Knowledge, Attitude, and Perception of COVID-19 Vaccine Uptake and Hesitancy among Healthcare Professionals in Sub-Saharan Africa: A Scoping Review

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K, A. A Solabi, Sadat M. U, A. A Adewole, Oluwasanu M. M, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9170267/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: The COVID-19 pandemic is one of the most profound global health emergencies of the 21st century that affected all and sundry, thereby causing a global disruption that exposed deep socioeconomic challenges, while increasing the burden of infections that overwhelmed healthcare systems. Due to the novel nature of the disease, vaccination emerged as a critical tool in mitigating the spread of the pandemic and paving the way towards recovery. This requires the cooperation and participation of healthcare professionals (HCPs) who are the first-line responders. Yet, vaccine hesitancy has been previously reported to be predominant among this target population, which is a significant barrier to achieving high vaccination coverage in Sub-Saharan Africa. This scoping review was designed to explore the knowledge, attitudes, and perceptions of COVID-19 vaccine uptake and hesitancy among HCPs in Sub-Saharan Africa. Methods : The review adopted the PRISMA-ScR framework for searching, reporting, and analysing relevant peer-reviewed articles extracted from five databases, including PubMed, Google Scholar, Africa Journals Online, CINAHL, and Scopus. The review analysed 22 studies from various countries in the Sub-Saharan region, and those studies included different methodologies, including cross-sectional surveys, qualitative studies, and mixed-methods approaches. Results: The findings revealed that the HCPs generally exhibited good knowledge and positive attitude towards COVID-19 vaccines, and the good knowledge actually translates to high but significantly varied vaccine uptake rates ranging between 90-53% across different countries, within the Sub-Saharan African region. The uptake variations were significantly influenced by factors such as misinformation, socio-cultural beliefs, urban-rural disparities, and logistical challenges. At the same time, the reported hesitancy rate also reflected concerns about vaccine safety and efficacy, as well as mistrust in government and pharmaceutical companies. Conclusion: This review revealed that HCPs in the Sub-Saharan African region had good knowledge and positive attitudes towards the COVID-19 vaccine, which reflected in the high rate of its uptake. Although there was a report of vaccine hesitance among the same target population, it was low compared to the rate of uptake. Adopting collaborative vaccine communication strategies, strengthening supply chains, and providing region-specific training for HCPs that has the potential of promoting vaccine acceptance and uptake is recommended for achieving high COVID-19 coverage. COVID-19 Vaccine Hesitancy Healthcare Professionals Sub-Saharan Africa Vaccine Uptake and Misinformation Background The COVID-19 pandemic has generated far-reaching impacts on health, the economy, and society at large, since its emergence in 2019 (1). The socio-economic and public health impacts are stronger in Sub-Saharan Africa (SSA) because of the usually weak, sub-capitalized systems (2). The coordinated global response for mitigating the impact of this disease has involved public health measures that included lockdowns, and directives for mask usage, and the rapid development of vaccines (3, 4). Among the tools highly rated for preventing and limiting the severe illness and death associated with COVID-19, vaccination features prominently (5). However, hesitancy has emerged as one critical barrier to reaching high vaccination coverage and herd immunity, defined by the World Health Organisation (WHO) as the reluctance or resistance towards vaccination, despite availability and accessibility to vaccine services. The attitude and perception of health professionals in SSA is very important, considering the dual role they have played: both in being among the first to be vaccinated and in influencing public vaccine uptake as change agents (6). It is, therefore, important to understand in this setting the behavioural indicators (Knowledge, Attitudes, and Perceptions) of health professionals on implementing interventions that can improve vaccine acceptability and reduce hesitancy to a bare minimum. Health professionals would, therefore, be expected to have a reasonably good understanding of vaccines regarding administration and the enlightenment of their patients. This is because of how their level of knowledge shapes behavioural communication change among the healthcare service users through participatory health education and informed awareness creation for vaccine uptake within their communities. Studies done throughout SSA have variably shown that the knowledge concerning COVID-19 vaccines was variably high among the HCPs. For instance, in Nigeria, it was established that while 72.3% of the HCPs had an awareness of the safety profiles for the COVID-19 vaccines available, only 55% showed detailed knowledge of the mode of action (7). The issue of skepticism related to COVID-19 vaccine among community members and HCPs alike in SSA countries did not start with COVID-19, this has been happening before COVID-19, as it is often driven by a prevailing negative personal experience from previous service use (possibly linked to COVID-19 misinformation and misconceptions) thereby leading to a distrust in government (8, 9, 10), and escalated by the high level of misinformation and misconception that characterized COVID-19 pandemic information sharing. This reason necessitates the need for HCPs to have a positive attitude towards the COVID-19 vaccine, so that they can be the voice of change that will create awareness regarding the vaccine potency, thereby driving uptake and high coverage among their professional colleagues and community members. An overwhelming majority of the HCPs recognise vaccination for its place in controlling the pandemic, although significant skepticism has remained among a higher proportion of them, which they attribute to concerns over safety and efficacy. A multi-country survey conducted amongst health professionals in three countries (South Africa, Uganda, and Ghana) revealed that 35% of respondents were uncertain about taking the vaccine due to fears of long-term side effects (11). This hesitancy was more pronounced among younger HCPs, many citing concerns over inadequate clinical trials in African populations. Further, the previous incidents of unequal distribution of medical supplies, coupled with the historical case of medical exploitation in Africa, have generally grown the distrust in the global vaccination effort to which the entire world has been subjected (12). Perception about COVID-19 vaccination among HCPs has been influenced by individual, institutional, and societal