Factors associated with COVID-19 vaccine uptake in the slums of Kawempe Division, Kampala District

Abstract

Although the World Health Organization recommended vaccination as the most effective way to prevent novel coronavirus disease (COVID-19), uptake of COVID-19 vaccines remains suboptimal in low-income countries such as Uganda. This study aimed to determine the level of uptake of the COVID-19 vaccine and associated factors among the people living in the slums of Kawempe division, Kampala district. Methods: This was a cross-sectional mixed methods study that utilised both quantitative and qualitative methods to collect data. Quantitative data was conducted among 467 randomly selected participants aged at least 18 years from selected slums in Kawempe division using a structured questionnaire designed in kobo collect. The qualitative data was collected from eight key informant interviews among local leaders, village health team members, health workers, and officials from Kawempe division health department. The main outcome variable was uptake of COVID-19 vaccine. Modified Poisson regression as the identified best model was used to determine the factors associated with uptake of COVID-19 vaccine among the people living in the slums of Kawempe division. Qualitative data was transcribed verbatim and analyzed manually using inductive thematic analysis. Out of 467 study participants, 55.2% (258/467) had completed all the recommended doses of COVID-19 vaccines. Factors that were associated with COVID-19 vaccine uptake were: being aged 35 years and above (APR = 1.22, 95% CI: 1.01-1.44), having ever suffered from COVID-19 (APR = 1.24, 95% CI: 1.04 -1.48), being in a position of leadership (APR = 1.31, 95% CI: 0.97-1.77), having received all necessary vaccines in one’s life (APR = 1.62, 95% CI: 1.21- 2.16), and being encouraged by a friend or a relative to take the COVID-19 vaccine (APR = 1.32, 95% CI: 1.07-1.61), higher household wealth position (APR=1.43, 95% CI=1.04-1.97) and having formal education (APR = 0.63, 95% CI: 0.46 -0.86). Perceptions that influenced COVID-19 vaccine uptake included: perceived concerns about safety, fear of infection, belief in vaccine efficacy, fear of being hospitalized, and fear of dying. The qualitative findings highlighted both facilitators and barriers to COVID-19 vaccine uptake across different levels. At the individual and interpersonal levels, factors such as personal vaccine preferences and the influence of family and peers were identified as key facilitators. Organizational factors, including initiatives by local organizations, the impact of community and political leadership, a high COVID-19 mortality rate, and an increased perceived need for vaccination, along with public policy measures such as the requirement for vaccination cards to access services, also played significant roles in encouraging vaccine uptake. The barriers to COVID-19 vaccine uptake included being aged between 18 to 35 years, low knowledge, perceived efficacy of the vaccine, perceived need of the vaccine, fear of adverse effects, mode of administration, lack of time for vaccination, government distrust, and long waiting times at vaccination centers. Conclusion: The study found that COVID-19 vaccine uptake was lower than the 70% WHO recommendation. There is need to develop strategies for addressing vaccine hesitance targeting different groups of people living in slums based on their characteristics, as age, education, wealth, and past health history influenced uptake. In particular, there is need for tailored educational campaigns, involving local leaders, to address age-related hesitancy and ensure equitable vaccination access in slum areas.