Knowledge, attitude, intentional practice and individualized determinants of COVID-19 vaccine uptake among adults: A cross-sectional study in Tanzania
Abstract
Aim
The study assessed the knowledge, attitude, intentional practice and individualized factors of COVID-19 vaccine uptake among adults in Tanzania.
Design
Hospital-based analytical cross-sectional study.
Methods
Quantitative approaches were adopted to study 312 randomly selected adults using an interviewer-administered structured questionnaire. Descriptive analysis established frequencies and percentages of variables at a 95% confidence interval and a 5% significance level.
Results
Mean age was 24.66 ± 6.503 of which 61.5% were males. 86.9% of them were not vaccinated. 57.7% of respondents had inadequate knowledge about the COVID-19 vaccine, and 61.5% had negative attitudes towards it. 63.8% of adults demonstrated an unwillingness to be vaccinated. Participants' sociodemographic characteristics profiles were significantly associated with COVID-19 vaccine knowledge, attitude and willingness to uptake it (p < 0.05). Findings highlight the need for large-scale interventions to address the low uptake vaccine. Adults' willingness to get a coronavirus vaccine was comparatively low. Sociodemographic profiles, knowledge and attitude were associated significantly with low uptake of the COVID-19 vaccine among adults in Tanzania.
1 INTRODUCTION
Since early 2019, the world has experienced the extensive spread of the coronavirus pandemic that has impersonated major threats to global health, the function of global health operations and services (Millanzi, Herman, & Ambrose, 2023). The coronavirus (COVID-19) remained to be a global threat to health industries for more than 2 years after being confirmed as a public health emergency of international concern (Galanis et al., 2022). The essential health system has experienced widespread disruption due to pandemic-related social restrictions, high pandemic caseload, scarcity of human and non-human infrastructures, and limited medical equipment, and medicine with the healthcare workers placed under strain conditions (Mugabe et al., 2022). Currently, World Health Organization (WHO) statistics through the Worldometer program show 605 million confirmed cases of COVID-19 with 6.4 million deaths directly contributing to the need of continuing the use of the COVID-19 vaccine as the preventive against pandemic (WHO, 2024).
However, some countries have limited reported cases due to the scarcity of COVID-19 test kits and other unknown reasons that shrink the rate of confirming patients affected with COVID-19 cases and associated deaths. A recent report from WHO shows that on 28 January 2022, there were 364,191,494 confirmed cases of COVID-19 including 5,631,457 deaths (WHO, 2024). Approximately 375 million cases of COVID-19 were detected in the United States, 75 million cases in India, 25 million instances in Brazil, 16 million cases in the United Kingdom, 11 million cases in Russia, 10 million cases in Italy, 9 million cases in Spain and 6 million cases in Iran in between 2019 and 2020 (Sanyaolu et al., 2021). Moreover, the African regions were affected provinces by the COVID-19 virus as Africa is the least developed continent in terms of human and non-human development that are found to be the wickedest affected continent by COVID-19 infection with cases and death forecasted to overwhelming health services (Tessema et al., 2021).
The pandemic spread increased over 2 years that is the scientist and health system industries to strain on the reduction strategies for the spread of coronavirus through the introduction and testing of industrial vaccines as the only means to increase immune boosting stabilities to reduce the widespread rate of coronavirus pandemic (Adu et al., 2022). The majority of the studies have been done to assess the efficacy of the COVID-19 vaccine, and their findings indicate that the vaccine has a significant preventive effect against COVID-19 infection. The knowledge, attitude and intention to receive vaccines were the potential pillars of increasing COVID-19 vaccine uptake, which is relatively linked with the reduced burden of COVID-19 infections around the globe (Kumar et al., 2021). Nevertheless, Kumar et al. (2021) and Shah et al. (2022) have highlighted that amidst several drivers, individual's attitude and beliefs about the vaccine has a significant influence choices and willingness to take it or not.
The 6.4 billion vaccine doses have been administered around the globe. However, only 2.5% have been administered in African regions (Watson et al., 2021). The COVID-19 vaccine task force has focused on the companies to prioritize and fulfil their contracts to the African vaccine trust, working with the government and private sectors to ensure high uptake of the vaccine in low- and middle-income countries in Africa and beyond (Ferdinands et al., 2022). However, African regions have the lowest number of research on COVID-19 vaccine prevalence, knowledge, attitude and willingness among adult populations that if known might bring light to the need for community-based vaccine sensitization programmes to raise the uptake of the COVID-19 vaccine among them (Sirikalyanpaiboon et al., 2021).
Despite the task force focused on the availability and accessibility of the vaccine, the low uptake of vaccine continues to prevail in low- and middle-income countries including Tanzania. Currently, 39,679,845 were confirmed COVID-19 cases and death respectively in Tanzania. According to the WHO statistics, a total of 28,091,873 vaccine doses have been administered in Tanzania, which indicates a low uptake of the COVID-19 vaccine as compared to 63,652,891 current populations (Mnyambwa et al., 2022). Studies have shown that some beliefs, religious commandments, duration of vaccine, culture, rumours and negative influences by social media were the contributing determinants of low uptake of the COVID-19 vaccine among people (Terry et al., 2022).
Moreover, low knowledge, negative attitude and unsatisfactory intentional practice were studied by the majority of literature including the study done by Adane et al. (2022) being the major barriers to COVID-19 vaccine uptake among healthcare workers. Based on the reviewed literature and reports, there appears a need of researching to examine knowledge, attitude and individualized determinants to map the trend of COVID-19 vaccine uptake among adults in developing countries Tanzania inclusive (Al et al., 2022). The country has implemented many strategies to control and prevent the COVID-19 pandemic including restriction of mass media gatherings, influencing social distancing, not shaking hands, promoting the use of personal protective equipment including face masks and use of vaccines as global strategies to prevent the spread of COVID-19 infections.
