Determinants of COVID-19 vaccine uptake among Nigerians: evidence from a cross- sectional national survey

doi:10.21203/rs.3.rs-2604251/v1

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Research Article

Determinants of COVID-19 vaccine uptake among Nigerians: evidence from a cross- sectional national survey

https://doi.org/10.21203/rs.3.rs-2604251/v1

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Journal Publication

published 26 May, 2023

Read the published version in Archives of Public Health →

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Objectives. This study assessed the factors influencing COVID-19 vaccine uptake among Nigerian households. Data from the COVID-19 High-Frequency Phone Survey of Households that was collected in late 2021-2022 by the National Bureau of Statistics was used for this study. Relevant data were analyzed using descriptive statistical tools and the multivariate binary logistic regression model.

Results: Out of 2370 respondents, only 32.8 percent of the respondents were vaccinated against COVID-19. Respondents living in urban areas (34.4%) had a higher level of COVID-19 vaccine uptake relative to those living in rural Nigeria (30.9%). Results from the Multivariate Regression model revealed that older adults, public servants, and those who obtained vaccine information from health workers, government, and the mass media were more likely to be vaccinated. The study also found respondents living in North Central, North East, South West and South South regions had higher odds of being vaccinated.

Conclusions: The study recommends increased media campaigns and advocacy for COVID-19 vaccination in the South East and North West regions. Younger persons should be targeted with COVID-19 information given that those aged 18-29 years were less likely to be vaccinated.

COVID-19

Nigeria

COVID-19 vaccine uptake

determinants

The coronavirus disease 2019 (COVID-19) is an acute respiratory disease caused by a novel coronavirus (SARS-CoV-2) that has received global attention.[1, 2] COVID-19 remains a public health issue with adverse impacts on food security, livelihoods and security globally.[3]

The World Health Organization (WHO) officially declared the COVID-19 pandemic a public health emergency of international concern on the 30th of January 2020.[1] The declaration ushered humanity into a new normal in which countries had to implement different control measures such as travel restrictions, phased lockdowns, ban on public gatherings and enforcement of mask use among others. The COVID-19 lockdown periods were associated with a 34.1 percent economic loss amounting to USD 16 billion in Nigeria’s Gross Domestic Product (GDP) with services and agriculture sectors being the worst hit.[4] Furthermore, about 60 percent of Nigerians were food insecure and this may have worsened due to the adverse impact of COVID-19.[5] Therefore, COVID-19 has multidimensional impacts on security, food security, and the economy.[6]

Recent data from the World Health Organization (WHO) revealed that over 651 million cases and 6.6 million deaths are attributed to COVID-19 globally.[7] In Nigeria, 266,057 cases with 3,155 deaths have been reported.[8] However, the trend is being reversed with the introduction of COVID-19 vaccines across the globe. Researchers and several pharmaceutical firms have developed and introduced COVID-19 vaccines to minimize the risk of COVID-19 -related deaths.[9, 10] Currently the WHO has approved 11 vaccines for emergency use listing[11], while Nigeria has only approved seven vaccines for emergency use listing namely Vaxveria (Oxford/AstraZeneca), Covishield (Serum Institute of India), Comirnaty (Pfizer/BioNTech), Jcovden (Johnson and Johnson) and Spikevax (Moderna), Sputnik V (Gamaleya) and Covilo (Sinopharm).[12, 13]

Vaccination has proven to be an effective public health intervention in reducing the burden of infectious diseases across the globe.[14, 15] The vaccines are safe and effective in preventing serious or fatal cases of COVID-19.[16] The COVID-19 vaccines have saved over 19 million lives across 185 countries thus reducing global deaths from COVID-19 by 63 percent.[17] However, the effectiveness of COVID-19 vaccine in preventing and mitigating the adverse impact of the disease is constrained by widespread hesitancy.[18, 19] About 111 million doses of the COVID-19 vaccines have been administered in Nigeria as of February 5, 2023.[20] Only 30.5% of the Nigerian population have full COVID-19 vaccination as of February 2023.[21] This rate is low relative to Nigeria’s 211 million population, hence the country missed the WHO’s 70 percent vaccination coverage targets by the end of June 2022.[9, 22, 23]. Although COVID-19 vaccines are available in-country, the underlying factors why low vaccine uptake exists require further investigation. Therefore, this study assessed the factors influencing the uptake of COVID-19 vaccine among a nationally representative sample of Nigerians. It is expected that the findings from this study will inform interventions aimed at improving COVID-19 vaccine uptake in Nigeria.

