Factors influencing hesitancy towards adult and child COVID-19 vaccines in rural and urban West Africa: a cross-sectional study

Abstract

Objectives: This study aims: (1) to identify and describe similarities and differences in both adult and child COVID-19 vaccine hesitancy, and (2) to examine sociodemographic, perception-related and behavioural factors influencing vaccine hesitancy across five West African countries.

Design: Cross-sectional survey carried out between 5 May and 5 June 2021.

Participants and setting: 4198 individuals from urban and rural settings in Burkina Faso, Guinea, Mali, Senegal and Sierra Leone participated in the survey.

Study registration: The general protocol is registered on clinicaltrial.gov.

Results: Findings show that in West Africa at the time only 53% of all study participants reported to be aware of COVID-19 vaccines, and television (60%, n=1345), radio (56%; n=1258), social media (34%; n=764) and family/friends/neighbours (28%; n=634) being the most important sources of information about COVID-19 vaccines. Adult COVID-19 vaccine acceptance ranges from 60% in Guinea and 50% in Sierra Leone to 11% in Senegal. This is largely congruent with acceptance levels of COVID-19 vaccinations for children. Multivariable regression analysis shows that perceived effectiveness and safety of COVID-19 vaccines increased the willingness to get vaccinated. However, sociodemographic factors, such as sex, rural/urban residence, educational attainment and household composition (living with children and/or elderly), and the other perception parameters were not associated with the willingness to get vaccinated in the multivariable regression model.

Conclusions: Primary sources of information about COVID-19 vaccines include television, radio and social media. Communication strategies addressed at the adult population using mass and social media, which emphasise COVID-19 vaccine effectiveness and safety, could encourage greater acceptance also of COVID-19 child vaccinations in sub-Saharan countries.

Trial registration number: NCT04912284.

Keywords: COVID-19; epidemiology; preventive medicine; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

COVID-19 vaccine awareness (A) and COVID-19 vaccination status (B) among the study population stratified by country (n=4198), 2021. Figure 1A depicts the proportion of respondents who have ever heard of COVID-19 vaccines stratified by country, and figure 1B shows the proportion of those study participants who actually accepted the COVID-19 vaccination when offered. In alignment with the requirements of the Ethical Committee in Senegal, those participants in Senegal who had already been offered a COVID-19 vaccination had to be excluded from this study.

Figure 2

Main sources of information about COVID-19 vaccines stratified by country (n=2242), 2021.

Figure 3

Respondents’ willingness to get vaccinated and their willingness to have their children vaccinated against COVID-19 stratified by country, (n=2242), 2021. Figure 3A shows respondents’ COVID-19 vaccine acceptance, refusal and hesitancy for themselves 8 (A) and for their children (B), respectively. Figure 3C shows a cross-tabulation 9 of those who would accept, hesitate or refuse to get themselves vaccinated against COVID-19, with those who would accept, hesitate or refuse to have their children vaccinated against COVID-19.

Figure 4

Bivariable (A) and multivariable prevalence ratios (PRs) (B) for willingness to get vaccinated against COVID-19 (n=1926), 2021. Dots represent the estimated PRs, and the six whiskers represent the 95% CI. Vac., vaccine; y, yes; n, no; dk, don’t know.