Non-uptake of COVID-19 vaccines and reasons for non-uptake among healthcare workers in Uganda: a cross-sectional study

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Therefore, understanding the reasons behind vaccine refusal and associated factors is essential for improving vaccine acceptance rates. Our objective was to examine the determinants of COVID-19 vaccine non-uptake and explore the reasons for non-uptake among healthcare workers in Uganda. Methods Between July and August 2021, we conducted a cross-sectional study among healthcare workers in primary healthcare facilities in Entebbe Municipality, Uganda. Participants were recruited using convenience sampling, and consenting individuals received credentials to access an electronic database and complete a structured questionnaire. Survey questions were based on the '3Cs' model of vaccine hesitancy, focusing on confidence, convenience, and complacency factors. We employed counts, percentages, and simple logit models to summarize the reasons for non-uptakeof COVID-19 vaccines and to identify associated factors. Results The study recruited 360 healthcare workers, 61.7% of whom were female, with an average age of 31 years (SD=7.9). Among them, 124 (34.4%) healthcare workers did not receive any COVID-19 vaccine. Non-uptake of COVID-19 vaccines was independently associated with several factors, including age [35+ years adjusted odds ratio (aOR)=0.30, 95% CI: 0.13-0.66 compared with 18-24 years], facility ownership [government, aOR=0.22 (0.10-0.49) compared with private not-for-profit], previous testing for coronavirus [yes, aOR=0.35 (0.19-0.65)], and previous involvement in COVID-19 vaccine activities [yes, aOR=0.17 (0.10-0.29)]. The primary reasons cited for non-uptake of COVID-19 vaccines were related to a lack of confidence in the vaccines, such as concerns about side effects (79.8%) and the need for more time to understand the vaccines (89.5%), as well as the importance of weighing benefits and risks (84.7%) before being vaccinated. A smaller proportion, approximately 23%, cited reasons related to complacency and lack of convenience in accessing vaccination services. Conclusion The high proportion of non-uptake of COVID-19 vaccines among this population primarily stems from a lack of confidence and trust in the vaccines, coupled with insufficient time allowed for users to make informed decisions. This underscores the urgent need for ongoing monitoring and trend analysis of vaccine non-uptake to guide the development and implementation of strategies aimed at building and sustaining vaccine confidence. COVID-19 vaccine non-uptake Healthcare workers determinants Figures Figure 1 Background The emergence of coronavirus disease 2019 (COVID-19) has presented a significant global health challenge, resulting in the loss of more than 7 million lives by December 31, 2023( 1 ). Failing to effectively control the spread of the virus poses substantial risks to public health, including increased morbidity and mortality rates, which could overwhelm healthcare systems worldwide. In response, global efforts have prioritized vaccination as a crucial strategy to combat the pandemic. Immunization campaigns aim to achieve widespread immunity, thereby reducing the incidence of severe disease and hospitalization among the population. Apart from the direct individual health benefits of conferring immunity, high vaccination coverage rates are important in attaining herd immunity ( 2 , 3 ). The attainment of herd immunity, which is critical for stopping disease spread, is directly affected by the non-uptake of COVID-19 vaccines ( 4 ). In Uganda, COVID-19 vaccines were introduced in March 2021 ( 5 ) and were prioritized for populations at high risk of developing severe disease and frontline healthcare workers (HCWs), who are not only at high risk of contracting the disease but also spreading the SARS-CoV-2 virus to patients under their care. HCWs are a trusted source of health information and are likely to influence the use of COVID-19 vaccines. Although HCWs are knowledgeable about the importance of vaccination, not all of them believe in vaccination, with some HCWs perceiving vaccines as unsafe and unnecessary ( 6 , 7 ). Studies have indicated that the non-uptake of COVID-19 vaccines among HCWs ranges from 4.3–72% ( 8 ) and varies with the role of HCWs, with nurses being less likely to take the vaccines ( 9 – 13 ). Several sociodemographic factors, including age, may influence the use of COVID-19 vaccines among healthcare workers (HCWs). Younger age has been identified as one such factor associated with lower vaccine uptake, possibly attributed to the perception of a reduced risk of severe disease among younger individuals ( 15 – 17 ). Other demographic factors, such as sex and education level, have been reported to affect the use of COVID-19 vaccines among healthcare workers ( 13 , 15 , 18 ). The decision to get vaccinated immediately, delay vaccination or complete refusal of vaccines may be influenced by factors such as confidence, complacency and convenience (‘3Cs’ model). The World Health Organization Strategic Advisory Group of Experts on Immunization (SAGE) working group developed the 3Cs model to explain vaccine hesitancy ( 19 ). Confidence refers to a level of trust in the effectiveness and safety of vaccines, the delivery system, the reliability of health professionals, and the motivations of policymakers who make determinations about vaccines. Convenience refers to the degree to which the comfort, time, place, and quality of a vaccine affect the uptake of the vaccine, while complacency refers to a low perceived risk of vaccine-preventable diseases and therefore assumes that vaccination is not required to prevent the disease. The ‘3Cs’ model was later extended to 5Cs by adding calculations (extensive information searching by the individual) and communal orientation (considering collective responsibility) ( 19 ). The decision to get vaccinated may vary with time, place, and type of vaccine; therefore, determinants of vaccine non-uptake need to be explored at different levels and among populations ( 20 ). Vaccine confidence is one such important determinant of vaccine uptake. Trust in COVID-19 vaccines was affected by the fast-track production of the vaccines, which could have led to low uptake of the vaccines ( 21 ). A study by Alshareef et al, 2021 reported that 50.29% of healthcare workers were not willing to get vaccinated until the safety of the vaccines was demonstrated ( 18 ). A similar study by Gadoth et al. (2021) reported a high COVID-19 vaccine non-uptake of 65.5% among HCWs in Los Angeles due to concerns about vaccine safety ( 22 ). Vaccine convenience, which refers to the degree to which the comfort, time, place, and quality of a vaccine affect the uptake of the vaccine, is an important factor in determining vaccine uptake ( 7 , 23 , 24 ). While numerous studies have explored individuals' intentions to get vaccinated against COVID-19 once vaccines become available, there remains a significant gap in the literature regarding actual vaccine uptake among healthcare workers (HCWs). It is crucial to recognize that the intention to get vaccinated does not necessarily translate into actual uptake, emphasizing the importance of studying real-world vaccine acceptance and utilization among HCWs. Therefore, the aim of this study was to describe the determinants of COVID-19 vaccine non-uptake among HCWs in primary healthcare facilities within the Entebbe municipality. This study further explored the reasons for the non-uptake of vaccines among HCWs using the 3Cs + 2 model factors of vaccine hesitancy. Methods Study Design We conducted a cross-sectional study aimed at describing the non-uptake of COVID-19 vaccines and the associated reasons and factors among healthcare workers in private and government primary health facilities in Entebbe Municipality, Uganda. Study setting The study was conducted in Entebbe Municipality, which is located approximately 40 km south of Kampala, the capital of Uganda. The estimated population (adults and children) in this municipality is approximately 700000 people. There are about 40 healthcare facilities, approximately 80%, are mostly privately owned. The municipality also has one regional referral hospital that was excluded from this study because a similar study was concurrently being conducted at this hospital. Study participants Participants for this study were drawn from HCWs in the primary healthcare facilities described above. The participants were categorized as either medical or nonmedical staff. The medical HCWs included medical doctors, nurses, nursing assistants, paramedics, social workers, and research scientists, while the nonmedical HCWs included health center managers, accountants, receptionists, and janitors. Due to the absence of established healthcare workers’ contact lists within the municipality, participants were selected through convenience sampling. The study was also conducted during the national lockdown; therefore, only participants who were on duty at the time of data collection were approached. COVID-19 vaccines On Friday 5th March 2021, the Uganda Ministry of Health received her first batch of 864,000 doses of AstraZeneca COVID-19 vaccine, shipped via the COVAX facility, and vaccination was prioritized for the following groups of people: health care workers, security personnel, teachers, journalists, persons aged 50 years and above and those with underlying health conditions ( 25 ). The COVAX facility allocated 3,552,000 doses of the AstraZeneca vaccine to Uganda for the period of January–June 2021 ( 25 ). On 31 July 2021, the country received 300,000 doses of the Sinovac vaccine from the Chinese government ( 26 ). On 6th September 2021, 647,080 doses of Moderna vaccines were received, and on 21 September, 1,674,270 doses of Pfizer vaccine were received as donations from the US government ( 27 ). On 8th October 2021, Uganda received the first batch of 196,000 doses of the Johnson and Johnson vaccine ( 28 ). Other vaccines were subsequently introduced into the country. Hence, at the time of rollout of this study, only the AstraZeneca and Sinovac vaccines were available in the country. Data collection The data were collected by research assistants between 1st July and 3rd