Covid‐19 Vaccine Acceptance in Pregnant Women Attending the Outpatient Clinic at Police Hospital, Khartoum, Sudan 2023

Covid‐19 Vaccine Acceptance in Pregnant Women Attending the Outpatient Clinic at Police Hospital, Khartoum, Sudan 2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Covid‐19 Vaccine Acceptance in Pregnant Women Attending the Outpatient Clinic at Police Hospital, Khartoum, Sudan 2023 Mustafa Sabir Abakar Awad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4605363/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Shortly after the COVID-19 Pandemic multiple researches were focused on manufacturing and synthesizing a vaccine to overcome the disease. Pregnant women being at increased risk of critical illness and having high rates of ICU admission especially due to respiratory prone illnesses, and Sudan being a third world country have high illiteracy rates among females, hence it was essential to determine vaccine acceptance and hesitancy attitudes toward COVID-19 vaccines in pregnant women. Methodology: A prospective cross sectional hospital based study, it was conducted at Police Hospital which is a tertiary specialized university hospital that falls under the administration of National Ribat University Faculty of Medicine. The sample size consisted of 240 pregnant women who attended the outpatient clinic during the study period. The collected data was analyzed using Statistical package for social sciences (SPSS) V26. Results: Out of all the 240 participants, 89 individuals (37%) expressed their willingness to receive the vaccination if it were advised for pregnant women. The primary reasons for denial were insufficient data about the safety of COVID-19 vaccines in pregnant individuals and concerns about potential harm to the developing fetus. There was a modest positive association observed between the acceptance of the COVID-19 vaccine and the number of children of school age. Pregnant women in the first trimester shown greater willingness to receive the COVID-19 vaccine compared to those in the second and third trimesters. Conclusion: The current study demonstrated a poor level of acceptance of COVID-19 vaccination among a group of pregnant women. The primary cause of reluctance was apprehension regarding the safety of the vaccine. An important step in developing effective immunization tactics during the ongoing epidemic is to identify the attitudes prevalent among priority groups. Introduction Even though more than one year have passed since the start of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there is no specific treatment for the disease. More than 2 million deaths have been registered worldwide by February 2021, according to the WHO. Therefore, it is important to avoid infection. In the absence of an effective treatment for novel coronavirus disease 2019 (COVID-19), non-pharmaceutical interventions are the only disease control available. Social distancing, face masks, and personal hygiene are the most effective preventive measures, but maintaining these measures in the long term is impractical. As a result, as with other viral outbreaks in the past, herd immunity through vaccination is becoming the most effective method of eradication.( 1 , 2 ). Research was done to develop a vaccine against SARS-CoV-2 shortly after the disease was discovered ( 3 ). The success of any vaccine depends not only on its efficacy but also on its acceptance. But as WHO highlighted in 2019, vaccine hesitance poses a major threat to global health ( 4 ), Fear and mistrust of vaccines, underestimation of their value, and lack of access to vaccines are some of the main factors behind this hesitancy to get vaccinated ( 5 ). Pregnant women are at increased risk of critical illness, ICU admission, and invasive ventilation compared with non-pregnant patients of the same age ( 6 ), ( 7 ), ( 8 ). Therefore, pregnant women are classified as a high-risk population for COVID‐19 infection ( 9 ). Even though pregnant women have not been included in any COVID-19 vaccine clinical trials to date ( 10 ), public health authorities, including the American College of Obstetricians and Gynecologists and the Society for Maternal‐Fetal Medicine recommend that The American College of Obstetricians and Gynecologists (ACOG) recommends that all eligible persons aged 6 months and older, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series. Messenger RNA (mRNA) and Novavax COVID-19 vaccines are preferred over the Johnson & Johnson/Janssen (J&J/Janssen) COVID-19 vaccine for most individuals, including pregnant and lactating individuals, for primary series ( 11 ). Limited information is available regarding COVID-19 during pregnancy. Insufficient understanding of the risks, benefits, and efficacy of vaccines; long-term consequences; and insufficient, faith in the current healthcare system affects the perception and acceptance of vaccine. However, a thorough understanding of the variables influencing behavioral changes is necessary for effective pandemic management. As the COVID-19 pandemic spreads around the globe, it's crucial to comprehend the pregnant women's attitudes toward COVID-19. In order to administer the COVID-19 vaccine when it is available and to develop a plan to overcome vaccine hesitancy, it is necessary to determine the prevalence of COVID-19 vaccine acceptance and reasons for rejection among pregnant women. The study aims to determine vaccine acceptance and hesitancy attitudes toward COVID-19 vaccines in pregnant women. Research Methods Study Design/Setting This is a prospective cross sectional hospital based study. It was conducted at Police Hospital which is a tertiary specialized university hospital that falls under the administration of National Ribat University Faculty of Medicine. It is located at Burrī al Maḩas, Khartoum state, Sudan. The Police Hospital represents one of the major health care service provider at the area, and it serve a large population most of whom are police affiliated. The study population were the pregnant women attending the outpatient clinic at the police hospital. Inclusion Criteria: All pregnant ladies presenting during the study period who agreed to participate in the study. Exclusion Criteria: Non-pregnant ladies. Pregnant ladies who already received the vaccine. Those who refuse to participate. Sample Size: Using the Solvin’s equation for estimated population n = N/1 + (N*e²) n = 240 Sampling Technique: Convenient sampling, whereby all pregnant ladies will be included until the sample size is reached. Data Collection Methods and Tools: Data was collected using interviewer administered questionnaire. The collected data was handled and cleaned from entering errors and duplication using Microsoft Excel 2016 then the cleansed data was analyzed using the statistical package for social sciences (SPSS) V.26 and displayed in the form of frequency tables. Ethical Consideration: Ethical Approval from the faculty of medicine National Ribat University ethical committee was obtained in accordance with the declaration of Helsinki. Results Demographic data: The sociodemographic characteristics