factors. Vaccination is most influenced by the perceptions of vaccine safety, efficacy, and need. Delays in vaccine rollout, further coupled with reliance on donations from high-income countries, have contributed to negative perceptions around vaccine quality and equity in SSA. A study from Ethiopia has revealed that 40% of the health professionals believe COVID-19 vaccines circulating in the region were less effective compared to those given in developed countries (13). Other deeply entrenched myths, such as infertility and DNA modification from vaccination, have also contributed to negative perceptions. On the other hand, several studies reported positive perceptions among HCPs who received awareness and training on vaccination. For example, targeted awareness campaigns in Rwanda yielded an unprecedented increase in vaccination uptake; 85% of the HCPs were convinced about the safety and efficacy of COVID-19 vaccines (14). Healthcare professionals’ hesitancy towards vaccine is influenced by a complex, multidimensional, and several individualistic, cultural, and systemic factors. Many cite adverse reactions, religious views, and mistrust of pharmaceutical corporations as motivating factors (15). Beliefs in the culture one finds in rural areas, to a great extent, intersect with misinformation on COVID-19 vaccines, hence raising skepticism about the vaccine. Systemic barriers, such as poor vaccine logistics, lack of training, and lack of government transparency, are other contributing factors identified in empirical studies for the current level of vaccine hesitancy rate in these countries. In Zambia, for example, confusing messages about vaccine availability and eligibility criteria caused confusion among health workers and undermined confidence in the vaccines (16). The attitudes and perceptions of health professionals towards COVID-19 vaccines have important implications for public health in SSA. Health care professionals are often regarded as trusted sources for medical information, thus making their views about vaccine strong enough to shape community acceptance of vaccination. Therefore, any report of vaccine hesitancy among them (the ones that community members look up to on health decisions) has the potential to undermine public confidence and contribute to low vaccine coverage rates. According to the African Union statistics, by the end of the year 2023, only 21% of the SSA population were fully vaccinated, which is below the global average of 70%. This highlights a need to address HCP vaccine hesitancy, which could encourage better response among the general public. COVID-19 vaccine awareness among health professionals is linked to their individual beliefs and personal circumstances, systemic factors, and societal dynamics. Several interventions have been made to create vaccine awareness and increase vaccine availability, but there are considerable disparities, and much still needs to be done through targeted interventions. It is therefore necessary to assess the challenges and barriers to vaccine uptake among HCPs and the general population, in order to improve COVID-19 pandemic control and other future pandemics within the region. Guiding Questions for the Scoping Review This scoping review is guided by the following research questions: 1. What is the level of knowledge, attitude, and perception regarding COVID-19 vaccine uptake among healthcare professionals in SSA? 2. What are the factors influencing vaccine hesitancy among healthcare professionals in the region? Aim of the Scoping Review This scoping review hopes to present findings from the literature on the knowledge, attitude, and perception of health professionals in SSA about COVID-19 vaccines, ascertain factors that predispose to vaccine hesitancy, highlight prevailing trends, and unearth critical gaps in the available evidence. This could inform targeted interventions to improve vaccine uptake among healthcare professionals in the region. Methods Search Strategy This scoping review process was guided by the reporting recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) (17, 18). Relevant literature was retrieved from several electronic databases, for example PubMed, Google Scholar, AJOL, CINAHL, and Scopus. The reviewer adopted Boolean operators, along with database-specific controlled vocabulary (AND, OR, and NOT), to create a comprehensive and inclusive search (by narrowing, broadening, and excluding search terms as appropriate) for identifying studies of various designs and relevant findings. Design and Steps Followed in the Review Process The review team conducted a comprehensive search in the five selected databases (PubMed, Google Scholar, AJOL, CINAHL, and Scopus), using three search strategies listed below: 1. Selected Databases search: Traditional databases such as PubMed, CINAHL, Scopus, and AJOL were accessed with the search term for a systematic search of relevant records (published articles). 2. General Internet Browsers: Google Scholar was also searched for relevant articles that were not indexed in the traditional databases. 3. Reference List Hand Searches (Chaining): The list of references presented in the identified records (articles) was also checked for any relevant articles that were not indexed in the traditional databases and those not found in the general internet browsers like Google Scholar. The review team adopted Hategeka et al.'s ( 2020 ) (19) strategy of limiting screening of identified records to the first 100 most relevant search outcomes from each database, which is to help in managing the feasibility and time constraints of screening search results. Two reviewers manually examined the list of identified studies from the reference lists to prevent the omission of pertinent literature. Furthermore, relevant scoping reviews and other related articles were identified for additional studies. Keywords central to this scoping review included: Knowledge, attitude, and perception of COVID19 vaccines Vaccine uptake and hesitancy among healthcare professionals Healthcare professionals in SSA COVID19 vaccine hesitancy predictors Barriers and facilitators of vaccine uptake MeSH terms in PubMed and subject headings in CINAHL and Scopus, were also included, with inclusion and exclusion criteria for selected articles (Table 1 ) Steps in Review Process The review process followed a structured and orderly sequence involving research question formulation, study identification, screening for relevant studies using the inclusion and exclusion criteria, data extraction, and synthesis. 1. Research Question Development: The corresponding author developed the initial research question: (What are the knowledge, attitudes, and perceptions of COVID-19 vaccine uptake and hesitancy among healthcare professionals in SSA?) 2. Study Identification: Literature was searched using different search engines and databases to identify relevant articles that are relative to the research question. 