August 2021. A structured questionnaire developed in Research Electronic Data Capture (REDCap) was used to collect the data. The questionnaire was adapted from the WHO Strategic Advisory Group on Experts (SAGE) on Immunization survey tool ( 29 ). The reasons for taking or not taking the vaccine were categorized based on the 3C + 2 model of vaccine hesitancy, which includes factors such as confidence, complacency, convenience, collective responsibility and calculation. HCWs who agreed to participate and provided consent had the questionnaire link shared through email or WhatsApp. Participants who had no computer or smartphone were offered the study’s smartphone to complete the survey. The 3C + 2 model of the reasons for the non-uptake of COVID-19 vaccines is provided in Table 1 below. Table 1 3C + 2 model of reasons why HCWs were not vaccinated Confidence 1. Did not think the vaccine was effective 2. Did not think the vaccine was safe 3. COVID-19 vaccine production was rushed 4. Had a bad experience or reaction with previous vaccines 5. Someone else told me he/she had/knows someone who had a bad reaction after vaccination 6. Concerned about side effects Complacency 7. My job does not put me at a high risk of getting infected with corona virus 8. My age doesn’t put me at a high risk of severe COVID-19 9. There are better ways of prevention other than vaccination 10. Fear of needles 11. Did not think it was needed 12. COVID-19 is not so severe that I should get vaccinated 13. My immune system is so strong; it protects against disease 14. Bad experience with similar vaccination Lack of convenience 15. Did not know where to get vaccination 16. Not possible to leave other work (home or office) 17. Long distance to the vaccination center 18. Transport costs to the vaccination center 19. Did not want to spend so much at the vaccination center Calculation (Increased information searching) 20. Heard or read negative media 21. Did not know where to get good/reliable information 22. Distrust in government making the decision in my best interest 23. It’s important for me to fully understand COVID-19 vaccines before I get vaccinated 24. I closely consider whether COVID-19 vaccine is useful for me 25. I weigh the benefits and risks to make the best decision possible Statistical analysis The data were electronically captured in the REDCap software database and transferred to STATA version 16 for statistical analysis. Participant characteristics were summarized overall and stratified by vaccine uptake status and compared using chi-square tests. Means with standard deviations and medians with interquartile ranges were used for continuous variables. The proportion of vaccine non-uptake was estimated as the number of participants who had not received any COVID-19 vaccine divided by the total number of participants studied, expressed as a percentage. The reasons for the lack of uptake of vaccines are summarized in the graphs. We used simple logistic regression models to determine factors associated with non-uptake of COVID-19 vaccines via univariate and multivariate models. We fitted logit models first for univariable analysis, and factors that attained a statistical significance likelihood ratio test (LRT) p value < 0.2 were considered for multivariable analysis. In the multivariable analysis, we used a backward elimination approach, retaining factors that attained a statistically significant LRT p value < 0.05, with the exception of sex, which was included a priori. Before multivariable analysis, we checked for multicollinearity and assessed for inclusion only those factors that were more statistically significantly associated with non-uptake in the univariate analysis. Results Participant characteristics We recruited 360 healthcare workers, mostly females (n = 222; 61.7%), with a mean age of 31 years (SD = 7.9). Approximately two-thirds were medical, with mostly a bachelor’s degree and above, n = 287 (80%), and the majority (n = 285; 79.2%) were aged more than 24 years (Table 2). Non-Uptake of COVID-19 vaccines A total of 124 (34.4%) of the participants did not take up any COVID-19 vaccine despite free access. The percentage of individuals who did not take vaccines decreased with increasing age (42.7% in the 18–24 years age group vs 39.2% in the 25–34 years age group and 20.2% in the 35 + year age group, p = 0.001); the percentage of individuals who did not take vaccines was greater among secondary contacts than among primary contacts (40.7% vs 28.5%, p < 0.001), and the percentage of individuals taking vaccines from the small roadside clinics (48.4%) than among those in the Health Centre III & IV clinics (20.8%) and hospitals (29.8%, p < 0.001) (Table 2). Table 2: Sociodemographic, clinical characteristics, and vaccine uptake among 360 healthcare workers enrolled in a COVID-19 uptake study in Uganda, 2021 Characteristics Vaccine uptake Total N = 360) No (n = 124) Yes(n = 236) p values Gender Male 222 (61.7) 71 (32.0) 151 (68.0) 0.212 Female 138 (38.3) 53 (38.4) 85 (61.6) Age group (years) 18–24 Years 75(20.8) 32(42.7) 43(57.3) 0.001 25–34 Years 181(50.3) 71(39.2) 110(60.8) 35 + Years 104(28.9) 21(20.2) 83(79.8) Level of qualification Certificate/Diploma 73(20.3) 29(39.7) 44(60.3) 0.288 Bachelors & Masters 287(79.7) 95(33.1) 192(66.9) Job category Medical 248 (68.9) 81 (32.7) 167 (67.3) 0.289 Nonmedical 112 (31.1) 43 (38.4) 69 (61.6) Contacts(n = 248) Primary contacts** 151 (60.9) 43 (28.5) 108 (71.5) < 0.001 Secondary contacts*** 97 (39.1) 38 (40.7) 59 (59.3) Level of service of the health facility Hospitals 57 (15.8) 17 (29.8) 40 (70.2) < 0.001 Health center III & IV 144 (40.0) 30 (20.8) 114 (79.2) Small Roadside clinics 159 (44.2) 77 (48.4) 82 (51.6) Type of ownership Private not for profit (PNFP) 84 (23.3) 39 (46.4) 45 (53.6) < 0.001 Private for profit (PFP) 146 (40.6) 72 (49.3) 74 (50.7) Government 130 (36.1) 13 (10.0) 117 (90.0) Previously cared for confirmed COVID-19 patient No 226 (62.8) 70 (31.0) 156 (69.0) 0.072 Yes 134 (37.2) 54 (40.3) 80 (59.7) Previously tested for Corona virus infection No 89 (24.7) 58 (65.2) 31 (34.8) < 0.001 Yes 271 (75.3) 66 (24.4) 205 (75.6) Previous Corona test results (N = 271) Negative 230 (84.9) 53 (23.0) 177(77.0) 0.234 Positive 41 (15.1) 13 (31.7) 28 (68.3) Ever involved in COVID-19 vaccine activities No 150 (41.7) 91 (60.7) 59 (39.3) < 0.001 Yes 210 (58.3) 33 (15.7) 177 (84.3) Note: p values-based Chi-square test; * significant at 5% level, ** HCWs who interface with patients first, ***HCWs who interface with patients who have been screened or deal with biological materials obtained from patients Factors associated with non-uptake of vaccines : According to the multivariable analysis, factors that were independently associated with non-uptake of the COVID-19 vaccine included age [25–34 years, adjusted odds ratio (aOR) = 0.7, 95% CI: 0.35–1.40, 35 + years aOR = 0.30, 95% CI: 0.13–0.66, all compared to 18–24 years], previous COVID-19 infection status [yes, aOR = 0.35, 95% CI: 0.19–0.65] and ever been involved in COVID-19 vaccine activities [yes, aOR = 0.17, 95% CI: 0.10–0.29]. Other factors are shown in Table 3 below. Table 3 Sociodemographic and clinical factors associated with non-uptake of COVID-19 vaccines among healthcare workers in Uganda Characteristics uOR (95%CI) LRT-pvalue aOR (95%CI) LRT-pvalue Gender 0.185 Male 1.00 0.214 1.00 Female 1.33 (0.85–2.07) 1.67 (0.95–2.94) Age group (complete years) 0.001 0.001 18–24 1.00 1.00 25–34 0.87 (0.50–1.50) 0.70 (0.35–1.40) 35+ 0.34 (0.18–0.66) 0.30 (0.13–0.66) Level of qualification 0.291 Certificate-diploma 1.00 Bachelors + 0.75 (0.44–1.27) Job category Clinical 1.00 0.292 Nonclinical 1.28 (0.81–2.04) Contact level Primary** 1.00 0.199 Secondary*** 1.34 (0.86–2.10) Health facility level < 0.001 Hospital 1.00 Health center III & IV 0.62 (0.31–1.24) Clinic 2.21 (1.16–4.22) Type of ownership < 0.001 < 0.001 Private not for profit (PNFP) 1.00 1.00 Private for profit (PFP) 1.12 (0.66–1.92) 0.90 (0.47–1.70) Government 0.13 (0.06–0.26) 0.22 (0.10–0.49) Previously cared for a COVID-19 confirmed patient 0.073 No 1.00 Yes 1.51 (0.96–2.35) Previously tested for Corona virus infection < 0.001 < 0.001 No 1.00 1.00 Yes 0.17 (0.11–0.29) 0.35 (0.19–0.65) Previous Corona test results (N = 271) 0.005 Negative 1.00 Positive 2.06 (1.25–3.41) Ever involved in COVID-19 vaccine activities < 0.001 < 0.001 No 1.00 1.00 Yes 0.12 (0.07–0.20) 0.17 (0.10–0.29) Note: p values based Chi-square test; *_significant at 5% level, ** HCWs who interface with patients first, ***HCWs who interface with patients who have been screened or deal with biological materials obtained from patients Primary reasons why healthcare workers were not vaccinated The reasons for vaccine non-uptake are depicted in Fig. 1 below. Mostly, reasons related to lack of confidence in the vaccines, such as concerns about side effects (79.8%) and calculations, including not enough time to understand the vaccines (89.5%) and weighing benefits and risk (84.7%) before being vaccinated, were considered key reasons for not accepting vaccination. An average of 23% of the respondents raised reasons related to complacency and lack of convenience (Fig. 1 ). Discussion The findings of this study revealed that one in three healthcare workers did not take up COVID-19 vaccines despite their availability. This finding contrasts with that of Patrick et al. (2023), who reported that one in ten healthcare workers in Uganda were unwilling to receive the COVID-19 vaccine ( 30 ). The difference in findings may be attributed to differences in the study setting. Our study was conducted in an urban setting, while Patrick et al. conducted the study in a rural setting. It is also well known that vaccine non-uptake is context specific, varying from place to place, time to time and between populations ( 19 ). Two-thirds of healthcare workers in the Patrick et al. study were nurses, and most were low-cadre healthcare workers; similar studies have reported low rates of COVID-19 vaccine uptake among nurses ( 9 , 31 ). Globally, healthcare workers were among the priority groups for COVID-19 vaccination due to their increased risk of exposure to infections, and since they are a trusted source of information, non-uptake could have impacted the overall uptake of the vaccines by the general