Nasimu Kyakuwa

Introduction: Cervical cancer (CC) is the leading cause of cancer-related deaths among women in Uganda, largely due to late diagnosis. CC screening (CCS) is key to preventing these deaths. Awareness of past CCS, its determinants, and uptake of CCS after receiving information is crucial to informing prevention programming. Methods: A two-phase community based cross-sectional survey was conducted among 600 randomly selected women aged 25-65 years, from two Ugandan districts (Mukono and Wakiso). Participants completed a baseline questionnaire that assessed their knowledge, attitudes, and past practices related to CCS. Information on cervical cancer and screening was provided during and after the survey to encourage uptake, which was assessed three months later. Logistic regression identified factors associated with past CCS and follow-up uptake after information giving. Results: Few women [5.3%, (32/600)] were aware that Human Papillomavirus (HPV) infection causes CC. Past CCS was low [22.3%, (134/600)], associated with the age group 36-65 years (AOR= 1.9, 95% CI 1.2 - 3.2), owning a mobile telephone (AOR = 2.3, 95% CI 1.4 - 3.9), residing in a household headed by someone with tertiary or higher education (AOR=2.6, 95% CI 1.3 - 5.0), self-reported HIV infection (AOR=10.5, 95% CI 5.2 - 21.3), awareness of the location of CCS services (AOR=3.2, 95% CI 1.3 - 7.8), and awareness that accessing the CCS location was not expensive (AOR=2.3, 95% CI 1.3 - 4.0). The uptake of CCS following information provision was 40.3%, (236/585), associated with employment (AOR=2.7, 95% CI 1.2 - 5.8), moderate-high income (AOR=1.6, 95% CI 1.0 - 2.6), and prior receipt of CCS services (AOR 6.7, 95% CI 4.0 -11.2). Conclusion: CCS remains low but is higher among women with better socioeconomic status, awareness of services, and HIV infection. Targeted strategies addressing awareness and motivating women to get screened can boost screening uptake.

Background: Vaccine hesitancy (VH) remains a major threat to global health that can reverse the progress in tackling vaccine-preventable diseases. Vaccine uptake among adolescent Girls and young women (AGYW) is often low. We assessed VH using a validated scale among AGYW in Uganda, Zambia, and South Africa. Methods: From June 2023 to February 2024, we recruited AGYW from fishing communities in Uganda, urban and peri-urban locations in Lusaka and Ndola, Zambia, and mining communities in Rustenburg, South Africa. Eligible participants were aged 15–24 years, sexually active, and HIV-negative but at risk for HIV acquisition. We collected demographic, HIV-related behavioral data, and vaccine hesitancy data using a structured questionnaire. Vaccine confidence was assessed using the 10-question Vaccine Hesitancy Scale that describes two factors, i.e., “vaccine confidence” and “risk tolerance”. Exploratory and Confirmatory Factor Analyses were performed to assess scale validity and internal consistency. Logistic regression was used to determine associations between demographics and vaccine confidence. Results: A total of 1213 AGYW participated in the study, with a mean age of 19.4 (SD ± 2.6) years. More than half (54%) were aged between 15 and 19 years. The majority of AGYW (94%) strongly believed that vaccines were important for their health and the community and that vaccination is a good way to protect them from diseases. About two-thirds of the AGYW (66%) indicated that they were concerned about the adverse effects of vaccines, while 30% responded that they did not need vaccines for diseases that were not common. We observed that 951 (78%) of the AGYW reported high vaccine confidence, while 494 (41%) reported low concerns over risks. Vaccine confidence varied across countries, with Zambia and Uganda showing lower vaccine confidence (adjusted odds ratios of 0.28 and 0.45, respectively, p < 0.005) in comparison to South Africa. Conclusions: A high level of vaccine confidence was observed among AGYW. Vaccine confidence among AGYW was driven more by the trust in vaccine safety and the need to protect communities against diseases. These findings suggest the potential for acceptance of vaccines, including future HIV vaccines, among AGYW. Despite high levels of vaccine confidence, concerns over vaccine risks remain substantial and must be addressed.

