COVID-19 vaccine hesitancy: Vaccination intention and attitudes of community health volunteers in Kenya

In Kenya, community health volunteers link the formal healthcare system to urban and rural communities and advocate for and deliver healthcare interventions to community members. Therefore, understanding their views towards COVID-19 vaccination is critical to the country's successful rollout of mass vaccination. The study aimed to determine vaccination intention and attitudes of community health volunteers and their potential effects on national COVID-19 vaccination rollout in Kenya. This cross-sectional study involved community health volunteers in four counties: Mombasa, Nairobi, Kajiado, and Trans-Nzoia, representing two urban and two rural counties, respectively. COVID-19 vaccination intention among community health volunteers was 81% (95% CI: 0.76–0.85). On individual binary logistic regression level, contextual influence: trust in vaccine manufacturers (adjOR = 2.25, 95% CI: 1.06–4.59;p = 0.030);individual and group influences: trust in the MoH (adjOR = 2.12, 90% CI: 0.92–4.78;p = 0.073);belief in COVID-19 vaccine safety (adjOR = 3.20, 99% CI: 1.56–6.49;p = 0.002), and vaccine safety and issues: risk management by the government (adjOR = 2.46, 99% CI: 1.32–4.56;p = 0.005) and vaccine concerns (adjOR = 0.81, 90% CI: 0.64–1.01;p = 0.064), were significantly associated with vaccination intention. Overall, belief in COVID-19 vaccine safety (adjOR = 2.04, 90% CI: 0.92–4.47 p = 0.076) and risk management by the government (adjOR = 1.86, 90% CI: 0.94–3.65;p = 0.072) were significantly associated with vaccination intention. Overall vaccine hesitancy among community health volunteers in four counties in Kenya was 19% (95% CI: 0.15–0.24), ranging from 10.2−44.6% across the counties. These pockets of higher hesitancy are likely to negatively impact national vaccine rollout and future COVID-19 vaccination campaigns. The determinants of hesitancy arise from contextual, individual and group, and vaccine or vaccination specific concerns, and vary from county to county.

Determinants of COVID-19 vaccine behaviour intentions among the youth in Kenya: a cross-sectional study.

INTRODUCTION: COVID-19 has become a public health concern globally with increased numbers of cases of the disease and deaths reported daily. The key strategy for the prevention of COVID-19 disease is to enhance mass COVID-19 vaccination. However, mass vaccination faces challenges of hesitation to acceptance of the vaccine in the community. The youth may not be among the vulnerable population to severe COVID-19 disease but are highly susceptible to contracting the virus and spreading it. The aim of the study was to assess COVID-19 vaccine youth behavior intentions and their determinants in Kenya. METHODS: The study used a mixed method design, employing a cross-sectional survey and focused group discussions across 47 counties in Urban, Peri-Urban and Rural settings of Kenya. The interviewees were youths aged 18-35, registered in online platforms/peer groups that included Shujaaz, Brck Moja, Aiffluence, Y Act and Heroes for Change. Quantitative data was collected using Google forms. A total of 665 interviews were conducted. Quantitative data was analysed using STATA version 16. In this paper we report quantitative study findings. RESULTS: The findings of the study indicated that only 42% of the youth were ready to be vaccinated, with 52% adopting a wait and see approach to what happens to those who had received the vaccine and 6% totally unwilling to be vaccinated. The determinants of these behavior intentions included: the perceived adverse effects of the vaccine on health, inadequate information about the COVID-19 vaccine, conflicting information about COVID-19 vaccine from the social media, religious implications of the vaccine, impact of education level on understanding of the vaccine, perceived risk of contracting the COVID-19 disease, efficacy of the COVID-19 vaccine, COVID-19 affecting women than men and trust in the ministry of health to lead COVID-19 interventions. Significantly it was found that hesitancy is higher among females, protestants and those with post-secondary education. Lack of information and concerns around vaccine safety and effectiveness were main cause of COVID-19 vaccine hesitancy. Social media was the major source of information contributing to hesitancy. Other contributors to hesitancy included low trust in the MoH and belief that mass vaccination is not helpful. CONCLUSION: Vaccine hesitancy remains high among the youth but the causes of it are modifiable and health systems need to have evidence based engagements with the youth to reduce vaccine hesitancy.