population. Furthermore, studies have shown that COVID-19 vaccine hesitant healthcare workers are less likely to recommend a COVID-19 vaccine to their patients ( 32 ). Young age was associated with non-uptake of the vaccines, a finding that has been reported by similar studies ( 8 , 9 ). This finding is not surprising since higher morbidity and mortality rates due to COVID-19 have been reported among older patients ( 33 , 34 ). While being young is associated with a low risk of severe COVID-19, non-uptake of vaccines among this age group should be addressed. A study by James et al. 2021 that explored the factors associated with COVID-19 severity in US children and adolescents reported that 20% of the children admitted to the hospital suffered from severe disease ( 35 ), and being black was associated with greater disease severity. Furthermore, young individuals are highly mobile and could contribute to increased transmission of the SARS-CoV-2 virus. Access to vaccination services is a critical determinant of vaccine uptake. In this study, we found that working in a private health facility was associated with increased non-uptake of vaccines compared with working in healthy government facilities. In Uganda, the rollout of COVID-19 vaccination has been concentrated in government healthcare facilities. This inaccessibility to vaccination services could have led to higher non-uptake rates among HCWs in these facilities. Being a private HCW is also associated with stringent work schedules, and some HCWs (22.6%) reported not being able to leave their workplaces to go for vaccination. Inaccessibility to COVID-19 vaccines has been reported to be one of the barriers to COVID-19 vaccine uptake ( 36 ). This study explored the effect of prior testing for coronavirus infection on vaccine uptake among HCWs. We found that HCWs who had never been tested for the coronavirus were less likely to take the vaccines than were the participants who had ever been tested. A study by Laura et al. ( 2023) reported that 96% of participants consumed a COVID-19 vaccine at least once, mostly after infection with the coronavirus ( 37 ). This difference in uptake could be due to differences in risk perceptions among HCWs. However, in our study, there was no relationship between the test results and the use of COVID-19 vaccines. The study further revealed that healthcare workers who were not involved in COVID-19 vaccination-related activities were less likely to take up vaccines than those who were involved in vaccine-related healthcare. Healthcare workers who participate in vaccination services are trained about vaccines, which improves their understanding of vaccines, how they work and their safety, hence building confidence and trust in vaccination services. However, there is a paucity of data in this area; hence, further research is needed. Using the 5C constructs (confidence, convenience, complacency, calculation, and collective responsibility model) of the determinants of vaccine uptake, we found that a lack of confidence in vaccines and an increased search for information were associated with the non-uptake of vaccines. Greater than 50% of the healthcare workers did not take up the vaccines due to safety concerns, increased vaccine production and concerns about side effects after vaccination. These concerns have also been reported by other studies as reasons for non-uptake of the vaccines ( 8 , 30 , 38 , 39 ). Hence, vaccine confidence should be regularly monitored to detect new trends to prompt interventions to build and maintain vaccine confidence. More than two-thirds of the healthcare workers who never received the vaccines reported having read negative media about COVID-19 vaccines, needed more time to understand COVID-19 vaccines and weighed the benefits vs the risks before deciding to receive the vaccines. This is not surprising, as COVID-19 vaccines are associated with many myths and misconceptions ( 40 ). This indicates that information-seeking actions such as deciding to take the vaccine based on the sought or established reliable information were important determinants of vaccine uptake. Therefore, providing information that meets the expectations of the public is critical for one’s decision to vaccinate, specifically the trust that COVID‐19 vaccines are safe and effective. This study is one of the few studies that has explored the reasons for non-uptake of COVID-19 vaccines among health care workers in sub-Saharan Africa. Information was collected during the peak of the epidemic, when the morbidity and mortality rates due to COVID-19 were highest. Therefore, the reasons for non-uptake would be most expressed during this time. Therefore, the findings of this study reflect true healthcare workers’ perceptions about COVID-19 vaccines. However, this study used convenience sampling; hence, the findings may not be generalizable to all healthcare workers. Only those HCWs who were on duty at the time of data collection were contacted and included in the study. Conclusions This study highlights a concerning level of vaccine non-uptake among HCWs in the Entebbe municipality, largely stemming from a lack of confidence and trust in the vaccines. This finding underscores the importance of continuous monitoring and trend identification to guide efforts aimed at building and sustaining vaccine confidence among HCWs. Given the association between participation in vaccine-related services and higher uptake, integrating vaccine safety information into continuous medical education programs for HCWs is essential to address safety concerns effectively. Moreover, it is imperative for government and development partners to ensure equitable involvement of both private and public healthcare systems in vaccination programs. This approach will help to enhance access to vaccines and strengthen overall vaccination coverage across the population. This study revealed that a lack of confidence in vaccines among HCWs could influence their uptake by the general population since healthcare workers are a trusted source of information. Healthcare workers who do not trust vaccines are unlikely to recommend that their patients or population receive vaccines. Therefore, exploring the reasons for the non-uptake of vaccines should be an ongoing process, especially for new vaccines. Abbreviations COVID-19 Corona Virus Disease 2019 HCWs Healthcare workers LRT likelihood ratio test SARS-COV-2 Severe Acute Respiratory Syndrome Corona virus-2 SAGE Strategic Advisory Group on Experts UVRI-REC Uganda Virus Research Institute’s Research and Ethics Committee WHO World Health Organization Declarations Ethics approval and consent to participate The study received ethical approval from the Uganda Virus Research Institute’s Research and Ethics Committee (UVRI-REC) approval number GC/127/845. Before participation, each participant signed a written informed consent form. Consent for publication The authors have agreed to publish this work. Availability of data and materials Data cannot be shared publicly because of country-specific data sharing restrictions. Data are available from the UVRI Institutional Data Access/Ethics Committee (contact via +256773747607) for researchers who meet the criteria for access to confidential data. Competing interests The authors declare that no competing interests exist. Funding This research was supported by funds from the European and Developing Countries Clinical Trials partnerships through the Eastern Africa Consortium for Clinical Research, grant number RIA2019IR-2873. The grant holder was Prof Pontiano Kaleebu. The funders did not play any role in the study design, data collection or manuscript development or the decision to publish. Funding website: www.edctp.org and www.eaccr.org Authors' contributions Conceptualization, writing, methods, and visualization: NK; writing, review, data analysis and editing: AA; data analysis and editing: CA; data management, and editing: HK and SM; supervision and editing: LP; supervision and funding acquisition: BK. All the authors contributed to the article and approved the submitted version. All the authors have read and agreed to the published version of the manuscript. 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Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nature medicine. 2021;27(2):225-8. Willis DE, Andersen JA, Bryant‐Moore K, Selig JP, Long CR, Felix HC, et al. COVID‐19 vaccine hesitancy: Race/ethnicity, trust, and fear. Clinical and translational science. 2021;14(6):2200-7. Gadoth A, Halbrook M, Martin-Blais R, Gray A, Tobin NH, Ferbas KG, et al. Cross-sectional assessment of COVID-19 vaccine acceptance among health care workers in Los Angeles. Annals of internal medicine. 2021;174(6):882-5. Campbell JV, Garfein RS, Thiede H, Hagan H, Ouellet LJ, Golub ET, et al. Convenience is the key to hepatitis A and B vaccination uptake among young adult injection drug users. Drug and alcohol dependence. 2007;91:S64-S72. Norton SP, Scheifele DW, Bettinger JA, West RM. Influenza vaccination in pediatric nurses: cross-sectional study of coverage, refusal, and factors in acceptance. Vaccine. 2008;26(23):2942-8. Reliefweb. Uganda receives 864,000 doses of COVID-19 vaccines Kampala, Uganda: OCHA services; 2021 [Available from: https://reliefweb.int/report/uganda/uganda-receives-864000-doses-covid-19-vaccines. Xinhua. Uganda receives Chinese-donated vaccines in fight against COVID-19 2021 [cited 2024 03 February]. Available from: http://www.xinhuanet.com/english/2021-07/31/c_1310099615_2.htm. Independent T. Uganda receives 1.6 million doses of Pfizer Covid-19 vaccine: The Independent; 2021 [Available from: https://www.independent.co.ug/uganda-receives-1-6-million-doses-of-pfizer-covid-19-vaccine/. Independent T. Uganda receives 196,000 doses of Johnson and Johnson vaccine Kampala, Uganda: The independent; 2021 [cited 2024 03 February ]. Available from: https://www.independent.co.ug/uganda-receives-196000-doses-of-johnson-and-johnson-vaccine/. Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: the development of a survey tool. Vaccine. 