Healthcare workers are at higher risk of COVID-19 infection with ease of infection transmissibility to coworkers and patients. Vaccine hesitancy rates of 56% and up to 25% have been reported among healthcare workers in US and China respectively. Vaccination is known as the most effective strategy to combat infectious diseases. Acceptance of the COVID-19 vaccine plays a major role in combating the pandemic. This study assessed the socio-demographic factors associated with COVID-19 vaccine hesitancy among healthcare workers in Abia State. A cross-sectional study among 422 healthcare workers was conducted in Abia State with an online-based questionnaire. The questionnaire extracted information on socio-demographics and willingness to take vaccine uptake. Descriptive statistics was used to calculate frequencies and proportions. Bivariate analysis was used to test the association between the socio-demographic factors and the outcome variable (vaccine hesitancy). Logistic regression was conducted to identify the predictors of COVID-19 vaccine hesitancy. The level of significance was 5%. Mean age of the respondents was 40.6 ± 9.5 years and 67.1% were females The COVID-19 vaccine hesitancy rate was 50.5% (95%CI: 45.6%-55.3%). Socio-demographic factors included age, marital status, location of practice, profession, and income. Vaccine Hesitancy was predicted significantly by younger age (a OR = 9.34, 95%C I:2.01-43.39), marital status (single) (a OR = 4.97,  95% C I:1.46-16.97), lower income (a OR=2.84, 95% CI:1.32 - 6.08), and Profession – Doctor (a OR =0.28, 95% C I:0.11-0.70), Nurse (a OR=0.31, 95% C I:0.15-0.64) and other allied health professionals (a OR=0.22, 95%CI:0.10-0.44). COVID-19 vaccine hesitancy was high among healthcare workers. Significant socio-demographic predictors influence the uptake of the COVID-19 vaccine. We recommend that the Federal and State Ministries of Health conduct awareness campaigns targeting the younger age group, singles, lower income class, and non-clinical staff.

The COVID-19 pandemic has resulted in so many cases and deaths all around the globe. Since the World Health Organization (WHO) was notified of an outbreak of a new disease in Wuhan, China, and its subsequent declaration as a pandemic on 11th March 2020, millions of cases and deaths have been reported worldwide. As of 11thMay 2021, a total of 160,160,122 confirmed cases with 3,326,536 deaths of confirmed COVID-19 infection have been reported globally (World Health Organization, 2020). The United States of America has had the highest number of cases worldwide, with 33,539,208 confirmed cases and 596,766 deaths (Nigeria Centre for Disease Control, 2021). As of the reference date, Nigeria had recorded 165,468 confirmed cases, 156,318 discharged and 2,065 deaths with Lagos State being the State with the highest number of cases -58,599 confirmed cases. Vaccines have been one of the most successful public health interventions of all time. Overtime, they have been successfully deployed in the control of vaccine- preventable diseases. Despite the wide availability of vaccines and huge success recorded in disease control, several individuals and groups still kick against vaccine use. Vaccine hesitancy (VH), as defined by the WHO refers to a delay in acceptance or refusal of vaccines despite the availability of vaccine services (Worldometer, 2021).

Healthcare workers are at a higher risk of COVID-19 infection and illness due to the ease with which infection can be transmitted to coworkers and patients (Stock, et. al, 2020). The WHO defines healthcare workers (HCWs) as “all people engaged in actions whose primary intent is to enhance health”. This includes doctors, nurses, midwives, paramedical staff, hospital administrators and support staff, and community workers. An earlier scoping review reported 3.9% of COVID-19 infections among HCWs worldwide (World Health Organization, 2018). In New York, United States, 19.4% was recorded among HCWs, similar to a rate of 19% reported for healthcare personnel in the United States [10]. A rate of 10.6% was noted in Qatar and as low as 5.62% in Iran (Sabetian, et al, 2019). In Nigeria, an earlier national survey reported that 9.3% of the confirmed cases were HCWs. A recent study in south southern Nigeria has observed a very low rate of 2% among HCWs during the period of study. Concurrently, another study in South southern Nigeria noted a rate of 15.2%. Healthcare workers are prioritized in almost all the countries of the world before vaccine availability. However, this prioritization is not associated with optimal utilization among the HCWs (Sallam, 2021).

