1
|
Tsega TD, Kebede AM, Dessie TM, Adane B, Yalew M, Ahmed AF, Mehari MG, Bayeh GM, Yeshiwas AG, Yizengaw MA, Alene T, Aynalem ZB. COVID-19 vaccine acceptance and its association with knowledge and attitude among patients with chronic diseases in Ethiopia. Hum Vaccin Immunother 2024; 20:2350815. [PMID: 38757639 PMCID: PMC11110712 DOI: 10.1080/21645515.2024.2350815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
COVID-19 vaccine acceptance is crucial for patients with chronic diseases, but previous studies in Ethiopia have yielded inconsistent and inconclusive findings. To fill this gap, we conducted a systematic review and meta-analysis following established guidelines. Our search included relevant articles published between 2019 and 2023 from various sources. We assessed study heterogeneity and publication bias, and performed subgroup and sensitivity analyses. Our findings indicate that the COVID-19 vaccine acceptance rate among patients with chronic diseases in Ethiopia was 55.4%. We also found that good knowledge and a favorable attitude toward the vaccine were positively associated with the acceptance rate. Based on these results, we recommend that healthcare professionals, policymakers, and healthcare guide developers should work more to address the relatively low acceptance rate. Improving the knowledge and attitude further about the COVID-19 vaccines is crucial. Future research should include community-based and qualitative studies to enhance our understanding of vaccines acceptance.
Collapse
Affiliation(s)
- Tilahun Degu Tsega
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Abebaw Molla Kebede
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Tadesse Miretie Dessie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Bezawit Adane
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Melaku Yalew
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Ahmed Fentaw Ahmed
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Molla Getie Mehari
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Gashaw Melkie Bayeh
- Department of Environmental health, College of medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Almaw Genet Yeshiwas
- Department of Environmental health, College of medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Mekuanent Asmare Yizengaw
- Department of Anesthesia, College of medicine and Health Sciences, Injibara University,Injibara, Ethiopia
| | - Tamiru Alene
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Zewdu Bishaw Aynalem
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| |
Collapse
|
2
|
Seid S, Gebru Gebremeskel T. Uptake, adverse effect, and associated factors of COVID-19 vaccine among those living with human immunodeficiency virus, at Bole sub-city health facility Addis Ababa, Ethiopia. Hum Vaccin Immunother 2024; 20:2389576. [PMID: 39286864 PMCID: PMC11409500 DOI: 10.1080/21645515.2024.2389576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/23/2024] [Accepted: 08/03/2024] [Indexed: 09/19/2024] Open
Abstract
COVID-19 vaccination in African people living with human immunodeficiency virus remains understudied, with limited research in Ethiopia that fails to consider contextual differences. To assess uptake, adverse effects, and associated factors of COVID-19 vaccine among PLWHA in Addis Ababa, Ethiopia, 2022. An institutional cross-sectional study design was employed among 404 participants. Sample selected by systematic random sampling technique. Descriptive and inferential statistical analyses were carried out. Finally, results were presented using Crude Odd Ratio, Adjusted Odd Ratio, and 95% Confidence Interval. Result: Out of all participants, 79% (314) received at least one dose of any type of COVID-19 vaccine, with varying percentages taking one (29.3%), two (50.3%), and three (20.4%) doses of the vaccine. Being knowledgeable (moderate and good) (AOR = 0.06, 95% CI: 0.01, 0.5) and medium attitude (AOR = 1.1, 95% CI: 0.7, 1.3) had a statistically significant association with the uptake of the COVID-19 vaccine. The prevalence of adverse events was 27.8% (110). More than three-quarters of participants were vaccinated for the COVID-19 vaccine. Moderate knowledge and medium attitude have a significant association with the uptake of the COVID-19 vaccine. Nearly a quarter of participants experienced adverse events related to COVID-19. Continued efforts are essential to overcome barriers to achieving full vaccination coverage for the most vulnerable in low-income countries. Addressing hesitancy, monitoring side effects, and implementing effective communication and strategies are crucial for widespread COVID-19 vaccination and public health safety in these regions.
Collapse
Affiliation(s)
- Sendu Seid
- Public Health Department, Addis Ababa Medical and Business College, Adis Abeba, Ethiopia
| | - Teferi Gebru Gebremeskel
- Flinders Health and Medical Research institute, Collage of medicine and Public Health, Flinders University, Adelaide, Australia
| |
Collapse
|
3
|
Gray A, Alemohammad SY, Ramírez-Ortiz D, Trepka MJ. A Systematic Review of Factors Associated with COVID-19 Vaccine Uptake, Hesitancy, and Acceptability Among Adults with HIV: Implications for Integrating COVID-19 Immunization into HIV Care. AIDS Patient Care STDS 2024; 38:393-427. [PMID: 39058653 DOI: 10.1089/apc.2024.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
The COVID-19 virus, once a public health emergency, is now endemic. Immunization remains an important measure for mitigating high levels of disease, morbidity, and mortality related to COVID-19 infection. People with HIV (PWH), in particular, benefit from COVID-19 vaccination because of increased risk for severe COVID-19 infection. However, previous data suggest vaccine hesitancy among this population. Given this context and the evolving epidemiology of COVID-19, this review examines factors associated with COVID-19 vaccine hesitancy, acceptability, and uptake among adults with HIV. Through a systematic search of electronic databases, we identified 56 peer-reviewed articles published between the years 2020 and 2023 that matched the objectives of our review out of a total of 797 screened citations. Among our final sample of articles, nearly all global regions were represented, and 61% of studies recruited only PWH. We identified eight categories of factors associated with COVID-19 vaccination outcomes, including HIV-specific factors (e.g., CD4 count), vaccine attitudes (e.g., vaccine confidence), factors related to the COVID-19 virus (e.g., concern about infection), factors specific to the COVID-19 vaccine (e.g., accessibility), social norms and peer factors (e.g., subjective norms), mental health (e.g., anxiety/depression) and other psychological factors (e.g., substance use), demographic characteristics (e.g., age), and health factors (e.g., vaccination history). Reflecting on these factors, we discuss populations in need of vaccine promotion, modifiable targets for intervention, and integrating immunization into HIV care. Public health efforts to promote COVID-19 immunization among PWH must include educational/informational, peer, and structural interventions and must now consider uptake of COVID-19 booster doses.