The positive implementation, prevention and mechanism control approaches necessitate harmonization, consistent approach and courageous public health leadership and political will to promote knowledge on the COVID-19 vaccine as the preventive measure to minimize the risk of infections (Dadras et al., 2021). Vaccine acceptance is the gradation to which individuals agree, question or reject the vaccination, which was highlighted as the rate of vaccine distribution and success. The argument over the efficacy, reliability and validity of vaccination has expanded momentum from one place to another, contributing a severe global public health vaccine uptake challenges including in developing countries (Sirikalyanpaiboon et al., 2021). Several studies around the world have reported hesitancy towards the COVID-19 vaccine among the public and this was reflected in different review studies across the world (Arası et al., 2021; He et al., 2022; Parsons et al., 2022).
The uptake of the COVID-19 vaccine has shown up rapidly in developed countries as compared to African countries in 2021, which showed resistance, refusal and hesitancy of COVID-19 vaccine use. The majority of the population in middle- and low-income counties were doubtful about getting the COVID-19 vaccine, which contributed to the low uptake vaccine. However, currently, several countries in Africa that struggled to get their COVID-19 vaccination responses off the ground in 2021 have made notable progress in scaling up their initial series for the first 6 months (Bwire et al., 2022). The coverage in Ethiopia raised from 3.5% to 33%, Ivory Coast from 9% to 25.8%, Zambia from 3.5% to 3.2% and Uganda from 4.4% to 25.5%.
The increase in coverage simply means a rise in vaccine uptake; however, the strategies have not reach the targeted population which resembles the ideal low uptake of the COVID-19 vaccine among adults in East Africa including Tanzania (Huda et al., 2022). The adults and elderly are the key potential population to receive the vaccine as a preventive measure despite their low immunity, and it is important to provide unlimited education on the advantages of vaccination. The acceptance and knowledge of the COVID-19 vaccine were influenced by the healthcare workers' thorough provision of health education as the important aspects of spreading knowledge and attitude that might influence the uptake of vaccination among the adult population (Samanta et al., 2022).
There seems importance to assess the knowledge, attitude and determinants of COVID-19 vaccine uptake to establish the indicators that predict its uptake among adults in Tanzanian context because some scholarly works including the review done in 33 countries and empirical study in India (Kumar et al., 2021) indicated that individualized attributes have a significant effect on the refusal and hesitance in uptaking the vaccine among people (Adu et al., 2022). Moreover, other scholars have established that the hesitancy to take vaccine may sometimes be significantly linked to people's mistrust of the vaccine (attitude and beliefs), lack of information, the contradiction in official information, vaccine safety and effectiveness (Bwire et al., 2022). It has unfortunately seemed that the low uptake of the vaccine is declining safety, reliability and some other traditional errors that might need society to be educated for raising the uptake of the COVID-19 vaccine among people (Nasr et al., 2021).
There are still some individual determinants that might lead to delayed decisions or even refusal of the acceptance of the COVID-19 vaccine including perception, demographic features and political standing points that were studied in several studies (Jairoun et al., 2022). Despite the effort made by the Tanzanian government, private sectors, agencies and stakeholders, the number of people receiving the vaccine is still low that causing an increased rate of infection among adults. There is limited scholarly information on the individualized factors, knowledge, attitude and perception of the COVID-19 vaccine that is directly linked with low uptake of the vaccine among adults. The perspective of the analysed situation and findings from previous studies calls for a need for scientists and researchers to think twice about the related determinants that are found to thwart the uptake of the COVID-19 vaccine among adults in Tanzania. Therefore, this study intended to assess knowledge, attitude, intention to practice and individualized determinants of COVID-19 vaccine uptake among adults aged 18 and above in Dodoma region, the Central part and the Capital city of Tanzania.
2 METHODS
Ethics and procedure were performed as per the regulations and guidelines after being approved and given an ethical clearance by the Institutional Research Review Ethics Committee (IRREC). Written informed consent was obtained from all study participants who demonstrated a willingness to participate in the study.
2.1 Study design and approach
A hospital-based analytical cross-sectional study design in a quantitative research approach was adapted to quantify, adults' knowledge, attitude, intentional practice and determinants of COVID-19 vaccine uptake in the Dodoma region, Tanzania from March to June 2022.
2.2 Study settings and targeted population
Dodoma is the capital city located in the central zone of Tanzania with about 2,083,588 populations. Despite being the growing academic centre, and the political and economic hub of the country, the region was selected because it has demonstrated a remarkable increase in the population. The study was conducted in four levels of health facilities including referral hospitals, district hospitals, health centres and dispensaries found within the Dodoma region. Adults were defined as any individual aged >18 years be it young adults, middle adults or older adults residing in Dodoma region, Tanzania.
2.3 Sampling procedure and sample size
As shown in Table 1, the study involved 312 out of 12,584 randomly sampled adults in the Dodoma region. As it has also been used by some previous studies (Millanzi, 2022; Millanzi et al., 2020, 2021; Millanzi, Herman, & Ambrose, 2023; Millanzi, Herman, & Mtangi, 2023; Millanzi, Osaki, et al., 2023; Mwanja et al., 2023; Shitindi et al., 2023), a proportionate formula was adopted based on the available number and level of health facilities that were stratified into dispensaries (n = 1: in one district) health centres (n = 2: in three districts), district hospitals (n = 2: in 6 districts) and referral hospital (n = 1: in Dodoma region). A simple random sampling technique by lottery methods was used to get study participants.
| Levels of health facilities | Available adults in OPD | Required sample |
|---|---|---|
| n = [p1 × (n÷p)] | ||
| Regional referral hospital | 7205 | 179 |
| District hospitals | 2950 | 73 |
| Health centres | 1984 | 49 |
| Dispensaries | 445 | 11 |
- Source: Study plan (2022).