COVID-19 vaccine hesitancy: Vaccination intention and attitudes of community health volunteers in Kenya.

In Kenya, community health volunteers link the formal healthcare system to urban and rural communities and advocate for and deliver healthcare interventions to community members. Therefore, understanding their views towards COVID-19 vaccination is critical to the country's successful rollout of mass vaccination. The study aimed to determine vaccination intention and attitudes of community health volunteers and their potential effects on national COVID-19 vaccination rollout in Kenya. This cross-sectional study involved community health volunteers in four counties: Mombasa, Nairobi, Kajiado, and Trans-Nzoia, representing two urban and two rural counties, respectively. COVID-19 vaccination intention among community health volunteers was 81% (95% CI: 0.76-0.85). On individual binary logistic regression level, contextual influence: trust in vaccine manufacturers (adjOR = 2.25, 95% CI: 1.06-4.59; p = 0.030); individual and group influences: trust in the MoH (adjOR = 2.12, 90% CI: 0.92-4.78; p = 0.073); belief in COVID-19 vaccine safety (adjOR = 3.20, 99% CI: 1.56-6.49; p = 0.002), and vaccine safety and issues: risk management by the government (adjOR = 2.46, 99% CI: 1.32-4.56; p = 0.005) and vaccine concerns (adjOR = 0.81, 90% CI: 0.64-1.01; p = 0.064), were significantly associated with vaccination intention. Overall, belief in COVID-19 vaccine safety (adjOR = 2.04, 90% CI: 0.92-4.47 p = 0.076) and risk management by the government (adjOR = 1.86, 90% CI: 0.94-3.65; p = 0.072) were significantly associated with vaccination intention. Overall vaccine hesitancy among community health volunteers in four counties in Kenya was 19% (95% CI: 0.15-0.24), ranging from 10.2-44.6% across the counties. These pockets of higher hesitancy are likely to negatively impact national vaccine rollout and future COVID-19 vaccination campaigns. The determinants of hesitancy arise from contextual, individual and group, and vaccine or vaccination specific concerns, and vary from county to county.

The perceived effects of COVID-19 pandemic on female genital mutilation/cutting and child or forced marriages in Kenya, Uganda, Ethiopia and Senegal.

BACKGROUND: The effects of COVID-19 on harmful traditional practices such Female Genital Mutilation/Cutting (FGM/C) and Child or Forced Marriages (CFM) have not been well documented. We examined respondents' perceptions on how the COVID-19 pandemic has affected FGM/C and CFM in Kenya, Uganda, Senegal, and Ethiopia. METHODS: A cross-sectional study design with a mixed methods approach was used. Data collection on participants' perceptions on the effects of COVID-19 on FGM/C and CFM took place between October-December 2020. Household surveys targeting women and men aged 15-49 years in Kenya (n = 312), Uganda (n = 278), Ethiopia (n = 251), and Senegal (n = 208) were conducted. Thirty-eight key informant interviews with programme implementers and policymakers were carried out in Kenya (n = 17), Uganda (n = 9), Ethiopia (n = 8), and Senegal (n = 4). RESULTS: In Kenya, the COVID-19 pandemic has contributed to the increase in both FGM/C and CFM cases. Minimal increase of FGM/C cases was reported in Uganda and a significant increase in CFM cases. In Ethiopia, the COVID-19 pandemic had a limited perceived effect on changes in FGM/C and CFM. In Senegal, there were minimal perceived effects of COVID-19 on the number of FGM/C and CFM cases. The pandemic negatively affected implementation of interventions by the justice and legal system, the health system, and civil societies. CONCLUSIONS: The pandemic has had varied perceived effects on FGM/C and CFM across the four countries. Generally, the pandemic has negatively affected implementation of interventions by the various sectors that are responsible for preventing and responding to FGM/C and CFM. This calls for innovative approaches in intervening in the various communities to ensure that women and girls at risk of FGM/C and CFM or in need of services are reached during the pandemic. Evidence on how effective alternative approaches such as the use of call centres, radio talk shows and the use of local champions as part of risk communication in preventing and responding to FGM/C and CFM amid COVID-19 is urgently required.

A Situation Assessment of Community Health Workers' Preparedness in Supporting Health System Response to COVID-19 in Kenya, Senegal, and Uganda.