2015;33(34):4165-75. Ouni PD, Namulondo R, Wanume B, Okia D, Olupot PO, Nantale R, et al. COVID-19 vaccine hesitancy among health workers in rural Uganda: A mixed methods study. Vaccine: X. 2023;13:100260. Hassan W, Kazmi SK, Tahir MJ, Ullah I, Royan HA, Fahriani M, et al. Global acceptance and hesitancy of COVID-19 vaccination: A narrative review. Narra J. 2021;1(3). Verger P, Scronias D, Dauby N, Adedzi KA, Gobert C, Bergeat M, et al. Attitudes of healthcare workers toward COVID-19 vaccination: a survey in France and French-speaking parts of Belgium and Canada, 2020. Euro Surveill. 2021;26(3). Li H, Wang S, Zhong F, Bao W, Li Y, Liu L, et al. Age-dependent risks of incidence and mortality of COVID-19 in Hubei Province and other parts of China. Frontiers in medicine. 2020;7:190. Roy J, Jain R, Golamari R, Vunnam R, Sahu N. COVID‐19 in the geriatric population. International journal of geriatric psychiatry. 2020;35(12):1437-41. Antoon JW, Grijalva CG, Thurm C, Richardson T, Spaulding AB, II RJT, et al. Factors associated with COVID‐19 disease severity in US children and adolescents. Journal of hospital medicine. 2021;16(10):603-10. Abba-Aji M, Stuckler D, Galea S, McKee M. Ethnic/racial minorities’ and migrants’ access to COVID-19 vaccines: A systematic review of barriers and facilitators. Journal of migration and health. 2022;5:100086. Schackmann L, Hek K, Vervloet M, Koster ES, van Dijk L. Provision of and trust in COVID‐19 vaccines information: Perspectives of people who have had COVID‐19. Health Expectations. 2023;26(2):806-17. De Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modeling study. The Lancet. 2020;396(10255):898-908. Trogen B, Oshinsky D, Caplan A. Adverse consequences of rushing a SARS-CoV-2 vaccine: implications for public trust. Jama. 2020;323(24):2460-1. Hammad AM, Al-Qerem W, Zaid AA, Khdair SI, Hall FS. Misconceptions related to COVID 19 vaccines among the Jordanian population: Myth and Public Health. Disaster Medicine and Public Health Preparedness. 2023;17:e207. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4094428","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":279486002,"identity":"78fd1c9c-8bf0-4e08-af27-31ed77764d18","order_by":0,"name":"Nasimu Kyakuwa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYLCCBCBk4AGxKoCYmbmBFC1nQFoYidDCANPC2AbiENBizn788YeHOWmJ/T1nzCR+zquN5m8HavlRsQ2nFsueHDOJxG05iTPO9phJ9m47njvjMGMDY8+Z2zi1GBzIYWNI3FaR2HCex+wG77ZjuQ1ALcyMbXi0nH/++ANIy3yglpt/5xzLnU9Qy40EA7DDNgAddpu3oSZ3A2Etb0B+STPeeOZY+W+ZYwdyNwK1HMTrl/Ppjz/+3JYsO+9M8mbDNzV1ufPOHz744EcFbi0w4NgAoQ+DyQME1QOBPZSuI0bxKBgFo2AUjDAAACtcZRgNhJFjAAAAAElFTkSuQmCC","orcid":"","institution":"Uganda Virus Research Institute","correspondingAuthor":true,"prefix":"","firstName":"Nasimu","middleName":"","lastName":"Kyakuwa","suffix":""},{"id":279486003,"identity":"f042f3a0-c6c1-4024-ad03-255cea3aa2a7","order_by":1,"name":"Andrew Abaasa","email":"","orcid":"","institution":"MRC/UVRI \u0026 LSHTM Uganda Research Unit, Entebbe","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Abaasa","suffix":""},{"id":279486006,"identity":"35e0e68a-2340-43ef-b133-316972981eb2","order_by":2,"name":"Simon Mpooya","email":"","orcid":"","institution":"Uganda Virus Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"","lastName":"Mpooya","suffix":""},{"id":279486010,"identity":"f934782b-3282-4025-96c1-2a18eea26844","order_by":3,"name":"Hamza Kalutte","email":"","orcid":"","institution":"Uganda Virus Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Hamza","middleName":"","lastName":"Kalutte","suffix":""},{"id":279486012,"identity":"eb153fa6-49dc-45fb-8216-62297f1c5ce7","order_by":4,"name":"Christine Atuhairwe","email":"","orcid":"","institution":"Uganda Martyrs University","correspondingAuthor":false,"prefix":"","firstName":"Christine","middleName":"","lastName":"Atuhairwe","suffix":""},{"id":279486013,"identity":"6e2977d7-93ea-470a-8bff-f4b8ae209dc6","order_by":5,"name":"Laurent Perez","email":"","orcid":"","institution":"Lausanne University Hospital, University of Lausanne","correspondingAuthor":false,"prefix":"","firstName":"Laurent","middleName":"","lastName":"Perez","suffix":""},{"id":279486014,"identity":"68cb3848-2787-48b2-8ff9-8baac21ec03b","order_by":6,"name":"Bernard Kikaire","email":"","orcid":"","institution":"Makerere University, College of Health sciences","correspondingAuthor":false,"prefix":"","firstName":"Bernard","middleName":"","lastName":"Kikaire","suffix":""}],"badges":[],"createdAt":"2024-03-13 15:47:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4094428/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4094428/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53189541,"identity":"b9ab8d3c-7d78-4827-9f5d-caef81c1c404","added_by":"auto","created_at":"2024-03-21 17:04:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47950,"visible":true,"origin":"","legend":"\u003cp\u003eReasons why HCWs were not vaccinated (n=124)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4094428/v1/f3e23baf1afb83b777d246f2.png"},{"id":53449883,"identity":"52c9102b-3fc0-4279-b2af-64e94d0543a5","added_by":"auto","created_at":"2024-03-26 06:26:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":554303,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4094428/v1/e3cdf6e1-27fb-4520-a237-60be4ffbcd5a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Non-uptake of COVID-19 vaccines and reasons for non-uptake among healthcare workers in Uganda: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe emergence of coronavirus disease 2019 (COVID-19) has presented a significant global health challenge, resulting in the loss of more than 7\u0026nbsp;million lives by December 31, 2023(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Failing to effectively control the spread of the virus poses substantial risks to public health, including increased morbidity and mortality rates, which could overwhelm healthcare systems worldwide. In response, global efforts have prioritized vaccination as a crucial strategy to combat the pandemic. Immunization campaigns aim to achieve widespread immunity, thereby reducing the incidence of severe disease and hospitalization among the population.\u003c/p\u003e \u003cp\u003eApart from the direct individual health benefits of conferring immunity, high vaccination coverage rates are important in attaining herd immunity (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The attainment of herd immunity, which is critical for stopping disease spread, is directly affected by the non-uptake of COVID-19 vaccines (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Uganda, COVID-19 vaccines were introduced in March 2021 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and were prioritized for populations at high risk of developing severe disease and frontline healthcare workers (HCWs), who are not only at high risk of contracting the disease but also spreading the SARS-CoV-2 virus to patients under their care. HCWs are a trusted source of health information and are likely to influence the use of COVID-19 vaccines. Although HCWs are knowledgeable about the importance of vaccination, not all of them believe in vaccination, with some HCWs perceiving vaccines as unsafe and unnecessary (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Studies have indicated that the non-uptake of COVID-19 vaccines among HCWs ranges from 4.3\u0026ndash;72% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and varies with the role of HCWs, with nurses being less likely to take the vaccines (\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral sociodemographic factors, including age, may influence the use of COVID-19 vaccines among healthcare workers (HCWs). Younger age has been identified as one such factor associated with lower vaccine uptake, possibly attributed to the perception of a reduced risk of severe disease among younger individuals (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Other demographic factors, such as sex and education level, have been reported to affect the use of COVID-19 vaccines among healthcare workers (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe decision to get vaccinated immediately, delay vaccination or complete refusal of vaccines may be influenced by factors such as confidence, complacency and convenience (\u0026lsquo;3Cs\u0026rsquo; model). The World Health Organization Strategic Advisory Group of Experts on Immunization (SAGE) working group developed the 3Cs model to explain vaccine hesitancy (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Confidence refers to a level of trust in the effectiveness and safety of vaccines, the delivery system, the reliability of health professionals, and the motivations of policymakers who make determinations about vaccines. Convenience refers to the degree to which the comfort, time, place, and quality of a vaccine affect the uptake of the vaccine, while complacency refers to a low perceived risk of vaccine-preventable diseases and therefore assumes that vaccination is not required to prevent the disease. The \u0026lsquo;3Cs\u0026rsquo; model was later extended to 5Cs by adding calculations (extensive information searching by the individual) and communal orientation (considering collective responsibility) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The decision to get vaccinated may vary with time, place, and type of vaccine; therefore, determinants of vaccine non-uptake need to be explored at different levels and among populations (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Vaccine confidence is one such important determinant of vaccine uptake. Trust in COVID-19 vaccines was affected by the fast-track production of the vaccines, which could have led to low uptake of the vaccines (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). A study by Alshareef et al, 2021 reported that 50.29% of healthcare workers were not willing to get vaccinated until the safety of the vaccines was demonstrated (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A similar study by Gadoth et al. (2021) reported a high COVID-19 vaccine non-uptake of 65.5% among HCWs in Los Angeles due to concerns about vaccine safety (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Vaccine convenience, which refers to the degree to which the comfort, time, place, and quality of a vaccine affect the uptake of the vaccine, is an important factor in determining vaccine uptake (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). While numerous studies have explored individuals' intentions to get vaccinated against COVID-19 once vaccines become available, there remains a significant gap in the literature regarding actual vaccine uptake among healthcare workers (HCWs). It is crucial to recognize that the intention to get vaccinated does not necessarily translate into actual uptake, emphasizing the importance of studying real-world vaccine acceptance and utilization among HCWs.