COVID-19 vaccine hesitancy among pregnant women attending public antenatal clinics in Dar es Salaam, Tanzania

Figures & data

Table

HEALTH FACILITY	Muhimbili	Amana	Mnazi Mmoja	Buguruni	TOTAL
Minimum number expected	329	477	580	538	1924
Minimum sample size	168	244	297	275	984

Table 1. Socio-demographic and obstetrics characteristics of pregnant women attending antenatal clinics at public health facilities of Dar-es-Salaam.

Variable	Frequency (n)	Percent (%)
Age group	Mean = 28.34 ± 5.57
<20	30	3.3
20–34	729	81.4
≥35	137	15.3
Education level
No formal	25	2.8
Primary	316	35.3
Secondary	408	45.5
Higher	147	16.4
Occupation status
Employed	187	2.9
Self-employed	435	48.5
Unemployed	274	3.6
Marital status
Married/cohabiting	776	86.7
Single/widow/separated	120	13.3
Parity
Nulliparous	277	3.9
One	272	3.4
Two	223	24.9
Three and above	124	13.8
Pregnancy risk
High	97	1.8
Low	799	89.2
Gestation age (weeks)
Up to 13 weeks	104	11.6
14–27 weeks	310	34.6
28 weeks and above	482	53.8

Figure 1. COVID-19 vaccine hesitancy and acceptance as indicated by the likelihood of the pregnant women to take the vaccine when available.

Table 2. Perceived social norms, action efficacy, divine will, and COVID-19 status.

1. If a vaccine for COVID −19 were available COVID-19 in your community, what portion of the people you know do you think would get the vaccine?	a. Most people would get the vaccine 18.3%
	b. About half of people would get the vaccine 16.3%
	c. Very few people would get the vaccine 36.8%
	d. Don’t know/won’t say 28.6%
2. Do you think that most of your close family and friends would want you to get a COVID-19 vaccine?	a. Yes 52.3%
	b. No 24.6%
	c. Don’t know/won’t say 23.1%
3. Do you think that most of your community leaders and religious leaders would want you to get a COVID-19 vaccine?	a. Yes 69.2%
	b. No 15.3%
	c. Don’t know/won’t say 15.5%
4. If a doctor or nurse recommended that you get the COVID-19 vaccine, how likely would you be to get it?	a. Very likely 35.8%
	b. Somewhat likely 24.9%
	c. Not likely 22.6%
	d. Don’t Know/Won’t say 16.7%
Access
5. How difficult is it for you to get to the clinic where vaccines are normally offered?	a. Very difficult 5.9%
	b. Somewhat difficult 30.5%
	c. Not difficult at all 63.6%
Perceived action efficacy
6. If you were to get the vaccine for COVID-19, how likely would it be that you would get COVID-19 disease after that?	a. Very likely 11.8%
	b. Somewhat likely 19.3%
	c. Not likely at all 43.6%
	d. Don’t Know/Won’t say 25.3%
7. How much would you trust a new COVID-19 vaccine?	a. Not trust it at all 12.2%
	b. Trust it a little 23.2%
	c. Trust it a moderate amount 16.3%
	d. Trust it a lot 21.2%
	e. Don’t Know/Won’t say 27.1%
8. How safe do you think it would be for you to get a COVID-19 vaccine?	a. Not safe at all 18%
	b. Mostly safe 34.8%
	c. Very safe 13.5%
	d. Don’t Know/Won’t say 33.6%
9. If one has been infected with COVID-19, vaccination with the COVID-19 vaccine is unnecessary.	a. Agree a little 8.8%
	b. Agree a lot 17.4%
	c. Disagree a little 22.1%
	d.Disagree a lot 27.3%
	e. Don’t Know/Won’t say 24.3%
10. Most people will eventually get infected with COVID-19, so getting the COVID-19 vaccine is unnecessary.”	a. Agree a little 9.5%
	b. Agree a lot 13.8%
	c. Disagree a little 23.1%
	d. Disagree a lot 30.8%
	e. Don’t Know/Won’t say 22.8%
Perceived divine will
11. Do you think that God (or Allah or the gods) approve(s) or disapprove(s) of people getting a COVID-19 vaccine?	a. I believe that God approves 12.6%
	b. I believe that God does not approve 10.4%
	c. Don’t Know/Won’t say 77%
12. Whether I get COVID-19 or not is purely a matter of God’s will or chance. The actions I take will have little bearing on whether or not I get COVID-19.”	a. Agree with a little 17.4%
	b. Agree with a lot 19.5%
	c. Disagree a little 33.5%
	d. Disagree a lot 29.6%
COVID-19 status and Vaccination.
1. Have you ever been diagnosed or treated for COVID-19 symptoms/disease?	Yes 2.7%
	No 94.9%
	Not sure 2.4%
2. Have you cared for close family member who had COVID-19 symptoms/disease?	Yes 5.4%
	No 94.6%
3. Has someone in your family died of COVID-19 or of suspected COVID-19 disease?	Yes 3.6%
	No 94%
	Don’t know 2.3%
4. Are you vaccinated with COVID-19 vaccine?	Yes 10.3%
	No 89.7%

Table 3. Attitudes of pregnant women toward COVID-19 vaccines.

