was administered in person by trained research nurses after obtaining written informed consent. Participants were asked about self-reported sociodemographics, medical comorbidities, perceptions of COVID-19 infection, and vaccination. Descriptive statistics were used for survey responses and univariate and multivariable logistic regression models were created to explore factors associated with COVID-19 vaccine acceptability. Results Fewer than one-third of participants were interested in receiving the COVID-19 vaccine (31%, 257/835) and rates did not differ by pregnancy status. Overall, 43% of participants doubted vaccine efficacy, and 85% stated that the vaccine available in Africa was less effective than vaccine available in Europe. Factors independently associated with vaccine acceptability included having children (aOR = 1.5; p = 0.04) and higher education (aOR = 1.6 for secondary school vs primary/none; p = 0.03). Perceived risks of vaccination ranged from death (33%) to fetal harm (31%) to genetic changes (1%). Health care professionals were cited as the most trusted source for health information (82%, n = 681). Conclusion COVID-19 vaccine hesitancy and misinformation in Cameroon was highly prevalent among pregnant and non-pregnant adults in 2021 while vaccine was available but not recommended for use in pregnancy. Based on study findings, consistent public health messaging from medical professionals about vaccine safety and efficacy and local production of vaccine are likely to improve acceptability.

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“…Pregnant women who had completed grade-9 and above education were more likely to receive COVID-19 vaccination than those who had not attended school. This finding is consistent with the result of studies conducted in Vietnam [ 32 ], India [ 33 ], Cameron [ 36 ], and Saudi Arabia [ 28 ]. The possible explanation might be that mothers who had completed primary education and above could read news and follow social media related to the COVID-19 virus's impact on the general population and its fatality.…”

“…Similarly, the result of this meta-analysis is lower than the study conducted in the United Kingdom (62.1%) [ 25 ], China (77.4%) [ 26 ], Czech Republic (70.2%) [ 27 ], two studies in Saudi Arabia (54.7%) [ 28 ],(68%) [ 29 ], Pennsylvania (65%) [ 30 ], Thailand (60.8%) [ 31 ], Vietnam(60.45) [ 32 ], India (78.2%) [ 33 ], and in Colombia (44.3%) [ 34 ] and California San Diego (43%) in the US [ 35 ]. In contrast, the finding of this meta-analysis is higher than the finding of studies conducted in Cameron (31%) [ 36 ], Afghanistan (8.6%) [ 37 ], Switzerland (29.7%) [ 38 ], and Turkey (37%)(39). Differences in the socio-economic status of countries, study period, awareness creation/campaign on COVID-19 vaccine, the impact of the COVID-19 pandemic on each country, and source of information might justify the discrepancies in the studies.…”

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“…Experience recorded in other languages contributing significant input may have been missed. Similarly, data and outcomes from vaccine rollout programs in pregnant populations in low- or middle-income countries may not be included in this review due to severe disparities in health policies and population hesitancy [ 102 , 103 ]. Moreover, one cannot overcome potential publication bias that already excludes negative results.…”

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“…28,29 Studies have also reported that pregnant women did not receive COVID-19 vaccines due to their limited availability in Africa, perhaps an indication of the inability of pharmaceutical companies to manufacture vaccines in Africa, and the compromised quality of the vaccines manufactured by international pharmaceutical companies for the African market. 27,30 COVID-19 vaccination uptake is also hampered by the low-risk perception of the pandemic, concern about adverse vaccine effects, low vaccination awareness, and low acceptance, intention and willingness to get vaccinated. 31,32 COVID-19 vaccine hesitancy occurs against a backdrop of social-cultural complexities, poor government response in demystifying social and traditional myths and theories, and poor community involvement in public health measures.…”

“…7,8 While survey results from Iran show that more than two-fifths of participants accepted receiving any vaccine, 9 fewer than one-third of pregnant women were interested in receiving the COVID-19 vaccine in Cameroon. 10 Understanding the factors influencing COVID-19 vaccine uptake among women attending antenatal care (ANC) is crucial for mitigating the impact of the virus on maternal and child health.…”