\u003c/p\u003e \u003cp\u003eTherefore, the aim of this study was to describe the determinants of COVID-19 vaccine non-uptake among HCWs in primary healthcare facilities within the Entebbe municipality. This study further explored the reasons for the non-uptake of vaccines among HCWs using the 3Cs\u0026thinsp;+\u0026thinsp;2 model factors of vaccine hesitancy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional study aimed at describing the non-uptake of COVID-19 vaccines and the associated reasons and factors among healthcare workers in private and government primary health facilities in Entebbe Municipality, Uganda.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eThe study was conducted in Entebbe Municipality, which is located approximately 40 km south of Kampala, the capital of Uganda. The estimated population (adults and children) in this municipality is approximately 700000 people. There are about 40 healthcare facilities, approximately 80%, are mostly privately owned. The municipality also has one regional referral hospital that was excluded from this study because a similar study was concurrently being conducted at this hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants\u003c/h2\u003e \u003cp\u003eParticipants for this study were drawn from HCWs in the primary healthcare facilities described above. The participants were categorized as either medical or nonmedical staff. The medical HCWs included medical doctors, nurses, nursing assistants, paramedics, social workers, and research scientists, while the nonmedical HCWs included health center managers, accountants, receptionists, and janitors. Due to the absence of established healthcare workers\u0026rsquo; contact lists within the municipality, participants were selected through convenience sampling. The study was also conducted during the national lockdown; therefore, only participants who were on duty at the time of data collection were approached.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCOVID-19 vaccines\u003c/h2\u003e \u003cp\u003eOn Friday 5th March 2021, the Uganda Ministry of Health received her first batch of 864,000 doses of AstraZeneca COVID-19 vaccine, shipped via the COVAX facility, and vaccination was prioritized for the following groups of people: health care workers, security personnel, teachers, journalists, persons aged 50 years and above and those with underlying health conditions (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The COVAX facility allocated 3,552,000 doses of the AstraZeneca vaccine to Uganda for the period of January\u0026ndash;June 2021 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). On 31 July 2021, the country received 300,000 doses of the Sinovac vaccine from the Chinese government (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). On 6th September 2021, 647,080 doses of Moderna vaccines were received, and on 21 September, 1,674,270 doses of Pfizer vaccine were received as donations from the US government (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). On 8th October 2021, Uganda received the first batch of 196,000 doses of the Johnson and Johnson vaccine (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Other vaccines were subsequently introduced into the country. Hence, at the time of rollout of this study, only the AstraZeneca and Sinovac vaccines were available in the country.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe data were collected by research assistants between 1st July and 3rd August 2021. A structured questionnaire developed in Research Electronic Data Capture (REDCap) was used to collect the data. The questionnaire was adapted from the WHO Strategic Advisory Group on Experts (SAGE) on Immunization survey tool (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The reasons for taking or not taking the vaccine were categorized based on the 3C\u0026thinsp;+\u0026thinsp;2 model of vaccine hesitancy, which includes factors such as confidence, complacency, convenience, collective responsibility and calculation. HCWs who agreed to participate and provided consent had the questionnaire link shared through email or WhatsApp. Participants who had no computer or smartphone were offered the study\u0026rsquo;s smartphone to complete the survey. The 3C\u0026thinsp;+\u0026thinsp;2 model of the reasons for the non-uptake of COVID-19 vaccines is provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e3C\u0026thinsp;+\u0026thinsp;2 model of reasons why HCWs were not vaccinated\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eConfidence\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Did not think the vaccine was effective\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Did not think the vaccine was safe\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. COVID-19 vaccine production was rushed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Had a bad experience or reaction with previous vaccines\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Someone else told me he/she had/knows someone who had a bad reaction after vaccination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Concerned about side effects\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eComplacency\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. My job does not put me at a high risk of getting infected with corona virus\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. My age doesn\u0026rsquo;t put me at a high risk of severe COVID-19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. There are better ways of prevention other than vaccination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Fear of needles\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Did not think it was needed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. COVID-19 is not so severe that I should get vaccinated\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. My immune system is so strong; it protects against disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Bad experience with similar vaccination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eLack of convenience\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Did not know where to get vaccination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. Not possible to leave other work (home or office)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. Long distance to the vaccination center\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18. Transport costs to the vaccination center\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19. Did not want to spend so much at the vaccination center\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCalculation (Increased information searching)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20. Heard or read negative media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21. Did not know where to get good/reliable information\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22. Distrust in government making the decision in my best interest\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23. It\u0026rsquo;s important for me to fully understand COVID-19 vaccines before I get vaccinated\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24. I closely consider whether COVID-19 vaccine is useful for me\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25. I weigh the benefits and risks to make the best decision possible\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data were electronically captured in the REDCap software database and transferred to STATA version 16 for statistical analysis. Participant characteristics were summarized overall and stratified by vaccine uptake status and compared using chi-square tests. Means with standard deviations and medians with interquartile ranges were used for continuous variables. The proportion of vaccine non-uptake was estimated as the number of participants who had not received any COVID-19 vaccine divided by the total number of participants studied, expressed as a percentage. The reasons for the lack of uptake of vaccines are summarized in the graphs. We used simple logistic regression models to determine factors associated with non-uptake of COVID-19 vaccines via univariate and multivariate models. We fitted logit models first for univariable analysis, and factors that attained a statistical significance likelihood ratio test (LRT) p value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 were considered for multivariable analysis. In the multivariable analysis, we used a backward elimination approach, retaining factors that attained a statistically significant LRT p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, with the exception of sex, which was included a priori. Before multivariable analysis, we checked for multicollinearity and assessed for inclusion only those factors that were more statistically significantly associated with non-uptake in the univariate analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cstrong\u003eParticipant characteristics\u003c/strong\u003e \u003cp\u003eWe recruited 360 healthcare workers, mostly females (n\u0026thinsp;=\u0026thinsp;222; 61.7%), with a mean age of 31 years (SD\u0026thinsp;=\u0026thinsp;7.9). Approximately two-thirds were medical, with mostly a bachelor\u0026rsquo;s degree and above, n\u0026thinsp;=\u0026thinsp;287 (80%), and the majority (n\u0026thinsp;=\u0026thinsp;285; 79.2%) were aged more than 24 years (Table\u0026nbsp;2).