Sampling and Data Collection

This study analyzed secondary data from the COVID-19 High-Frequency Phone Survey of Households that were collected by the National Bureau of Statistics between November 2021 and January 2022. Specifically, the data from phase 2 round 1 Sections A,2,5,6, 9a and 12 of the phone surveys was analyzed in this study. The households were drawn from the sample of 4,976 households interviewed in 2018/2019 for Wave 4 of the General Household Survey-Panel (GHS-Panel) which served as the sampling frame. The sample of households is nationally representative as data was collected across the six geopolitical zones. In every visit of the GHS-Panel, phone numbers are collected from up to 4 members of each household or two non-members through which respondents can be reached in future surveys.

A total of 3,000 households were selected from the frame of 4,934 using the balanced sampling approach. However, the information from 2,370 household heads was utilized for this study.HH

The data provides information on the COVID-19 induced changes on food security, employment, income, access to basic services, coping strategies and vaccination.[24]

Data Analysis

The data were analysed using Stata version 15 (StataCorp, College Station, TX). Categorical variables were summarized using frequencies and percentages. Sampling weights were applied to all analysis and the unit of analysis was individuals (heads of household). The chi square test was conducted to assess association between categorical variables such as vaccine uptake versus sociodemographic characteristics. The outcome variable of interest was “ever received COVID-19 vaccine” which means the respondent has received at least one dose of the COVID-19 vaccine. Independent variables included age, place of residence (rural/urban), information sources about COVID-19 vaccine, geopolitical zones, occupation of household head, access to health insurance and Job loss due to COVID-19.

Frequencies and percentages were used to summarize categorical variables. The chi-square test was used for bivariate analysis to compare proportions between categorical variables. Multivariate binary logistic regression with odds ratio (OR) and 95% confidence intervals (CI) was used to assess factors influencing vaccine uptake. Multivariable binary logistic regression model was used to assess predictors of COVID 19 vaccine uptake. The level of statistical significance was set at 0.05

Approvals: Approval to download and analyse the dataset was obtained from the World Bank.

A total of 2370 responses were analyzed and 1593 (67.2%) persons were unvaccinated. Most of the respondents were within the 30-59 years’ age bracket (67.7%), more than half of the respondents across all age brackets were not vaccinated. Respondents who were less than 30 years old had the lowest vaccine uptake while those who were 60 years and above had the highest vaccine uptake. A higher proportion of females (69.8%) did not receive the COVID-19 vaccine.

Respondents living in urban areas had a slightly higher level of vaccine uptake (34.4%) compared to those living in rural Nigeria with 30.9 percent. Respondents who indicated that they received information about the COVID-19 vaccine from health workers, government sources had higher vaccination uptake and this was statistically significant (p<0.001). However, a lesser proportion of those who received information about COVID-19 vaccine from family and friends were vaccinated. (p<0.001) Across the geopolitical zones, Southwest recorded the highest COVID-19 vaccine uptake (43.2%) whereas North West had the lowest uptake (24.5%), p<0.001. Majority (50.5%) of the respondents who had access to health insurance were vaccinated and this was statistically significant (p=0.006). Respondents who were public servants had the highest vaccination rates (38.9%), while those who were unemployed were the least vaccinated (29.6%) and this was statistically significant (p =0.037). (Table 1)

Table 1: Distribution of the respondents by vaccination status, 2022

Variables	Vaccinated (n=777)	Non-vaccinated (n=1,593)	Total (n=2,370)	Statistical comparison
Age (years)
< 30	16 (19.3)	67 (80.7)	83 (3.5)	χ²= 6.593
30 - 59	529 (33.0)	1076 (67.0)	1605 (67.7)	p= 0.003
≥ 60	232 (34.0)	450 (66.0)	682 (28.8)
Sex
Male	681(33.2)	1371 (66.8)	2,052 (86.6)	χ²= 0.9743
Female	96 (30.2)	222 (69.8)	318 (13.4)	p= 0.509
Household size
1 to 6	415 (32.4)	866 (67.6)	1,281 (54.)	χ²= 0.078
>6	362 (33.2)	727 (66.8)	1,089 (46.0)	p= 0.849
Place of residence
Urban	334(34.4)	625 (65.6)	959 (40.5)	χ²= 794
Rural	443(30.9)	968 (69.1)	1,411 (59.5)	p= 0.129
Information sources:
Health workers
Yes	290 (49.2)	303(50.8)	593 (25.02)	χ²= 48.181
No	487 (26.8)	1,290(73.2)	1,777 (74.98)	p<0.001
Government sources
Yes	242 (44.7)	299 (55.3)	541 (22.8)	χ²= 14.960
No	535 (28.7)	1,294 (71.3)	1,829 (77.2)	p<0.001
Family and Friends
Yes	50 (20.4)	195 (79.6)	245 (10.3)	χ²= 10.964
No	727 (34.2)	1,398 (65.8)	2,125 (89.7)	p<0.001
Media
Yes	63 (27.2)	169 (72.8)	232 (9.8)	χ²= 0.010
No	714 (33.40)	1,424 (66.6)	2,138 (90.2)	p=0.920
Geopolitical zones
North Central	159 (39.3)	246 (60.7)	405 (17.1)
North East	137 (32.8)	281 (67.2)	418 (17.6)	χ²= 6.570
North West	83 (24.5)	256 (75.5)	339 (14.3)	p<0.001
South East	191(26.2)	538(73.8)	729 (30.8)
South South	111 (32.4)	232 (67.6)	343 (14.5)
South West	207 (43.2)	272 (56.8)	479 (20.2)
Respondent had Job loss arising from COVID-19
No	531 (33.2)	1069 (66.8)	1,600 (67.5)	χ²= 0.709
Yes	246 (32.0)	524 (68.0)	770 (32.5)	p=0.400
Access to health insurance
No	684 (31.3)	1502 (68.7)	2,186 (92.2)	χ²= 7.547
Yes	93 (50.5)	91 (49.5)	184 (7.8)	p=0.006
Occupation
Unemployed	114 (29.6)	271 (70.4)	385 (16.2)
Agriculture	283 (32.5)	587 (67.5)	870 (36.7)
Trading and Transport	156 (30.8)	351 (69.2)	507 (21.4)	χ²= 2.589
Public Servant	173 (38.9)	272 (61.1)	445 (18.8)	p=0.037
Others	51 (31.3)	112 (68.7)	163 (6.9)