of the subjects are presented in Table 1 . Out of the 240 pregnant women who filled out the questionnaire, 89 (37%) expressed their intention to receive the vaccine if it was advised. Table 1 Sociodemographic data Characteristic Value Age 27.99 ± 5.6 Gravidity 2.32 ± 1.37 Parity 1.01 ± 1.08 Gestational week 28.74 ± 8.88 Number of people in the household 3.13 ± 1.21 Number of school age children 0.46 ± 0.90 Co- morbidity 0.07 ± 0.28 Number of people in the household > 65 year 0.03 ± 0.17 Income (month) (Turkish Lira) 4176.74 ± 2431.99 High- risk pregnancy 92 (30.7) Education Status None 4 (1.3) Primary school 76 (25.4) Secondary school 148 (49.3) University 72 ( 24 ) Career Housewife 231 (77) Government official 46 (15.3) Private sector 12 ( 4 ) Worker 11 (3.7) Husbands Career Worker 120 (40) Government official 76 (25.3) Merchant 63 ( 21 ) Private sector 41 (13.7) The acceptance rates of the COVID-19 vaccine and the replies of patients with high-risk and low-risk pregnancies are provided in Table 2 for comparison. No statistically significant distinction was observed between the high-risk and low-risk groups. Table 3 provides a concise overview of the justifications for declining the COVID-19 vaccination. The primary concerns expressed by pregnant women who indicated their intention to decline the vaccine were; the absence of sufficient data about the safety of the COVID-19 vaccine specifically for pregnant individuals, and the potential risk of adverse effects on the developing fetus. When we compared pregnant women in their first trimester with those in their second and third trimesters, we found that women in their first trimester showed a higher level of interest in obtaining the COVID-19 immunization compared to the others (P < 0.05). Table 2 Covid-19 vaccine acceptance rate Questions Answer Want to be vaccinated ( n = 89; 37%) Do not want to be vaccinated ( n = 151; 63%) P value Have you ever been vaccinated? Yes 78 (87.6) 111 (73.5) 0.653 No 11 (12.4) 40 (26.5) Have you been vaccinated in the last 5 years? Yes No 76 (85.4) 13 (14.6) 108 (71.5) 43 (28.5) 0.354 If the influenza vaccine was recommended, would you have vaccinated in the present pregnancy? Yes No 52 (58.4) 37 (41.6) 42 (27.8) 109 (72.2) 0.000 Have you been vaccinated for influenza in the present pregnancy? Yes No 5 (5.6) 84 (94.4) 3 ( 2 ) 148 (98) 0.363 Was the tetanus vaccine recommended in the present pregnancy? Yes No 68 (76.4) 21 (23.6) 116 (76.8) 35 (23.2) 0.821 Have you been vaccinated for tetanus in the present pregnancy? Yes No 63 (70.8) 26 (29.2) 102 (67.5) 49 (32.5) 0.533 Are you going to have your baby vaccinated after birth? Yes No 88 (98.9) 1 (1.1) 149 (98.7) 2 (1.3) 1 Do you have a high risk of COVID- 19 transmission at work? Yes No 7 (7.9) 82 (92.1) 12 (7.9) 139 (92.1) 0.958 Did you have close contact with a COVID- 19- positive person? Yes No 14 (15.7) 75 (84.3) 26 (17.2) 125 (82.8) 0.630 Did you care about hand hygiene during the pandemic? Yes No 89 (100) 151 (100) Did you care about social distancing during the pandemic? Yes No 89 (100) 151 (100) Did you care about using a mask during the pandemic? Yes No 89 (100) 151 (100) Did you have COVID- 19 in this pregnancy? Yes No 11 (12.4) 78 (87.6) 19 (12.6) 131 (87.4) 0.552 Have you heard about the COVID- 19 vaccine before? Yes No 88 (98.9) 1 (1.1) 149 (98.7) 2 (1.3) 0.901 Do you think that you have enough information about the COVID- 19 vaccine? Yes No 49 (55.1) 40 (45.9) 64 (42.4) 87 (57.6) 0.007 If the COVID- 19 vaccine were recommended for pregnant women, would you have vaccinated? Yes No 89 (100) 151 (100) Table 3 Reasons for refusing Covid-19 vaccine Questions Answer Refuse to get vaccinated ( n = 151) P value Afraid of injection Yes No 7 (4.6) 144 (95.4) 0.304 Vaccine will harm my body Yes No 27 (17.9) 124 (82.1) 0.027 Vaccine will cause COVID- 19 infection Yes No 14 (9.3) 137 (90.7) 0.495 Vaccine will harm my baby Yes No 63 (41.7) 88 (58.3) 0.076 COVID- 19 is not a serious disease Yes No 4 (2.6) 147 (97.4) 0.115 I have low risk for COVID- 19 infection Yes No 7 (4.6) 144 (95.4) 0.238 I believe that even if I am sick my baby and I will not encounter any negative events Yes No 1 (0.7) 150 (99.3) 0.500 I do not think the vaccine will work Yes No 41 (27.2) 110 (72.8) 0.000 Family members have hesitancy toward the COVID- 19 vaccine Yes No 27 (17.9) 124 (82.1) 0.000 Lack of data about COVID- 19 vaccine safety in pregnant women Yes No 99 (65.6) 52 (34.4) 0.628 The bold characters were used to signify the significant "P" values P < 0.05. Discussion The current study demonstrated a poor level of acceptance of COVID-19 vaccination among a group of pregnant women. The vaccination acceptance group believed that they received sufficient information regarding the COVID-19 vaccine in comparison to the vaccine refusal group (P < 0.05). Media outlets served as their primary means of obtaining information. Accessible and widely available sources of information are crucial in disseminating comprehensive knowledge on the significance of vaccination to all segments of the population. The individuals exhibited comparable levels of acceptability towards both influenza and COVID-19 vaccinations. Upon comparing the COVID-19 vaccine acceptance and refusal groups, it was shown that the refusal group had a lower level of acceptance towards the influenza vaccine. This outcome aligns with the phenomenon of vaccination hesitancy, which has been an escalating issue in the field of public health for the past 10 years ( 12 ). According to Özceylan et al., there was a 2% decline in the immunization rate in Turkey between 2016 and 2018 when compared to other developed countries. ( 13 ) The key factors contributing to vaccine reluctance were the underestimation of the vaccine's effectiveness and a lack of trust. The study revealed that vaccine refusal was mostly driven by a significant level of mistrust towards the vaccine, ranking it as the third most prevalent factor. ( 14 , 15 ) Administration of tetanus toxoid during pregnancy is a mandatory component of the health policy in Turkey and is being rigorously adhered to by obstetricians and family practitioners. Within the cohort of individuals involved in this investigation, the level of acceptability for the tetanus vaccine was much greater compared to both the COVID-19 and influenza vaccines. The acceptance percentages for tetanus immunization were comparable between the COVID-19 vaccine acceptance and refusal groups. Thus, pregnant women comprehend the beneficial impacts of tetanus vaccination on the health of both the mother and the newborn by preventing the occurrence of infectious diseases and death. This case highlights the significance of actively pursuing vaccination as a strategic health policy, particularly in the context of a pandemic. ( 16 , 17 ) Multiple studies on the effectiveness and safety of vaccines were conducted during the H1N1 pandemic specifically targeting pregnant women. The findings indicated a reduction in influenza-related illness among pregnant patients and verified infection in their newborns. ( 18 ) Experts in women's health have