Collapse
Affiliation(s)
- Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Seyedeh Yasaman Alemohammad
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Daisy Ramírez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
| |
Collapse
|
4
|
Pereira M, Santos Aleluia IR, de Castro CT, de Almeida Oliveira T, Cunha MS, Magno L, Dourado I, Barreto F, Natividade M, Appiah SCY, Abade E, Paixao ES, de Souza MLT. COVID-19 Vaccine Acceptance and Hesitancy among People Living with HIV: Review and Meta-Analysis. AIDS Behav 2024; 28:2193-2204. [PMID: 38713281 DOI: 10.1007/s10461-024-04351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
This study aims to estimate the COVID-19 vaccine acceptance and hesitancy among people living with HIV (PLWHA). A search for observational studies was conducted in five databases and preprinted literature. Summary estimates were pooled using a random effects model and meta-regression. Of 150 identified studies, 31 were eligible (18,550 PLWHA). The weighted prevalence of COVID-19 vaccine hesitancy overall was 29.07% among PLWHA (95%CI = 24.33-34.32; I² = 98%,) and that of vaccine acceptance was 68.66% (95%CI = 62.25-74.43; I² = 98%). Higher hesitancy prevalence was identified in low/lower-middle income countries (35.05; 95% CI = 19.38-54.78). The heterogeneity was explained by the risk of bias, region, and year of data collection. The findings conclude that the COVID-19 vaccine hesitancy rate remains high, especially in low-income countries. Evidence-informed interventions aimed at increasing COVID-19 vaccine acceptance at the national and individual levels ought to be designed to increase COVID-19 vaccine acceptance among PLWHA.
Collapse
Affiliation(s)
- Marcos Pereira
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil.
| | | | - Caroline Tianeze de Castro
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Tarcio de Almeida Oliveira
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Mila Silva Cunha
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Florisneide Barreto
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Marcio Natividade
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Seth Christopher Yaw Appiah
- Department of Sociology and Social Work, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Erick Abade
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Enny S Paixao
- London School of Hygiene and Tropical Medicine, London, UK
| | | |
Collapse
|
5
|
Zurashvili T, Chakhaia T, King EJ, DeHovitz J, Djibuti M. HIV stigma and other barriers to COVID-19 vaccine uptake among Georgian people living with HIV/AIDS: A mixed-methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003069. [PMID: 38547297 PMCID: PMC10977874 DOI: 10.1371/journal.pgph.0003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/08/2024] [Indexed: 04/01/2024]
Abstract
We conducted a study in Georgia to examine behavioral insights and barriers to COVID-19 vaccine uptake among people living with HIV (PLWH). Between December 2021-July 2022, we collected quantitative data to evaluate participants' demographics, COVID-19 knowledge, attitude, perception, and HIV stigma as potential covariates for being vaccinated against COVID-19. We conducted a multivariate analysis to define the factors independently associated with COVID-19 vaccination among PLWH. We collected qualitative data to explore individual experiences of their positive or negative choices, main barriers, HIV stigma, and preferences for receiving vaccination. Of the total 85 participants of the study, 52.9% were vaccinated; 61.2% had concerns with the disclosure of HIV status at the vaccination site. Those who believed they would have a severe form of COVID-19 were more likely to be vaccinated (OR = 23.8; 95% CI: 5.1-111.7). The association stayed significant after adjusting for sex, age, education level, living area, health care providers' unfriendly attitudes, and their fear of disclosing HIV status at vaccination places. Based on the qualitative study, status disclosure was a significant barrier to receiving care; therefore, PLWH prefer to receive COVID-19 vaccination integrated in HIV services. Conclusions: In this study, around half of the participants were not vaccinated against COVID-19. The main reasons for not being vaccinated included stigma, misleading health beliefs, and low awareness about COVID-19. An integrated service delivery model may improve vaccination uptake among PLWH in Georgia.
Collapse
Affiliation(s)
- Tamar Zurashvili
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
- Partnership for Research and Action for Health, Tbilisi, Georgia
| | - Tsira Chakhaia
- Partnership for Research and Action for Health, Tbilisi, Georgia
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Elizabeth J. King
- School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jack DeHovitz
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Mamuka Djibuti
- Partnership for Research and Action for Health, Tbilisi, Georgia
| |
Collapse
|
6
|
Alie MS, Abebe GF, Negesse Y, Girma D, Adugna A. Pandemic fatigue, behavioral intention and predictors of COVID-19 vaccination among individuals living with HIV in Bench Sheko Zone, in Southern Ethiopia, application of TBP: a facility based cross sectional study. Front Public Health 2024; 12:1305777. [PMID: 38476495 PMCID: PMC10927957 DOI: 10.3389/fpubh.2024.1305777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction People living with HIV often face inequalities and negative outcomes, which make them vulnerable. To protect this population and achieve herd immunity, it is crucial for COVID-19 vaccination efforts to prioritize and encourage vaccination among people living with HIV (PLWH). However, in Ethiopia, there is a lack of motivation in this regard. To tackle this issue, a study was conducted in the Bench Sheko Zone of Southwest Ethiopia. The study aimed to assess pandemic fatigue, behavioral intention to get vaccinated, and factors influencing COVID-19 vaccine acceptance among PLWH in that region. Methods A facility-based cross-sectional study was conducted among individuals living with HIV who were over 18 years old in Bench-Sheko Zone, located in Southwest Ethiopia. The study included a total of 590 participants from four ART healthcare facilities within the zone. The researchers utilized the Theory of Planned Behavior to examine the predictors of intention to use preconception care. Multiple linear regression analysis was employed to determine these predictors, with a p-value of less than 0.05 considered as indicative of a significant association. The final analysis of the study involved the use of linear regression analysis, and the measure of association was presented as the standardized B coefficient following a multivariable logistic regression analysis. Result In the conducted study, the response rate was an impressive 98%. The researchers aimed to investigate the behavioral intention toward the COVID-19 vaccine, which was found to be 55.7%. The average age of the participants in the study was 34.65 ± 6.67. The study was the assessment of pandemic fatigue, which had a mean value of 17.22 ± 5.28. During the multivariate linear regression analysis, four predictor variables were identified. Among these, three variables, namely subjective norm, pandemic fatigue, and age, positively influenced the behavioral intention toward the COVID-19 vaccine. Comprehending these factors can assist healthcare professionals and policymakers in formulating precise interventions and strategies aimed at enhancing the acceptance and adoption of vaccines. Conclusion The study indicates that individuals living with HIV have shown lower vaccine intention compared to previous research. The study identifies subjective norm, pandemic control measures, income, and age as predictors of individuals' intention to receive the COVID-19 vaccine.