3. Inclusion and Exclusion Criteria: Inclusion criteria focused on studies published in English, conducted in SSA, and addressing COVID19 vaccine knowledge, attitudes, and perceptions among healthcare professionals. Exclusion criteria included studies outside the region, non-English publications, and studies not focusing on healthcare professionals. 4. Data Charting: Data extraction included key themes on knowledge levels, attitudes toward vaccines, perceptions of vaccine safety and efficacy, and factors influencing hesitancy or uptake. 5. Data Collation and Summary: Data were collated and summarised using narrative synthesis to provide a full synopsis of the findings. Reports of the Search Process Multiple electronic databases, including PubMed, Scopus, CINAHL, African Journals Online, and Google Scholar, were utilized to conduct a structured search that combined controlled vocabulary and free-text terms related to COVID-19 vaccination, vaccine hesitancy, healthcare professionals, and Sub-Saharan Africa. Boolean operators (“AND”, “OR”) were applied to refine the search and ensure comprehensive coverage of relevant studies. Detailed search strings for each database are provided in the appendix section (see appendix 2) Search Syntax The search strings for each of the databases are presented below as a broad search encompassing various aspects of vaccine uptake and hesitancy: (vaccine*[tiab] OR immunization*[tiab] OR vaccination*[tiab]) AND (hesitancy OR acceptance OR refusal OR uptake OR confidence OR attitude OR perception OR barrier*[tiab] OR challenge*[tiab]) AND (healthcare professional*[tiab] OR health worker*[tiab] OR clinician*[tiab] OR doctor*[tiab] OR nurse*[tiab] OR midwife*[tiab] OR physician*[tiab] OR allied health*[tiab]) AND (COVID-19 OR SARS-CoV-2 OR coronavirus) AND (sub-sahara africa*[tiab] OR Nigeria*[tiab] OR Kenya*[tiab] OR Ghana*[tiab] OR South Africa*[tiab] OR Ethiopia*[tiab] OR Uganda*[tiab] OR Tanzania*[tiab] OR Zimbabwe*[tiab] OR Malawi*[tiab] OR Zambia*[tiab]) A search focusing specifically on knowledge, attitudes, and perceptions related to COVID-19 vaccines: (vaccine*[tiab] OR immunization*[tiab]) AND (knowledge OR attitude OR perception OR belief*[tiab] OR understanding*[tiab] OR misinformation OR disinformation) AND (healthcare professional*[tiab] OR health worker*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab] OR Nigeria*[tiab] OR Kenya*[tiab] OR Ghana*[tiab] OR South Africa*[tiab] OR Ethiopia*[tiab] OR Uganda*[tiab] OR Tanzania*[tiab] OR Zimbabwe*[tiab] OR Malawi*[tiab] OR Zambia*[tiab]) A search specifically targeting vaccine hesitancy among HCPs: (vaccine*[tiab] OR immunization*[tiab]) AND (hesitancy OR resistance OR reluctance OR skepticism OR doubt*[tiab]) AND (healthcare professional*[tiab] OR health worker*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab] OR Nigeria*[tiab] OR Kenya*[tiab] OR Ghana*[tiab] OR South Africa*[tiab] OR Ethiopia*[tiab] OR Uganda*[tiab] OR Tanzania*[tiab] OR Zimbabwe*[tiab] OR Malawi*[tiab] OR Zambia*[tiab]) A search incorporating a date restriction to limit results to the pandemic period: (vaccine*[tiab] OR immunization*[tiab]) AND (hesitancy OR acceptance) AND (healthcare professional*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab]) (2020–2024) A search excluding animal studies to refine the results: (vaccine*[tiab] OR immunization*[tiab]) AND (hesitancy OR uptake) AND (healthcare professional*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab]) NOT (animal*[tiab] OR rat*[tiab] OR mouse*[tiab] OR mice*[tiab]) A combined search focusing on specific healthcare roles and excluding in vitro or cell culture studies: (vaccine*[tiab] OR immunization*[tiab] OR vaccination*[tiab]) AND (hesitancy OR acceptance OR refusal OR uptake) AND (nurse*[tiab] OR midwife*[tiab] OR physician*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab] OR Nigeria*[tiab] OR Ghana*[tiab]) NOT (in vitro OR cell culture) These search strategies were adapted and refined as needed based on the initial search results and the specific focus of the review. While each article’s title and abstract (from the outcomes) were screened by the remaining two reviewers (2 of 4), working independently and different from those who ran the search. This was done so as to reduce individual bias and also to allow for a thorough consideration of the content of the studies, thereby ensuring that no potentially eligible studies were overlooked. Full texts of selected articles were then retrieved and assessed for inclusion based on pre-defined criteria. Disagreements or inconsistencies were resolved by consulting with a fourth reviewer. Identification of Relevant Studies The review only considered peer-reviewed articles published between 2019 and 2024 in the English language. The duplicates and titles not in the English language were excluded. The search included studies related to the knowledge, attitude, and perception of COVID-19 vaccines and vaccine hesitancy among health professionals in SSA. Exclusions were made for those articles that were focused on populations other than health professionals or were from any other geographical region and unrelated to vaccine topics of vaccines. To establish eligibility using the inclusion criteria, the PICOS framework (Participants, Intervention, Context, Outcomes, and Study Design) was employed : Participants: Health professionals. Issue: Assessment of knowledge, attitude, and perception regarding COVID-19 vaccination uptake and hesitancy. Context: Sub-Saharan Africa. Outcomes: Evidence-based insights into the factors that determine vaccine uptake and hesitancy. Study Design: A quantitative, qualitative, or mixed-method study. Selection of Relevant and Reliable Studies The selection of studies was done in several stages: 1. Title and Abstract Screening: Initial screening of studies based on titles and abstracts. 2. Full-text inclusion: The inclusion criteria was employed to select studies that were reviewed in full text for final inclusion. This review process was done by three different researchers, and during the stages of selection, no conflict came up that would have required additional reviewers. Data Extraction A structured extraction of data was performed with Microsoft Excel, based on key information listed in the data extraction form below: Date and Time of Extraction Reviewer(s) Study Author and Year Location Main Objective of the Study Study Settings and Design Population Issue(s) Context of the study Outcome Table 1 Sample of Data Extraction Form S/N Criteria For Extraction Extracted Information 1. Date and Time of Extraction 11/11/2024 (8:28 pm) 2. Reviewer(s) Adegbore, Sholabi, and Adewole 3. Study Author and Year Madzorera, I. et al. ( 2022 ) 4. Location Burkina Faso, Ethiopia, Nigeria, Tanzania, and Ghana 5. Main Objective of the Study To understand the extent of COVID-19 vaccine hesitancy among health care providers (HCP) and its contributing factors in sub-Saharan Africa. 