advised that pregnant women should consult their healthcare professionals to discuss immunization choices ( 19 , 20 ). It is crucial to emphasize that, thus far, no study has presented evidence of the COVID-19 vaccine being safe for fetuses and newborns when assessing the risks and benefits of vaccination ( 21 ). The primary apprehension among those who refuse to take the COVID-19 vaccination is the absence of sufficient safety data pertaining to its use in pregnant individuals. Although the CDC has identified pregnant women as a high-risk group, no COVID-19 vaccine trials have specifically targeted this population. The Advisory Committee on Immunization Practices issued a recommendation endorsing the administration of the COVID-19 vaccination to pregnant women, even though they were not included in the clinical trials. ( 21 , 22 ). High-risk pregnant women had a higher prevalence of anxiety in comparison to low-risk pregnant women ( 23 ). Our hypothesis was that the amount of anxiety would influence the acceptability of the COVID-19 vaccine in pregnant women at high risk. However, our findings indicate that there is no discernible difference in COVID-19 vaccine acceptance between high-risk and low-risk groups. Significantly higher acceptance rates for influenza and tetanus vaccines were observed in the high-risk group as compared to the low-risk group. The absence of safety data about the COVID-19 vaccine's effects during pregnancy may have played a role in this discovery. The study identified three primary reasons for refusal among respondents experiencing a low-risk pregnancy who declined vaccination: concerns about potential harm to their health, doubts about the vaccine's effectiveness, and hesitancy influenced by family members (P < 0.05). These findings suggest that the low-risk pregnant group exhibits a higher level of skepticism towards the COVID-19 vaccine, highlighting the need for targeted dissemination of accurate information to this demographic. An affirmative link was observed between the acceptance of the COVID-19 vaccine and the quantity of school-age children residing in the family (P < 0.05). Households with school-age children reported increased anxiety around the potential for these children to transmit the virus to other household members. A recent meta-analysis has been released regarding the involvement of children in the transmission of SARS-CoV-2 within households. The analysis concluded that the risk of children acquiring the virus and transmitting it inside the household is rather low. ( 24 ) There is still a lack of clarity and incorrect information regarding the transmission of Covid-19, and it is important to address this issue within communities. It is vital for the majority of people to receive the vaccine in order to achieve herd immunity. Individuals in the early stage of pregnancy (first trimester) showed more interest in getting the COVID-19 vaccine compared to individuals in the later stages of pregnancy (second and third trimesters) (P < 0.05). The primary advantages of the current study were its originality, forward-looking design, and multitude of study variables. Ultimately, the advantages of the COVID-19 vaccination show great potential, and health authorities strongly advise its administration during pregnancy. This study represents the initial assessment of pregnant women's perspectives on the COVID-19 vaccine. Vaccine safety concerns pose a significant barrier to vaccination, particularly for recently produced vaccinations. Conclusion A group of pregnant women were interviewed for this study, and the results showed that they had a low level of acceptance of the COVID-19 vaccination. The most significant reason for the reluctance was the fear that the vaccine would not be safe to use. During the ongoing epidemic, one of the most important steps in developing effective immunization strategies is to identify the attitudes that are prevalent among priority groups. Recommendations: Raising awareness about the importance of vaccination especially in high risk groups. Educating pregnant women about the efficacy of the vaccines. Further studies with larger sample sizes. Including pregnant women in clinical trials to test for efficacy and safety of the vaccines Declarations Ethics approval and consent to participate: Ethical Approval from the faculty of medicine National Ribat University ethical committee was obtained in accordance with the declaration of Helsinki. Consent for publication: Not Applicable. Availability of data and materials : All data generated or analyzed during this study are included in this published article. Competing interests: The authors declare that they have no competing interests. Funding: Not applicable. Authors contributions: Mustafa Sabir Abakar Awad is the sole author of the study. Acknowledgements: Not applicable. References Hinman AR. The eradication of Polio: Have we succeeded? Vaccine. 2017 Oct 9;35(42):5519–21. Durrheim DN, Crowcroft NS, Strebel PM. Measles – The epidemiology of elimination. Vaccine. 2014 Dec 5;32(51):6880–3. Sharma O, Sultan AA, Ding H, Triggle CR. A Review of the Progress and Challenges of Developing a Vaccine for COVID-19. Front Immunol [Internet]. 2020 Oct 14 [cited 2023 Jan 18];11:585354. Available from: /pmc/articles/PMC7591699/ Ten threats to global health in 2019 [Internet]. [cited 2023 Jan 18]. Available from: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 Prematunge C, Corace K, McCarthy A, Nair RC, Pugsley R, Garber G. Factors influencing pandemic influenza vaccination of healthcare workers—A systematic review. Vaccine. 2012 Jul 6;30(32):4733–43. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ [Internet]. 2020 Sep 1 [cited 2023 Jan 18];370. 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Mistrust in biomedical research and vaccine hesitancy: the forefront challenge in the battle against COVID- 19 in Italy. Eur J Epidemiol . 2020;35(8):785- 788. Fiore AE, Uyeki TM, Broder K, et al. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) . 2010;59(RR- 8):1– 62. Orgul G, Keles AI, Yucel A, Sahin D. The rate of influenza vaccination after face- to- face interview in pregnancy. Z Geburtshilfe Neonatol . 2021. https://doi.org/10.1055/a- 1332- 2623 Blanchard- Rohner G, Meier S, Bel M, et al. Influenza vaccination given at least 2 weeks before delivery to pregnant women facilitates transmission of seroprotective influenza- specific antibodies to the newborn. Pediatr Infect Dis J . 2013;32(12):1374- 1380. American College of Obstetricians and Gynecologists Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group in collaboration with Riley LE, Beigi R, Jamieson DJ, et al. Vaccinating pregnant and lactating patients against COVID- 19. https://www.acog.org/clini cal/clini cal-g uida nce/pract ice- advis ory/artic les/2020/12/vacci natin g- pregn ant- and- lacta ting- patie nts- again st- covid - 19. Accessed April 25, 2020. Society for Maternal- Fetal Medicine. Society for Maternal- Fetal Medicine (SMFM) statement: SARS- CoV- 2 vaccination in pregnancy. https://s3.amazo naws.com/cdn.smfm.org/media/ 2591/SMFM_Vacci ne_State ment_12- 1- 20_(final ).pdf. Accessed April 25, 2020 Oliver SE, Gargano JW, Marin M, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for use of Pfizer- BioNTech COVID- 19 vaccine— United States, December 2020. Morb Mortal Wkly Rep . 