Collapse
Affiliation(s)
- Melsew Setegn Alie
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Gossa Fetene Abebe
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Yilkal Negesse
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Desalegn Girma
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Amanuel Adugna
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| |
Collapse
|
7
|
Sulaiman SK, Musa MS, Tsiga-Ahmed FI, Sulaiman AK, Bako AT. A systematic review and meta-analysis of the global prevalence and determinants of COVID-19 vaccine acceptance and uptake in people living with HIV. Nat Hum Behav 2024; 8:100-114. [PMID: 37904021 PMCID: PMC10810755 DOI: 10.1038/s41562-023-01733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
People living with HIV (PLHIV) are at higher risk of poor outcomes of SARS-CoV-2 infection. Here we report the pooled prevalence of COVID-19 vaccine acceptance/uptake and determinants among this vulnerable population of PLHIV based on a systematic review and meta-analysis of studies published by 25 August 2023. Among the 54 included studies (N = 167,485 participants), 53 (N = 166,455) provided data on vaccine acceptance rate, while 27 (N = 150,926) provided uptake data. The global prevalences of COVID-19 vaccine acceptance and uptake were 67.0% and 56.6%, respectively. Acceptance and uptake rates were 86.6% and 90.1% for the European Region, 74.9% and 71.6% for the Region of the Americas, 62.3% and 78.9% for the South-East Asian Region, 64.6% and 19.3% for the Eastern Mediterranean Region, 58.0% and 35.5% for the African Region, and 57.4% and 44.0% for the Western Pacific Region. The acceptance rate increased from 65.9% in 2020 to 71.0% in 2022, and the uptake rate increased from 55.9% in 2021 to 58.1% in 2022. Men, PLHIV aged ≥40 years and those who had recently received the influenza vaccine were more likely to accept and receive the COVID-19 vaccine. Factors associated with lower uptake included Black race, other races (Latinx/Hispanic/mixed race), low education level and being unemployed. Vaccine-related factors associated with higher acceptance included belief in vaccine effectiveness, vaccine trust, perceived high susceptibility to SARS-CoV-2 infection and fear of potential COVID-19 effect in PLHIV. Sustained efforts and targeted interventions are needed to reduce regional disparities in COVID-19 vaccine uptake among PLHIV.
Collapse
Affiliation(s)
| | - Muhammad Sale Musa
- Department of Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | - Abdulwahab Kabir Sulaiman
- Department of Medicine, Murtala Muhammad Specialist Hospital, Kano, Nigeria
- Kwanar Dawaki COVID-19 Isolation Center, Kano, Nigeria
| | | |
Collapse
|
8
|
Ejamo JY, Legese GL, Tesfaye YA, Liben FE. COVID-19 vaccine acceptance among people living with HIV: A systematic review and meta-analysis. Trop Med Int Health 2023. [PMID: 37402693 DOI: 10.1111/tmi.13908] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
OBJECTIVE To assess coronavirus disease 2019 (COVID-19) vaccine acceptance among people living with HIV (PLHIV) worldwide. METHODS We searched MEDLINE, PSYINFO, CINHAL, Scopus and EMBASE databases and other sources including free Google search and subject-specific journals from January 2020 to September 2021. The study population included adults (aged 18+ years) living with HIV and evaluated for COVID-19 vaccine acceptance. A random effect meta-analysis model was used to estimate the pooled COVID-19 vaccine acceptance rate. Subgroup analyses were performed, and factors associated with COVID-19 vaccine hesitancy underwent narrative analysis. Of 558 initial records, 14 studies were eligible for review. RESULTS The overall pooled COVID-19 vaccine acceptance rate among adult PLHIV was 62% (95% confidence interval [CI], 56%-69%). In subgroup analysis, the estimated pooled COVID-19 vaccine acceptance rate was higher in high-income countries: 63% (95% CI, 55%-70%) versus 62% (95% CI, 54%-71%) in low- and middle-income countries, and in studies conducted in 2022 (66% [95% CI, 58%-75%]) than in studies conducted in 2021 (57% [95% CI, 47%-68%]). Reasons for lower COVID-19 vaccine acceptance included higher monthly income, being non-homosexual, history of chronic disease, COVID-19-related medical mistrust, not knowing anyone who died of COVID-19, believing oneself to be immune to COVID-19, general vaccine refusal, negative attitude to the vaccine, concerns about efficacy, safety and side effects, distrust in common sources of vaccine-related information and using social media as a source of information on COVID-19. CONCLUSION Among PLHIV, acceptance of COVID-19 vaccine is generally low. A greater emphasis on collaborative efforts between all concerned bodies is needed to boost vaccine acceptance in this population.
Collapse
Affiliation(s)
- Janet Yohannes Ejamo
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Gebrehiwot Lema Legese
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yeabsira Aklilu Tesfaye
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fitsum Endale Liben
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| |
Collapse
|
9
|
Krause KD, Pérez-Figueroa RE, Halkitis PN. Barriers and facilitators related to COVID-19 vaccine acceptance and uptake among people living with HIV. Curr Opin HIV AIDS 2023; 18:142-147. [PMID: 36943471 DOI: 10.1097/coh.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This review reports on the myriad barriers and facilitators related to COVID-19 vaccine hesitancy and factors contribution to uptake among people living with HIV (PLWH) globally published over the past year (2021-2022). RECENT FINDINGS Across the literature, participants indicated concerns about the safety, efficacy and overall rapid development of the COVID-19 vaccine as a reason for delaying or not being vaccinated. Medical mistrust and perceptions about the risk of COVID-19 immune response and severity also played a role in COVID-19 vaccine hesitancy among PLWH. Almost every study examined different sociodemographic characteristics associated with COVID-19 vaccination acceptance and uptake, and although strong themes emerged around race/ethnicity, sex and educational attainment, the results were mixed across other characteristics, including age. Some studies also examined medical factors specifically related to PLWH including CD4 + cell count and adherence to antiretroviral therapy. SUMMARY The findings highlight individual, structural and social differences in COVID-19 vaccine acceptance and uptake among PLWH, which are varied throughout the world. We call on researchers and interventionists to not just consider the role of medical mistrust and disinformation, but also how emotional, financial and political vulnerability plays into making decisions around COVID-19 vaccine uptake and overall healthcare.
