ABSTRACT
Background: The COVID-19 vaccine rollout program in Uganda was launched in March 2021 with Healthcare Workers (HCWs), older persons (50 years and above), and persons with chronic conditions as priority groups for vaccination. To inform the vaccine rollout efforts, we set out to explore the social and structural factors that influenced the uptake of COVID-19 vaccines among HCWs and older people in Uganda. Methods Between September and October 2021, we conducted 33 in-depth interviews with 25 HCWs aged 21 to 63 years from three hospitals from two districts in the central region of Uganda and eight older people from communities in Wakiso district. Selection was purposive based on sex, occupation, education, cadre of HCWs (doctors, nurses, laboratory technologist, hospital support staff, administrator) and vaccination status. We explored participants knowledge, beliefs, personal experiences, barriers, and facilitators to vaccine uptake and suggestions for future COVID-19 vaccine rollout. Interviews were audio-recorded, data was transcribed and translated from the local language, coded, and analysed by themes. Results Twenty-two of the 25 (88%) HCWs and 3 of the 8 (38%) older people had received at least one dose of the COVID-19 vaccine at the time of interview. The structural facilitating factors to vaccine uptake included access to correct information, fear of a risky work environment, and mandatory vaccination requirements especially for frontline HCWs. Old age, chronic health conditions, and the fear of death are contextual facilitating factors, while influence from leaders was the main social facilitating factor. Myths and misconceptions about COVID-19 vaccines and the fear of side effects were common social barriers to vaccine uptake among HCWs and older people. Long distances to vaccination centres, vaccine stock-outs, and long queues at the vaccination centres were specific barriers to vaccine uptake for older people. The prerequisite of signing a consent form was a specific structural barrier for the HCWs. Transport challenges linked to long distances to the vaccination centres, for older people, and having underlying chronic health conditions, for both older people and HCWs, were the reported contextual factors. Conclusion Future roll out of new vaccines should have a comprehensive information dissemination strategy about the vaccines. Improved access to vaccines through community outreaches, reliable vaccine supply and addressing vaccine misinformation, may enhance COVID-19 vaccine uptake in Uganda and other future mass vaccination campaigns.
Subject(s)
COVID-19 , DeathABSTRACT
Objectives We assessed the prevalence of immunoglobulin G (IgG) and immunoglobulin M (IgM) against four endemic human coronaviruses (HCoVs) and two SARS-CoV-2 antigens, among vaccinated and unvaccinated staff at health care centres in Uganda, Sierra Leone, and the Democratic Republic of Congo (DRC). Methods Government health facility staff who had patient contact in Goma (DRC), Kambia District (Sierra Leone), and Masaka District (Uganda) were enrolled. Questionnaires and blood samples were collected at three timepoints over four months. Blood samples were analysed with the Luminex MAGPIX. Results Among unvaccinated participants, the prevalence of IgG/IgM antibodies against SARS-CoV-2 RBD or N-protein at enrolment was 70% in Goma (138/196), 89% in Kambia (112/126) and 89% in Masaka (190/213). IgG responses against endemic HCoVs at baseline were not associated with SAR-CoV-2 sero-acquisition during follow-up. Among vaccinated participants, those who had evidence of SARS-CoV-2 IgG/IgM at baseline tended to have higher IgG responses to vaccination compared to those SARS-CoV-2 seronegative at baseline, controlling for the time of sample collection since vaccination. Conclusions The high levels of natural immunity and hybrid immunity should be incorporated into both vaccination policy and prediction models of the impact of subsequent waves of infection in these settings.
Subject(s)
Hemorrhagic Fever, Crimean , Severe Acute Respiratory SyndromeABSTRACT
Introduction This study aimed to determine whether the COVID-19 pandemic had an impact on the number of people seen at public facilities in Uganda, the Democratic Republic of the Congo (DRC) and Sierra Leone for essential primary healthcare services. Methods The number of weekly consultations for antenatal care (ANC), outpatient (OPD), expanded programme on immunisations (EPI), family planning (FP) services and HIV, for the period of January 2018-December 2020, were collected from 25 primary healthcare facilities in Masaka district, Uganda, 21 health centres in Goma, DRC, and 29 facilities in Kambia district, Sierra Leone. Negative binomial regression models accounting for facility level clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020. Results We found no evidence that the COVID-19 pandemic affected the number of OPD, EPI or ANC consultations in Goma. Family planning consultations were 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. Compared to the same periods in 2019, facilities in Sierra Leone had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020, but this had recovered by Jul-Dec. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV, throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered in 2020 compared to 2019. Conclusions The level of disruption appeared to correlate with the strength of lockdown measures in the different settings and community attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services proved important to limit the impact of lockdowns on primary healthcare services.