A systematic review showed that the COVID-19 acceptance rate among HCWs surveyed ranged from as low as 27.7% in the Democratic Republic of Congo to as high as 78.1% in Israel. A study in Nigeria recorded a vaccine hesitancy rate of 41.8% among the adult population. Various determinants influence vaccine hesitancy, some of which include socio-demographic factors arising from personal interpretation of the vaccines (Seale, 2020). Globally, many individual characteristics known to affect vaccine uptake have been documented in studies. Most of these factors include sex, age, education, employment, religion, income, having children at home (Alasia & Maduka, 2021). Male gender is associated with vaccine hesitancy. This is very important, especially in patriarchal societies, as seen in many African countries.  The level of education has a major link to the receipt of information about vaccines. It is known that the less educated have poor access to information and rely on other sources for reliable information. We therefore aimed in this study to assess the socio-demographic factors associated with COVID-19 vaccine hesitancy among healthcare workers in Abia State.

Study Area and Design:

This was a descriptive cross- sectional study conducted in March 2021 among healthcare workers of Abia State in Southeastern Nigeria. It had an estimated population of 3,784,355 in 2017 projected from the 2006 national population census with an annual growth rate of 3.0% (Wang, et al, 2020). Geopolitically, Abia State is divided into three senatorial zones (Abia North, Abia South, and Abia Central) with 17 local government areas and 291 political wards. The State has 517 public primary healthcare centres, 17 public secondary healthcare facilities, three public tertiary healthcare centres, and two diagnostics centres. This is complemented by many privately-owned primary healthcare facilities (Elimian, et al, 2020). The study sites selected by simple random sampling included: two tertiary hospitals (Federal Medical Centre Umuahia, Abia State, and Abia State Teaching Hospital Abayi Aba, Abia State), two secondary health care facilities (General Hospital Amachara and General Hospital Ohafia), and three ward primary healthcare facilities (PHCs), one each from the three Senatorial Zones of the State. The ward PHCs were World Bank PHC, Eziukwu PHC and Eziama PHC.

Study Population:

Medical doctors, nurses, pharmacists, medical laboratory scientists, scientific officers, administrative officers, and other allied health professionals comprised the study population. Those eligible for the study were healthcare workers working in government-owned health facilities who had access to the internet on their smart phones and other computer devices. Eligible participants currently not working in Abia State, with debilitating illnesses that would interfere with the communication process, such as cerebrovascular accidents, and those working in COVID-19 designated isolation centres, were excluded from the study. In each of the study sites, the WhatsApp/Telegram platforms of various groups of healthcare workers were identified with the help of the heads of departments. Amid the global pandemic, members of these online platforms were recruited for the study. The main outcome of this study was COVID-19 vaccine hesitancy, while the predictor variables were the socio-demographic characteristics.

Data Collection Tool and Methods:

A semi- structured questionnaire created on Google forms was used to collect the data. A brief message with a link to the questionnaire was posted selectively on the WhatsApp and Telegram of different health groups within the study sites, through the admins of the groups. The questionnaire was adapted from the WHOSAGE (Strategic Advisory Group of Experts questions (Enabulele & Esther, 2021). The introductory section of the questionnaire contained the informed consent and overview of the study. The questionnaire was structured in two different sections. The first section contained information on the socio- demographic characteristics of the participants, like age, sex, marital status, profession, educational status, income, and location of practice. In the second section, participants were asked whether they would accept receiving the COVID-19 vaccine when it became available in Abia State. The response modalities were 'yes', 'no', or 'maybe'. A pre-test with a sample size of 40 (10% of the sample size) was done in a health facility not included in the study, to improve the wording and clarity of the items on the questionnaire. The final version of the questionnaire required an approximated time of 10 minutes to be completed. Data was collected over two weeks (6th-20thMarch 2021). To reduce bias introduced by self-reported data, participants were assured of the confidentiality and privacy of their responses in the introductory session of the questionnaire. To ensure that the responses were solely from the eligible participants, the first question on the questionnaire was ‘are you a healthcare worker currently working in Abia State? If 'no' was ticked, that was the end of the survey for the individual and vice versa for 'yes'. The calculated minimum sample size was 416 based on a potential vaccine hesitancy rate of 41.8% in a previous study (Alajmi, et al, 2020), a non-response rate of 10%, a confidence level of 95%, and a 5% margin of error.

