Hesitancy in COVID-19 vaccine uptake and its associated factors among the general adult population: a cross-sectional study in six Southeast Asian countries.

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 coverage to flatten the infection curve. This study explores the public perception regarding COVID-19 vaccination and identifies factors associated with vaccine hesitancy among the general adult populations in six Southeast Asian countries. METHODS: Using a snowball sampling approach, we conducted a descriptive cross-sectional study among 5260 participants in Indonesia, Malaysia, Myanmar, Philippines, Thailand, and Vietnam between February and May 2021. Binary logistic regression analysis with a backward conditional approach was applied to identify factors associated with COVID-19 vaccine hesitancy. RESULTS: Of the total, 50.6% were female, and the median age was 30 years (range: 15-83 years). The majority of the participants believed that vaccination effectively prevents and controls COVID-19 (81.2%), and 84.0% would accept COVID-19 vaccines when they become available. They agreed that health providers' advice (83.0%), vaccination convenience (75.6%), and vaccine costs (62.8%) are essential for people to decide whether to accept COVID-19 vaccines. About half (49.3%) expressed their hesitancy to receive the COVID-19 vaccines. After adjustment for other covariates, COVID-19 vaccine hesitancy was significantly associated with age, residential area, education levels, employment status, and family economic status. Participants from Indonesia, Myanmar, Thailand, and Vietnam were significantly more likely to express hesitancy in receiving COVID-19 vaccines than those from Philippines. CONCLUSIONS: In general, participants in this multi-country study showed their optimistic perception of COVID-19 vaccines' effectiveness and willingness to receive them. However, about half of them still expressed their hesitancy in getting vaccinated. The hesitation was associated with several socioeconomic factors and varied by country. Therefore, COVID-19 vaccination programs should consider these factors essential for increasing vaccine uptake in the populations.

Is Population Density a Risk Factor for Communicable Diseases Like COVID-19? A Case of Bangladesh.

Bangladesh is one of the most densely populated countries in the world struggling to prevent COVID-19 (coronavirus disease 2019). This study employed correlation, cluster analysis, and multiple linear regression analyses using district-wise COVID-19 infection and socioeconomic data. It is observed that there is a strong positive correlation (r = 0.876, P < .001) between population density and COVID-19, explaining a 60% variation in Bangladesh. The relationship between urbanization and COVID-19 is also positively strong (r = 0.802, P < .001). Urban settlements have a higher risk of spreading diseases due to the enormous population density. For future planning to prevent COVID-19 and other related infectious diseases, population density should be considered a risk factor.

COVID-19 vaccine hesitancy among the adult population in Bangladesh: A nationwide cross-sectional survey.

INTRODUCTION: Studies related to the COVID-19 vaccine hesitancy are scanty in Bangladesh, despite the growing necessity of understanding the population behavior related to vaccination. Thus, the present study was conducted to assess the prevalence of the COVID-19 vaccine hesitancy and its associated factors in Bangladesh to fill the knowledge gap. METHODS AND MATERIALS: This study adopted a cross-sectional design to collect data from 1497 respondents using online (Google forms) and face-to-face interviews from eight administrative divisions of Bangladesh between 1-7 February 2021. We employed descriptive statistics and multiple logistic regression analysis. RESULTS: The prevalence of vaccine hesitancy was 46.2%. The Muslims (aOR = 1.80, p ≤ 0.01) and the respondents living in the city corporation areas (aOR = 2.14, p ≤0.001) had more hesitancy. There was significant variation in vaccine hesitancy by administrative divisions (geographic regions). Compared to the Sylhet division, the participants from Khulna (aOR = 1.31, p ≤0.001) had higher hesitancy. The vaccine hesitancy tended to decrease with increasing knowledge about the vaccine (aOR = 0.88, p≤0.001) and the vaccination process (aOR = 0.91, p ≤ 0.01). On the other hand, hesitancy increased with the increased negative attitudes towards the vaccine (aOR = 1.17, p≤0.001) and conspiracy beliefs towards the COVID-19 vaccine (aOR = 1.04, p≤0.01). The perceived benefits of COVID-19 vaccination (aOR = 0.85, p≤0.001) were negatively associated with hesitancy, while perceived barriers (aOR = 1.16, p ≤0.001) were positively associated. The participants were more hesitant to accept the vaccine from a specific country of origin (India, USA, Europe). CONCLUSIONS: Our findings warrant that a vigorous behavior change communication campaign should be designed and implemented to demystify negative public attitudes and conspiracy beliefs regarding the COVID-19 Vaccine in Bangladesh. The policymakers should also think about revisiting the policy of the online registration process to receive the COVID-19 vaccine, as online registration is a key structural barrier for many due to the persistent digital divide in the country. Finally, the government should consider the population's preference regarding vaccines' country of manufacture to reduce the COVID-19 vaccine hesitancy.