6. Study Settings and Design A repeated cross-sectional telephone survey (quantitative) 7. Population 1,499 health care providers (HCP) across five African countries 8. Issue (s) Concerns about vaccine effectiveness, side effects, and fear of unsafe/experimental vaccines drive COVID-19 vaccine hesitancy among HCP. 9. Context Sub-Saharan Africa 10. Outcome Prevalence: 45.7% vaccine hesitancy in Burkina Faso, 25.7% in Tanzania, 9.8% in Ethiopia, 9% in Ghana, and 8.1% in Nigeria. Factors reducing hesitancy: Belief in vaccine effectiveness (RR: 0.21) and older age (45 + years, RR: 0.65). Nurses were more likely to be hesitant (RR: 1.38) compared to doctors. Study design (quantitative, qualitative, or mixed methods). This scoping review considered all types of primary studies that were either quantitative, qualitative, or mixed methods Search Outcomes From the five databases, a total of 7,022 records were produced. This includes PubMed (1,236 articles), AJOL (2,710 articles), CINAHL (1,042 articles), Scopus (94 articles), Google Scholar (1,050 articles), and an additional 1,060 records from other sources (see Table 2 ). After removing duplicates, the remaining records for screening were 1,094. Following the screening of titles and abstracts, only 129 full-text articles were available for full-text review, which excluded 2 studies due to insufficient data or irrelevance. The remaining 127 studies were subjected to eligibility assessment, leaving only 22 studies that were included in the qualitative synthesis after further refinement and data extraction. This process ensured a comprehensive review of the scope of the literature on COVID-19 vaccine hesitancy and uptake among healthcare professionals in SSA (See Appendix 1). Table 2 First Search Outcome (Identification and Screening of Title and Abstract) S/N Database Data Limit Applied Search Strategy Number of Articles Retrieve from Search 1. PubMed 2019–2024 ("COVID-19 Vaccines"[MeSH] OR "SARS-CoV-2 vaccine") AND ("vaccine hesitancy" OR "vaccine uptake") AND ("healthcare professionals" OR "health workers") AND ("Sub-Saharan Africa" OR "Africa South of the Sahara") 1,236 2. AJOL 2019–2024 ("COVID-19 vaccines" OR "SARS-CoV-2 vaccine") AND ("vaccine hesitancy" OR "vaccine uptake") AND ("healthcare professionals" OR "health workers") AND ("Sub-Saharan Africa"). 2710 3. CINAHL 2019–2024 ("COVID-19 Vaccines"[MeSH] OR "SARS-CoV-2 vaccine") AND ("vaccine hesitancy" OR "vaccine uptake") AND ("healthcare professionals" OR "health workers") AND ("Sub-Saharan Africa"). 1042 4. Scopus 2019–2024 ("COVID-19 vaccines" OR "SARS-CoV-2 vaccine") AND ("vaccine hesitancy" OR "vaccine uptake") AND ("healthcare professionals" OR "health workers") AND ("Sub-Saharan Africa"). 94 5. Google Scholar 2019–2024 ("COVID-19 vaccines" OR "SARS-CoV-2 vaccine") AND ("vaccine hesitancy" OR "vaccine uptake") AND ("healthcare professionals" OR "health workers") AND ("Sub-Saharan Africa"). 1,060 Total 7,022 Collating, Summarising, and Reporting the Findings The included twenty-two (22) studies were synthesised using the narrative synthesis analysis method because of the heterogeneity of the studies’ methodologies. The findings were summarized narratively to allow for comparison across the patterns and themes of the included studies, due to the differences in study designs and outcome measures. Results Characteristics of the Reviewed Articles The characteristics of the studies that were included show that 70% were published between 2022 and 2024, while the remaining 30% were published between 2020 and 2022, which were all between the years that research on COVID-19 vaccine were trending. Out of the total 22 included studies, 20 were conducted as mono-country studies, while two were multi-country studies, with Nigeria (18%) and Ethiopia (18%) having the highest frequency of studies with four each, followed by South Africa (14.5%) with three studies. Kenya (9%) and Ghana (9%) have two studies each, while Guinea (4.5%), Malawi (4.5%), Sierra Leone (4.5%), Tanzania (4.5%), and Uganda (4.5%) have 1 study each to complete 22 (100%) studies (See Table 1 ). Thematic Findings on Knowledge, Attitudes, and Perceptions of COVID-19 Vaccine Uptake and Hesitancy Among Healthcare Professionals in Sub-Saharan Africa The narrative synthesis conducted on the twenty-two included studies yielded four emergent overarching themes presented below. Each of the themes addresses the core objectives of the review. The factors influencing the knowledge, attitude, and perceptions of COVID-19 vaccine uptake, the extant vaccine uptake rate, and hesitancy rate were integrated within the umbrella themes without separating them, as the factors were intricately interwoven within the main variables. The four themes were discussed below: Theme 1: Varying High Level of Knowledge of COVID-19 Vaccines Among Healthcare Professionals in Sub-Saharan Africa Nine out of twenty-two studies presented findings on knowledge among healthcare professionals (HCPs) in SSA reveal significant variability. In Nigeria, Imediegwu et al. ( 2023 ) (20) and Ejeh et al. ( 2020 ) (21) reported high knowledge levels (78% and 88.75%, respectively), with social and traditional media as primary information sources. Egbuniwe et al. ( 2021 ) (22) found an even higher rate of 92.4%. The variations were more pronounced in many of the studies, as Berhe et al. ( 2022 ) (23) identified factors such as intra-professional misinformation and limited training as key hindrances among HCPs, such as the Ethiopian health extension workers, while Brackstone et al. ( 2022 ) (24) highlighted insufficient vaccine-related information as a major cause of hesitancy in Ghana. Regional disparities were also reported as one of the factors causing the variation that is evident. Ekpenyong et al. ( 2021 ) (25), Madzorera et al. ( 2022 ) (26), and Mudhune et al. ( 2023 ) (27) were some of the studies that reported on factors that bring about variations, as some found that rural Kenyan HCPs had lower knowledge levels (50%) than their urban counterparts, how HCPs have better knowledge than Non-HCPs, and how confidence in the vaccine also influences interest in knowledge-practice. Theme 2: Positive Attitudes Toward COVID-19 Vaccination Campaigns The review shows that HCPs had positive attitudes toward COVID-19 vaccination campaigns, as nine of the twenty-two studies included studies towards this assertion. The included studies reported that HCPs have a positive attitude and translated to HCPs' willingness to recommend the vaccine to their colleagues and family, while also having confidence in supporting the distribution of the vaccine for disease prevention and control among the larger population Adeniyi et al., 2021 , (28) and Seid & Gebremeskel ( 2024 ) (29). Mohammed et al. ( 2021 ), Amuzie et al. ( 2021 ), Brackstone et al. ( 2022 ) (24), and Toure et al. ( 2022 ) (30) also reported similar findings of positive attitude; they collectively reported potential factors that may undermine confidence, which include mistrust in governments and vaccine providers and misinformation. Additionally, Ejeh et al. ( 