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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 28
| Issue : 2 | Page : 161-166 |
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COVID-19 vaccine uptake among clinical medical students in Enugu, Nigeria
Chinedu A Idoko1, Ikechukwu C Chidolue2, Ntat C Ibiok1, Kingsley Eze2
1 Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu Campus, Nigeria
2 Department of Medicine, University of Nigeria, Enugu, Nigeria
| Date of Submission | 05-Oct-2022 |
| Date of Decision | 10-Dec-2022 |
| Date of Acceptance | 14-Jan-2023 |
| Date of Web Publication | 21-Mar-2023 |
Correspondence Address:
Chinedu A Idoko
Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu 400001
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijmh.IJMH_65_22
Background: The COVID-19 pandemic shook the world, claimed a lot of lives, incapacitated many, and forced majority of the world into a lockdown. Vaccination is the key strategy to tackling the virus. Objectives: To ascertain the level of vaccination and the difficulties associated with vaccination, among clinical medical students in Enugu, South-East Nigeria. Materials and Methods: A multistage sampling was used to select 160 respondents while questionnaires (hard and soft copy) were administered to the participants. The IBM Statistical Package for the Social Sciences was used for data entry and data analysis. Results: There was a poor (16.3%) knowledge, negative perception (66.3%), and poor uptake of the COVID-19 vaccine (20.6%). There were statistically significant relationships between vaccination status, knowledge of vaccine, age, and perception of the vaccine (P = 0.000) as well as between level of training and vaccine perception (P = 0.03). Conclusion: There was very low level of COVID-19 vaccination in the study population that may be attributable to the low knowledge of the vaccine and the high negative perception. The rush to development of the vaccine, possible side effects, and possible long-term complications may be contributory to the poor uptake of the COVID-19 vaccine among the study respondents. Keywords: Clinical medical students, COVID-19, perception, knowledge, vaccine uptake
How to cite this article:
Idoko CA, Chidolue IC, Ibiok NC, Eze K. COVID-19 vaccine uptake among clinical medical students in Enugu, Nigeria. Int J Med Health Dev 2023;28:161-6 |
How to cite this URL:
Idoko CA, Chidolue IC, Ibiok NC, Eze K. COVID-19 vaccine uptake among clinical medical students in Enugu, Nigeria. Int J Med Health Dev [serial online] 2023 [cited 2023 Jun 3];28:161-6. Available from: https://www.ijmhdev.com/text.asp?2023/28/2/161/372155 |
| Introduction | |  |
Background of the study
The Corona Virus Disease 2019 (COVID-19) is a disease caused by a virus named SARS-CoV-2 and was discovered in December 2019 in Wuhan, China. It is very contagious and has quickly spread around the world. COVID-19 often causes respiratory symptoms that can feel much like a cold, flu, or pneumonia. It may also attack more than just the lungs and respiratory system. Most people with the disease have mild symptoms, but some people become severely ill. Older adults and people who have underlying medical conditions are at increased risk of severe illness from COVID-19. Currently, as of April 2022, there were 503,604,985 cases and 6,195,647 deaths worldwide and in Nigeria, 4,977,858 have been tested, 255,606 confirmed cases, 2,671 active cases, 249,669 discharged cases, and 3,142 deaths.[1],[2]
COVID-19 is a major cause of morbidity and mortality in the world today, hence the need to be adequately protected and vaccinated to prevent increase in spread of infection. COVID-19 vaccination is a necessary and key step that will help reduce the manifestation and spread of the deadly disease, ultimately reducing the number of deaths and people affected.
Despite the wide availability of COVID-19 vaccine, previous experience suggests a huge limitation on vaccination uptake. Sometimes, available information on COVID-19 are misleading and result in confusion among those involved. Vaccination uptake among medical students and health care workers is usually met with some impedance, which include fear of complications due to inadequate knowledge of the effects of vaccination, arguments in favor of herd immunity, and inadequate awareness of the benefits of being vaccinated. It is important, however, to point out that clinical students are vulnerable to SARS-CoV-2 infection due to factors of increased exposure as a result of their clinical postings in the wards, etc.
Vaccines are the best hope for ending the pandemic to prevent COVID-19, and this can be done by looking into herd immunity. Herd immunity is the goal of vaccination against vaccine preventable diseases, and the more contagious the disease, the higher the threshold required for herd immunity. The development of a safe, effective, and cheap vaccine, however, is only a first step toward community-wide control.[3]
Several prophylactic vaccines against COVID-19 have been developed in various countries and they include vaccines produced by AstraZeneca, Pfizer-Billionth, Moderna, and Johnson & Johnson (Jansen). These vaccines have been distributed to various countries. In Nigeria, however, AstraZeneca COVID-19 vaccine has been rolled out for use as approved by the National Agency for Food and Drug Administration and Control and several others. COVID-19 vaccination is the major preventive tool that exists with respect to reducing the morbidity and mortality rates that are a result of the virus. It is necessary therefore to understand the factors that contribute to COVID-19 vaccination uptake among medical students especially in demographic subgroups like clinical students with a seemingly low uptake of COVID-19 vaccines.