Determinants of COVID-19 vaccine uptake among Nigerian households

The factors influencing COVID-19 vaccine uptake of Nigerian households are presented in Table 2. The results revealed that head of households aged between 30 and 59 years (OR 5.29; 95% CI 2.36, 11.88; p=<0.001) and those above 60 years (OR 5.98; 95% CI 2.56, 13.93; p<0.001) had higher odds of being vaccinated compared to those less than 30 years. Head of households that received COVID information from health workers had higher odds (OR 5.59; 95% CI 3.82, 8.16; p<0.001) of getting vaccinated. Similarly, head of households that received COVID information from government sources had higher odds (OR 3.88; 95% CI 2.6185, 5.78; p<0.001) of being vaccinated relative to those who did not. Households whose source of COVID information was from mass media, were more likely to get vaccinated (OR 2.64; 95% CI 1.51, 4.60; p=0.001). Households living in the North Central (OR 2.89; 95% CI 1.74, 4.82; p<0.001), North East (OR 1.88; 95% CI 1.14, 3.11; p=0.014), South south (OR 2.61; 95% CI 1.61, 4.24; p<0.001) and South West zones (OR 1.80; 95% CI 1.04, 4.27; p=0.036) had higher odds of being vaccinated relative to their counterparts in the North West. Also, public servants had higher odds of being vaccinated (OR 1.94; 95% CI 1.20, 3.14; p=0.007) when compared with their unemployed counterparts.

Table 2: Determinants of COVID-19 Vaccine Uptake among Nigerian Households, 2022

Variables	Odds Ratio	95% CI	P- values
Age of household head
<30 years	Ref
30-59 years	5.29	2.36, 11.88	<0.001
≥60 years	5.98	2.56, 13.93	<0.001
Household size
1-6 people	Ref
>6 people	0.97	0.70, 1.35	0.858
Sex of household head
Female	Ref
Male	0.79	0.53, 1.18	0.245
Job loss arising from COVID-19
No	Ref
Yes	1.28	0.93, 1.76	0.986
Rural location
No	Ref
Yes	0.97	0.70, 1.36	0.871
Access to health insurance
No	Ref
Yes	1.52	0.82, 2.81	0.188
Source of Information about COVID-19:
Health workers
No	Ref
Yes	5.59	3.82, 8.16	<0.001
Government sources
No	Ref
Yes	3.88	2.61, 5.78	<0.001
Family & friends
No	Ref
Yes	1.16	0.67, 2.01	0.606
Mass Media
No	Ref
Yes	2.64	1. 51, 4.60	0.001
Geopolitical Zone
North West	Ref
North Central	2.89	1.74, 4.82	<0.001
North East	1.88	1.14, 3.11	0.014
South West	1.80	1.04, 4.27	0.036
South East	1.10	0.64, 1.91	0.725
South South	2.61	1.61, 4.24	<0.001
Occupation
Unemployed	Ref
Agriculture	1.29	0.86, 1.94	0.212
Trading and Transport	1.20	0.77, 1.86	0.418
Public Servant	1.94	1.20, 3.14	0.007
Others	1.05	0.55, 1.98	0.886

The need to investigate the factors influencing COVID-19 vaccine uptake in Nigeria cannot be overemphasized. An understanding of the determinants of uptake will guide policymakers in prioritizing effective communication channels, addressing the concerns of the citizens and ensure easy access to the vaccines. This study reported that about two-third of the respondents (67 percent) did not obtain the COVID-19 vaccine. This is consistent with the earlier findings of Soares et al. in Portugal which reported that 56 percent of the respondents wanted to delay and 9 percent outrightly refused COVID-19 vaccination. [25] The low levels of COVID-19 vaccine uptake may hamper pandemic control efforts in the Nigeria more so the country missed the 70% vaccine coverage targets by June 2022 recommended by the WHO.[23]