2.4 Inclusion and exclusion criteria
The study includes all adults aged 18 years and above who resided in the Dodoma region and were available during the time of study and agreed to participate in the current study. On the other hand, individuals having health problems or disabilities and those who reported being part of other projects or had other special duties were excluded from this study.
2.5 Data collection procedure
As done by previous scholars (Millanzi et al., 2021; Nyampundu et al., 2020; Salim et al., 2022; Yustus et al., 2024), a separate convenient room was used as an unoccupied space for data collection. The principal investigator assisted by the trained research assistants collected data on knowledge, attitude, intentional practice and individualized factors on COVID-19 vaccine uptake among adults. The research assistants were oriented on the tools and the process of data collection to familiarize themselves before the actual collection of data. The questionnaire was translated from English to Kiswahili version for easy readability and understanding based on the literacy levels of the study participants. Participants were seated in separate independent chairs to minimize copying, discussing, sharing and pasting the response from one another. The guided self-administered questionnaire with closed-ended questions with a duration of a maximum of 30–45 min was then administered to gather data from the study participants. Codes were used in the place of participants' names in the questionnaire to assure privacy and confidentiality. All participants consented and were able to read and write the Swahili language and filled out the questionnaires.
2.6 Data collection tools and variable measurement
All research tools were adapted from reliable sources and shared with experts and colleagues to check the clarity, contents and language. The tools were confirmed to be clear and no further editing and deletion of the items were done, but it was translated into the Swahili language to blend to the literacy level of the study participants. As suggested by previous scholars (Millanzi, Herman, & Ambrose, 2023; Millanzi, Herman, & Mtangi, 2023; Mwanja et al., 2023; Shitindi et al., 2023), the data collection tool was pre-tested among 30 adults aged 18 years and above at a different location from where the actual data collection was conducted to assure its validity and reliability. Respondents filled all items in the questionnaires entirely. The findings for each tool were subjected to reliability scale analysis to determine their Cronbach's alpha values. The findings of the scale analysis on knowledge, attitude and intention to practice variables were 0.842, 0.90 and 0.850 which are based on the recommendations from previous studies (Lima et al., 2012; Taber, 2018) (>0.7) which were statistically significant, respectively.
The questionnaires consisted of 50 items categorized into 4 parts including a sociodemographic profile (20 items), knowledge (10 items), attitude (10 items) and intentional practice (10 items). The measurement of the variables in this study was informed by previous studies. Knowledge items had “Yes” and “No” responses of which those whose response was “Yes” weighed 1 point indicating the correct response, otherwise “No” response to “0” indicating the incorrect response. The highest point for knowledge was defined as “Adequate” knowledge, and the lowest point was defined as “Inadequate” knowledge. Attitude items were on 5-point Likert scale ranging from 1 strongly disagree to 5 strongly agree. For the descriptive purpose, item responses were transformed into agree, neutral and disagree responses. The highest score was given a “positive,” disagree was termed a “Negative,” and the medium point was “neutral.” Intention to uptake the vaccine had “Yes” and “No” responses of which those whose response was “Yes” weighed 1 point indicating that they were willing, otherwise “No” responded to “0” indicating that they were not willing. The highest score was categorized as “Willing,” while the lowest score was categorized as “Not willing” and the medium score was categorized as “Neural.” The prevalence of the vaccine was assessed whether the participant received the COVID-19 vaccine to identify the uptake of the vaccine within the selected study participants.
2.7 Data analysis
3 RESULTS
The findings of the current study were given based on acknowledged models adopted to analyse data among sampled adults aged above 18 years. The variables including demographic profile, knowledge, attitude and intentional practice were used to determine the uptake of the COVID-19 vaccine among adults.
3.1 The proportional distribution of individual demographic among adults aged above 18 years
This part presents the descriptive findings of sociodemographic profiles among adults aged 18 years and above. The findings in Table 2 indicate that 25 years ± 6.503 was the participants' mean age of which a significant number of them 93.6% (n = 292) were aged ranging between 36 and 55 years while 61.5% (n = 192) of the study participants were males. 74.1% (n = 231) of the participants had a college-level education, and 81.1% (n = 253) and 75.3% (n = 235) of them were married and living in urban areas, respectively. However, 58.3% (n = 182) of the study participants were peasants, while 80.4% (n = 251) of them were living families headed by men. Refer to Table 2 for other participants' sociodemographic characteristics profiles.
