Factors influencing COVID-19 vaccine uptake among pregnant women aged 18 - 45 attending antenatal care in Nakivale Refugee Settlement, Isingiro District – Uganda

Abstract

Background: The COVID-19 pandemic has necessitated global vaccination efforts, with particular attention to vulnerable populations, including pregnant women (Amimo, Lambert, Magit, & Hashizume, 2021). Despite these efforts, vaccine uptake remains inconsistent, especially in low-resource settings like refugee settlements (Rosen, Waitzberg, Israeli, Hartal, & Davidovitch, 2021). This study aimed to assess the factors influencing COVID-19 vaccine uptake among pregnant women aged 18 to 45 years attending antenatal care in Nakivale Refugee Settlement. Methods: We conducted a cross-sectional study that utilized both quantitative and qualitative data collection methods. Quantitative: structured questionnaires were administered to 444 pregnant women, aged 18–45 years to obtain data which was then analyzed using STATA v 15.0. Qualitative: for the qualitative component, we employed Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). 10 FGDs were held, 5 with vaccinated pregnant women and 5 with unvaccinated ones, divided into younger women < 24 years, and older women > 25 years. Additionally, 10 KIIs were conducted with healthcare providers, including EPI/nurse in-charges, and community health workers (VHTs), to explore vaccine hesitancy and acceptance in greater depth. Collected data was then transcribed verbatim and analyzed using Atlas. ti 8.0 software. Results: Out of the 444 pregnant women surveyed, 56% (248/444) had received at least one dose of a COVID-19 vaccine, with Johnson & Johnson being the most commonly administered, accounting for 33.1% (82/248) of those vaccinated. The primary motivation for vaccination was the belief that it would protect both pregnant women and their unborn babies. The most commonly reported side effects were muscle pain and fever, with 19.4% (86/444) of respondents reporting muscle soreness after the first dose. 81% (201/248) of the vaccinated women were knowledgeable about COVID-19 vaccines, compared to 55% (108/196) among the unvaccinated group. Healthcare workers were the primary source of their vaccine awareness. 34% (84/248) of the vaccinated women had a positive perception of the vaccine, compared to only 12% (24/196) of unvaccinated women. The primary reason for their positive views was the perceived protection for themselves and their unborn babies. Health workers were the main source of information on COVID-19 vaccination for 67.3% (298/444) of respondents. Qualitative data highlighted significant barriers to vaccination, including fears of harm to the baby, the belief that COVID-19 was no longer a threat, and the unavailability of vaccines. Conclusions: COVID-19 vaccine uptake among pregnant women in Nakivale Refugee Settlement stands at a moderate 56%, with key factors significantly influencing uptake being household vaccination status, testing positive for COVID-19, educational attainment, knowledge of community vaccination, and vaccine preferences. However, major barriers, such as vaccine unavailability, and safety concerns continue to hinder vaccine uptake. To improve vaccine uptake, public health initiatives should prioritize increasing vaccine access, addressing safety concerns, and utilizing health workers as vital influencers within the community.