Generally, the uptake of COVID-19 vaccine can be linked to the awareness level, information sources and the perception of individuals.[26] The main information sources were family and friends, government, media and health workers. This is consistent with the earlier findings of Faye and colleagues across some west African counties where they reported that important information sources were family and friends and media.[27]

Our study reported that respondents who received COVID-19 vaccines information from health workers, government sources and media had significantly higher odds of being vaccinated. This may suggest that these three information sources were probably the most trusted among the available information sources by the citizenry. In addition, health workers and government sources were more likely to provide reliable information on the vaccines to the general public especially in this era of pandemic-related misinformation. Having more exposure to information on COVID-19 vaccine from credible sources, makes individuals more likely to get vaccinated.[28]

The study found a positive and statistically significant relationship between age and COVID-19 vaccine uptake. Persons aged 30 years or more were more likely to be vaccinated against COVID-19 and this could be linked to the fact that older persons were more likely to have severe symptoms if they contract the disease.[29, 30] Hence, they may appreciate the urgent need to get vaccinated. This is consistent with the findings of many other studies which reported that younger people were less keen to take the vaccine as compared to older persons.[10, 25, 31, 32] However, it should be noted that at the time of the survey, vaccination was recently extended to all adults (18 years or older) in the country.[33]

The study also found a direct and statistically significant association between access to health insurance and the likelihood of being vaccinated. Specifically, household heads with access to health insurance were twice as likely to be vaccinated when compared to their counterparts with no access to health insurance. This can be linked to the fact that most people in Nigeria who have access to health insurance are educated, as either themselves or a family member works in the formal sector of the Nigerian economy. This implies that such households may have better access to credible information on the prevention and adverse impacts of COVID-19 that may encourage them to take the vaccine.

Across the geopolitical zones, it appears that respondents from the North Central, North East, South West and South south regions had higher odds of being vaccinated. This geographical disparity in vaccine uptake has huge public health implications. To address this challenge, more mobilization and community engagements are required in the other regions as a part of measures to address the low level of vaccine uptake across the country.

Based on the findings of this study, there following recommendations are suggested. Firstly, Government and development partners should increase media campaigns and empower health workers to intensify advocacy for COVID-19 vaccination. Secondly, the government should increase access to health insurance given that the surveyed households with insurance cover were less likely to be hesitant to get vaccinated. Lastly, the Nigerian youths who constitute a majority of the population should be targeted with COVID-vaccine related information aimed at improving their vaccine uptake. Lastly, for future research, it is important to conduct a qualitative study that will assess the social drivers of vaccine hesitancy among Nigerians.

Limitations: The study was prone to social desirability bias as some respondents may have indicated that they had received vaccines while they did not. Also, selection bias is another limitation that may characterize phone-based surveys because some group of persons without phones are naturally excluded from interviews.

CI	Confidence Interval
COVID-19	Corona Virus Disease 2019
GDP	Gross Domestic Product
GHS-Panel	General Household Survey-Panel
SARS-CoV2	Severe Acute Respiratory Syndrome- Coronavirus 2
UN	United Nations
WHO	World Health Organization

Ethical approval: The dataset used for this study is publicly available. The dataset contains depersonalized information and was only used for secondary analysis. However, the study complied with the Declaration of Helsinki on conducting research among human subjects. Ethics approval: not applicable

Competing interests: We declare no conflict of interest

Authors’ contribution: TOO conceived the study, participated in data analysis, and partly drafted the initial manuscript (introduction and discussion. AOO and OEO participated in data analysis, provided insightful inputs in the drafting of the manuscript’s results and discussion. AFA and BOA worked on the tables and interpreted the results. All authors contributed to the discussion and approved the final version of the manuscript.

Funding details: This study did not receive any funding from any individual or organization

Availability of data and material: The dataset used for this study is available at https://microdata.worldbank.org/index.php/catalog/3712

Consent for publication: Not applicable.

Acknowledgement: The first author is supported by the Consortium for Advanced Research Training in Africa (CARTA) which is funded by the Carnegie Corporation of New York (Grant No--B 8606.R02), SIDA (Grant No:54100029) and the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) Initiative (Grant No: 107768/Z/15/Z). The views expressed in this publication are those of the authors and not necessarily those of the partners in the consortium.

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No competing interests reported.

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Determinants of COVID-19 vaccine uptake among Nigerians: evidence from a cross- sectional national survey

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Abstract

Introduction

Materials And Methods

Results

Discussion

Abbreviations

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References

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