Background: Vaccine hesitancy (VH) remains a major threat to global health and can reverse the progress in tackling vaccine-preventable diseases. Vaccine uptake among adolescents and young women (AGYW) is often low. We assessed VH using a validated scale among AGYW in Uganda, Zambia, and South Africa. Methods: From June 2023 to February 2024, we recruited AGYW from fishing communities in Uganda, as well as urban and peri-urban locations in Lusaka and Ndola, Zambia, and mining communities in Rustenburg, South Africa. Eligible participants were aged 15-24 years, sexually active, and HIV-negative but at-risk for HIV acquisition. We collected demographic, HIV-related behavioral data, and vaccine hesitancy data using a structured questionnaire. Vaccine confidence was assessed using the 10-question Vaccine Hesitancy Scale that describes two factors, i.e., “vaccine confidence” and “risk tolerance’’. Exploratory and confirmatory factor analyses were done to assess scale validity and internal consistency. Logistic regression was used to determine associations between demographics and VH. Results: A total of 1,213 AGYW participated in the study, with a mean age of 19.4 (SD ± 2.6) years. More than half (54%) were aged between 15-19 years. The majority of AGYW (94%) strongly believed that vaccines were important for their health and the community and that getting vaccinated is a good way to protect them from diseases. About two-thirds of the AGYW (66%) indicated that they were concerned about the adverse effects of vaccines, while 30% responded that they did not need vaccines for diseases that were not common. We observed that 951 (78%) of the AGYW reported high vaccine confidence, while 494 (41%) reported low concerns over risks. Vaccine confidence varied across countries, with Zambia and Uganda showing lower vaccine confidence (adjusted Odds Ratios of 0.28 and 0.45, respectively, p< 0.005) in comparison to South Africa. Conclusion: A high level of vaccine confidence was observed among AGYW at risk of HIV acquisition. Vaccine confidence among AGYW was driven more by the trust in vaccine safety and the need to protect communities against diseases. These findings suggest the potential for acceptance of vaccines, including future HIV vaccines, among AGYW. Despite high levels of vaccine confidence, concerns over vaccine risks remain substantial and must be addressed.

Introduction: The Corona virus disease (COVID-19) is a respiratory illness that is caused by SARS-CoV-2 virus. This virus was first reported in China in December 2019. It then spread to all countries and from March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In Uganda, the disease was first reported in March 2020 and COVID-19 vaccines became available by January 2021. Although COVID-19 vaccines were available in Uganda, uptake remained low. The aim of this study was to establish COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda. Methods: This was a cross-sectional study conducted among 127 men and 263 women who reside in Entebbe City, Uganda. Data was collected on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine using interviewer administered questionnaires. Uptake of COVID-19 vaccine was defined as the proportion of participants who had received at least one dose of the COVID-19 vaccine. We used descriptive statistics to estimate awareness of COVID-19 vaccines. The ‘chi-square test’ and ‘modified Poisson regression’ were used to assess variations in uptake of COVID-19 vaccines among respondents and their socio-demographics as well as other characteristics. Results: Ninety-nine percent (388 out of 390) of the study population were aware of at least one brand of COVID-19 vaccines in the country. Thirty-five percent (138 out of 390) knew that the vaccine immunity was achieved 14 days after the 2^nd dose and 98.7% (385 out of 390) admitted that observing the standard operating procedure for COVID-19 infection prevention was necessary after vaccination. There was a gap in knowledge on vaccine safety reported by 74.6% (291 out of 390) participants. Some participants 37.2% (145 out of 390) had concerns about the vaccine. Of these, 57.9% (84 out of 145) believed that the vaccines were not helpful; and 30.3% (44 out of 145) feared serious side effects. Sixty-six percent (257 out of 390) believed that vaccines were not working and 79.0% (308 out of 390) admitted that vaccines were promoted for financial gain. At the time of performing the study, 36.2% and 22.3% had received the 1^st and 2^nd dose respectively. The main sources of information on COVID-19 vaccine were television (TV) and social media (p-value 0.001). In a multivariate model, COVID-19 vaccine acceptability was associated with salaried and self-employment (p-value 0.046). The other predicative factors were awareness of the COVID-19 vaccine (p-value <0.001) and having vaccine concerns (p-value 0.013). Conclusion: Uptake of COVID-19 vaccination in Entebbe community was low, partly attributed to knowledge gaps and concerns about vaccine safety and effectiveness. This highlights the need to enhance dissemination of information about COVID-19 vaccine. The lessons learnt in this study would be relevant for other emerging infections by informing vaccination implementation programs in similar settings.