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNon-Uptake of COVID-19 vaccines\u003c/strong\u003e\u003c/p\u003e \u003cp\u003eA total of 124 (34.4%) of the participants did not take up any COVID-19 vaccine despite free access. The percentage of individuals who did not take vaccines decreased with increasing age (42.7% in the 18\u0026ndash;24 years age group vs 39.2% in the 25\u0026ndash;34 years age group and 20.2% in the 35\u0026thinsp;+\u0026thinsp;year age group, p\u0026thinsp;=\u0026thinsp;0.001); the percentage of individuals who did not take vaccines was greater among secondary contacts than among primary contacts (40.7% vs 28.5%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the percentage of individuals taking vaccines from the small roadside clinics (48.4%) than among those in the Health Centre III \u0026amp; IV clinics (20.8%) and hospitals (29.8%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eTable 2: Sociodemographic, clinical characteristics, and vaccine uptake among 360 healthcare workers enrolled in a COVID-19 uptake study in Uganda, 2021\u003c/p\u003e\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVaccine uptake\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal N\u0026thinsp;=\u0026thinsp;360)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;124)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes(n\u0026thinsp;=\u0026thinsp;236)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e222 (61.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138 (38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (61.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75(20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43(57.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e181(50.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71(39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110(60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026thinsp;+\u0026thinsp;Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104(28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83(79.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of qualification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCertificate/Diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73(20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44(60.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelors \u0026amp; Masters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e287(79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95(33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e192(66.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJob category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e248 (68.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e167 (67.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.289\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonmedical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (61.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContacts(n\u0026thinsp;=\u0026thinsp;248)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary contacts**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (71.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary contacts***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (59.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of service of the health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (70.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth center III \u0026amp; IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall Roadside clinics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (48.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 (51.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of ownership\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate not for profit (PNFP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate for profit (PFP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146 (40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (49.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreviously cared for confirmed COVID-19 patient\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e226 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e156 (69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreviously tested for Corona virus infection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e271 (75.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205 (75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious Corona test results (N\u0026thinsp;=\u0026thinsp;271)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230 (84.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e177(77.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (31.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (68.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver involved in COVID-19 vaccine activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e177 (84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote: p values-based Chi-square test; * significant at 5% level, ** HCWs who interface with patients first, ***HCWs who interface with patients who have been screened or deal with biological materials obtained from patients\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with non-uptake of vaccines\u003c/b\u003e: According to the multivariable analysis, factors that were independently associated with non-uptake of the COVID-19 vaccine included age [25\u0026ndash;34 years, adjusted odds ratio (aOR)\u0026thinsp;=\u0026thinsp;0.7, 95% CI: 0.35\u0026ndash;1.40, 35\u0026thinsp;+\u0026thinsp;years aOR\u0026thinsp;=\u0026thinsp;0.30, 95% CI: 0.13\u0026ndash;0.66, all compared to 18\u0026ndash;24 years], previous COVID-19 infection status [yes, aOR\u0026thinsp;=\u0026thinsp;0.35, 95% CI: 0.19\u0026ndash;0.65] and ever been involved in COVID-19 vaccine activities [yes, aOR\u0026thinsp;=\u0026thinsp;0.17, 95% CI: 0.10\u0026ndash;0.29]. Other factors are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and clinical factors associated with non-uptake of COVID-19 vaccines among healthcare workers in Uganda\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003euOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLRT-pvalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLRT-pvalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.33 (0.85\u0026ndash;2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.67 (0.95\u0026ndash;2.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group (complete years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.87 (0.50\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.70 (0.35\u0026ndash;1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.34 (0.18\u0026ndash;0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30 (0.13\u0026ndash;0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of qualification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCertificate-diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelors +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.75 (0.44\u0026ndash;1.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJob category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonclinical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.28 (0.81\u0026ndash;2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContact level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.34 (0.86\u0026ndash;2.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth facility level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth center III \u0026amp; IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.62 (0.31\u0026ndash;1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.21 (1.16\u0026ndash;4.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of ownership\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate not for profit (PNFP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate for profit (PFP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.12 (0.66\u0026ndash;1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.90 (0.47\u0026ndash;1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.13 (0.06\u0026ndash;0.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.22 (0.10\u0026ndash;0.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreviously cared for a COVID-19 confirmed patient\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.51 (0.96\u0026ndash;2.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreviously tested for Corona virus infection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.17 (0.11\u0026ndash;0.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.35 (0.19\u0026ndash;0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious Corona test results (N\u0026thinsp;=\u0026thinsp;271)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.06 (1.25\u0026ndash;3.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver involved in COVID-19 vaccine activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.12 (0.07\u0026ndash;0.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.17 (0.10\u0026ndash;0.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote: p values based Chi-square test; *_significant at 5% level, ** HCWs who interface with patients first, ***HCWs who interface with patients who have been screened or deal with biological materials obtained from patients\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePrimary reasons why healthcare workers were not vaccinated\u003c/strong\u003e \u003cp\u003eThe reasons for vaccine non-uptake are depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below. Mostly, reasons related to lack of confidence in the vaccines, such as concerns about side effects (79.8%) and calculations, including not enough time to understand the vaccines (89.5%) and weighing benefits and risk (84.7%) before being vaccinated, were considered key reasons for not accepting vaccination. An average of 23% of the respondents raised reasons related to complacency and lack of convenience (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study revealed that one in three healthcare workers did not take up COVID-19 vaccines despite their availability. This finding contrasts with that of Patrick et al. (2023), who reported that one in ten healthcare workers in Uganda were unwilling to receive the COVID-19 vaccine (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The difference in findings may be attributed to differences in the study setting. Our study was conducted in an urban setting, while Patrick et al. conducted the study in a rural setting. It is also well known that vaccine non-uptake is context specific, varying from place to place, time to time and between populations (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Two-thirds of healthcare workers in the Patrick et