| Variables | Frequency (%) |
|---|---|
| Age | M = 25 years ± 6.503 |
| 18–35 years | 16 (5.1) |
| 36–55 years | 292 (93.6) |
| 56–65 years | 4 (1.3) |
| Sex | |
| Male | 192 (61.5) |
| Female | 120 (38.5) |
| Education level | |
| Primary | 45 (14.4) |
| Secondary | 36 (11.5) |
| College/above | 231 (74.1) |
| Type of family | |
| Nuclear family | 181 (58.1) |
| Extended family | 59 (18.9) |
| Single parent family | 72 (23.0) |
| Marital status | |
| Single | 45 (14.4) |
| Married | 253 (81.1) |
| Divorced | 14 (4.5) |
| Occupation | |
| Peasant | 182 (58.3) |
| Business | 101 (32.4) |
| Employed | 29 (9.3) |
| Head of family | |
| Father | 251 (80.4) |
| Mother | 36 (11.6) |
| Father and mother | 17 (5.4) |
| Others | 8 (2.6) |
| Religion | |
| Christian | 174 (55.8) |
| Muslim | 138 (44.2) |
| Current residence | |
| Rural | 77 (24.7) |
| Urban | 235 (75.3) |
| How long do you spend walking from home to health facility | |
| Less than 1 h | 142 (45.5) |
| More than 1 h | 170 (54.5) |
| Do you watch television | |
| Yes | 243 (77.9) |
| No | 69 (22.1) |
| Do you own TV | |
| Yes | 83 (26.6) |
| No | 229 (73.4) |
| Do you read newspapers | |
| Yes | 108 (34.6) |
| No | 204 (65.4) |
| Means of transportation | |
| By foot | 98 (31.4) |
| By public transport | 210 (67.3) |
| By private car | 4 (1.3) |
| Income | |
| Under 1US dollar | 200 (64.1) |
| Over 1US dollar | 112 (35.9) |
- Source: Field data (2022).
3.2 Prevalence of COVID-19 vaccine uptake among adults aged 1 above 18 years
This part is presented by the findings in Table 3 that show the prevalence of COVID-19 vaccine uptake among adults aged 18 and above who were included in this study. The findings in Table 3 revealed that 86.9% (n = 271) of the study participants were not vaccinated. These findings may be an impression that despite the governmental and other health stakeholders' efforts to promote the importance and advantages of the COVID-19 vaccine people are still hesitant to get vaccinated with it.
| Item | Frequency (%) |
|---|---|
| The prevalence of COVID-19 vaccine uptake | |
| Vaccinated | 41 (13.1) |
| Not vaccinated | 271 (86.9) |
- Source: Field data (2022).
3.3 The association between the uptake of the COVID-19 vaccine and the individual characteristics among adults aged above 18 years
Binary and multivariate logistic regression analyses were performed to determine the association between the study participants' sociodemographic characteristics profiles and the uptake of the COVID-19 vaccine. The findings in Table 4 indicate that the odds of being male (AOR = 1.723, p < 0.05; 95% CI: 4.946, 4.830); living in a nuclear family (AOR = 2.015, p < 0.05; 95% CI: 1.801, 5.209); living in extended families (AOR = 1.057, p < 0.05; 95% CI: 0.703, 3.018); families headed by men (AOR: 1.117; p < 0.05; 95% CI: 0.027, 3.502); and being married (AOR = 1.181, p < 0.05; 95% CI: 0.081, 3.736) on influencing the uptake of COVID-19 vaccine among adults were significantly high as compared to other factors. Nevertheless, study participants who were educated to secondary level (AOR: 1.547; p < 0.05; 95% CI: 1.863, 2.468); above college level (AOR = 5.105, p < 0.05; 95% CI: 2.377, 10.964), living in rural areas (AOR: 1.027; p < 0.05; 95% CI: 0.019, 3.739); and were able to read newspapers (AOR = 1.012, p < 0.05; 95% CI: 0.107, 2.108) were one time more likely to be vaccinated with COVID-19 vaccine than their counterparts. Other findings are shown in the table.
| Variables | COR | p-value | 95% CI | p-value | AOR | 95% CI | ||
|---|---|---|---|---|---|---|---|---|
| Lower | Upper | Lower | Upper | |||||
| Sex | ||||||||
| Male | 2.906 | 0.010 | 1.293 | 6.527 | 0.023 | 1.723 | 0.946 | 4.830 |
| Female | Ref | |||||||
| Types of family | ||||||||
| Nuclear family | 4.570 | 0.015 | 1.348 | 7.486 | 0.021 | 2.015 | 1.801 | 5.209 |
| Extended family | 3.602 | 0.007 | 1.912 | 6.275 | 0.025 | 1.057 | 0.703 | 3.018 |
| Single parent family | Ref | |||||||
| Marital status | ||||||||
| Single | 1.103 | 0.061 | 0.181 | 3.143 | 0.091 | 0.223 | 0.019 | 1.437 |
| Married | 2.193 | 0.001 | 1.049 | 4.503 | 0.012 | 1.181 | 0.081 | 3.736 |
| Divorced | Ref | |||||||
| Head of family | ||||||||
| Father | 1.151 | 0.010 | 0.636 | 3.635 | 0.034 | 1.117 | 0.027 | 3.502 |
| Mother | 0.125 | 0.019 | 0.022 | 2.707 | 0.045 | 0.074 | 0.012 | 1.449 |
| Others | Ref | |||||||
| Current residence | ||||||||
| Rural | 1.311 | 0.016 | 0.633 | 3.716 | 0.023 | 1.027 | 0.019 | 3.739 |
| Urban | Ref | |||||||
| Education level | ||||||||
| Primary | Ref | |||||||
| Secondary | 2.652 | 0.010 | 1.580 | 5.255 | 0.032 | 1.547 | 1.863 | 2.468 |
| College/above | 4.546 | 0.001 | 1.173 | 7.511 | 0.011 | 3.105 | 1.077 | 6.964 |
| Reading newspapers | ||||||||
| Yes | 1.142 | 0.001 | 0.051 | 3.393 | 0.019 | 1.012 | 0.107 | 2.108 |
| No | Ref | |||||||
| Owning mobile phone | ||||||||
| Yes | 1.347 | 0.001 | 0.148 | 3.811 | 0.059 | 0.089 | 0.008 | 1.057 |
| No | Ref | |||||||
- Note: The bolded values indicate statistical significant association between a specific independent variable/factor and the outcome variable under study.