2020 ) (21), Balegha et al. ( 2024 ) (31), and Slivesteri et al. ( 2024 ) (32) collectively noted that the positive attitudes reported may be hindered by the potential frustration of logistical and resource constraints that weaken campaign effectiveness when the HCPs are involved, while cultural and religious beliefs are also other fundamental factors that may impact HCPs ' attitudes on COVID-19 in the SSA region. Theme 3: Predominantly High Vaccine Uptake Among Healthcare Professionals The analysis of the included studies revealed that there is a generally high vaccine uptake among HCPs in the SSA region, although it varies due to regional differences, access, and sociocultural factors. In this review, ten studies out of the twenty-two presented findings that supported this assertion. Starting with Adeniyi et al.'s ( 2021 ) (28) study in South Africa, which reported the highest COVID-19 acceptance at 90.1%, followed by Ejeh et al. ( 2020 ) (21) in Nigeria (72%), and Mudhune et al. ( 2023 ) (27) in Kenya (72%) and (40%) among HCPs in urban and rural regions, respectively. Madzorera et al. ( 2022 ) (26), in South Africa, also reported 67%, and both Toure et al. ( 2022 ) (30) in Guinea and Seid & Gebremeskel ( 2024 ) (29) in Ethiopia, documented moderate uptake rates of 65%. Amour et al. ( 2023 ) (33) in Tanzania reported 53.4%, while Amuzie et al. ( 2021 ) (34) in Nigeria found only 35% uptake among nurses and pharmacists. The factors responsible for the reported uptake, as reported by the collective included studies is shaped by a mix of systemic, cultural, and trust-related factors. In countries like South Africa, where confidence in health systems and communication was stronger, uptake reached impressive levels, while a contrasting case is highlighted with a report of how uptake was shaped by mistrust in government and vaccine providers. All these show clearly that vaccine uptake is not simply about supply or availability, but also depends on trust, clear communication, and equitable access to healthcare across the board. Theme 4: Vaccine Hesitancy and Determinants Twelve out of twenty-two (12/22) studies identified different levels and determinants of vaccine hesitancy among HCPs in the SSA region. The reported rate was as high 60% as in Mohammed et al. ( 2021 ) (35) study in Ethiopia, and as low as 35% in Amuzie et al. ( 2021 ) (34) study in Nigeria. The Key drivers of hesitancy include vaccine safety concerns (36, 22), mistrust in governments and providers (35, 30, 34), and fears of long-term effects (37). Adane et al. ( 2022 ) (13) directly linked negative attitudes to refusal. Misinformation spread about the vaccine was also reported to play a crucial role, as Brackstone et al. ( 2022 ) (24) study found that false narratives in Ghana reduced vaccine acceptance by 60%. Cultural beliefs and access issues were also noted by Berhe et al. ( 2022 ) (23) in Ethiopia and Slivesteri et al. ( 2024 ) (32) in Uganda. George et al. ( 2023 ) (38) study highlighted that South African allied health professionals were more hesitant than doctors due to efficacy concerns. In contrast, Nkambule & Mbakaya ( 2024 ) (39) in Malawi found that increased vaccine availability significantly reduced hesitancy, emphasising logistical challenges. Discussion The outcomes of this scoping review reveal critical insights into COVID-19 vaccine knowledge, uptake, hesitancy, and attitudes among healthcare professionals (HCPs) in SSA, while also aligning with and diverging from global trends. The adequate COVID-19 vaccine knowledge among HCPs in SSA, as reported by (20), (22), and (21), are consistent with findings from other regions. Some of those include those conducted by Gadoth et al. ( 2021 ) (40) and Mathur et al. ( 2021 ) (41) in the US and India, respectively, where more than 8 out of 10 HCPs in both studies were reported to have good knowledge regarding COVID-19 vaccines. Although the factors responsible for the good knowledge in both studies were not the same, as Gadoth's study reported that the HCPs assessed sourced their information from professional medical journals and government health websites, while those from Marthur’s attributed their good knowledge to frequent professional training sessions. The similarity in findings with comparative studies and current review findings points to the critical role that HCPs play a role in pandemic response, which necessitates continuous professional training and education for them to be able to discharge their duties. However, the dissimilarities noted were specifically reported in the study conducted among Nigerian HCPs, where television and social media were cited as their information sources on the COVID-19 vaccine due to inadequate professional training (21). In contrast, studies in high-income countries revealed that professional training is the formal source of information on COVID-19 for HCPs (40). Despite the difference in the source of information that influenced their level of knowledge, both groups of studies reported that the HCPs have a good level of knowledge, which highlights the role and importance of formal professional training in high-income countries and the opportunity and usefulness of digital platforms for impacting professional knowledge in low-resource settings. This review also revealed that positive attitudes toward vaccination campaigns were generally predominant among HCPs in the SSA region, as reported by (31) and (29), which aligns with a study in Canada, where 90% of HCPs had a positive attitude towards and supported vaccination campaigns as a way of protecting vulnerable populations for achieving herd immunity (42). Similarly, another study also reported how HCPs in Australia viewed vaccination campaigns as essential for pandemic control within the general population (43). This review reported high vaccine uptake rates among HCPs in SSA between the ranges of 60% and 90%, which is above average and comparable to the global rate trends. This is corroborated by a study in Brazil by Machado et al. ( 2021 ) (44), where more than 80% of the HCPs in the study had received the COVID-19 vaccine, likewise the 65% reported in Martin et al. ( 2021 ) among UK HCPs. Despite the report that vaccine uptake rates are comparatively high among HCPs in the SSA region and in comparative studies conducted in high-income countries, yet, there were different factors responsible for the reported findings. In the UK, professional cadres were reported in Barry et al. ( 2021 ) (45) and Martin et al. ( 2021 ) (46) studies, as both studies reported that doctors, compared to nurses, had a higher percentage of uptake, while workplace mandates and fear of infection influence the COVID-19 vaccine rate in Brazil (44). Despite all the high rates of uptake reported in this review, the findings also reported urban-rural disparities as a factor that hinders even distribution of the vaccine, as it was highlighted in a study conducted among rural HCPs in Kenya by (27). This low uptake is different