Justification
A number of studies have assessed the perception and attitude of not only clinical medical students but also of the general population to COVID-19 vaccine uptake in Nigeria.[4],[5] However, as it is evident COVID-19 has come to stay and should therefore not be looked at as a one-off epidemic/pandemic occurrence but rather one needing a controlled, coordinated, and sustained approach to combating. Principal to achieving this is COVID-19 vaccination, the major preventive tool that exists with respect to reducing the morbidity and mortality consequent to the viral infection. Having said this, the importance of building the literature on COVID-19 vaccine uptake even among clinical medical students cannot be overemphasized.
| Materials and Methods | | |
Study area
The study area is Enugu at the University of Nigeria Teaching Hospital and the Enugu State University Teaching Hospital (ESUTH).[6]
Study population
The undergraduate clinical medical students of University of Nigeria and ESUTH served as the study population.
Study design
This was a cross-sectional study among clinical medical students of the University of Nigeria and the Enugu State University of Science and Technology.
Inclusion criteria
The clinical medical students of University of Nigeria and ESUTH who were available and willing were included in the study.
Exclusion criteria
Students of other faculties in the University of Nigeria, nonclinical medical students, as well as clinical medical students who were not available nor willing were excluded from the study.
Sample size
The sample size was calculated using Cochrane’s sample size formula[7]; minimum sample size, n = Z2p (1 − p)/d2, where Z = 1.96 at 95% confidence limit, P = prevalence of COVID-19 from a previous study (9.6%),[8],[9] and d = margin of error tolerated usually 5% (or 0.05). Thus, n = 127.96 students. Considering an addition of 10% to make up for possible attrition will bring the sample size to approximately 141 students. However, a sample size of 160 was used for this study.
Sampling method
A multistage sampling was used to select the 160 respondents into the study from both schools.
Stage 1. The students were stratified into years of study, 4th, 5th, and 6th year for both medical schools. Stage 2: The class lists were utilized as sampling frame and the samples gotten by imputing the required number per class matched against numbers from the sampling frame into a randomization site which produced numbers randomly, until the require sample was collected for both schools.
Survey instrument
The questionnaire that is standardized was pretested (by the researchers) among 20 randomly selected law students of the University of Nigeria before adaptation to the study.
Data collection
This study was done by collecting primary data with a self-administered questionnaire.
Ethical considerations
The proposal for the study was from the health research and ethical committee, University of Nigeria Teaching Hospital, Ituku-Ozalla (UNTH/CSA/329/OL.5:NHREC/05/01/2008BFWA00002458-1RB00002323). Written informed consent was obtained from the respondents before they were administered the survey material even as they were assured of complete confidentiality of their responses. Clarifications were made that information sought for and obtained was strictly for research purposes while the respondents were reassured they could withdraw from the study at any stage without consequences.
| Results | | |
[Table 1] reflects the sociodemographic characteristics of the respondents. The mean age of the respondent was 24.5 years with an S.D. of ±1.95 years. Majority of the respondents were male (55.6%) with final year clinical students having the highest number of respondents (60.6%). Expectedly, a greater number were single (98.9%), Ibo of tribe (92.5%), with Christians (98.1%), and (80.6%) domiciled in the University hostels. [Table 2] captures knowledge of vaccine and its uptake. It shows that all the respondents were aware of the COVID-19 vaccine prior to questionnaire administration. However, only 20.6% have taken the vaccine with majority (79.4%) unvaccinated.  | Table 2: Level of knowledge of COVID-19 vaccine and uptake among the respondents
Click here to view |
More than half of the respondents 52.5% opted for the mRNA-based vaccine, while a few 6.9% chose the killed vaccine. The majority 75.6% of the respondents affirmed AstraZeneca (12.5%) the most available vaccine followed by Moderna, Pfizer BioNtech, Johnson and Johnson, and Sputniv V; 6.9%, 4.4%, and 0.6%, respectively. Most of the respondents (66.9%) said the vaccine does not provide full protection. Majority (78.1%) of respondents had no vaccine preference though a minority (0.6%) had a predilection for Johnson & Johnson. The reasons for vaccine preference were approval by availability (5%), trust (4.4%), and effectiveness (5.0%). Only a small proportion (18.8%) of respondents knew NPHCDA to be the body control COVID-19 vaccine in Nigeria, while 43.8% were cognizant of the fact that a second dose would be received one month following.
[Table 3] represents the fact that as a result of COVID-19 vaccine perception among respondents, a third of the respondent (33.8%) were not certain of safety of the vaccine; even a higher proportion (43.8%) were not certain of the necessity of COVID-19 vaccine but more than two fifth (41.9%) agreed that vaccines are the best protection against the COVID-19 virus. However, a third of the respondents (36.3%) were uncertain vaccine prevents the spread of the virus with 43.8% not certain the vaccines make one immune to the virus. A half, 50.0% was unsure everyone getting vaccinated would result in eradication of the virus, while 53.8% were not certain herd immunity is a safer option to vaccine.