- Source: Field data (2022).
3.4 The proportional distribution of the overall levels of knowledge on the COVID-19 vaccine among adults aged above 18 years
Descriptive analysis was performed to establish the frequency and percentage of participants' COVID-19 vaccine knowledge. Findings in Table 5 revealed that 57.7% (n = 180) of the study participants had an inadequate understanding of the COVID-19 vaccine. They demonstrated to be less knowledgeable about it despite they knew about COVID-19 infection. This piece of a finding may suggest that people were either not reached with the vaccine education/sensitization programmes at the community level, perceived less severity of the pandemic, or media, religious facilities and political organs including healthcare facilities were behind in educating people about the importance and advantages of the vaccine in the day-to-day life.
| Item | Frequency (%) |
|---|---|
| The levels of knowledge | |
| Adequate knowledge | 132 (42.3) |
| Inadequate knowledge | 180 (57.7) |
- Source: Field data (2022).
3.5 Determinants of knowledge on COVID-19 vaccine among adults aged above 18 years
Binary logistic regression analysis was performed to determine the association between the sociodemographic characteristics profiles of the study participants and the levels of knowledge on the COVID-19 vaccine. Findings in Table 6 show that study participants who were living in rural settings (AOR = 1.491; p < 0.05; 95% CI: 0.085, 4.429); walking on foot (AOR = 2.197; p < 0.05; 95% CI: 1.917, 6.189); travelling using public transport (AOR = 1.798; p < 0.05; 95% CI: 0.898, 4.896); having habits of watching television (AOR = 1.310; p < 0.05; 95% CI: 0.148, 4.978); and study participants who were residing less than 1 h distance from health facilities (AOR = 1.182; p < 0.05; 95% CI: 0.122, 4.246) were more times likely to have a good understanding of the COVID-19 vaccine than others. Other findings were found not significantly associated with participants' COVID-19 vaccine as shown in the table (p > 0.05), respectively.
| Variables | COR | p-value | 95% CI | p-value | AOR | 95% CI | ||
|---|---|---|---|---|---|---|---|---|
| Lower | Upper | Lower | Upper | |||||
| Religion | ||||||||
| Christian | 2.594 | 0.001 | 1.620 | 4.154 | 0.065 | 1.890 | 0.960 | 3.757 |
| Muslim | Ref | |||||||
| Current residence | ||||||||
| Rural | 2.832 | 0.004 | 0.492 | 5.408 | 0.017 | 1.491 | 0.085 | 4.429 |
| Urban | Ref | |||||||
| Occupation | ||||||||
| Peasant | 0.491 | 0.153 | 0.085 | 2.304 | 0.210 | 0.079 | 0.019 | 1.329 |
| Business | 0.174 | 0.063 | 0.072 | 2.423 | 0.086 | 0.045 | 0.002 | 1.165 |
| Students | 0.871 | 0.239 | 0.188 | 2.957 | 0.605 | 0.346 | 0.047 | 1.259 |
| Employed | Ref | |||||||
| Income | ||||||||
| >1USD | 1.284 | 0.061 | 1.029 | 3.317 | 0.086 | 0.069 | 1.012 | 2.231 |
| <1USD | Ref | |||||||
| Means of transportation | ||||||||
| On foot | 4.125 | 0.001 | 1.895 | 9.836 | 0.012 | 2.197 | 1.917 | 6.189 |
| Public transport | 2.687 | 0.001 | 1.687 | 5.687 | 0.031 | 1.798 | 0.898 | 4.896 |
| Private car | Ref | |||||||
| Watch television | ||||||||
| Yes | 2.213 | 0.001 | 0.185 | 3.563 | 0.045 | 1.310 | 0.148 | 4.978 |
| No | Ref | |||||||
| Listen radio | ||||||||
| Yes | 2.003 | 0.006 | 1.220 | 5.278 | 0.064 | 1.974 | 0.960 | 4.057 |
| No | Ref | |||||||
| Distance to health facility | ||||||||
| >1 h | 2.219 | 0.001 | 1.403 | 5.509 | 0.022 | 1.182 | 0.122 | 4.246 |
| <1 h | Ref | |||||||
- Note: The bolded values indicate statistical significant association between a specific independent variable/factor and the outcome variable under study.
- Source: Field data (2022).
3.6 Proportional distribution of attitude on COVID-19 vaccine among adults aged above 18 years
The descriptive findings in Table 7 indicate the proportional distributions of participants' attitudes towards the COVID-19 vaccine. 61.5% (n = 192) and 20.2% (n = 63) of them had a negative attitude and a neutral point towards the COVID-19 vaccine, which may disseminate a message that the majority of the study participants either perceived COVID-19 infection was of less dangerous or held a belief that the COVID-19 vaccine had some adverse health outcomes that would persist in their entire life and the lives of a new generation. Refer to the table for more findings.
| Items | Frequency (%) |
|---|---|
| The levels of attitudes | |
| Positive attitude | 57 (18.3) |
| Negative attitude | 192 (61.5) |
| Neutral | 63 (20.2) |
- Source: Field data (2022).