Background: Vaccines play a crucial role in eradicating and containing disease outbreaks. Therefore, understanding the reasons behind vaccine refusal and associated factors is essential for improving vaccine acceptance rates. Our objective was to examine the determinants of COVID-19 vaccine non-uptake and explore the reasons for non-uptake among healthcare workers (HCWs) in Uganda. Methods: Between July and August 2021, we conducted a cross-sectional study among healthcare workers in primary healthcare facilities (private and government) in Entebbe Municipality, Uganda. Participants were recruited using convenience sampling, and consenting individuals received credentials to access an electronic database and complete a structured questionnaire. There were no established HCWs contact registers in the municipality, and the study was conducted during a national lock down, therefore, the HCWs who were on duty at the time of the study were approached. The survey questions were based on the ‘3Cs’ model of vaccine hesitancy and focused on confidence, convenience, and complacency factors. Non-uptake of vaccines was defined as not having received any of the available vaccines in the country. We employed counts, percentages, and simple logit models to summarize the reasons for non-uptake of COVID-19 vaccines and to identify associated factors. Results: The study recruited 360 HCWs, 61.7% of whom were female, with an average age of 31 years (SD = 7.9). Among them, 124 (34.4%) healthcare workers did not receive any COVID-19 vaccine. Non-uptake of COVID-19 vaccines was independently associated with several factors, including age [35 + years adjusted odds ratio (aOR) = 0.30, 95% CI: 0.13–0.66 compared with 18–24 years], facility ownership [government, aOR = 0.22 (0.10–0.49) compared with private not-for-profit], previous testing for coronavirus [yes, aOR = 0.35 (0.19–0.65)], and previous involvement in COVID-19 vaccine activities [yes, aOR = 0.17 (0.10–0.29)]. The primary reasons cited for non-uptake of COVID-19 vaccines were related to a lack of confidence in the vaccines, such as concerns about side effects (79.8%) and the need for more time to understand the vaccines (89.5%), as well as the importance of weighing benefits and risks (84.7%) before being vaccinated. A smaller proportion, approximately 23%, cited reasons related to complacency and lack of convenience in accessing vaccination services. Conclusion: The high proportion of non-uptake of COVID-19 vaccines among this population primarily stems from a lack of confidence and trust in the vaccines, coupled with insufficient time allowed for users to make informed decisions. This underscores the urgent need for ongoing monitoring and trend analysis of vaccine non-uptake to guide the development and implementation of strategies aimed at building and sustaining vaccine confidence. Adequate time should be allowed to explain benefits of vaccination to the population to allay fears that might exist before actual vaccination is rolled out.