Collapse
Affiliation(s)
- Kristen D Krause
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Urban-Global Health
| | - Rafael E Pérez-Figueroa
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Urban-Global Health
| | - Perry N Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| |
Collapse
|
10
|
Lyons N, Bhagwandeen B, Todd S, Boyce G, Samaroo-Francis W, Edwards J. Correlates and Predictors of COVID-19 Vaccine Hesitancy Among Persons Living With HIV in Trinidad and Tobago. Cureus 2023; 15:e35961. [PMID: 37051005 PMCID: PMC10085522 DOI: 10.7759/cureus.35961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Persons living with HIV may be at risk of more severe forms of COVID-19 infection and minimizing health risks largely depends on their acceptance of the COVID-19 vaccinations. OBJECTIVE This study examined the correlates and predictors of COVID-19 vaccine hesitancy among persons living with HIV in Trinidad and Tobago. METHODS A cross-sectional survey using a structured interview was conducted. Data were compiled on patient socio-demographics, diagnosed chronic diseases, psychological factors, and decisions to take the COVID-19 vaccine. Pearson χ2 tests examined the associations between study variables and COVID-19 vaccine hesitancy, and multivariable logistic regression analyses examined its predictors. RESULTS In this study, 84% were virally suppressed, i.e., HIV viral load <1000 copies/ml. COVID-19 vaccine hesitancy was found to be 39%. Univariate analysis showed that higher vaccine hesitancy was significantly associated with females (OR 2.02, 95% CI 1.23-3.33) and patients of mixed ethnicity (OR 1.84, 95% CI 1.07-3.15). In our multivariable analysis, psychological factors namely, confidence in the COVID-19 vaccine (OR 0.16, 95% CI 0.05-0.47), the perceived benefits of the vaccine (OR 0.54, 95% CI 0.37-0.79), and cues to action (OR 0.68, 95% CI 0.47-0.97) were observed as predictors of COVID-19 vaccine hesitancy. CONCLUSION Psychological factors such as confidence in the COVID-19 vaccine, perceived benefits of the vaccine, and cues to action were possible predictors of COVID-19 vaccine hesitancy. This study underscored the continued need for strategies to increase confidence and knowledge about the benefits of taking the COVID-19 vaccine among persons living with HIV.
Collapse
|
11
|
Kabir Sulaiman S, Sale Musa M, Isma'il Tsiga-Ahmed F, Muhammad Dayyab F, Kabir Sulaiman A, Dabo B, Idris Ahmad S, Abubakar Haruna S, Abdurrahman Zubair A, Hussein A, Usman S, Usman Wada J, Yekeen Ayodele A, Wulgo Ali M, Tijjani Makama B, Tijjani Bako A, Garba Ismail A, Tijjani Makama B, Dalhatu Abdulkadir A, Jamal Abdulnasir N, Zakar Gambo B, Usman Mustapha M, Mohammed M, Ibrahim G, Adamu Dogo H, Ishaq Abubakar F, kurugu Y, Auwal Yusufari G, Saleh S, Yakubu A, Sulaiman S, Tijjani Bako A. COVID-19 vaccine hesitancy among people living with HIV in a low-resource setting: A multi-center study of prevalence, correlates and reasons. Vaccine 2023; 41:2476-2484. [PMID: 36932032 PMCID: PMC9946883 DOI: 10.1016/j.vaccine.2023.02.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Hesitancy to COVID-19 vaccine may worsen the burden of COVID-19 among people living with HIV (PLHIV), who are at a higher risk of COVID-19-related hospitalization and death, compared to HIV non-infected individuals. Therefore, we evaluate the predictors and reasons for COVID-19 vaccine hesitancy among unvaccinated PLHIV in six antiretroviral therapy (ART) clinics across northern Nigeria. METHODOLOGY In this cross-sectional study, conducted between October 2021 and February 2022 in six hospitals across two geopolitical regions of Nigeria, we utilized interviewer-administered questionnaires to assess COVID-19 vaccine hesitancy among a convenience sample of 790 eligible adult PLHIV. Hesitancy was defined as answering 'no' or 'maybe' to a question asking participants their willingness to accept the COVID-19 vaccine. A multivariate logistic regression model was used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the factors associated with COVID-19 vaccine hesitancy among PLHIV. RESULTS Of the total 660 unvaccinated participants included in the analysis (61.82% female, mean age [SD] of 39.76 [10.75]), 381 (57.72%) were hesitant to COVID-19 vaccine. Being 50 years and older (aOR: 0.43; 95% CI: 0.21-0.89), being unemployed (aOR: 0.57; 95% CI: 0.34-0.95), experiencing the adverse effects of ART (aOR: 0.36; 95% CI: 0.15-0.86), and perception of being at high risk of contracting COVID-19 (aOR: 0.22; 95% CI: 0.13-0.37) were associated with significantly lower odds of hesitancy. Conversely, being female (aOR: 1.64; 95% CI: 1.02-2.61) and attending ART clinics at state administrative capital cities (IIDH Kano [aOR: 2.40; 95% CI: 1.10-5.25], MMSH Kano [aOR: 5.59; 95% CI: 1.97-10.66], YSSH Damaturu [aOR: 9.88; 95% CI: 4.02-24.29] vs. GH Gashua) were associated with significantly higher odds of hesitancy. The most common reasons for hesitancy include fear of potential adverse effects, skepticism about vaccine efficacy, the rapid development of the COVID-19 vaccine, and the perceived lack of effort to develop a cure or vaccine for HIV/AIDS. CONCLUSION Interventions aimed at combating misperceptions and misinformation regarding the COVID-19 vaccination program may reduce the prevalence of COVID-19 vaccine hesitancy among unvaccinated PLHIV.
Collapse
Affiliation(s)
| | - Muhammad Sale Musa
- Department of Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | - Farouq Muhammad Dayyab
- Infectious Diseases Hospital, Kano, Nigeria; Department of Medicine, Kwanar Dawaki COVID-19 Isolation Center, Kano, Nigeria
| | - Abdulwahab Kabir Sulaiman
- Department of Medicine, Kwanar Dawaki COVID-19 Isolation Center, Kano, Nigeria; Department of Medicine, Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - Bashir Dabo
- Department of Epidemiology, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Saidu Idris Ahmad
- Department of Medicine, Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - Salisu Abubakar Haruna
- Department of Family Health, Kano State Primary Healthcare Management Board, Kano, Nigeria
| | | | - Aminu Hussein
- Department of Family Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | - Sadiya Usman
- HIV Clinic, General Hospital Gashua, Gashua Yobe State, Nigeria
| | | | | | | | | | | | | | | | | | | | | | - Bashir Zakar Gambo
- Department of Nursing, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | - Mustapha Mohammed
- Department of Nursing, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | - Gambo Ibrahim
- Department of Nursing, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | - Hadiza Adamu Dogo
- Department of Nursing, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | - Yakubu kurugu
- Department of Nursing, General Hospital Geidam, Yobe State
| | | | | | - Abubakar Yakubu
- College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Saeed Sulaiman
- College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | | |
Collapse
|
12
|
Gudayu TW, Mengistie HT. COVID-19 vaccine acceptance in sub-Saharan African countries: A systematic review and meta-analysis. Heliyon 2023; 9:e13037. [PMID: 36686610 PMCID: PMC9846884 DOI: 10.1016/j.heliyon.2023.e13037] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Vaccination is the most effective intervention for the primary prevention of COVID-19. Several studies have been conducted in sub-Saharan African countries on the acceptance and associated factors of COVID-19 vaccine. This review and meta-analysis aimed to recapitulate the pooled magnitude of vaccine acceptance and its favoring factors in sub-Saharan African countries. PUBMED, MEDLINE, Science Direct, Web of Science, and SCOPUS were the main databases searched from 15 March to 5 June 2022; and all the articles written in the English language were included. Also, some articles were retrieved from biomedical peer-reviewed journal sites and Google scholar. The quality of thirty-five selected articles was evaluated using an adapted scale for evaluating cross-sectional studies based on the Newcastle-Ottawa Scale. The result of the review and meta-analysis revealed that COVID-19 vaccine acceptance rate varied across studies. In a pooled analysis, factors such as; higher-level perception of infection risk (OR (95% CI (2.7 (2.1, 3.4))), perceived vaccine safety (13.9 (9.2, 20.9)), virus-related good knowledge (2.7 (2.3, 3.2)) and appropriate attitude (5.9 (4.4, 7.8)), adherence to safety precautions (5.5 (4.8, 6.2)), and infection experience (4.4 (2.8, 6.9)) were positively affected the COVID-19 vaccine acceptance. Also, vaccine acceptance was found to be high among males and chronically ill individuals. Thus, understanding factors that enhance vaccine acceptance would support planners to augment vaccine uptake in the region.