3.7 Determinants associated with attitude towards COVID-19 vaccine among adults aged above 18 years
Multivariate logistic regression analysis was performed to determine the association between the attitude regarding the COVID-19 vaccine and the participants' sociodemographic characteristics profiles. Findings in Table 8 depict that the odds of study participants being male (AOR = 1.549; p < 0.05; 95% CI: 0.264, 4.142); having been educated to secondary education level (AOR = 1.177; p < 0.05; 95% CI: 0.345, 4.702); and working as a peasant (AOR: 2.013; p < 0.05; 95% CI: 1.352, 6.521) were statistically significantly high on influencing them to have positive attitude towards COVID-19 vaccine than their counterparts. Refer to the findings in the table.
| Variables | COR | p-value | 95% CI | p-value | AOR | 95% CI | ||
|---|---|---|---|---|---|---|---|---|
| Lower | Upper | Lower | Upper | |||||
| Sex | ||||||||
| Male | 2.821 | 0.035 | 1.440 | 5.532 | 0.044 | 1.549 | 0.264 | 4.142 |
| Female | Ref | |||||||
| Education | ||||||||
| Primary | 0.893 | 0.188 | 0.393 | 2.031 | 0.464 | 0.493 | 0.060 | 1.084 |
| Second | 2.346 | 0.016 | 1.116 | 6.029 | 0.034 | 1.177 | 0.345 | 4.702 |
| College/above | Ref | |||||||
| Occupation | ||||||||
| Peasant | 3.677 | 0.009 | 0.152 | 8.013 | 0.032 | 2.013 | 1.352 | 6.521 |
| Business | 2.116 | 0.105 | 0.664 | 6.741 | 0.211 | 1.199 | 0.403 | 4.511 |
| Students | Ref | |||||||
- Note: The bolded values indicate statistical significant association between a specific independent variable/factor and the outcome variable under study.
- Source: Field data (2022).
3.8 Proportions of intentional practice on COVID-19 vaccine uptake among adults aged above 18 years
Descriptive analysis was performed to establish frequencies and percentages of the participant's willingness to be vaccinated with the COVID-19 vaccine. Findings in Table 9 indicate that only 13.1 (n = 41) of the study participants were vaccinated with COVID-19 vaccine. 68.3% (n = 199) of them were not willing to be vaccinated with the COVID-19 vaccine, while 7.1% (n = 22) of the study participants were at a neutral point as to whether they were willing to be vaccinated or not. Nevertheless, 16.0% (n = 50) of the study participants were willing to be vaccinated with the COVID-19 vaccine. Refer to the table for more findings.
| Items | Frequency (%) |
|---|---|
| The overall intentional practice | |
| Willing | 50 (16.0) |
| Not willing | 199 (63.8) |
| Vaccinated | 41 (13.1) |
| Neutral | 22 (7.1) |
- Source: Field data (2022).
3.9 Association between knowledge, attitude and sociodemographic characteristics profiles on the intentional practice of COVID-19 vaccine uptake among adults aged above 18 years
Binary and multivariate logistic regression analyses were performed to determine the association between participants' characteristics, knowledge and attitude regarding the intentional practice of COVID-19 vaccine uptake. Findings in Table 10 demonstrate that male participants (AOR = 1.884; p < 0.05; 95% CI: 0.985, 3.606); participants who were Christians (AOR = 1.041; p < 0.05; 95% CI: 0.085, 3.606); working as peasants (AOR = 1.024; p < 0.05; 95% CI: 0.062, 2.803); having primary education (AOR = 1.208; p < 0.05; 95% CI: 0.649, 4.677); having good understanding about the vaccine (AOR = 1.261; p < 0.05; 95% CI: 0.387, 3.684); and having positive attitude towards the vaccine (AOR = 1.088; p < 0.05; 95% CI: 0.575, 3.056) were one time more likely to demonstrate willingness to be vaccinated with COVID-19 vaccine against their counterparts. Refer to the table for more findings.
| Variables | COR | p-value | 95% CI | p-value | AOR | 95% CI | ||
|---|---|---|---|---|---|---|---|---|
| Lower | Upper | Lower | Upper | |||||
| Sex | ||||||||
| Male | 2.140 | 0.003 | 1.300 | 4.524 | 0.012 | 1.884 | 0.985 | 3.606 |
| Female | Ref | |||||||
| Religion | ||||||||
| Christian | 1.893 | 0.032 | 0.561 | 3.420 | 0.045 | 1.041 | 0.085 | 3.606 |
| Muslim | Ref | |||||||
| Occupation | ||||||||
| Peasant | 1.487 | 0.030 | 0.628 | 3.261 | 0.043 | 1.024 | 0.062 | 2.803 |
| Business | 2.833 | 0.053 | 1.724 | 6.824 | 0.087 | 1.991 | 0.786 | 4.144 |
| Employed | Ref | |||||||
| Education | ||||||||
| Primary | 2.187 | 0.002 | 1.623 | 5.261 | 0.019 | 1.208 | 0.649 | 4.677 |
| Secondary | 0.789 | 0.096 | 0.237 | 2.983 | 0.169 | 0.149 | 0.097 | 1.798 |
| College/above | Ref | |||||||
| Knowledge | ||||||||
| Adequate | 2.115 | 0.002 | 1.322 | 5.384 | 0.011 | 1.261 | 0.387 | 3.684 |
| Inadequate | ||||||||
| Attitude | ||||||||
| Positive | 2.429 | 0.022 | 1.599 | 5.786 | 0.036 | 1.088 | 0.575 | 3.056 |
| Neutral | 0.580 | 0.095 | 1.099 | 0.306 | 0.150 | 0.622 | 0.326 | 1.187 |
| Negative | Ref | |||||||
- Note: The bolded values indicate statistical significant association between a specific independent variable/factor and the outcome variable under study.
- Source: Field data (2022).