Attitudes	AGREE	NOT SURE	DISAGREE
	n (%)	n (%)	n (%)
1. I think the COVID-19 vaccine probably will not work	90(10.0)	331(37.0)	475(53.0)
2. I don’t trust the COVID-19 vaccine	217(24.2)	202(22.5)	477(53.3)
3. I think the COVID-19 vaccine is unnecessary	126(14.1)	213(23.8)	557(62.1)
4. I think it is not important to get a vaccine to protect people from COVID-19	118(13.1)	219(24.4)	559(62.4)
5. I don’t need vaccine because I am healthy and at low risk for infection	168(18.7)	237(26.5)	491(54.8)
6. I do not need a COVID-19 vaccine because even if I get infected, I will not become seriously ill	146(16.3)	277(30.9)	473(52.8)

Table 4. Perceptions of pregnant women toward COVID-19 vaccines.

		AGREE	NOT SURE	DISAGREE
		n (%)	n (%)	n (%)
Perceived susceptibility and severity of COVID-19
1	I am worried about the likelihood of getting infected by COVID-19	310(34.6)	205(22.9)	381(42.5)
2	I am at high risk of COVID-19 because of my health conditions	211(23.5)	244(27.2)	441(49.2)
3	I will be very sick if I get infected by COVID-19	185(20.6)	355(39.6)	356(39.7)
4	I am very concerned that I could die from COVID-19	209(23.3)	319(35.6)	368(41.1)
Perceived benefits of vaccine
1	I think vaccination is good because it will make me less worried about COVID-19	562(62.7)	196(21.8)	138(15.4)
2	I believe vaccination will decrease my risk of getting infected by COVID-19	564(62.9)	208(23.2)	124(13.8)
3	I think the complications of COVID-19 will decrease if I get vaccinated and then get infected with the coronavirus	531(59.3)	245(27.3)	120(13.4)
Perceived barriers to vaccine
1	I am worried about the possible side effects of the COVID-19 vaccination	351(39.2)	279(31.1)	266(29.7)
2	I am concerned about the efficacy of COVID-19 vaccine	637(71.1)	137(15.3)	122(13.6)
3	I have a concern that I may receive a faulty/fake vaccine	344(38.4)	287(32.0)	265(29.6)
4	It concerns me that the development of the vaccine is too rushed to test its safety properly	300(33.5)	390(43.5)	206(23.0)
5	I am concerned about the long-term side effects of the COVID-19 vaccination.	233(26.0)	380(42.4)	283(31.6)

Table 5. Factors associated with COVID-19 vaccine hesitancy among pregnant women using a binary logistic regression model.

	Vaccine hesitancy	Bivariate analysis		Multivariable analysis
Variable	n (%)	COR (95% CI)	P value	AOR (95% CI)	P value
Age group
≥35	70(50.2)	1	1	1	1
<20	113(44.8)	1.25(0.56–2.77)	.58	0.67(0.27–1.64)	.38
20–34	219(43.2)	0.72(0.50–1.05)	.09	0.63(0.43–0.95)	.03
Education level
Higher	56(38.1)	1	1	1	1
No formal	13(52.0)	1.76(0.75–4.13)	.19	0.65(0.25–1.70)	.38
primary	154(48.7)	1.54(1.04–2.30)	.03	0.87(0.54–1.40)	.57
Secondary	179(43.9)	1.27(0.86–1.87)	.22	0.98 (0.63–1.53)	.94
Occupation
Employed	63(33.7)	1	1	1	1
Self-employed	197(45.3)	1.63(1.14–2.33)	.007	1.62(1.07–2.44)	.02
Unemployed	142(51.8)	2.12(1.44–3.11)	<.001	2.16(1.36–3.42)	.001
Marital status
Married/cohabiting	342(44.1)	1	1	1	1
Single/widow/divorced	60(50.0)	1.27(0.86–1.86)	.22
Parity
Three and above	54(43.5)	1	1	1	1
Nulliparous	125(45.1)	1.07(0.70–1.63)	.769
One	120(44.1)	1.02(0.67–1.57)	.916
Two	103(46.2)	1.11(0.72–1.73)	.636
Gestation age (weeks)
up to 13 weeks	47(45.2)	1	1	1	1
14 to 27 weeks	143(46.1)	1.04(0.66–1.62)	.868
28 weeks and above	212(44.0)	0.95(0.62–1.46)	.822
Pregnancy risk
High	45(46.4)	1	1	1	1
Low	357(44.7)	0.93(0.61–1.42)	.749
Knowledge level
Good (≥70%)	146(41.2)	1	1	1	1
Poor (<70%)	256(47.2)	1.28(0.97–1.67)	.078	0.92(0.69–1.24)	.60
Attitude status
Good (≥70%)	212(35.0)	1	1	1	1
Poor (<70%)	190(65.3)	3.49(2.60–4.68)	<.001	2.44(1.75–3.39)	<.001
Perceived susceptibility and severity
High (≥70%)	71(36.8)	1	1	1	1
Low (<70%)	331(47.1)	1.53(1.10–2.12)	.011	1.28(0.90–1.81)	.17
Perceived benefits of the vaccine
High (≥70%)	222(35.5)	1	1	1	1
Low (<70%)	180(66.4)	3.59(2.66–4.85)	<.001	2.57(1.83–3.60)	<.001
Perceived barriers
High (≥70%)	8(44.4)	1	1	1	1
Low (<70%)	394(44.9)	1.02(0.40–2.60)	.971