Collapse
Affiliation(s)
- Temesgen Worku Gudayu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Corresponding author.
| | | |
Collapse
|
13
|
Lyons N, Bhagwandeen B, Edwards J. Factors Affecting COVID-19 Vaccination Intentions among Patients Attending a Large HIV Treatment Clinic in Trinidad Using Constructs of the Health Belief Model. Vaccines (Basel) 2022; 11:vaccines11010004. [PMID: 36679849 PMCID: PMC9861852 DOI: 10.3390/vaccines11010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Persons living with HIV are particularly vulnerable to COVID-19 and understanding the factors influencing their decision to take the COVID-19 vaccine are crucial. Using the Health Belief Model (HBM), our study examined the role of psychological factors in predicting vaccine intention in patients with HIV. The underlying concept of the HBM is that behaviour is determined by personal beliefs about a disease, and access to strategies to decrease its occurrence. A cross-sectional survey using a structured questionnaire was conducted between August and September 2021 at an HIV clinic in Trinidad. Data on the HBM constructs, namely patient's beliefs about the perceived severity and susceptibility to COVID-19, their perceived benefits of taking the vaccine, and external cues to action, i.e., factors that may motivate them to take the vaccine, were collected. Univariate and multivariable logistic regression analyses were used to examine associations and whether the HBM components were predictors of vaccination intention. In this study, 59.9% of patients indicated their intentions to take the vaccine. Females (OR 0.49, 95% CI 0.30-0.81) were less inclined to take the COVID-19 vaccine compared to males, while Indo-Trinidadian patients with HIV (OR 4.40, 95% CI 1.26-15.3) were more inclined to take the vaccine compared to Afro-Trinidadians. Health beliefs such as having confidence in the vaccine (p = 0.001) and believing in its perceived benefits (p = 0.001) were significant predictors of vaccination intention. Patients who were confident about the vaccine were six times more likely to take the vaccine (OR 6.45, 95% CI 2.13-19.5) than persons who were not confident in it. Having adequate information about the vaccine or the knowledge of others who received the vaccine (OR 1.48, 95% CI 1.03-2.11) were significant cues to action influencing their decision. Guided by the HBM, understanding patient's health beliefs is important in the design of tailored interventions to improve vaccine outcomes. The HBM may also be useful in the design of approaches to increase the uptake of critical HIV prevention, and treatment services.
Collapse
Affiliation(s)
- Nyla Lyons
- Medical Research Foundation of Trinidad and Tobago, 7 Queen’s Part E, Port-of-Spain, Trinidad and Tobago
- Correspondence:
| | - Brendon Bhagwandeen
- School of Mathematical and Computer Sciences, Heriot Watt University Malaysia, 1 Jalan Venna P5/2, Precinct 5, Putrajaya 62200, Malaysia
| | - Jeffrey Edwards
- Medical Research Foundation of Trinidad and Tobago, 7 Queen’s Part E, Port-of-Spain, Trinidad and Tobago
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| |
Collapse
|
14
|
Muhindo R, Okoboi S, Kiragga A, King R, Arinaitwe WJ, Castelnuovo B. COVID-19 vaccine acceptability, and uptake among people living with HIV in Uganda. PLoS One 2022; 17:e0278692. [PMID: 36459514 PMCID: PMC9718389 DOI: 10.1371/journal.pone.0278692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite being a priority population for COVID-19 vaccination, limited data are available regarding acceptability of COVID-19 vaccines among people living with HIV (PLWH) in Sub-Saharan Africa. We described COVID-19 vaccine acceptability and factors associated with vaccine acceptability among PLWH in Uganda. METHODS This was a cross-sectional study conducted among PLWH, aged ≥18 years, enrolled participants who were seeking HIV care from six purposely selected accredited ART clinics in Kampala. We obtained data on vaccine acceptability defined as willingness to accept any of the available COVID-19 vaccines using interviewer-administered questionnaires. In addition, we assessed vaccination status, complacency regarding COVID-19 disease, vaccine confidence, and vaccine convenience. Factors associated with COVID-19 vaccine acceptability were evaluated using modified Poisson regression with robust standard errors. RESULTS We enrolled 767 participants of whom 485 (63%) were women. The median age was 33 years [interquartile range (IQR) 28-40] for women and 40 years [IQR], (34-47) for men. Of the respondents 534 (69.6%,95% confidence interval [CI]: 66.3%-72.8%) reported receiving at least one vaccine dose, with women significantly more likely than men to have been vaccinated (73% vs. 63%; p = 0.003). Among the unvaccinated 169 (72.7%, 95% CI: 66.6%-78.0%) were willing to accept vaccination, had greater vaccine confidence (85.9% had strong belief that the vaccines were effective; 81.9% that they were beneficial and 71% safe for PLWH; 90.5% had trust in health care professionals or 77.4% top government officials), and believed that it would be easy to obtain a vaccine if one decided to be vaccinated (83.6%). Vaccine acceptability was positively associated with greater vaccine confidence (adjusted prevalence ratio [aPR] 1.44; 95% CI: 1.08-1.90), and positive perception that it would be easy to obtain a vaccine (aPR 1.57; 95% CI: 1.26-1.96). CONCLUSION vaccine acceptance was high among this cohort of PLWH, and was positively associated with greater vaccine confidence, and perceived easiness (convince) to obtained the vaccine. Building vaccine confidence and making vaccines easily accessible should be a priority for vaccination programs targeting PLWH.