[Table 4] shows the general perception about COVID vaccine, and majority (66.9%) of the respondents have a negative perception of COVID-19 while only a third (33.1%) of the respondents has a positive perception to the vaccine. [Table 5] is reflective of the knowledge of the COVID-19 vaccine, and the majority (83.8%) of the respondents had poor knowledge while only (16.3%) had good knowledge of COVID-19 vaccine. [Table 6] shows the association between good perception of COVID-19 and sociodemographic factors, knowledge of COVID-19 vaccine and those who have been vaccinated among the participants. There is statistically significant relationships between vaccination status and perception of the vaccine (P = 0.000), between knowledge vaccine and perception of the vaccine (P = 0.000), between age and perception of the vaccine (P = 0.000) and between level of training and perception of the vaccine (P = 0.03).  | Table 6: Association between perception of COVID-19 and sociodemographic factors, knowledge of COVID-19 vaccine, and those who have vaccinated among the participants
Click here to view |
| Discussion | | |
It is important for healthcare workers to achieve high COVID-19 vaccination rates for self-protection and of course for other people around them, especially their patients. The findings from the study were indicative of low acceptance of COVID-19 vaccination among the respondents as only a small proportion (20.6%) of respondents had received the COVID-19 vaccine. This corroborates with the findings of the study from Congo that reported a 27.7% of health care workers willing to accept a COVID-19 vaccine if it were available. The reason for this poor acceptance of the COVID vaccines could be lack of trust in the government, inadequate and or false information, the attendant rush in development of the vaccine, possible vaccine side effects, as well as possible long-term complications. This is contrary to studies done in Ghana[10] among junior doctors where 66.9% of junior doctors were willing to accept the COVID-19 vaccine and another 78% acceptability rate among doctors in Israel[11] In many countries, antivaccination and misinformation are seen biggest obstacles to successful immunization and community immunity.[12]
This study also revealed respondents knowledge ability of COVID-19 vaccines already been approved for use; however, their knowledge on the properties of these vaccines and their workability appeared inconsistent. Furthermore, it appeared that most respondents did not know the vaccines available in Nigeria, the body in charge of administration of COVID-19 vaccines, the number of doses required and time interval between doses. This is consistent with findings of Rhodes et al., who reported a weak knowledge of COVID-19 vaccines among Australians.[13] Interestingly, most students had an inconsistent knowledge of what could be achieved with COVID-19 vaccination. Research has shown that the quality, content, and dissemination of health education about vaccines will help in promoting acceptability, reduce hesitancy, and guide informed decisions about vaccination.[14] Various myths regarding the vaccines would also be addressed.
A significant percentage of respondents (50.6%) even though had not received the COVID-19 vaccination, stated they would advise a loved one to receive the vaccine.
Highlighting the difficulties experienced in getting the vaccine, this study findings is that the major attitudinal barriers to receiving a COVID-19 vaccine among the respondents are worries about the unforeseen effect, preference for natural immunity, as well as general mistrust of vaccine benefit. Majority were afraid of the possible side effects that could ensue from taking the vaccine.
In this study also, there was a low perception of the vaccine, only a third (33.1%) of our respondents had a positive outlook, this invariably affects the number of vaccinated medical students. This corroborates the findings of a study of the Attitudes toward vaccines and intention to vaccinate against COVID-19: implications for public health communications, done by Paul et al., showing that there is a general mistrust in the benefits and safety of vaccines and concerns about their unforeseen effects are the key barriers to vaccine acceptance.[15]
In this study, specific knowledge of vaccines is seen to affect the intent to vaccinate, this is similar to findings by Galle et al.,[16] who found a significant relationship between knowledge and vaccine acceptance. These findings though are in contrast with the study done by Pogue et al.,[17] who revealed that knowledge score did not significantly correlate with intent to vaccinate. Moreover, an inverse relationship was found between negative attitudes toward COVID-19 vaccines and intent to vaccinate.
Study limitations
A major challenge was that some respondents chosen by the randomization were not available in person during the period of data collection. For those not physically present, we devised a means of producing an online questionnaire that was forwarded them for needed attention.
| Conclusion | | |
The findings in this study were a low uptake of COVID-19 vaccination following a poor perception. This is despite the respondents’ high knowledge and awareness of the vaccine. Factors responsible for the low uptake were found to be questions/doubts regarding the speed of development of the vaccine, possible side effects, and long-term complications of the vaccine. It is recommended that continuous public enlightenment on the subject of COVID-19 infection, symptoms and complications, and the need to get the COVID-19 vaccination by relevant authorities. Managements of the teaching hospitals should educate their students the need for vaccination for not just COVID-19 but of other conditions they are likely exposed to by virtue of their discipline/clinical training.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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