Health Belief Model, Theory of Planned Behavior, or Psychological Antecedents: What Predicts COVID-19 Vaccine Hesitancy Better Among the Bangladeshi Adults?

This study aimed to determine the prevalence and investigate the constellations of psychological determinants of the COVID-19 vaccine hesitancy among the Bangladeshi adult population utilizing the health belief model-HBM (perceived susceptibility to and severity of COVID-19, perceived benefits of and barriers to COVID-19 vaccination, and cues to action), the theory of planned behavior-TPB (attitude toward COVID-19 vaccine, subjective norm, perceived behavioral control, and anticipated regret), and the 5C psychological antecedents (confidence, constraints, complacency, calculation, and collective responsibility). We compared the predictability of these theoretical frameworks to see which framework explains the highest variance in COVID-19 vaccine hesitancy. This study adopted a cross-sectional research design. We collected data from a nationally representative sample of 1,497 respondents through both online and face-to-face interviews. We employed multiple linear regression analysis to assess the predictability of each model of COVID-19 vaccine hesitancy. We found a 41.1% prevalence of COVID-19 vaccine hesitancy among our study respondents. After controlling the effects of socio-economic, demographic, and other COVID-19 related covariates, we found that the TPB has the highest predictive power (adjusted R 2 = 0.43), followed by the 5C psychological antecedents of vaccination (adjusted R 2 = 0.32) and the HBM (adjusted R 2 = 0.31) in terms of explaining total variance in the COVID-19 vaccine hesitancy among the adults of Bangladesh. This study provides evidence that theoretical frameworks like the HBM, the TPB, and the 5C psychological antecedents can be used to explore the psychological determinants of vaccine hesitancy, where the TPB has the highest predictability. Our findings can be used to design targeted interventions to reduce vaccine hesitancy and increase vaccine uptake to prevent COVID-19.

Population-Level Preparedness About Preventive Practices Against Coronavirus Disease 2019: A Cross-Sectional Study Among Adults in Bangladesh.

This study assessed the preparedness regarding the preventive practices toward the coronavirus disease 2019 (COVID-19) among the adult population in Bangladesh. Data were collected through an online survey with a sample size of 1,056. We constructed four variables (individual, household, economic, and community and social distancing) related to preparedness based on the principal component analysis of eight items. We employed descriptive statistics and multiple linear regression analysis. The results showed that the accuracy rate of the overall preparedness scale was 68.9%. The preparedness level related to economic, individual, household, and community and social distancing was 64.9, 77.1, 50.4, and 83.2%, respectively. However, the economic preparedness significantly varied by sex, education, occupation, attitude, and worries related to COVID-19. Individual preparedness was significantly associated with education, residence, and attitudes. The household preparedness significantly varied by education, residence, and worries, while the respondent's community and social distancing-related preparedness significantly varied by sex, region, residence, and attitude. This study implies the necessity of the coverage of financial schemes for the vulnerable group. Increased coverage of health education regarding personal hygiene targeting the less educated and rural population should be ensured.

Do knowledge and attitudes matter for preventive behavioral practices toward the COVID-19? A cross-sectional online survey among the adult population in Bangladesh.

The Government of Bangladesh has adopted several non-therapeutic measures to tackle the pandemic of SARS-CoV-2. However, the curve of COVID-19 positive cases has not significantly flattened yet, as the adoption of preventive measures by the general population is predominantly a behavioral phenomenon that is often influenced by people's knowledge and attitudes. This study aimed to assess the levels of knowledge, attitudes, and preventive behavioral practices toward COVID-19 and their interrelationships among the population of Bangladesh aged 18 years and above. This study adopted a web-based cross-sectional survey design and collected data from 1056 respondents using the online platform Google Form. We employed the independent sample t-test, one-way ANOVA, Pearson's product-moment correlation, and Spearman rank-order correlation to produce the bivariate level statistics. We also run multiple linear and logistic regression models to identify the factors affecting knowledge, attitudes, and preventive behavioral practices toward COVID-19. The respondents had an average knowledge score of 17.29 (Standard Deviation (SD) = 3.30). The average score for attitude scale toward COVID-19 was 13.6 (SD = 3.7). The respondents had excellent preventive behavioral practices toward COVID-19 (mean 7.7, SD = 0.72). However, this study found that knowledge and attitudes did not matter for preventive behavioral practices toward COVID-19. Instead, education appeared as a sole predictor for preventive behavioral practices toward COVID-19; that means preventive behavioral practices toward COVID-19 was lower among the less educated respondents. This study suggests increasing education as a long-term strategy and taking immediate action to increase knowledge and decrease negative attitudes toward COVID-19 through targeted health education initiatives as a short-term strategy.