Collapse
Affiliation(s)
- Richard Muhindo
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Stephen Okoboi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rachel King
- University of California, San Francisco, California, United states of America
| | - Walter Joseph Arinaitwe
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
15
|
Folayan MO, Arije O, Enemo A, Sunday A, Muhammad A, Nyako HY, Abdullah RM, Okiwu H, Lamontagne E. Associations between COVID-19 vaccine hesitancy and the experience of violence among women and girls living with and at risk of HIV in Nigeria. AFRICAN JOURNAL OF AIDS RESEARCH 2022; 21:306-316. [DOI: 10.2989/16085906.2022.2118615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Morenike Oluwatoyin Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Nigeria Institute of Medical Research, Yaba, Nigeria
- Community Oral Health Department, Tehran University of Medical Sciences, Iran
- Faculty of Health Sciences, University of Zaragoza, Spain
| | - Olujide Arije
- Institute of Public Health, College of Health Sciences, Obafemi Awolowo University, Nigeria
| | - Amaka Enemo
- Nigeria Sex Workers Association, Kubwa, Nigeria
| | - Aaron Sunday
- African Network of Adolescent and Young Persons Development, Barnawa, Nigeria
| | - Amira Muhammad
- Northern Nigerian Transgender Initiative, Abuja, Nigeria
| | | | | | | | - Erik Lamontagne
- Joint United Nations Programme on HIV/AIDS, Strategic Information, Geneva, Switzerland
- Aix-Marseille University, School of Economics, Marseille, France
| |
Collapse
|
16
|
Jin J, Wang X, Carapito R, Moog C, Su B. Advances in Research on COVID-19 Vaccination for People Living with HIV. INFECTIOUS DISEASES & IMMUNITY 2022; 2:213-218. [PMID: 37520898 PMCID: PMC9612416 DOI: 10.1097/id9.0000000000000065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Junyan Jin
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Xiuwen Wang
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Raphael Carapito
- Laboratoire d’ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg 67000, France
| | - Christiane Moog
- Laboratoire d’ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg 67000, France
| | - Bin Su
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| |
Collapse
|
17
|
Adella GA, Abebe K, Atnafu N, Azeze GA, Alene T, Molla S, Ambaw G, Amera T, Yosef A, Eshetu K, Yeshambel A, Nigatu D, Abebe EC, Birhan B, Assefa Y. Knowledge, attitude, and intention to accept COVID-19 vaccine among patients with chronic diseases in southern Ethiopia: Multi-center study. Front Public Health 2022; 10:917925. [PMID: 36249216 PMCID: PMC9557055 DOI: 10.3389/fpubh.2022.917925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/14/2022] [Indexed: 01/22/2023] Open
Abstract
Background Most of the COVID-19 fatal cases and severe illnesses like acute respiratory distress syndrome occur in older adults and other people who have underlying medical comorbidities. Understanding patients with chronic disease' knowledge, attitudes, and intention to take the COVID-19 vaccine and related factors are necessary to control the mortality of COVID-19 infection. Therefore, this study aimed to assess knowledge, attitudes, and intention to take the COVID-19 vaccine among patients with chronic disease in Southern Ethiopia. Methods and materials A facility-based cross-sectional study was conducted among 409 patients with chronic diseases having a follow-up at the hospitals of the Southern region of Ethiopia from November 14, 2021, to December 24, 2021. A structured, interviewer-administered questionnaire was used to collect data. Bivariate and multivariable logistic regression was conducted to show the association of variables with knowledge, attitude, and intention to take the COVID-19 vaccine. The associations of variables were declared with the use of a 95% CI and P-value < 0.05. Results Overall, 79.2, 70.9, and 58.2% of participants had good knowledge, favorable attitude, and intent to take the COVID-19 vaccine, respectively. Age ≥49 years old (AOR = 1.643; 95% CI = 1.008-3.060) and college and above level of education (AOR = 3.002; 95% CI = 1.897-5.021) were found to be significantly associated with knowledge about COVID-19 vaccine. College and above level of education (AOR = 1.510; 95% CI = 1.002-3.975) and good knowledge (AOR = 3.560; 95% CI = 1.481-6.120) were found to be significantly associated with intention to take COVID-19 vaccine. Conclusion and recommendation Intention to take the COVID-19 vaccine was low among patients with chronic diseases to achieve herd immunity. Therefore, a holistic and multi-sectoral partnership is necessary for a successful COVID-19 vaccination campaign. Further health education and communication are very crucial methods to improve vaccine acceptance and lastly to achieve herd immunity.
Collapse
Affiliation(s)
- Getachew Asmare Adella
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia,*Correspondence: Getachew Asmare Adella
| | - Kelemu Abebe
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Natnael Atnafu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Gedion Asnake Azeze
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Tamiru Alene
- Department of Nursing, College of Health Science, Injibara University, Injibara, Ethiopia
| | - Simegn Molla
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Gizachew Ambaw
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Tekalign Amera
- Department of Adult Health Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amanuel Yosef
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Kirubel Eshetu
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Adisu Yeshambel
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Dabere Nigatu
- School of Public Health, College of Health Science and Medicine, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Medical Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Belete Birhan
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| |
Collapse
|
18
|
Yehualashet DE, Seboka BT, Tesfa GA, Mamo TT, Yawo MN, Hailegebreal S. Prevalence and Determinants of COVID-19 Vaccine Hesitancy Among the Ethiopian Population: A Systematic Review. Healthc Policy 2022; 15:1433-1445. [PMID: 35937966 PMCID: PMC9346414 DOI: 10.2147/rmhp.s368057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Although vaccination is the most effective way to end the COVID-19 pandemic, there are growing concerns that vaccine hesitancy may undermine its effectiveness. In Ethiopia, vaccine hesitancy forms a major challenge to the uptake of COVID-19 vaccines. This systematic review examined the prevalence and determinants of the COVID-19 vaccine hesitancy among the Ethiopian population. Methods A systematic search of articles was conducted in PubMed, EBSCO, Google Scholar, and Semantic Scholar. Studies that evaluated the prevalence and determinants of COVID-19 vaccine hesitancy in Ethiopia were included. The identified determinants of COVID-19 vaccine hesitancy were analyzed based on the frequency of occurrence in the included studies. Results The overall COVID-19 vaccine hesitancy level in the Ethiopian population ranged from 14.1% to 68.7%. The high COVID-19 vaccine hesitancy rate observed in this study was due to contextual factors, individual factors, and vaccine-specific factors. Young age, female sex, living in rural areas, lack of adequate information, and lower education are the most common contextual determinants of the COVID-19 vaccine hesitancy. Lack of awareness about the COVID-19 vaccine, low risk of COVID-19, poor adherence to COVID-19 prevention strategies, and negative attitude towards the COVID-19 vaccine are the most frequently reported personal factors. Common vaccine-specific determinants of COVID-19 vaccine hesitation are the side effects of the vaccine and doubts about its effectiveness of the vaccine. Conclusion Our review showed that COVID-19 vaccine hesitancy remains highly prevalent and varied across regions of Ethiopia, with a wide variety of factors associated with it. Potential interventions on the benefits of vaccination and the adverse effects of vaccine rejection are crucial to enhance COVID-19 vaccine uptake among the Ethiopian population.