2020;69(50):1922. LaCourse S, John- Stewart G, Adams Waldorf KM. Importance of inclusion of pregnant and breastfeeding women in COVID- 19 therapeutic trials. Clin Infect Dis . 2020;71(15):879- 881. Sinaci S, Tokalioglu EO, Ocal D, et al. Does having a high- risk pregnancy influence anxiety level during the COVID- 19 pandemic? Eur J Obstet Gynecol Reprod Biol . 2020;255:190- 196. Zhu Y, Bloxham CJ, Hulme KD, et al. A meta- analysis on the role of children in SARS- CoV- 2 in household transmission clusters. medRxiv . 2020. https://doi.org/10.1101/2020.03.26.20044826. 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. 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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-4605363","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":320796999,"identity":"f914bc64-ac10-4b37-84b8-459ddd41c134","order_by":0,"name":"Mustafa Sabir Abakar Awad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYFACxgcMDDZAWoKxgflPBZDBzNxAQAuzAQNDGkQLA88ZkAAj0VqAmLcNbC9+LfLth5k//EhgsOef3dz2QXJebTR/O1DLj4ptOLUYnElmk+xJYEiccedg8wzDbcdzZxxmbGDsOXMbtxaG/GMMvD8YEhhuJDYzJG47ltsA1MLM2IZbi3z/Y+aPf4AOkwdpOTjnWO58QloYbiQzSPMkMDBuAGphbGyoyd1ASIvBjcds0jIJEokbgX5hZjh2IHcjUMtBfH6R709m/vgmwcZe7nb7Y2aGmrrceecPH3zwowKPwyBAAsY4DCYPEFKPDOpIUTwKRsEoGAUjBAAAZrpbbWKuGUcAAAAASUVORK5CYII=","orcid":"","institution":"Al-Neelain University","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"Sabir Abakar","lastName":"Awad","suffix":""}],"badges":[],"createdAt":"2024-06-19 10:53:47","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4605363/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4605363/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61796018,"identity":"0f4d983f-2c39-403f-b6b1-7d3ddc9703d5","added_by":"auto","created_at":"2024-08-05 16:32:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":557945,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4605363/v1/ef6cc3a2-ed27-43eb-9d86-d5a6418f5116.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Covid‐19 Vaccine Acceptance in Pregnant Women Attending the Outpatient Clinic at Police Hospital, Khartoum, Sudan 2023","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEven though more than one year have passed since the start of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there is no specific treatment for the disease. More than 2\u0026nbsp;million deaths have been registered worldwide by February 2021, according to the WHO. Therefore, it is important to avoid infection. In the absence of an effective treatment for novel coronavirus disease 2019 (COVID-19), non-pharmaceutical interventions are the only disease control available. Social distancing, face masks, and personal hygiene are the most effective preventive measures, but maintaining these measures in the long term is impractical. As a result, as with other viral outbreaks in the past, herd immunity through vaccination is becoming the most effective method of eradication.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch was done to develop a vaccine against SARS-CoV-2 shortly after the disease was discovered (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The success of any vaccine depends not only on its efficacy but also on its acceptance. But as WHO highlighted in 2019, vaccine hesitance poses a major threat to global health (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), Fear and mistrust of vaccines, underestimation of their value, and lack of access to vaccines are some of the main factors behind this hesitancy to get vaccinated (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePregnant women are at increased risk of critical illness, ICU admission, and invasive ventilation compared with non-pregnant patients of the same age (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Therefore, pregnant women are classified as a high-risk population for COVID‐19 infection (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEven though pregnant women have not been included in any COVID-19 vaccine clinical trials to date (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), public health authorities, including the American College of Obstetricians and Gynecologists and the Society for Maternal‐Fetal Medicine recommend that The American College of Obstetricians and Gynecologists (ACOG) recommends that all eligible persons aged 6 months and older, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series. Messenger RNA (mRNA) and Novavax COVID-19 vaccines are preferred over the Johnson \u0026amp; Johnson/Janssen (J\u0026amp;J/Janssen) COVID-19 vaccine for most individuals, including pregnant and lactating individuals, for primary series (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLimited information is available regarding COVID-19 during pregnancy. Insufficient understanding of the risks, benefits, and efficacy of vaccines; long-term consequences; and insufficient, faith in the current healthcare system affects the perception and acceptance of vaccine. However, a thorough understanding of the variables influencing behavioral changes is necessary for effective pandemic management. As the COVID-19 pandemic spreads around the globe, it's crucial to comprehend the pregnant women's attitudes toward COVID-19. In order to administer the COVID-19 vaccine when it is available and to develop a plan to overcome vaccine hesitancy, it is necessary to determine the prevalence of COVID-19 vaccine acceptance and reasons for rejection among pregnant women. The study aims to determine vaccine acceptance and hesitancy attitudes toward COVID-19 vaccines in pregnant women.\u003c/p\u003e"},{"header":"Research Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design/Setting\u003c/h2\u003e \u003cp\u003eThis is a prospective cross sectional hospital based study. It was conducted at Police Hospital which is a tertiary specialized university hospital that falls under the administration of National Ribat University Faculty of Medicine. It is located at Burrī al Maḩas, Khartoum state, Sudan. The Police Hospital represents one of the major health care service provider at the area, and it serve a large population most of whom are police affiliated. The study population were the pregnant women attending the outpatient clinic at the police hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria:\u003c/h2\u003e \u003cp\u003eAll pregnant ladies presenting during the study period who agreed to participate in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eExclusion Criteria:\u003c/h2\u003e \u003cp\u003eNon-pregnant ladies.\u003c/p\u003e \u003cp\u003ePregnant ladies who already received the vaccine.