Factors associated with incomplete COVID-19 vaccination among healthcare workers in Kampala Capital City Health Facilities. An explanatory sequential mixed methods study

Abstract

Introduction: Health workers involved in rapid response to viral infectious disease outbreaks like Ebola, Marburg among others are almost certainly at an increased risk of acquiring infection compared to the public. Like other viral outbreaks, the inclusion of healthcare workers as a high priority population for COVID-19 vaccination is among the special efforts to protect them from the acquisition of SARS-CoV-2 infection in addition to other public health measures to maximize their protection. Despite efforts such as prioritizing healthcare workers (HCWs), making vaccines available, and reporting willingness to get fully vaccinated, it is unknown what proportion of HCWs have completed the primary vaccination schedule and the factors that may influence completion. General Objective: To determine the prevalence and factors associated with incomplete COVID-19 vaccination among HCWs in facilities in Kampala City, Uganda. Methods: A mixed methods cross-sectional study was conducted among 323 multistage sampled HCWs at healthcare facilities within Kampala capital city. A pre-tested questionnaire was administered by trained research assistants to the selected HCWs. Quantitative data was analysed using Stata Corp v17.0. while qualitative data was analyzed using inductive thematic content analysis, aided by Atlas ti.8. Associations between vaccination status and independent variables were explored using Generalized Linear Models with a poisson family and log link (modified poisson regression) with robust standard errors. A p-value of less than 0.05 was used to show statistical significance. Prevalence ratios with their 95% confidence intervals were reported as the measure of association. Results: The prevalence of COVID-19 vaccination incompletion was 21.7%. Age 30 – 39 years (aPR = 0.51, 95%CI 0.29 – 0.90), confidence in the vaccine (aPR = 0.31, 95%CI 0.17 – 0.56) and ease in accessing vaccination services (aPR = 0.54, 95%CI 0.34 – 0.84) were associated with a reduced likelihood of an incomplete vaccination status while being at a private not for profit facility (aPR = 1.83, 95%CI 1.20 – 2.78), disbelief that vaccinations reduce risk of death from Infectious Diseases (aPR = 1.84, 95%CI 1.26 – 2.70), disbelief that vaccination reduces the risk of sickness and death from COVID-19 (aPR = 2.05, 95%CI 1.34 – 3.14), failure to recommend the vaccines (aPR = 1.75, 95%CI 1.07 – 2.86), Health Professionals (aPR = 3.52, 95%CI 1.12 – 11.06) and having high access rate to information (aPR = 1.93, 95%CI 1.11 – 3.37) were associated with increased likelihood of incomplete vaccination status. Enablers of vaccine completion included perceived protection (belief that vaccines boost immunity), vaccination being a requirement by law/ institution, and availability of services. Barriers to vaccine completion included misinformation, communication and media environment, negative perceptions of the pharmaceutical industry, knowledge/ awareness, perceived risk/ benefits and vaccine specific issues such as speed of development, source of the vaccine and attitudes of HCWs. Conclusions and recommendations: The prevalence of COVID-19 vaccination incompletion among HCWs was 21.7%. Confidence in the vaccine and ease in accessing vaccination services were associated with a reduced likelihood of an incomplete vaccination status while being at a private not for profit facility, disbelief that vaccinations reduce the risk of death from Infectious Diseases, disbelief that vaccination reduces the risk of sickness and death from COVID-19, failure to recommend the vaccines, those in the health professionals category and having high access rate to information were associated with increased likelihood of incomplete vaccination status. The Ministry of Health needs to intensify risk communication efforts among HCWs, with messaging focused on filling gaps around vaccine safety and efficacy to build confidence levels of the HCWs particularly those at non-governmental facilities and those vulnerable to misinformation.