Collapse
Affiliation(s)
- Delelegn Emwodew Yehualashet
- School of Public Health, Dilla University, Dilla, Ethiopia
- Correspondence: Delelegn Emwodew Yehualashet, School of Public Health, Dilla University, Dilla, Ethiopia, Tel +251 976061907, Email
| | | | | | | | | | | |
Collapse
|
19
|
Folayan MO, Abeldaño Zuñiga RA, Virtanen JI, El Tantawi M, Abeldaño GF, Ishabiyi AO, Jafer M, Al-Khanati NM, Quadri MFA, Yousaf MA, Ellakany P, Nzimande N, Ara E, Khalid Z, Lawal FB, Lusher J, Popoola BO, Idigbe I, Khan ATA, Ayanore MA, Gaffar B, Osamika BE, Aly NM, Ndembi N, Nguyen AL. Associations between COVID-19 testing status, non-communicable diseases and HIV status among residents of sub-Saharan Africa during the first wave of the pandemic. BMC Infect Dis 2022; 22:535. [PMID: 35692050 PMCID: PMC9188915 DOI: 10.1186/s12879-022-07498-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study determined if non-communicable disease status, HIV status, COVID-19 status and co-habiting were associated with COVID-19 test status in sub-Saharan Africa. METHODS Data of 5945 respondents age 18-years-old and above from 31 countries in sub-Saharan Africa collected through an online survey conducted between June and December 2020, were extracted. The dependent variable was COVID-19 status (testing positive for COVID-19 and having symptoms of COVID-19 but not getting tested). The independent variables were non-communicable disease status (hypertension, diabetes, cancer, heart conditions, respiratory conditions, depression), HIV positive status, COVID-19 status (knowing a close friend who tested positive for COVID-19 and someone who died from COVID-19) and co-habiting (yes/no). Two binary logistic regression models developed to determine associations between the dependent and independent variables were adjusted for age, sex, employment, sub region and educational status. RESULTS Having a close friend who tested positive for COVID-19 (AOR:6.747), knowing someone who died from COVID-19 infection (AOR:1.732), and living with other people (AOR:1.512) were significantly associated with higher odds of testing positive for COVID-19 infection, while living with HIV was associated with significantly lower odds of testing positive for COVID-19 infection (AOR:0.284). Also, respondents with respiratory conditions (AOR:2.487), self-reported depression (AOR:1.901), those who had a close friend who tested positive for COVID-19 infection (AOR:2.562) and who knew someone who died from COVID-19 infection (AOR:1.811) had significantly higher odds of having symptoms of COVID-19 infection but not getting tested. CONCLUSION Non-communicable diseases seem not to increase the risk for COVID-19 positive test while cohabiting seems to reduce this risk. The likelihood that those who know someone who tested positive to or who died from COVID-19 not getting tested when symptomatic suggests there is poor contact tracing in the region. People with respiratory conditions and depression need support to get tested for COVID-19.
Collapse
Affiliation(s)
- Morenike O Folayan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Roberto Ariel Abeldaño Zuñiga
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Postgraduate Department, University of Sierra Sur, Oaxaca, Mexico
| | - Jorma I Virtanen
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Maha El Tantawi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt
| | - Giuliana Florencia Abeldaño
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- School of Medicine, University of Sierra Sur, Oaxaca, Mexico
| | - Anthonia Omotola Ishabiyi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mohammed Jafer
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Nuraldeen Maher Al-Khanati
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Mir Faeq Ali Quadri
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Dental Public Health, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Muhammad Abrar Yousaf
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Biology, Virtual University of Pakistan, Lahore, Pakistan
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulraman Bin Faisal University, Dammam, Saudi Arabia
| | - Ntombifuthi Nzimande
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Economic and Social Geography, Faculty of Science and Informatics, University of Szeged, 6722, Szeged, Hungary
| | - Eshrat Ara
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Psychology, Government College for Women, Moulana Azad Road, Srinagar, Kashmir (J&K), India
| | - Zumama Khalid
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Health Sciences, University of Genoa, 16132, Genoa, Italy
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Joanne Lusher
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Regent's University London, London, UK
| | - Bamidele O Popoola
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Child Oral Health, University of Ibadan, Ibadan, Nigeria
| | - Ifeoma Idigbe
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Abeedha Tu-Allah Khan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- School of Biological Sciences, University of the Punjab, New Campus, Lahore, 54590, Punjab, Pakistan
| | - Martin Amogre Ayanore
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Preventive Dental Sciences Department, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bamidele Emmanuel Osamika
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Psychology, Miami University, Oxford, OH, USA
| | - Nourhan M Aly
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt
| | - Nicaise Ndembi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Africa Centres for Disease Control and Prevention, African Union Commission, Roosevelt Street, Addis Ababa, Ethiopia
| | - Annie Lu Nguyen
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
20
|
Kalu ME, Oyinlola O, Ibekaku MC, Adandom II, Iwuagwu AO, Ezulike CJ, Nwachukwu EC, Uduonu E. A Mapping Review on the Uptake of the COVID-19 Vaccine among Adults in Africa Using the 5A's Vaccine Taxonomy. Am J Trop Med Hyg 2022; 106:tpmd210515. [PMID: 35533697 PMCID: PMC9209920 DOI: 10.4269/ajtmh.21-0515] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 03/14/2022] [Indexed: 12/01/2022] Open
Abstract
Uptake of a vaccine is complete if individuals are aware of the associated risks of the vaccine, accept the vaccine, and respond positively to the nudges (activation) to increase the uptake, and respond when the vaccine is made accessible and affordable. We mapped systematically the existing literature concerning the 5As-acceptability, accessibility, affordability, awareness, and activation-of COVID-19 vaccination among adults and, specifically, older adults (55 years and older) in Africa. We searched multiple databases from 2020 to December 2021. Using predefined inclusion and exclusion criteria, two reviewers screened citations, conducted title and abstract screening, and extracted data independently. We included 68 articles conducted in 33 African countries, primarily cross-sectional studies (n = 49, 72%). None of the articles focused on older adults only, but 22 articles (32%) included at least one older adult (55 years and older) in their sample size. Acceptance (n = 58, 85%) was the most commonly researched aspect of vaccine uptake, followed by accessibility (n = 17, 25%), awareness (n = 13, 19%), and affordability (n = 5, 7.0%). We found only one report on activation. Factors affecting acceptance of the COVID-19 vaccine in Africa were grouped into sociodemographic factors; knowledge-, attitude-, and belief-related factors; a COVID-19 vaccine efficacy and safety concern factor; and trust in government and public health authorities. The governments of African nations should focus on strategies to influence the modifiable factors identified in this review. More studies are needed to evaluate the impact of nudges (activation) to improve COVID-19 vaccine uptake in African nations.