from vaccine hesitancy because of the difference in their meaning, as disparities reduce access, while hesitancy speaks to behavioural refusal despite availability. The rate of vaccine hesitancy reported in this review shows that the HCPs have concerns about safety, potency, and potential side effects that may come from taking the vaccines (26, 34, 24). Other studies in high-income countries also exhibit similar reasons for vaccine hesitancy, as some of the HCPs in the US and India expressed hesitancy due to concerns about whether there were poor ethical and clinical practices due to the speed at which the vaccines were developed (concern about rapid vaccine development) (46, 41, 26, 38). The findings from this SSA regional review present interesting insights as they align with existing findings from global studies and those studies across other continents. This shows that the knowledge levels that were high were a result of many contextual but diverse factors that are peculiar to the systemic circumstances of healthcare systems in different geographical locations. This has created an opportunity for future research to cover these regional disparities and gaps by focusing on region-specific strategies to enhance HCPs vaccine acceptance and accessibility, as well as their roles in promoting COVID-19 vaccines across the general population. Study Implications This review has significant positive implications for both professional and practice in the area of implementing effective public health policies for disease prevention and health promotion in SSA. Healthcare professionals' role in disease prevention starts with tailored communication strategies to help overcome misinformation about vaccination and other behavioural changes that prevent disease. Having a clear understanding of their KAP regarding vaccines, as revealed in this review, will put the interventions involving them in a better perspective. This review also presented findings on how systemic barriers influence logistic challenges for COVID-19 vaccine distribution, which will have implications for planning and implementation policies that will enhance the delivery of COVID-19 vaccines by effectively managing supply chains and addressing logistical challenges; training programs will also be provided to health professionals so that they acquire appropriate knowledge and skills for effective dissemination at community levels. These findings have also provided insights into the need for interventions in this regard to consider sociocultural and regional contexts that contribute to vaccine hesitancy if the interventions are to be truly effective and sustainable. Conclusion The findings from this review indicate generally an adequate knowledge, and favourable attitudes and perceptions of COVID-19 vaccination among health professionals in Sub-Saharan Africa. The good knowledge, positive perception, and attitude also translated to high vaccine uptake; however, vaccine hesitancy is still high due to many factors that hinge on cultural beliefs, inherent inequity in healthcare system service provision, and misinformation among professionals and at community levels. These factors were believed to negatively impact COVID-19 vaccine coverage in the region; therefore, these factors require holistic interventions, such as collaborative vaccine communication strategies, strengthening supply chains, and providing region-specific training for HCPs to promote vaccine acceptance and uptake. These are thereby recommended for achieving high COVID-19 coverage. Abbreviations HCPs- Healthcare Professionals COVID-19- Coronavirus Disease-2019 PRISMA-ScR- Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews SARS-CoV-2 – Severe Acute Respiratory Syndrome Coronavirus 2 SSA- Sub-Saharan Africa Declarations Ethics Approval and Consent to Participate Not Applicable Consent for Publication Not Applicable Availability of Data and Materials Data sharing does not apply to this article, as no datasets were generated during the current study. Competing Interest The Authors declare that they have no competing interests Funding This research received no external funding. Authors’ Contribution Y.O. and M.M. conceived the research idea and worked as the project coordinators. A.K., A.A., M.U., and A.A. were involved in data curation, formal analysis, methodology, and initial draft writing. All authors revised the manuscript thoroughly for the content, after which they all approved the final manuscript. 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Cross-sectional assessment of COVID-19 vaccine acceptance among healthcare workers in Los Angeles. Ann Intern Med. 2021;174(6):882–5. 10.7326/M20-7580 . Mathur R, Dhabhai N, Gupta S. COVID-19 vaccine hesitancy among healthcare workers in India: a systematic review. Indian J Public Health. 2021;65(3):247–53. 10.4103/ijph.IJPH_123_21 . African Union. COVID-19. 2023. Available from: https://au.int/en/covid19 Machado BAS, Pereira LR, de Oliveira MA, da Silva LF. COVID-19 vaccine hesitancy among healthcare workers in Brazil: a cross-sectional study. Vaccines. 2021;9(7):713. 10.3390/vaccines9070713 . Barry M, Temsah MH, Aljamaan F, Saddik B, Al-Eyadhy A, Alenezi S, et al. COVID-19 vaccine uptake among healthcare workers in the fourth country to authorize BNT162b2 during the first month of rollout. Vaccine. 2021;39(40):5762–8. Martin CA, Marshall C, Patel P, Goss C, Jenkins DR, Ellwood C, et al. SARS-CoV-2 vaccine uptake in a multi-ethnic UK healthcare workforce: a cross-sectional study. PLoS Med. 2021;18:e1003823. 10.1371/journal.pmed.1003823 . Wiysonge CS, Alobwede SM, De Marie Katoto P, Kidzeru EB, Lumngwena EN, Cooper S, et al. COVID-19 vaccine acceptance and hesitancy among healthcare workers in South Africa. Expert Rev Vaccines. 2022;21:549–59. 10.1080/14760584.2022.2023355 . Additional Declarations No competing interests reported. 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The socio-economic and public health impacts are stronger in Sub-Saharan Africa (SSA) because of the usually weak, sub-capitalized systems (2). The coordinated global response for mitigating the impact of this disease has involved public health measures that included lockdowns, and directives for mask usage, and the rapid development of vaccines (3, 4). Among the tools highly rated for preventing and limiting the severe illness and death associated with COVID-19, vaccination features prominently (5). However, hesitancy has emerged as one critical barrier to reaching high vaccination coverage and herd immunity, defined by the World Health Organisation (WHO) as the reluctance or resistance towards vaccination, despite availability and accessibility to vaccine services. The attitude and perception of health professionals in SSA is very important, considering the dual role they have played: both in being among the first to be vaccinated and in influencing public vaccine uptake as change agents (6). It is, therefore, important to understand in this setting the behavioural indicators (Knowledge, Attitudes, and Perceptions) of health professionals on implementing interventions that can improve vaccine acceptability and reduce hesitancy to a bare minimum.