\u003c/p\u003e \u003cp\u003eThose who refuse to participate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample Size:\u003c/h2\u003e \u003cp\u003eUsing the Solvin\u0026rsquo;s equation for estimated population\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;N/1 + (N*e\u0026sup2;)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003en\u0026thinsp;=\u0026thinsp;240\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eSampling Technique:\u003c/h2\u003e \u003cp\u003eConvenient sampling, whereby all pregnant ladies will be included until the sample size is reached.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Methods and Tools:\u003c/h2\u003e \u003cp\u003eData was collected using interviewer administered questionnaire. The collected data was handled and cleaned from entering errors and duplication using Microsoft Excel 2016 then the cleansed data was analyzed using the statistical package for social sciences (SPSS) V.26 and displayed in the form of frequency tables.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical Approval\u003c/strong\u003e \u003cp\u003e from the faculty of medicine National Ribat University ethical committee was obtained in accordance with the declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDemographic data:\u003c/h2\u003e \u003cp\u003eThe sociodemographic characteristics of the subjects are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Out of the 240 pregnant women who filled out the questionnaire, 89 (37%) expressed their intention to receive the vaccine if it was advised.\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\u003eSociodemographic data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.99\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.74\u0026thinsp;\u0026plusmn;\u0026thinsp;8.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of people in the household\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of school age children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCo- morbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of people in the household\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;65 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome (month) (Turkish Lira)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4176.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2431.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh- risk pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (30.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEducation Status\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (25.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148 (49.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCareer Housewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e231 (77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment official\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (15.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (3.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHusbands Career\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120 (40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment official\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (25.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (13.7)\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\u003eThe acceptance rates of the COVID-19 vaccine and the replies of patients with high-risk and low-risk pregnancies are provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for comparison. No statistically significant distinction was observed between the high-risk and low-risk groups.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides a concise overview of the justifications for declining the COVID-19 vaccination. The primary concerns expressed by pregnant women who indicated their intention to decline the vaccine were; the absence of sufficient data about the safety of the COVID-19 vaccine specifically for pregnant individuals, and the potential risk of adverse effects on the developing fetus.\u003c/p\u003e \u003cp\u003eWhen we compared pregnant women in their first trimester with those in their second and third trimesters, we found that women in their first trimester showed a higher level of interest in obtaining the COVID-19 immunization compared to the others (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\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 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCovid-19 vaccine acceptance rate\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\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnswer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWant to be vaccinated (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;89; 37%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDo not want to be vaccinated (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;151; 63%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHave you ever been vaccinated?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (87.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111 (73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.653\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (26.5)\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\u003eHave you been vaccinated in the last 5 years?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (85.4)\u003c/p\u003e \u003cp\u003e13 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (71.5)\u003c/p\u003e \u003cp\u003e43 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf the influenza vaccine was recommended, would you have vaccinated in the present pregnancy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (58.4)\u003c/p\u003e \u003cp\u003e37 (41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (27.8)\u003c/p\u003e \u003cp\u003e109 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you been vaccinated for influenza in the present pregnancy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5.6)\u003c/p\u003e \u003cp\u003e84 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e148 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas the tetanus vaccine recommended in the present pregnancy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (76.4)\u003c/p\u003e \u003cp\u003e21 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116 (76.8)\u003c/p\u003e \u003cp\u003e35 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.821\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you been vaccinated for tetanus in the present pregnancy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (70.8)\u003c/p\u003e \u003cp\u003e26 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102 (67.5)\u003c/p\u003e \u003cp\u003e49 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre you going to have your baby vaccinated after birth?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (98.9)\u003c/p\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149 (98.7)\u003c/p\u003e \u003cp\u003e2 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you have a high risk of COVID- 19 transmission at work?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (7.9)\u003c/p\u003e \u003cp\u003e82 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (7.9)\u003c/p\u003e \u003cp\u003e139 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid you have close contact with a COVID- 19- positive person?