Data analysis:

Data was analyzed using the SPSS IBM version 26. Descriptive statistics was used to derive frequencies and percentages for the socio-demographic characteristics and willingness to accept the COVID-19 vaccines. The dependent outcome was the vaccine hesitancy rate with two (2) binary outcomes ('yes' and 'no'). The response options were 'yes', 'no', and 'maybe'. At the level of data analysis, 'yes' responses were recoded to '1' and 'no/maybe' were recoded to '0'. Bivariate analysis was done to compute and compare Odd Ratios (ORs) for the interpretation of the association between socio-demographic factors and vaccine hesitancy. P values less than 0.05 and confidence intervals excluding one (1) were considered significant. Multiple logistic regression was done using the vaccine hesitancy as the outcome variable and the socio-demographic factors as the predictor variables to compute the adjusted odds ratios (AORs). The level of significance was pre-determining a tap-value of less than 0.05 with a 95% confidence interval.

Ethical consideration:

Ethical approval was obtained from the Health Research Ethics Committee of the Federal Medical Centre Umuahia, Abia State, Nigeria with reference number (FMC/QEH/G.596/Vol.10/497). Respondents were informed that their participation was voluntary, and consent was implied upon completion of the questionnaire.

Socio-demographic Characteristics of Respondents:

The socio-demographic characteristics of the respondents are shown in table 1. The questionnaire was completed by a total of 422 respondents. The mean age of the respondents was 40.6 ± 9.5 years. The majority of the respondents were females (67.1%) and 163(38.6%) were in the 30-39 years age group. Most of the respondents were single (76.5%). The majority were practicing in the Abia Central Senatorial Zone (65.4%) and were in the category of other allied health professionals (32.9%). Furthermore, the great majority were university degree holders (56.2%) with 65.4% of them earning less than NGN200,000 (approx. 526 USD) (Table 1).

Table1: Socio-Demographic Characteristics of Respondents (N=422)

Prevalence of vaccine hesitancy:

The overall prevalence of Vaccine Hesitancy among the respondents was 50.5% (95%CI: 45.6%– 55.3%). Across the different professions, a higher proportion of non-clinical staff (73.2%) were more hesitant about the COVID-19 vaccine compared to other cadres of staff (Figure 1).

Distribution of COVID-19 vaccine hesitancy rates by respondents´ characteristics:

Vaccine hesitancy was sixfold higher among those aged 20-29 years compared to those over 50years (OR = 6.59, 95%CI:1.71-25.46). Respondents who were single were thrice more likely to be hesitant compared to those who were divorced or widowed (OR = 3.40, 95% CI: 1.15-10.00). Respondents practicing in the Abia South Senatorial Zone were twice more likely to be vaccine-hesitant compared to those practicing in the Abia Central Senatorial Zone (OR= 2.00, 95% CI: 1.27-3.16). Participants who were doctors (OR = 0.34, 95% CI:0.16-0.70), nurses (OR = 0.36, 95% CI: 0.18-0.72) or other allied health professionals (OR = 0.27, 95% CI:0.14-0.54) were less likely to be vaccine-hesitant compared to non- clinical staff. Being in the category of NGN200,000- NGN400,000 income group had higher odds of vaccine hesitancy compared to those within the income level of above NGN400,000 (Approx. 1051USD) (OR = 3.00, 95% CI:1.52-5.91) (Table 2).

Variables

Hesitancy to COVID-19 Vaccine

Total (%)

OR (95 Discussion This study aimed to assess the socio-demographic factors associated with COVID-19 vaccine hesitancy among healthcare workers of the State. We observed that half of the respondents reported COVID-19 vaccine hesitancy. The predictors for COVID-19vaccine hesitancy included–age, marital status, income and profession. This value is similar to a previous report of 50% among HCWs from the south of the United States (Burrer, et. al, 2017). It is also consistent with the report from an additional study in the United States, with a VH rate of 56% among healthcare workers. However, this contrasts with the reported VH rates in different countries. A systematic review of VH among healthcare workers observed a VH rate of more than 70%, as only 27.1 Conclusion In this study, 1 in 2 healthcare workers in Abia State was COVID-19 vaccine-hesitant. Age, marital status, profession and income were the significant socio-demographic predictors reported in the study. 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