\u003c/p\u003e \u003cp\u003eHealth professionals would, therefore, be expected to have a reasonably good understanding of vaccines regarding administration and the enlightenment of their patients. This is because of how their level of knowledge shapes behavioural communication change among the healthcare service users through participatory health education and informed awareness creation for vaccine uptake within their communities. Studies done throughout SSA have variably shown that the knowledge concerning COVID-19 vaccines was variably high among the HCPs. For instance, in Nigeria, it was established that while 72.3% of the HCPs had an awareness of the safety profiles for the COVID-19 vaccines available, only 55% showed detailed knowledge of the mode of action (7).\u003c/p\u003e \u003cp\u003eThe issue of skepticism related to COVID-19 vaccine among community members and HCPs alike in SSA countries did not start with COVID-19, this has been happening before COVID-19, as it is often driven by a prevailing negative personal experience from previous service use (possibly linked to COVID-19 misinformation and misconceptions) thereby leading to a distrust in government (8, 9, 10), and escalated by the high level of misinformation and misconception that characterized COVID-19 pandemic information sharing. This reason necessitates the need for HCPs to have a positive attitude towards the COVID-19 vaccine, so that they can be the voice of change that will create awareness regarding the vaccine potency, thereby driving uptake and high coverage among their professional colleagues and community members.\u003c/p\u003e \u003cp\u003eAn overwhelming majority of the HCPs recognise vaccination for its place in controlling the pandemic, although significant skepticism has remained among a higher proportion of them, which they attribute to concerns over safety and efficacy. A multi-country survey conducted amongst health professionals in three countries (South Africa, Uganda, and Ghana) revealed that 35% of respondents were uncertain about taking the vaccine due to fears of long-term side effects (11). This hesitancy was more pronounced among younger HCPs, many citing concerns over inadequate clinical trials in African populations. Further, the previous incidents of unequal distribution of medical supplies, coupled with the historical case of medical exploitation in Africa, have generally grown the distrust in the global vaccination effort to which the entire world has been subjected (12).\u003c/p\u003e \u003cp\u003ePerception about COVID-19 vaccination among HCPs has been influenced by individual, institutional, and societal factors. Vaccination is most influenced by the perceptions of vaccine safety, efficacy, and need. Delays in vaccine rollout, further coupled with reliance on donations from high-income countries, have contributed to negative perceptions around vaccine quality and equity in SSA. A study from Ethiopia has revealed that 40% of the health professionals believe COVID-19 vaccines circulating in the region were less effective compared to those given in developed countries (13). Other deeply entrenched myths, such as infertility and DNA modification from vaccination, have also contributed to negative perceptions. On the other hand, several studies reported positive perceptions among HCPs who received awareness and training on vaccination. For example, targeted awareness campaigns in Rwanda yielded an unprecedented increase in vaccination uptake; 85% of the HCPs were convinced about the safety and efficacy of COVID-19 vaccines (14).\u003c/p\u003e \u003cp\u003eHealthcare professionals\u0026rsquo; hesitancy towards vaccine is influenced by a complex, multidimensional, and several individualistic, cultural, and systemic factors. Many cite adverse reactions, religious views, and mistrust of pharmaceutical corporations as motivating factors (15). Beliefs in the culture one finds in rural areas, to a great extent, intersect with misinformation on COVID-19 vaccines, hence raising skepticism about the vaccine. Systemic barriers, such as poor vaccine logistics, lack of training, and lack of government transparency, are other contributing factors identified in empirical studies for the current level of vaccine hesitancy rate in these countries. In Zambia, for example, confusing messages about vaccine availability and eligibility criteria caused confusion among health workers and undermined confidence in the vaccines (16).\u003c/p\u003e \u003cp\u003eThe attitudes and perceptions of health professionals towards COVID-19 vaccines have important implications for public health in SSA. Health care professionals are often regarded as trusted sources for medical information, thus making their views about vaccine strong enough to shape community acceptance of vaccination. Therefore, any report of vaccine hesitancy among them (the ones that community members look up to on health decisions) has the potential to undermine public confidence and contribute to low vaccine coverage rates. According to the African Union statistics, by the end of the year 2023, only 21% of the SSA population were fully vaccinated, which is below the global average of 70%. This highlights a need to address HCP vaccine hesitancy, which could encourage better response among the general public. COVID-19 vaccine awareness among health professionals is linked to their individual beliefs and personal circumstances, systemic factors, and societal dynamics. Several interventions have been made to create vaccine awareness and increase vaccine availability, but there are considerable disparities, and much still needs to be done through targeted interventions. It is therefore necessary to assess the challenges and barriers to vaccine uptake among HCPs and the general population, in order to improve COVID-19 pandemic control and other future pandemics within the region.\u003c/p\u003e\n\u003ch3\u003eGuiding Questions for the Scoping Review\u003c/h3\u003e\n\u003cp\u003eThis scoping review is guided by the following research questions:\u003c/p\u003e \u003cp\u003e \u003cp\u003e1. What is the level of knowledge, attitude, and perception regarding COVID-19 vaccine uptake among healthcare professionals in SSA?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cp\u003e2. What are the factors influencing vaccine hesitancy among healthcare professionals in the region?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAim of the Scoping Review\u003c/h2\u003e \u003cp\u003eThis scoping review hopes to present findings from the literature on the knowledge, attitude, and perception of health professionals in SSA about COVID-19 vaccines, ascertain factors that predispose to vaccine hesitancy, highlight prevailing trends, and unearth critical gaps in the available evidence. This could inform targeted interventions to improve vaccine uptake among healthcare professionals in the region.