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (15.7)\u003c/p\u003e \u003cp\u003e75 (84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (17.2)\u003c/p\u003e \u003cp\u003e125 (82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.630\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid you care about hand hygiene during the pandemic?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (100)\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\u003eDid you care about social distancing during the pandemic?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (100)\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\u003eDid you care about using a mask during the pandemic?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (100)\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\u003eDid you have COVID- 19 in this pregnancy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (12.4)\u003c/p\u003e \u003cp\u003e78 (87.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (12.6)\u003c/p\u003e \u003cp\u003e131 (87.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you heard about the COVID- 19 vaccine before?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (98.9)\u003c/p\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149 (98.7)\u003c/p\u003e \u003cp\u003e2 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you think that you have enough information about the COVID- 19 vaccine?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (55.1)\u003c/p\u003e \u003cp\u003e40 (45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64 (42.4)\u003c/p\u003e \u003cp\u003e87 (57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf the COVID- 19 vaccine were recommended for pregnant women, would you have vaccinated?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReasons for refusing Covid-19 vaccine\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnswer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRefuse to get vaccinated\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfraid of injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (4.6)\u003c/p\u003e \u003cp\u003e144 (95.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccine will harm my body\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (17.9)\u003c/p\u003e \u003cp\u003e124 (82.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccine will cause COVID- 19 infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (9.3)\u003c/p\u003e \u003cp\u003e137 (90.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.495\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccine will harm my baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (41.7)\u003c/p\u003e \u003cp\u003e88 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOVID- 19 is not a serious disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.6)\u003c/p\u003e \u003cp\u003e147 (97.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have low risk for COVID- 19 infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (4.6)\u003c/p\u003e \u003cp\u003e144 (95.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI believe that even if I am sick my baby and I will not encounter any negative events\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.7)\u003c/p\u003e \u003cp\u003e150 (99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI do not think the vaccine will work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (27.2)\u003c/p\u003e \u003cp\u003e110 (72.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily members have hesitancy toward the\u003c/p\u003e \u003cp\u003eCOVID- 19 vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (17.9)\u003c/p\u003e \u003cp\u003e124 (82.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of data about COVID- 19 vaccine safety in pregnant women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (65.6)\u003c/p\u003e \u003cp\u003e52 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.628\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\u003eThe bold characters were used to signify the significant \"P\" values P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study demonstrated a poor level of acceptance of COVID-19 vaccination among a group of pregnant women. The vaccination acceptance group believed that they received sufficient information regarding the COVID-19 vaccine in comparison to the vaccine refusal group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Media outlets served as their primary means of obtaining information. Accessible and widely available sources of information are crucial in disseminating comprehensive knowledge on the significance of vaccination to all segments of the population.\u003c/p\u003e \u003cp\u003eThe individuals exhibited comparable levels of acceptability towards both influenza and COVID-19 vaccinations. Upon comparing the COVID-19 vaccine acceptance and refusal groups, it was shown that the refusal group had a lower level of acceptance towards the influenza vaccine. This outcome aligns with the phenomenon of vaccination hesitancy, which has been an escalating issue in the field of public health for the past 10 years (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). According to \u0026Ouml;zceylan et al., there was a 2% decline in the immunization rate in Turkey between 2016 and 2018 when compared to other developed countries. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) The key factors contributing to vaccine reluctance were the underestimation of the vaccine's effectiveness and a lack of trust. The study revealed that vaccine refusal was mostly driven by a significant level of mistrust towards the vaccine, ranking it as the third most prevalent factor. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAdministration of tetanus toxoid during pregnancy is a mandatory component of the health policy in Turkey and is being rigorously adhered to by obstetricians and family practitioners. Within the cohort of individuals involved in this investigation, the level of acceptability for the tetanus vaccine was much greater compared to both the COVID-19 and influenza vaccines. The acceptance percentages for tetanus immunization were comparable between the COVID-19 vaccine acceptance and refusal groups. Thus, pregnant women comprehend the beneficial impacts of tetanus vaccination on the health of both the mother and the newborn by preventing the occurrence of infectious diseases and death. This case highlights the significance of actively pursuing vaccination as a strategic health policy, particularly in the context of a pandemic. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMultiple studies on the effectiveness and safety of vaccines were conducted during the H1N1 pandemic specifically targeting pregnant women. The findings indicated a reduction in influenza-related illness among pregnant patients and verified infection in their newborns. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Experts in women's health have advised that pregnant women should consult their healthcare professionals to discuss immunization choices (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). It is crucial to emphasize that, thus far, no study has presented evidence of the COVID-19 vaccine being safe for fetuses and newborns when assessing the risks and benefits of vaccination (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe primary apprehension among those who refuse to take the COVID-19 vaccination is the absence of sufficient safety data pertaining to its use in pregnant individuals. Although the CDC has identified pregnant women as a high-risk group, no COVID-19 vaccine trials have specifically targeted this population. The Advisory Committee on Immunization Practices issued a recommendation endorsing the administration of the COVID-19 vaccination to pregnant women, even though they were not included in the clinical trials. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHigh-risk pregnant women had a higher prevalence of anxiety in comparison to low-risk pregnant women (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur hypothesis was that the amount of anxiety would influence the acceptability of the COVID-19 vaccine in pregnant women at high risk. However, our findings indicate that there is no discernible difference in COVID-19 vaccine acceptance between high-risk and low-risk groups. Significantly higher acceptance rates for influenza and tetanus vaccines were observed in the high-risk group as compared to the low-risk group. The absence of safety data about the COVID-19 vaccine's effects during pregnancy may have played a role in this discovery.\u003c/p\u003e \u003cp\u003eThe study identified three primary reasons for refusal among respondents experiencing a low-risk pregnancy who declined vaccination: concerns about potential harm to their health, doubts about the vaccine's effectiveness, and hesitancy influenced by family members (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These findings suggest that the low-risk pregnant group exhibits a higher level of skepticism towards the COVID-19 vaccine, highlighting the need for targeted dissemination of accurate information to this demographic.\u003c/p\u003e \u003cp\u003eAn affirmative link was observed between the acceptance of the COVID-19 vaccine and the quantity of school-age children residing in the family (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Households with school-age children reported increased anxiety around the potential for these children to transmit the virus to other household members. A recent meta-analysis has been released regarding the involvement of children in the transmission of SARS-CoV-2 within households. The analysis concluded that the risk of children acquiring the virus and transmitting it inside the household is rather low. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) There is still a lack of clarity and incorrect information regarding the transmission of Covid-19, and it is important to address this issue within communities. It is vital for the majority of people to receive the vaccine in order to achieve herd immunity.\u003c/p\u003e \u003cp\u003eIndividuals in the early stage of pregnancy (first trimester) showed more interest in getting the COVID-19 vaccine compared to individuals in the later stages of pregnancy (second and third trimesters) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe primary advantages of the current study were its originality, forward-looking design, and multitude of study variables.\u003c/p\u003e \u003cp\u003eUltimately, the advantages of the COVID-19 vaccination show great potential, and health authorities strongly advise its administration during pregnancy. This study represents the initial assessment of pregnant women's perspectives on the COVID-19 vaccine. Vaccine safety concerns pose a significant barrier to vaccination, particularly for recently produced vaccinations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA group of pregnant women were interviewed for this study, and the results showed that they had a low level of acceptance of the COVID-19 vaccination. The most significant reason for the reluctance was the fear that the vaccine would not be safe to use. During the ongoing epidemic, one of the most important steps in developing effective immunization strategies is to identify the attitudes that are prevalent among priority groups.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eRaising awareness about the importance of vaccination especially in high risk groups.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEducating pregnant women about the efficacy of the vaccines.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFurther studies with larger sample sizes.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIncluding pregnant women in clinical trials to test for efficacy and safety of the vaccines\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Ethical Approval from the faculty of medicine National Ribat University ethical committee was obtained in accordance with the declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: All data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions:\u0026nbsp;\u003c/strong\u003eMustafa Sabir Abakar Awad is the sole author of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHinman AR. The eradication of Polio: Have we succeeded? Vaccine. 2017 Oct 9;35(42):5519\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eDurrheim DN, Crowcroft NS, Strebel PM. Measles \u0026ndash; The epidemiology of elimination. Vaccine. 2014 Dec 5;32(51):6880\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eSharma O, Sultan AA, Ding H, Triggle CR. A Review of the Progress and Challenges of Developing a Vaccine for COVID-19. Front Immunol [Internet]. 2020 Oct 14 [cited 2023 Jan 18];11:585354. Available from: /pmc/articles/PMC7591699/\u003c/li\u003e\n\u003cli\u003eTen threats to global health in 2019 [Internet]. [cited 2023 Jan 18]. Available from: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019\u003c/li\u003e\n\u003cli\u003ePrematunge C, Corace K, McCarthy A, Nair RC, Pugsley R, Garber G. Factors influencing pandemic influenza vaccination of healthcare workers\u0026mdash;A systematic review. Vaccine. 2012 Jul 6;30(32):4733\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eAllotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ [Internet]. 2020 Sep 1 [cited 2023 Jan 18];370. Available from: /pmc/articles/PMC7459193/\u003c/li\u003e\n\u003cli\u003eAbdelazim IA, AbuFaza M, Al-Munaifi S. COVID-19 Positive Woman Presented with Preterm Labor: Case Report. Gynecol Obstet Reprod Med [Internet]. 2021 Dec 15 [cited 2023 Jan 18];27(3):294\u0026ndash;6. Available from: https://gorm.com.tr/index.php/GORM/article/view/1170\u003c/li\u003e\n\u003cli\u003eDey M, Singh S, Tiwari R, Nair VG, Arora D, Tiwari S. Pregnancy Outcome in First 50 SARS-Cov-2 Positive Patients at Our Center. Gynecol Obstet Reprod Med [Internet]. 