4 DISCUSSION
The current study assessed knowledge, attitude and intentional practice of COVID-19 vaccine uptake that were linked with the individualized sociodemographic characteristics profiles that would be associated with the uptake of vaccines among adults aged above 18 years. Findings revealed that the majority of the study participants were not vaccinated. The uptake of the COVID-19 vaccine among the studied study participants was significantly low. The low uptake of the vaccine was linked to inadequate knowledge and negative attitude towards the efficacy, effectiveness, mistrust, beliefs, myths and cultural practice that contributed to an unwillingness to receive the COVID-19 vaccine. Findings of the study indicated that the majority of the study participants reported that healthcare workers demonstrated hesitancy to administer the vaccine to them due to the fear of vaccine safety, efficacy and inability to reach the majority of the population. Similar findings were observed from the findings of the study done by Vincze et al. (2022) and Young-Xu et al. (2021) on the coverage of vaccines among healthcare workers that indicated only a few healthcare workers received the COVID-19 vaccine.
Moreover, it was found that most of them demonstrated a low understanding of the vaccine, had negative attitudes towards the COVID-19 vaccine and were not willing to be vaccinated with it. These findings implied that the knowledge and attitude among adults towards the COVID-19 vaccine varied across geographical locations and diverse populations in Tanzania. Factors including religion, occupation, residence, income, means of transport and watching television had a statistically significant influence on the participants' knowledge of the COVID-19 vaccine attitude and willingness to be vaccinated with it. Although some study participants demonstrated that they had heard about the COVID-19 vaccine from social media, newspapers, radio, television and other web-based official and non-official platforms, the majority of them who lived in rural areas were found to have difficulty access on social media platforms for COVID-19 vaccine information; thus, they accessed the information from community and church leaders.
On the other hand, factors including sex, education level and occupation were found to have a significant association with the attitude towards COVID-19 vaccine uptake. The study revealed that those who had college and above education level demonstrated a positive attitude to accept the vaccine. Similarly, the findings of the study done by Hassen et al. (2021) and Aklil (2022) uncovered that individualized attributes such as knowledge, attitude, perception and age are probably significant drivers for people to demonstrate willingness and choose to take COVID-19 vaccine following their belief that vaccines are beneficial in protecting their health. The correspondences of the findings were observed from the study by Gray and Fisher (2022) on the determinants of COVID-19 vaccine uptake, whereas it was found that individual's age and family income knowledge were factors associated with vaccine acceptance. Similar findings were observed from the study done in India by Kumar et al. (2021) that aimed at assessing COVID-19 vaccine acceptability, determinants of potential vaccination and hesitancy in public for effective health communication among adults visiting tertiary care hospital. Findings of the study indicated three categories of adults including approximately half of them (53.4%) who were interested and willing to take the vaccine, some (19.4%) of adults were not interested to take it and the rest did not even intend on taking COVID-19 vaccine at all.
The hesitancy to take the vaccine among adults was significantly linked with their gender; lack of information regarding the safety of vaccines; perceived severity and susceptibility to contact coronavirus disease in the next 6 months after the study; awareness about the availability and accessibility of the vaccine; availability of Indian manufacturing companies for the vaccine; family history of laboratory-confirmed cases; and/or individual's health status. The observed findings may imply that majority of people still hold negative beliefs towards COVID-19 vaccine including the shared mind that they are bad for their health and thus there is a need to provide health-related education to the targeted population to enhance vaccine coverage and uptake. Moreover, there was a cross-section study, which was conducted by Dagnew Baye et al. (2022) in Northwest Ethiopia on attitude and level of COVID-19 vaccination and its determinants among patients with chronic disease visiting Debre Tabor Comprehensive Specialized Hospital.
Finding of their study showed that the uptake of any COVID-19 vaccine was very low by 29.6%, of individuals aged between 31 and 40 years; college and above education; positive attitude towards the vaccine; good understanding about the vaccine; history of being infected by COVID-19; and/or not tested for the disease were significantly associated with the uptake of COVID-19 vaccine. These similarities may be linked to matching in geographical location, cultural perspectives and the nature of the study participants recruited between studies. However, the unlike findings of this study about the uptake of the COVID-19 vaccine among adults, findings, which were observed from the study conducted in Malawi by Moucheraud et al. (2023) on the uptake of COVID-19 vaccine among healthcare workers revealed that 82.5% of them received the vaccine. Factors such as individualized attributes such as eagerness to be vaccinated; safety of the vaccine; and/or vaccine benefits were significantly associated with the uptake of vaccines among healthcare workers. The dissimilarities of findings between the two studies might be attributed by the nature of the study population which implies that there is a significant priority in including 10 communities to be empowered about the significance of using the COVID-19 vaccine to enhance the coverage of vaccine at different levels including community.
Finding of the intentional practice of the COVID-19 vaccine revealed that the majority of study participants were not willing to accept the vaccine as compared to those who were willing and who received the vaccine. Factors including sex, religion, adequate knowledge, positive attitude, educational level and occupation showed a significant association with intention to practice COVID-19 vaccine uptake. The findings of this study are similar to the study done by Kabiri et al. (2021) which revealed that the level of education and social media were found to have a significant knowledge of COVID-19 vaccine uptake. These findings indicate that the more knowledge and a positive attitude an individual has, the more willing s/he is to receive vaccines. Individualized factors including males were found to be willing to accept the COVID-19 vaccine as compared to female participants. The findings were similar to those of the systematic review and meta-analysis on factors associated with COVID-19 vaccine intention that indicated male participants were more likely to receive the vaccine as compared to females (Terry et al., 2022). The similarities of the findings might be due to the matching in the study population, geographical location and study designs.