The aim of the study was to describe the facilitators, barriers to and level of uptake of COVID-19 vaccines among healthcare workers in primary healthcare facilities in an urban setting in Uganda. We conducted a cross-sectional study among HCWs in private and public health facilities in Entebbe municipality between July 2021 and August 2021. Data was collected using a structured questionnaire that was shared, via an online link, to consented participants. Uptake of the vaccines among healthcare workers was analysed as proportions, and logistic regression was used to analyse barriers and facilitators to uptake of COVID-19 vaccines. The study enrolled 360 participants, with 61.7% (n = 222) females. A total of 236 (65.6%) healthcare workers had received at least one dose of COVID-19 vaccine, with higher uptake among females 64% (n = 151). Age above 40 years (OR 2.16), working in a government healthcare facility (OR 3.12), participating in COVID-19 vaccine related activities (OR 4.62), and having tested for SARS-COV-2 (OR 3.05) increased the odds of having been vaccinated. Working in small roadside clinics reduced the odds of being vaccinated by almost 70%, while HCWs in government health services were 3.1 times more likely to have been vaccinated. History of having cared for a COVID-19 patient and having a positive SARS-COV-2 test result did not influence the uptake of the vaccines in the study population. Vaccine uptake among HCWs was close to the World Health Organisation (WHO) recommended uptake of 70% by mid-2022.

Background Vaccination is one of the most successful public health interventions for preventing infectious diseases. A successful vaccination program depends on high coverage, and health care workers (HCWs) play a pivotal role in ensuring high uptake of vaccines in the population. COVID-19 vaccines have been proven to be efficacious, and vaccination campaigns have been ongoing, however there is a perceived high vaccine hesitancy even among health care workers in Uganda. This study aimed at describing the facilitators, barriers to and level of uptake of COVID 19 vaccines among healthcare workers in primary healthcare facilities in an urban setting in Uganda. Methods We conducted an online cross-sectional survey among healthcare workers in private and public healthcare facilities in Entebbe municipality between July 2021 and August 2021. Data was collected using an online questionnaire. Uptake of the vaccines among healthcare workers was analysed as proportions, and logistic regression was used to analyse barriers and facilitators to uptake of COVID 19 vaccines. Results The study enrolled 360 participants, with 61.7% (n=222) females. A total of 236 (65.6%) healthcare workers had received at least one dose of COVID 19 vaccine with higher uptake among females 64%(n=151). Age above 40 years (OR 4.29), participating in COVID 19 vaccine related activities (OR 4.18) and having had a negative SARS-COV-2 test result (OR 1.79) increased the odds of having been vaccinated. Working in either a private for profit (OR 0.23) or a private not for profit (OR 0.19) reduced the odds of having been vaccinated. History of having cared for a COVID 19 patient and having a positive SARS-COV-2 test result did not influence the uptake of the vaccines in the study population. Conclusion Vaccine uptake among healthcare workers was close to the World Health Organisation (WHO) recommended uptake of 70% by mid-2022.

Background Routine vaccination is an essential highly successfully public health intervention in the prevention of infectious diseases that greatly depends on high coverage, and health care workers (HCWs) who play a pivotal role in ensuring the high uptake of vaccines in the population. COVID-19 vaccines have been proven efficacious, and vaccination campaigns have been ongoing, however, there is a perceived high vaccine hesitancy among health care workers in Uganda. This study describes the level and determinants of uptake of COVID-19 vaccines among HCWs in Entebbe municipality, Uganda. Materials and methods We conducted a health facility based cross-sectional study among HCWs from private and government health facilities in Entebbe municipality between July 2021 and August 2021. Structured questionnaires were used, and data were analysed using Stata version 12. We defined uptake as having received at least the first doze of COVID-19 vaccine or completed the two dozes. Results The level of vaccine uptake was 65.6%with higher uptake among males than females. HCWs aged 30-39 years were 2.7 times more likely to have been vaccinated than those less than 30 years (OR 2.72, 95% CI: 1.26-5.88, P-value Conclusion Vaccine uptake among HCWs was relatively high compared to the WHO recommended uptake of 70% by mid-2022, although some HCWs were still hesitant. The convenience of vaccination services was an important factor in vaccine uptake. Hence, governments should endeavour to improve access to vaccination both for HCWs and the public.