Abstract

Background: Vaccines are effective and reliable public health interventions against viral outbreaks and pandemics. However, hesitancy regarding the Coronavirus disease (COVID-19) vaccine is evident worldwide. Therefore, understanding vaccination-related behavior is critical in expanding the vaccine uptake to flatten the infection curve. This study explores the public perception regarding COVID-19 vaccination and identifies factors associated with vaccine uptake among the elderly.

Materials and methods: The study was a community-based quantitative cross-sectional study that took place across 5 health areas in the Buea Health District. Data was collected using a well- structured pretested questionnaire. Data management and analysis were done using SPSS and Epi Info and descriptive statistics was used to summarize data in frequency tables, charts and graphs. Associations between KAPs and predictor variables were established using Chi square. Logistic regression was used to determine the factors associated with vaccine uptake.

Results: A total number of 302 participants were enrolled in the study they were all aged ≥50 years. Majority (65.2%) of these participants were females, a total number of 241 (79.8%), 176 (58.3%) participants had bad practices and poor attitudes respectively. There was a significant association between knowledge and practices in the study. Predictors like marital status, level of education, and history of COVID-19 symptoms were significantly associated to COVID-19 uptake.

Conclusion: Covid-19 vaccine uptake was low. The proportion of the elderly with good knowledge was above average, while. Attitude and practices towards COVID-19 vaccine was low.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

The COVID-19 pandemic has imposed an enormous burden globally and locally by disrupting not only health services but social and economic systems. As per the World Health Organization (WHO) report for COVID-19 on 1st June 2022, there have been 529,410,287 confirmed cases of COVID-19, including 6,296,771 deaths globally[1].

In Cameroon, the first case of COVID- 19 was reported on the 06th March 2020, a traveler who arrived in Cameroon on the 24th February 2020 from France[2]. As a response, Cameroon adopted public health measures which evolved with the trends of the pandemic. On the 17th of March 2020, social regulations were enforced in Cameroon: closure of borders, confinement at home from 6PM, and regulations on transportation means (passengers 1m apart).

Towards 13th April 2020, it became compulsory to wear a facial mask [3]. Specialized COVID-19 treatment centers and laboratories were identified for diagnosis and management of COVID-19 in Cameroon. As of December 3rd, 2021, there had been 119,947 confirmed cases of COVID-19 in Cameroon with 1,930deaths [1].

Vaccination is considered a crucial advance in the field of public health, where it has succeeded in the eradication and control of many infectious diseases worldwide (e.g., smallpox, polio, and rubella) [4]. It is widely acknowledged that if most of the population is immunized to that particular infection, they indirectly protect the unvaccinated individuals [5].

Of the variety of COVID-19 prevention measures, vaccination is the most effective preventive method against severe disease and deaths [6]. After the happening of the COVID-19 pandemic, several scientist teams and WHO are working on the development of vaccines [7]. The development of this vaccine against COVID-19 has been much accelerated than the development of any other vaccine in different parts of the world [5]. Surprisingly, within less than 12 months, there were more than 100 vaccines in pre-clinical development and more than 60 vaccines have been permitted for use in different countries [9].

Many research institutions and pharmaceutical companies began developing vaccines and conducting clinical trials to evaluate their safety and efficacy [10]. In December 2020, dozens of COVID-19 vaccines gained approval for commercialization in multiple countries. These included such brand names as Pfizer–BioNTech, Moderna, Jonson, Sinopharm- BBIBP, Sputnik V, CoviVac, and Covaxin [11].

Despite the development of successful SARSCOV-2 vaccine within a short period and continuing vaccine supply, vaccine uptake, which is quite low in Africa, including Cameroon offers an opportunity to COVID-19 re-outbreak and WHO listed vaccine hesitancy as one of the top ten threats to global health [5]. Evidence showed that only 60.5% of the population have received the COVID-19 vaccine in the world [12]. As of November 24, 2021 report, about 5.4 million people have been vaccinated in Cameroon [6].

Identifying vaccine hesitancy rates and factors associated with vaccine uptake is critical for successful vaccination rollouts, especially in developing countries that are continuously struggling with emerging infectious diseases [13]. Public trust and satisfaction with government health authorities are factors that may be used to help understand vaccine uptake [14]. Adopting various preventive measures during the early phase of the COVID-19 pandemic, such as social distancing and non-pharmaceutical interventions, have been associated with trust in governments [15]. These factors were eroded for some individuals when governmental health authorities were criticized for improperly supporting healthcare systems and responding slowly to the pandemic [16].

Although anti-vaccination attitudes and associated misconceptions are prevalent worldwide [17], COVID-19 vaccines save from not only infection but also severe illness and death. Though mass vaccination programs have already been started globally, the effectiveness of vaccination programs has been affected by a hesitancy to receive the vaccines in populations [7], Many studies showed that COVID-19 vaccination decreased infection, hospitalization, and mortality rates. A study in Chile using an inactivated SARS-CoV-2 vaccine (CoronaVac) showed its effectiveness in preventing infection, hospitalization, and death was 65.9%, 90.3%, and 86.3%, respectively [18]. Therefore, to successfully manage SARS-CoV-2 infection, countrywide COVID-19 vaccination is needed to achieve herd immunity.

Vaccine uptake is the number of people vaccinated with a certain dose of the vaccine in a certain period, which can be expressed as an absolute number or as the proportion of a target population [19]. Our study aimed to evaluate factors associated with COVID-19 vaccine uptake and determinants amongst the elderly in the Buea Health District. The findings will offer important insights for promoting vaccination among older people in Cameroon.

1.2 Problem Statement

Globally, the coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused illness and deaths in more people than any other pandemic in the last hundred years. As of October 22 2021, nearly 242 million people had been infected, while 4.9 million had died worldwide.

Evidence supporting COVID-19 vaccine safety and cost-effectiveness is mounting, yet Cameroon records a percentage of 3.1% vaccination coverage as of March 2nd 2022 which is far beyond target in attaining herd- immunity (70%) level coverage. The elderly are known to be at increased risk of contracting COVID-19 and their odds of survival is lowest and they turn in developing severe complications and have increased risk of morbidity and mortality. Whilst an age-based vaccination approach prioritizing older groups is being implemented worldwide, vaccine uptake is low amongst this group.

1.3 Research Questions

1. What are the Sociodemographic factors associated with COVID-19 uptake amongst the elderly in the Buea Health District?
2. Are the elderly knowledgeable about covid-19 vaccine in the Buea Health District?
3. What are the attitudes and practices of the elderly towards the COVID-19 vaccine in the Buea Health District?

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