Moreover, the findings of the study done by Adane et al. (2022) in Northeastern Ethiopia among 404 healthcare workers on COVID-19 vaccines knowledge, attitude and perception indicated that majority of them had good knowledge, good perception and positive attitude about the vaccine. Nevertheless, 64.0% of healthcare workers demonstrated willingness to be vaccine against 36.0% of them who shared their intention to refuse taking it. Findings imply that the probability of people to take any COVID-19 vaccine doses might be significantly linked with their levels of understanding and attitude towards it. The proportion of vaccine uptake was high among healthcare workers probably due to the fact that based on the nature of their professions, they might sometimes be required to be vaccinated first before they attend patients/clients and educated frequently about the vaccine as compared to the study population of the current study who had different levels of ordinary/basic education and residential location than they would have professional educational backgrounds.
Kumar et al. (2021) conducted a quick Online Survey in India on the determinants of COVID-19 vaccination willingness among healthcare workers. Findings of the study indicated that high proportion (73.0%) of healthcare workers demonstrated willingness to take the vaccine; 10.9% of them refused and 16.2% healthcare workers reported a need for them to have sometimes to decide for it. Their willingness to take the vaccine was significantly associated with their gender; occupation; working status as front-line workers; vaccine manufacturing country preferences; and perceived susceptibility of being infected with COVID-19. These findings look similar to the findings of the current study probably because of the similarities in the study context and intent.
These findings were similar to the findings of the study done by Id et al. (2021, 2022); Mohammed et al. (2022); and Sirikalyanpaiboon et al. (2021), which revealed that hesitancy about COVID-19 was associated with moderate knowledge, which accelerated the reluctance of people to the COVID-19 vaccine. Based on the discussion of findings made in this section, it appears that findings of the current study and those from some previous scholarly works have added new knowledge that the uptake of COVID-19 vaccine among people is still low. Factors ranging from individual attributes such as gender; education level; occupation; knowledge; and/or attitude to family variables demonstrated a significant influence to their competencies and uptake of the vaccine.
5 CONCLUSION
This study discovered that there was low uptake of the COVID-19 vaccine among adults. The majority of the study participants had inadequate knowledge and negative attitudes towards COVID-19 vaccines, and thus, they demonstrated unwillingness to be vaccinated with it. More than half of the study participants were not willing to receive the COVID-19 vaccine. The sociodemographic characteristics profiles of the study participants were significantly associated with their knowledge, attitude and intentional practices of COVID-19 vaccine uptake. The majority of the participants who were in rural geographical locations had low uptake of the vaccine as compared to those who resided in urban settings probably due to the limited use of mass media including television, newspaper, and social media platforms, and the use of mobile phones (smartphone). The findings may also suggest the need to develop and apply physical-based community facilitation campaigns on the nature of problem-based models that might empower adults with knowledge, positive attitude and intention on coronavirus infection and the importance of being vaccinated by the COVID-19 vaccine.
6 RECOMMENDATION
This study recommends the strengthening and establishment of a COVID-19 vaccine education programme at the community level to easily reach adults, health facilities and the community in general to catalyse its uptake. Initiatives such as home visiting, phone calls and/or community-based visits may be encouraged and given priority to strengthening follow-ups with adults and the community at their homes to assure the uptake of the COVID-19 vaccine.
6.1 The strength of the study
This study has addressed very important issues regarding COVID-19 uptake among adults aged 18 years and above on the aspects of knowledge, attitude and intention to practise COVID-19 vaccine uptake. It also addressed SDG number 3 indicating good health and well-being through thorough, curative and preventive measures to assure the well-being of the community and to increase life expectancy using prophylaxis and vaccination.
6.2 Limitations of the study
The study was conducted in a very confined locality, and thus, findings may not be generalized to adults aged 18 years and above of other geographical locations than those residing in Dodoma region, the central part of Tanzania. The findings of this study have to be interpreted carefully since it involved a small sample based on the nature of the study. The study, moreover, did not use a triangulation approach for data collection, and thus, the rigour of dependability, transferability and/or conformability may have not been addressed in this study. Nevertheless, the findings of this study may need to be interpreted with caution, as adults would have faced recall problems remembering and sharing their previous vaccine.
AUTHOR CONTRIBUTIONS
Amimu A. Nassoro: Conceptualization, methodology, investigation and resources. Walter C. Millanzi: Conceptualization, methodology, supervision, data curation, formal analysis, original draft & writing and review & editing. Patricia Z. Herman: Conceptualization, methodology, writing and review & editing.
ACKNOWLEDGEMENTS
It is honoured to thank our Almighty God for the life and strengths of achieving this work. Heartfelt gratitude goes to the University of Dodoma (UDOM) and the managerial organs of health facilities within the Dodoma region for their willingness and support in offering ethical clearances. We acknowledge the readiness and consent among adults aged 18 and above to join and offer extensive teamwork in providing unlimited information throughout the study. Contributions of the above-mentioned organs/people have been substantial to the beneficiaries of this work.
FUNDING INFORMATION
This work did not receive any specific grant from funding agencies in a public, commercial or not for profit sectors.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
RESEARCH ETHICS COMMITTEE APPROVAL AND CONSENT TO PARTICIPATE
This was not an interventional study that involved experiments on live vertebrates and/or higher vertebrates. The study adhered to the institution's guidelines and Institutional Research Review Ethics Committee (IRREC) approved it with an approval letter referenced DJ.232/238/0-28. The principal investigator collected written informed consent from the participating respondents as one of the criteria to join the study after explaining to them about the advantages, disadvantages, their roles during the study and rights to withdraw from it at any time.
Open Research
DATA AVAILABILITY STATEMENT
Data will be available under special request at [email protected].