Collapse
Affiliation(s)
- Michael E. Kalu
- Emerging Researchers and Professionals in Ageing–African Network, Hamilton, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Oluwagbemiga Oyinlola
- Emerging Researchers and Professionals in Ageing–African Network, Hamilton, Ontario, Canada
- Medical Social Services Department, University College Hospital Ibadan, Ibadan, Nigeria
| | - Michael C. Ibekaku
- Emerging Researchers and Professionals in Ageing–African Network, Hamilton, Ontario, Canada
- University of Benin Teaching Hospital, Benin, Nigeria
| | - Israel I. Adandom
- Emerging Researchers and Professionals in Ageing–African Network, Hamilton, Ontario, Canada
- Cedarcrest Hospitals, FCT-Abuja, Nigeria
| | - Anthony O. Iwuagwu
- Emerging Researchers and Professionals in Ageing–African Network, Hamilton, Ontario, Canada
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
| | - Chigozie J. Ezulike
- Emerging Researchers and Professionals in Ageing–African Network, Hamilton, Ontario, Canada
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
- Department of Social and Behavioral Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Ernest C. Nwachukwu
- Emerging Researchers and Professionals in Ageing–African Network, Hamilton, Ontario, Canada
- Physiotherapy Department, Enugu State University of Science and Technology Teaching Hospital, Parklane-Enugu
| | - Ekezie Uduonu
- Emerging Researchers and Professionals in Ageing–African Network, Hamilton, Ontario, Canada
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus
| |
Collapse
|
21
|
Bekele F, Fekadu G. Factors associated with intention to receive COVID-19 vaccine among HIV positive patients attending ART clinic. Ann Med Surg (Lond) 2022; 75:103435. [PMID: 35261768 PMCID: PMC8890784 DOI: 10.1016/j.amsu.2022.103435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Firomsa Bekele
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
22
|
Mesele H, Shiferaw M, Tunta A, Seid A, Kassahun W. Willingness to Receive COVID-19 Vaccination Among Adult Diabetes Patients in Woldia Comprehensive Specialized Hospital, North Ethiopia; A Cross-Sectional Study. Patient Prefer Adherence 2022; 16:2451-2459. [PMID: 36081925 PMCID: PMC9447444 DOI: 10.2147/ppa.s379531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND According to recently published data, individuals infected with COVID-19 having concomitant diabetes may experience disease worsening or even death. The purpose of this study was to determine diabetes patients' willingness to get the COVID-19 vaccine as well as its magnitude and determinants. METHODS Three hundred eighty six diabetes patients who visited Woldia Comprehensive Specialized Hospital during February and March 2022 participated in this institution-based cross-sectional study. Descriptive statistics were used to demonstrate frequencies and percentages, while logistic regression was used to identify the relevant determinants of vaccination readiness. Age, gender, income, place of residence, COVID-19 exposure, length of diabetes, awareness of and attitudes toward the COVID-19 immunization were all evaluated as associated factors. RESULTS Out of 386 study participants, 268 (69.43%) were male and 146 (37.82) completed their secondary schooling. From 386 study participants 82.6% (95% CI; 78.5-86.3%) were willing to get vaccinated. The uptake of the COVID-19 vaccination among diabetes patients was independently influenced by sex (Adjusted Odd Ratio [AOR] = 6.84 (2.98, 15.68)), exposure to the illness (AOR 8.98 (3.22, 25.04)), attitude (AOR = 2.63 (1.2, 5.77)), and length of the disease (AOR = 0.62 (0.51, 0.76)). CONCLUSION Most of the study participants were willing to get the COVID-19 immunization. The relevant agency should make the immunization available in order to enhance disease control and reduce infection-related complications with special consideration of diabetes patients.
Collapse
Affiliation(s)
- Habtamu Mesele
- Woldia Comprehensive Specialized Hospital, Woldia, Ethiopia
| | - Mulu Shiferaw
- Biomedical Unit, School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
- Correspondence: Mulu Shiferaw, Biomedical Unit, School of Nursing, College of Health Sciences, Woldia University, PO Box 400, Woldia, Ethiopia, Email
| | - Abayneh Tunta
- Biomedical Unit, School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Addisie Seid
- Woldia Comprehensive Specialized Hospital, Woldia, Ethiopia
| | - Woldeteklehymanot Kassahun
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| |
Collapse
|
23
|
Bayou FD, Amare SN. Acceptance of COVID-19 Vaccine and Its Associated Factors Among Ethiopian Population: A Systematic Review. Patient Prefer Adherence 2022; 16:1093-1103. [PMID: 35492852 PMCID: PMC9048957 DOI: 10.2147/ppa.s360174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/14/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is a global health threat. Millions of lives were lost to COVID-19 and it has caused a substantial economic crisis throughout the world. The development of coronavirus vaccines has pinned a new hope in combating the pandemic. The success of vaccination and development of herd immunity highly depend on the willingness to be vaccinated, not merely on the availability of a vaccine. This review aims to provide comprehensive evidence on acceptance of COVID-19 vaccine and its associated factors in Ethiopia. METHODS Literature searching was done using PubMed, Google scholar and Science direct databases. Studies conducted in Ethiopia, published in English language from inception until January 9, 2022 were included. Retrieved articles were screened based on titles, abstracts and full text reading to identify studies that met the inclusion criteria. About 21 eligible studies were included in this systematic review. The data were extracted using a data extraction checklist. RESULTS A total of 2058 records were retrieved, of which 21 were eligible for this systematic review. All of the articles were cross-sectional studies published in 2021. In Ethiopia, the level of COVID-19 vaccine acceptance ranged from 31.4% to 92.33%. The vaccine acceptance level was significantly associated with age groups, sex, educational status, perceived susceptibility, perceived benefit, knowledge about COVID-19 vaccine, and other socio-demographic factors. CONCLUSION A significant portion of the studies revealed vaccine acceptance level was low. Variation of vaccine acceptance was associated with socio-demographic factors (age, sex, educational status, etc.), information-related factors, and other health-related behaviors. Dissemination of clear and adequate information concerning the vaccine might be the required prior activity to increase acceptance of the vaccine. Hence, there should be a coordinated effort to halt the pandemic through increasing the acceptance of COVID-19 vaccine.
Collapse
Affiliation(s)
- Fekade Demeke Bayou
- Department of Epidemiology, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
- Correspondence: Fekade Demeke Bayou, Email
| | - Shambel Nigussie Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| |
Collapse
|