2021 Apr 16 [cited 2023 Jan 18];27(1):11\u0026ndash;6. Available from: https://www.gorm.com.tr/index.php/GORM/article/view/1176\u003c/li\u003e\n\u003cli\u003ePeople with Certain Medical Conditions | CDC [Internet]. [cited 2023 Jan 18]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html\u003c/li\u003e\n\u003cli\u003eSmith DD, Pippen JL, Adesomo AA, Rood KM, Landon MB, Costantine MM. Exclusion of Pregnant Women from Clinical Trials during the Coronavirus Disease 2019 Pandemic: A Review of International Registries. Am J Perinatol [Internet]. 2020 Jun 1 [cited 2023 Jan 18];37(8):792. Available from: /pmc/articles/PMC7356075/\u003c/li\u003e\n\u003cli\u003eCOVID-19 Vaccination Considerations for Obstetric\u0026ndash;Gynecologic Care | ACOG [Internet]. [cited 2023 Jan 18]. Available from: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care?utm_source=redirect\u0026amp;utm_medium=web\u0026amp;utm_campaign=int\u003c/li\u003e\n\u003cli\u003eVolkov S, World Health Organization. Vaccine hesitancy. https:// www.who.int/news- room/spotl ight/ten- threa ts- to- globa l- healt h- in- 2019. Accessed April 25, 2020.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zceylan G, Toprak D, Esen ES. Vaccine rejection and hesitation in Turkey. \u003cem\u003eHum Vaccines Immunother\u003c/em\u003e. 2020;16(5):1034- 1039\u003c/li\u003e\n\u003cli\u003ePrematunge C, Corace K, McCarthy A, Nair RC, Pugsley R, Garber G. Factors influencing pandemic influenza vaccination of healthcare workers\u0026mdash; a systematic review. \u003cem\u003eVaccine\u003c/em\u003e. 2012;30(32):4733- 4743.\u003c/li\u003e\n\u003cli\u003ePalamenghi L, Barello S, Boccia S, Graffigna G. Mistrust in biomedical research and vaccine hesitancy: the forefront challenge in the battle against COVID- 19 in Italy. \u003cem\u003eEur J Epidemiol\u003c/em\u003e. 2020;35(8):785- 788.\u003c/li\u003e\n\u003cli\u003eFiore AE, Uyeki TM, Broder K, et al. \u003cem\u003ePrevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)\u003c/em\u003e. 2010;59(RR- 8):1\u0026ndash; 62.\u003c/li\u003e\n\u003cli\u003eOrgul G, Keles AI, Yucel A, Sahin D. The rate of influenza vaccination after face- to- face interview in pregnancy. \u003cem\u003eZ Geburtshilfe Neonatol\u003c/em\u003e. 2021. https://doi.org/10.1055/a- 1332- 2623\u003c/li\u003e\n\u003cli\u003eBlanchard- Rohner G, Meier S, Bel M, et al. Influenza vaccination given at least 2 weeks before delivery to pregnant women facilitates transmission of seroprotective influenza- specific antibodies to the newborn. \u003cem\u003ePediatr Infect Dis J\u003c/em\u003e. 2013;32(12):1374- 1380.\u003c/li\u003e\n\u003cli\u003eAmerican College of Obstetricians and Gynecologists Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group in collaboration with Riley LE, Beigi R, Jamieson DJ, et al. Vaccinating pregnant and lactating patients against COVID- 19. https://www.acog.org/clini cal/clini cal-g uida nce/pract ice- advis ory/artic les/2020/12/vacci natin g- pregn ant- and- lacta ting- patie nts- again st- covid - 19. Accessed April 25, 2020.\u003c/li\u003e\n\u003cli\u003eSociety for Maternal- Fetal Medicine. Society for Maternal- Fetal Medicine (SMFM) statement: SARS- CoV- 2 vaccination in pregnancy. https://s3.amazo naws.com/cdn.smfm.org/media/ 2591/SMFM_Vacci ne_State ment_12- 1- 20_(final ).pdf. Accessed April 25, 2020\u003c/li\u003e\n\u003cli\u003eOliver SE, Gargano JW, Marin M, et al. The Advisory Committee on Immunization Practices\u0026rsquo; Interim Recommendation for use of Pfizer- BioNTech COVID- 19 vaccine\u0026mdash; United States, December 2020. \u003cem\u003eMorb Mortal Wkly Rep\u003c/em\u003e. 2020;69(50):1922.\u003c/li\u003e\n\u003cli\u003eLaCourse S, John- Stewart G, Adams Waldorf KM. Importance of inclusion of pregnant and breastfeeding women in COVID- 19 therapeutic trials. \u003cem\u003eClin Infect Dis\u003c/em\u003e. 2020;71(15):879- 881.\u003c/li\u003e\n\u003cli\u003eSinaci S, Tokalioglu EO, Ocal D, et al. Does having a high- risk pregnancy influence anxiety level during the COVID- 19 pandemic? \u003cem\u003eEur J Obstet Gynecol Reprod Biol\u003c/em\u003e. 2020;255:190- 196.\u003c/li\u003e\n\u003cli\u003eZhu Y, Bloxham CJ, Hulme KD, et al. A meta- analysis on the role of children in SARS- CoV- 2 in household transmission clusters. \u003cem\u003emedRxiv\u003c/em\u003e. 2020. https://doi.org/10.1101/2020.03.26.20044826.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"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":"","lastPublishedDoi":"10.21203/rs.3.rs-4605363/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4605363/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eShortly after the COVID-19 Pandemic multiple researches were focused on manufacturing and synthesizing a vaccine to overcome the disease. Pregnant women being at increased risk of critical illness and having high rates of ICU admission especially due to respiratory prone illnesses, and Sudan being a third world country have high illiteracy rates among females, hence it was essential to determine vaccine acceptance and hesitancy attitudes toward COVID-19 vaccines in pregnant women.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eA prospective cross sectional hospital based study, it was conducted at Police Hospital which is a tertiary specialized university hospital that falls under the administration of National Ribat University Faculty of Medicine. The sample size consisted of 240 pregnant women who attended the outpatient clinic during the study period. The collected data was analyzed using Statistical package for social sciences (SPSS) V26.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eOut of all the 240 participants, 89 individuals (37%) expressed their willingness to receive the vaccination if it were advised for pregnant women. The primary reasons for denial were insufficient data about the safety of COVID-19 vaccines in pregnant individuals and concerns about potential harm to the developing fetus. There was a modest positive association observed between the acceptance of the COVID-19 vaccine and the number of children of school age. Pregnant women in the first trimester shown greater willingness to receive the COVID-19 vaccine compared to those in the second and third trimesters.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThe current study demonstrated a poor level of acceptance of COVID-19 vaccination among a group of pregnant women. The primary cause of reluctance was apprehension regarding the safety of the vaccine. An important step in developing effective immunization tactics during the ongoing epidemic is to identify the attitudes prevalent among priority groups.\u003c/p\u003e","manuscriptTitle":"Covid‐19 Vaccine Acceptance in Pregnant Women Attending the Outpatient Clinic at Police Hospital, Khartoum, Sudan 2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-15 04:51:24","doi":"10.21203/rs.3.rs-4605363/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":"ce91391c-06fa-4c4d-8459-6fdf18476c7a","owner":[],"postedDate":"July 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-05T16:24:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-15 04:51:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4605363","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4605363","identity":"rs-4605363","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}