al. study were nurses, and most were low-cadre healthcare workers; similar studies have reported low rates of COVID-19 vaccine uptake among nurses (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Globally, healthcare workers were among the priority groups for COVID-19 vaccination due to their increased risk of exposure to infections, and since they are a trusted source of information, non-uptake could have impacted the overall uptake of the vaccines by the general population. Furthermore, studies have shown that COVID-19 vaccine hesitant healthcare workers are less likely to recommend a COVID-19 vaccine to their patients (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eYoung age was associated with non-uptake of the vaccines, a finding that has been reported by similar studies (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This finding is not surprising since higher morbidity and mortality rates due to COVID-19 have been reported among older patients (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). While being young is associated with a low risk of severe COVID-19, non-uptake of vaccines among this age group should be addressed. A study by James et al. 2021 that explored the factors associated with COVID-19 severity in US children and adolescents reported that 20% of the children admitted to the hospital suffered from severe disease (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), and being black was associated with greater disease severity. Furthermore, young individuals are highly mobile and could contribute to increased transmission of the SARS-CoV-2 virus.\u003c/p\u003e \u003cp\u003eAccess to vaccination services is a critical determinant of vaccine uptake. In this study, we found that working in a private health facility was associated with increased non-uptake of vaccines compared with working in healthy government facilities. In Uganda, the rollout of COVID-19 vaccination has been concentrated in government healthcare facilities. This inaccessibility to vaccination services could have led to higher non-uptake rates among HCWs in these facilities. Being a private HCW is also associated with stringent work schedules, and some HCWs (22.6%) reported not being able to leave their workplaces to go for vaccination. Inaccessibility to COVID-19 vaccines has been reported to be one of the barriers to COVID-19 vaccine uptake (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study explored the effect of prior testing for coronavirus infection on vaccine uptake among HCWs. We found that HCWs who had never been tested for the coronavirus were less likely to take the vaccines than were the participants who had ever been tested. A study by Laura et al. \u003cem\u003e(\u003c/em\u003e2023) reported that 96% of participants consumed a COVID-19 vaccine at least once, mostly after infection with the coronavirus (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). This difference in uptake could be due to differences in risk perceptions among HCWs. However, in our study, there was no relationship between the test results and the use of COVID-19 vaccines.\u003c/p\u003e \u003cp\u003eThe study further revealed that healthcare workers who were not involved in COVID-19 vaccination-related activities were less likely to take up vaccines than those who were involved in vaccine-related healthcare. Healthcare workers who participate in vaccination services are trained about vaccines, which improves their understanding of vaccines, how they work and their safety, hence building confidence and trust in vaccination services. However, there is a paucity of data in this area; hence, further research is needed.\u003c/p\u003e \u003cp\u003eUsing the 5C constructs (confidence, convenience, complacency, calculation, and collective responsibility model) of the determinants of vaccine uptake, we found that a lack of confidence in vaccines and an increased search for information were associated with the non-uptake of vaccines. Greater than 50% of the healthcare workers did not take up the vaccines due to safety concerns, increased vaccine production and concerns about side effects after vaccination. These concerns have also been reported by other studies as reasons for non-uptake of the vaccines (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Hence, vaccine confidence should be regularly monitored to detect new trends to prompt interventions to build and maintain vaccine confidence. More than two-thirds of the healthcare workers who never received the vaccines reported having read negative media about COVID-19 vaccines, needed more time to understand COVID-19 vaccines and weighed the benefits vs the risks before deciding to receive the vaccines. This is not surprising, as COVID-19 vaccines are associated with many myths and misconceptions (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). This indicates that information-seeking actions such as deciding to take the vaccine based on the sought or established reliable information were important determinants of vaccine uptake. Therefore, providing information that meets the expectations of the public is critical for one\u0026rsquo;s decision to vaccinate, specifically the trust that COVID‐19 vaccines are safe and effective.\u003c/p\u003e \u003cp\u003eThis study is one of the few studies that has explored the reasons for non-uptake of COVID-19 vaccines among health care workers in sub-Saharan Africa. Information was collected during the peak of the epidemic, when the morbidity and mortality rates due to COVID-19 were highest. Therefore, the reasons for non-uptake would be most expressed during this time. Therefore, the findings of this study reflect true healthcare workers\u0026rsquo; perceptions about COVID-19 vaccines. However, this study used convenience sampling; hence, the findings may not be generalizable to all healthcare workers. Only those HCWs who were on duty at the time of data collection were contacted and included in the study.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights a concerning level of vaccine non-uptake among HCWs in the Entebbe municipality, largely stemming from a lack of confidence and trust in the vaccines. This finding underscores the importance of continuous monitoring and trend identification to guide efforts aimed at building and sustaining vaccine confidence among HCWs. Given the association between participation in vaccine-related services and higher uptake, integrating vaccine safety information into continuous medical education programs for HCWs is essential to address safety concerns effectively. Moreover, it is imperative for government and development partners to ensure equitable involvement of both private and public healthcare systems in vaccination programs. This approach will help to enhance access to vaccines and strengthen overall vaccination coverage across the population.\u003c/p\u003e \u003cp\u003eThis study revealed that a lack of confidence in vaccines among HCWs could influence their uptake by the general population since healthcare workers are a trusted source of information. Healthcare workers who do not trust vaccines are unlikely to recommend that their patients or population receive vaccines. Therefore, exploring the reasons for the non-uptake of vaccines should be an ongoing process, especially for new vaccines.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOVID-19\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Corona Virus Disease 2019\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHCWs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Healthcare workers\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLRT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; likelihood ratio test\u003c/p\u003e\n\u003cp\u003eSARS-COV-2\u0026nbsp; Severe Acute Respiratory Syndrome Corona virus-2\u003c/p\u003e\n\u003cp\u003eSAGE\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Strategic Advisory Group on Experts\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUVRI-REC \u0026nbsp; \u0026nbsp;\u0026nbsp;Uganda Virus Research Institute\u0026rsquo;s Research and Ethics Committee\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eapproval\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the Uganda Virus Research Institute\u0026rsquo;s Research and Ethics Committee (UVRI-REC) approval number GC/127/845. Before participation, each participant signed a written informed consent\u0026nbsp;form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have agreed to publish this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData cannot be shared publicly because of\u0026nbsp;country-specific data sharing restrictions. Data are available from the UVRI Institutional Data Access/Ethics Committee (contact via +256773747607) for researchers who meet the criteria for access to confidential data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no competing interests exist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by funds from the European and Developing Countries Clinical Trials partnerships through the Eastern Africa Consortium for Clinical Research, grant number RIA2019IR-2873. The grant holder was Prof Pontiano Kaleebu. The funders did not play any role in the study design, data collection or manuscript development or the decision to publish. Funding website: www.edctp.org and www.eaccr.org\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, writing, methods, and visualization: NK; writing, review, data analysis and editing: AA; data analysis and editing: CA; data management, and editing: HK and SM; supervision and editing: LP; supervision and funding acquisition: BK. All the authors contributed to the article and approved the submitted version. All the authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to\u0026nbsp;acknowledge\u0026nbsp;the training and support from the University of Nairobi\u0026rsquo;s Building Capacity for Writing Scientific Manuscripts (UANDISHI) Program at the Faculty of Health Sciences. This work was funded in part\u0026nbsp;through the\u0026nbsp;ADVANCE program at IAVI. This work\u0026nbsp;was made possible by the support of the American People through the U.S. President\u0026rsquo;s Emergency Plan for AIDS Relief (PEPFAR) through\u0026nbsp;the United States Agency for International Development (USAID). The contents of this study are the sole responsibility\u0026nbsp;of the authors and do not necessarily reflect the views of PEPFAR, USAID, or the United States Government.