BACKGROUND: Coronavirus disease (COVID-19) caused socio-economic disruptions across the globe. The pandemic disrupted the health system (HS) calling for reengineering in response to high infection rates, deaths, and resultant containment measures. To deal with COVID-19 and promote resilience, community health workers (CHWs) were engaged across countries. OBJECTIVE: Assess the preparedness of CHWs in supporting health system response in prevention and management of COVID-19 in Kenya, Senegal, and Uganda. METHODS: A mixed methods design study involving national and subnational jurisdictions in the 3 countries. Key informant interviews were conducted with policy actors (16) and health care workers (24) while in-depth interviews involved CHWs (14) and community members (312) subjected to survey interviews. RESULTS: Most (>50%) households survived on

Impact of the First Wave of the COVID-19 Pandemic on HIV/AIDS Programming in Kenya: Evidence from Kibera Informal Settlement and COVID-19 Hotspot Counties.

The study sought to determine the impact of COVID-19 on HIV/AIDS programming in the Kibera informal settlement and COVID-19 hotspot counties during the first wave of the pandemic. The study was conducted in two phases. The first phase entailed the analysis of HIV care and treatment secondary data (2018-2020) from the Kenya Health Information System. In the second phase, a prospective cohort study was conducted among people living with HIV in the Kibera informal settlement. A total of 176 participants aged 18 years and above accessing HIV services at selected healthcare facilities in Kibera were randomly sampled from facility electronic medical records and followed up for three months. Socio-demographics and contact details were abstracted from the records and telephone interviews were conducted with consenting participants. Results from the retrospective review of HIV program data indicated a 56% (p < 0.000, 95% CI: 31.3%-62.8%) reduction in uptake of HIV services. Clients starting antiretroviral therapy (ART) reduced significantly by 48% (p < 0.001, 95% CI: 35.4%-77%) in hotspot counties. However, pre-exposure prophylaxis uptake increased significantly by 24% (p < 0.019, 95% CI: 4%-49%). In Kibera, 14% reported missing medications at the onset of the COVID-19 pandemic because of lack of food (38%) and government measures (11%), which affected ART access; 11% did not access health facilities due to fear of contracting COVID-19, government regulations and lack of personal protective equipment. Socioeconomic factors, food insecurity and government measures affected uptake of HIV/AIDS services; hence, the need for scaling up measures to increase access to HIV/AIDS services during the onset of pandemics.

The Effect of COVID-19 and Its Control Measures on Sexual Satisfaction Among Married Couples in Kenya.

BACKGROUND: COVID-19 was first diagnosed in Kenya in March 2020 following which the government instituted control measures which could have affected people's sexual satisfaction and overall quality of life including restrictions in travels; ban on alcohol consumption and closure of bars; 9 pm to 5 am curfew; ban on political rallies, and closure of many workplaces with people being encouraged to work from home. AIM: The objective of this study was to determine how perceived and experienced sexual satisfaction changed with the advent of COVID-19 among heterosexual married individuals in Kenya. METHODS: The study was a cross-sectional survey. Data was collected virtually using monkey survey from social groups. A total of 194 participants responded to the survey. OUTCOMES: The difference in overall sexual satisfaction as well as satisfaction with sex frequency; sex process; and time, place and ambience around sexual intercourse before and during COVID-19. RESULTS: Most of the participants (73.4%) reported that they were satisfied with their marital sex before COVID-19 but the proportion of those reporting satisfaction dropped to 58.4% when they were asked about their experience during the COVID-19 pandemic. Among participants surveyed during the pandemic itself, therefore, 41.3% reported that they were currently sexually dissatisfied whereas just 26.6% reported that they were dissatisfied even prior to the pandemic. There was a significant difference in the overall distributions before and during COVID-19 (χ² = 38.86, P< .001). CLINICAL TRANSLATION: COVID-19 pandemic should be considered an etiology of sexual dissatisfaction and possibly sexual dysfunctions and COVID-19 control measures should incorporate ways of enhancing sexual well-being. CONCLUSION: There was perceived increase in dissatisfaction with sex which could be a pointer to the falling quality of life during COVID-19 pandemic especially among the most sexually active men aged 31-50 years living in places where COVID-19 control measures are being stringently implemented. Osur J, Ireri EM, Esho T. The Effect of COVID-19 and Its Control Measures on Sexual Satisfaction Among Married Couples in Kenya. Sex Med 2021;9:100354.