\u003c/p\u003e\n\u003cp\u003eSpecial thanks to the healthcare workers who agreed to participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO C-d. Number of COVID-19 deaths reported to WHO: WHO; 2024 [Available from: https://data.who.int/dashboards/covid19/deaths?n=c.\u003c/li\u003e\n\u003cli\u003eBetsch C, B\u0026ouml;hm R, Korn L, Holtmann C. On the benefits of explaining herd immunity in vaccine advocacy. Nature human behavior. 2017;1(3):1-6.\u003c/li\u003e\n\u003cli\u003eBrisson M, Edmunds WJ. 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COVID-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates. Vaccines 2021, 9, 160. Publisher Full Text. 2021.\u003c/li\u003e\n\u003cli\u003eShaw J, Stewart T, Anderson KB, Hanley S, Thomas SJ, Salmon DA, et al. Assessment of US health care personnel (HCP) attitudes toward COVID-19 vaccination in a large university health care system. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2021.\u003c/li\u003e\n\u003cli\u003eGagneux-Brunon A, Detoc M, Bruel S, Tardy B, Rozaire O, Frappe P, et al. Intention to get vaccinations against COVID-19 in French healthcare workers during the first pandemic wave: a cross-sectional survey. Journal of Hospital Infection. 2021;108:168-73.\u003c/li\u003e\n\u003cli\u003eMaltezou HC, Pavli A, Dedoukou X, Georgakopoulou T, Raftopoulos V, Drositis I, et al. Determinants of intention to get vaccinated against COVID-19 among healthcare personnel in hospitals in Greece. Infection, Disease \u0026amp; Health. 2021;26(3):189-97.\u003c/li\u003e\n\u003cli\u003eKuter BJ, Browne S, Momplaisir FM, Feemster KA, Shen AK, Green-McKenzie J, et al. Perspectives on the receipt of a COVID-19 vaccine: A survey of employees in two large hospitals in Philadelphia. Vaccine. 2021;39(12):1693-700.\u003c/li\u003e\n\u003cli\u003eKukreti S, Lu M, Lin Y, Strong C, Lin C, Ko N, et al. Willingness of Taiwan\u0026rsquo;s healthcare workers and outpatients to vaccinate against COVID-19 during a period without community outbreaks. Vaccines. 2021; 9 (3), 246. s Note: MDPI stays neutral with regard to jurisdictional claims in published \u0026hellip;; 2021.\u003c/li\u003e\n\u003cli\u003eWang K, Wong ELY, Ho KF, Cheung AWL, Chan EYY, Yeoh EK, et al. Intention of nurses to accept coronavirus disease 2019 vaccination and change of intention to accept seasonal influenza vaccination during the coronavirus disease 2019 pandemic: A cross-sectional survey. 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Cross-sectional assessment of COVID-19 vaccine acceptance among health care workers in Los Angeles. Annals of internal medicine. 2021;174(6):882-5.\u003c/li\u003e\n\u003cli\u003eCampbell JV, Garfein RS, Thiede H, Hagan H, Ouellet LJ, Golub ET, et al. Convenience is the key to hepatitis A and B vaccination uptake among young adult injection drug users. Drug and alcohol dependence. 2007;91:S64-S72.\u003c/li\u003e\n\u003cli\u003eNorton SP, Scheifele DW, Bettinger JA, West RM. Influenza vaccination in pediatric nurses: cross-sectional study of coverage, refusal, and factors in acceptance. Vaccine. 2008;26(23):2942-8.\u003c/li\u003e\n\u003cli\u003eReliefweb. Uganda receives 864,000 doses of COVID-19 vaccines Kampala, Uganda: OCHA services; 2021 [Available from: https://reliefweb.int/report/uganda/uganda-receives-864000-doses-covid-19-vaccines.\u003c/li\u003e\n\u003cli\u003eXinhua. Uganda receives Chinese-donated vaccines in fight against COVID-19 2021 [cited 2024 03 February]. Available from: http://www.xinhuanet.com/english/2021-07/31/c_1310099615_2.htm.\u003c/li\u003e\n\u003cli\u003eIndependent T. Uganda receives 1.6 million doses of Pfizer Covid-19 vaccine: The Independent; 2021 [Available from: https://www.independent.co.ug/uganda-receives-1-6-million-doses-of-pfizer-covid-19-vaccine/.\u003c/li\u003e\n\u003cli\u003eIndependent T. Uganda receives 196,000 doses of Johnson and Johnson vaccine Kampala, Uganda: The independent; 2021 [cited 2024 03 February ]. Available from: https://www.independent.co.ug/uganda-receives-196000-doses-of-johnson-and-johnson-vaccine/.\u003c/li\u003e\n\u003cli\u003eLarson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: the development of a survey tool. Vaccine. 2015;33(34):4165-75.\u003c/li\u003e\n\u003cli\u003eOuni PD, Namulondo R, Wanume B, Okia D, Olupot PO, Nantale R, et al. COVID-19 vaccine hesitancy among health workers in rural Uganda: A mixed methods study. Vaccine: X. 2023;13:100260.\u003c/li\u003e\n\u003cli\u003eHassan W, Kazmi SK, Tahir MJ, Ullah I, Royan HA, Fahriani M, et al. Global acceptance and hesitancy of COVID-19 vaccination: A narrative review. Narra J. 2021;1(3).\u003c/li\u003e\n\u003cli\u003eVerger P, Scronias D, Dauby N, Adedzi KA, Gobert C, Bergeat M, et al. Attitudes of healthcare workers toward COVID-19 vaccination: a survey in France and French-speaking parts of Belgium and Canada, 2020. Euro Surveill. 2021;26(3).\u003c/li\u003e\n\u003cli\u003eLi H, Wang S, Zhong F, Bao W, Li Y, Liu L, et al. Age-dependent risks of incidence and mortality of COVID-19 in Hubei Province and other parts of China. Frontiers in medicine. 2020;7:190.\u003c/li\u003e\n\u003cli\u003eRoy J, Jain R, Golamari R, Vunnam R, Sahu N. COVID‐19 in the geriatric population. International journal of geriatric psychiatry. 2020;35(12):1437-41.\u003c/li\u003e\n\u003cli\u003eAntoon JW, Grijalva CG, Thurm C, Richardson T, Spaulding AB, II RJT, et al. Factors associated with COVID‐19 disease severity in US children and adolescents. Journal of hospital medicine. 2021;16(10):603-10.\u003c/li\u003e\n\u003cli\u003eAbba-Aji M, Stuckler D, Galea S, McKee M. Ethnic/racial minorities\u0026rsquo; and migrants\u0026rsquo; access to COVID-19 vaccines: A systematic review of barriers and facilitators. Journal of migration and health. 2022;5:100086.\u003c/li\u003e\n\u003cli\u003eSchackmann L, Hek K, Vervloet M, Koster ES, van Dijk L. Provision of and trust in COVID‐19 vaccines information: Perspectives of people who have had COVID‐19. Health Expectations. 2023;26(2):806-17.\u003c/li\u003e\n\u003cli\u003eDe Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modeling study. The Lancet. 2020;396(10255):898-908.\u003c/li\u003e\n\u003cli\u003eTrogen B, Oshinsky D, Caplan A. Adverse consequences of rushing a SARS-CoV-2 vaccine: implications for public trust. Jama. 2020;323(24):2460-1.\u003c/li\u003e\n\u003cli\u003eHammad AM, Al-Qerem W, Zaid AA, Khdair SI, Hall FS. Misconceptions related to COVID 19 vaccines among the Jordanian population: Myth and Public Health. Disaster Medicine and Public Health Preparedness. 2023;17:e207.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, vaccine non-uptake, Healthcare workers, determinants","lastPublishedDoi":"10.21203/rs.3.rs-4094428/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4094428/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVaccines play a crucial role in eradicating and containing disease outbreaks. Therefore, understanding the reasons behind vaccine refusal and associated factors is essential for improving vaccine acceptance rates. Our objective was to examine the determinants of COVID-19 vaccine non-uptake and explore the reasons for non-uptake among healthcare workers in Uganda.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween July and August 2021, we conducted a cross-sectional study among healthcare workers in primary healthcare facilities in Entebbe Municipality, Uganda. Participants were recruited using convenience sampling, and consenting individuals received credentials to access an electronic database and complete a structured questionnaire. Survey questions were based on the '3Cs' model of vaccine hesitancy, focusing on confidence, convenience, and complacency factors. We employed counts, percentages, and simple logit models to summarize the reasons for non-uptakeof COVID-19 vaccines and to identify associated factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study recruited 360 healthcare workers, 61.7% of whom were female, with an average age of 31 years (SD=7.9). Among them, 124 (34.4%) healthcare workers did not receive any COVID-19 vaccine. Non-uptake of COVID-19 vaccines was independently associated with several factors, including age [35+ years adjusted odds ratio (aOR)=0.30, 95% CI: 0.13-0.66 compared with 18-24 years], facility ownership [government, aOR=0.22 (0.10-0.49) compared with private not-for-profit], previous testing for coronavirus [yes, aOR=0.35 (0.19-0.65)], and previous involvement in COVID-19 vaccine activities [yes, aOR=0.17 (0.10-0.29)].\u003c/p\u003e\n\u003cp\u003eThe primary reasons cited for non-uptake of COVID-19 vaccines were related to a lack of confidence in the vaccines, such as concerns about side effects (79.8%) and the need for more time to understand the vaccines (89.5%), as well as the importance of weighing benefits and risks (84.7%) before being vaccinated. A smaller proportion, approximately 23%, cited reasons related to complacency and lack of convenience in accessing vaccination services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe high proportion of non-uptake of COVID-19 vaccines among this population primarily stems from a lack of confidence and trust in the vaccines, coupled with insufficient time allowed for users to make informed decisions. This underscores the urgent need for ongoing monitoring and trend analysis of vaccine non-uptake to guide the development and implementation of strategies aimed at building and sustaining vaccine confidence.\u003c/p\u003e","manuscriptTitle":"Non-uptake of COVID-19 vaccines and reasons for non-uptake among healthcare workers in Uganda: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-21 17:04:22","doi":"10.21203/rs.3.rs-4094428/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"322e2ac6-4152-44ab-953f-4c3713637db8","owner":[],"postedDate":"March 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-26T06:18:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-21 17:04:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4094428","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4094428","identity":"rs-4094428","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}