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSearch Strategy\u003c/h2\u003e \u003cp\u003eThis scoping review process was guided by the reporting recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) (17, 18). Relevant literature was retrieved from several electronic databases, for example PubMed, Google Scholar, AJOL, CINAHL, and Scopus. The reviewer adopted Boolean operators, along with database-specific controlled vocabulary (AND, OR, and NOT), to create a comprehensive and inclusive search (by narrowing, broadening, and excluding search terms as appropriate) for identifying studies of various designs and relevant findings.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDesign and Steps Followed in the Review Process\u003c/h3\u003e\n\u003cp\u003eThe review team conducted a comprehensive search in the five selected databases (PubMed, Google Scholar, AJOL, CINAHL, and Scopus), using three search strategies listed below:\u003c/p\u003e \u003cp\u003e \u003cp\u003e1. Selected Databases search: Traditional databases such as PubMed, CINAHL, Scopus, and AJOL were accessed with the search term for a systematic search of relevant records (published articles).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cp\u003e2. General Internet Browsers: Google Scholar was also searched for relevant articles that were not indexed in the traditional databases.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e\u003cp\u003e3. Reference List Hand Searches (Chaining): The list of references presented in the identified records (articles) was also checked for any relevant articles that were not indexed in the traditional databases and those not found in the general internet browsers like Google Scholar.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe review team adopted Hategeka et al.'s (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) (19) strategy of limiting screening of identified records to the first 100 most relevant search outcomes from each database, which is to help in managing the feasibility and time constraints of screening search results. Two reviewers manually examined the list of identified studies from the reference lists to prevent the omission of pertinent literature. Furthermore, relevant scoping reviews and other related articles were identified for additional studies. Keywords central to this scoping review included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eKnowledge, attitude, and perception of COVID19 vaccines\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eVaccine uptake and hesitancy among healthcare professionals\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHealthcare professionals in SSA\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCOVID19 vaccine hesitancy predictors\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eBarriers and facilitators of vaccine uptake\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eMeSH terms in PubMed and subject headings in CINAHL and Scopus, were also included, with inclusion and exclusion criteria for selected articles (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n\u003ch3\u003eSteps in Review Process\u003c/h3\u003e\n\u003cp\u003eThe review process followed a structured and orderly sequence involving research question formulation, study identification, screening for relevant studies using the inclusion and exclusion criteria, data extraction, and synthesis.\u003c/p\u003e \u003cp\u003e \u003cp\u003e1. Research Question Development: The corresponding author developed the initial research question: (What are the knowledge, attitudes, and perceptions of COVID-19 vaccine uptake and hesitancy among healthcare professionals in SSA?)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cp\u003e2. Study Identification: Literature was searched using different search engines and databases to identify relevant articles that are relative to the research question.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cp\u003e3. Inclusion and Exclusion Criteria: Inclusion criteria focused on studies published in English, conducted in SSA, and addressing COVID19 vaccine knowledge, attitudes, and perceptions among healthcare professionals. Exclusion criteria included studies outside the region, non-English publications, and studies not focusing on healthcare professionals.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cp\u003e4. Data Charting: Data extraction included key themes on knowledge levels, attitudes toward vaccines, perceptions of vaccine safety and efficacy, and factors influencing hesitancy or uptake.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cp\u003e5. Data Collation and Summary: Data were collated and summarised using narrative synthesis to provide a full synopsis of the findings.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eReports of the Search Process\u003c/h2\u003e \u003cp\u003eMultiple electronic databases, including PubMed, Scopus, CINAHL, African Journals Online, and Google Scholar, were utilized to conduct a structured search that combined controlled vocabulary and free-text terms related to COVID-19 vaccination, vaccine hesitancy, healthcare professionals, and Sub-Saharan Africa. Boolean operators (\u0026ldquo;AND\u0026rdquo;, \u0026ldquo;OR\u0026rdquo;) were applied to refine the search and ensure comprehensive coverage of relevant studies. Detailed search strings for each database are provided in the appendix section (see appendix 2)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearch Syntax\u003c/h3\u003e\n\u003cp\u003eThe search strings for each of the databases are presented below as a broad search encompassing various aspects of vaccine uptake and hesitancy:\u003c/p\u003e \u003cp\u003e(vaccine*[tiab] OR immunization*[tiab] OR vaccination*[tiab]) AND (hesitancy OR acceptance OR refusal OR uptake OR confidence OR attitude OR perception OR barrier*[tiab] OR challenge*[tiab]) AND (healthcare professional*[tiab] OR health worker*[tiab] OR clinician*[tiab] OR doctor*[tiab] OR nurse*[tiab] OR midwife*[tiab] OR physician*[tiab] OR allied health*[tiab]) AND (COVID-19 OR SARS-CoV-2 OR coronavirus) AND (sub-sahara africa*[tiab] OR Nigeria*[tiab] OR Kenya*[tiab] OR Ghana*[tiab] OR South Africa*[tiab] OR Ethiopia*[tiab] OR Uganda*[tiab] OR Tanzania*[tiab] OR Zimbabwe*[tiab] OR Malawi*[tiab] OR Zambia*[tiab])\u003c/p\u003e \u003cp\u003eA search focusing specifically on knowledge, attitudes, and perceptions related to COVID-19 vaccines:\u003c/p\u003e \u003cp\u003e(vaccine*[tiab] OR immunization*[tiab]) AND (knowledge OR attitude OR perception OR belief*[tiab] OR understanding*[tiab] OR misinformation OR disinformation) AND (healthcare professional*[tiab] OR health worker*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab] OR Nigeria*[tiab] OR Kenya*[tiab] OR Ghana*[tiab] OR South Africa*[tiab] OR Ethiopia*[tiab] OR Uganda*[tiab] OR Tanzania*[tiab] OR Zimbabwe*[tiab] OR Malawi*[tiab] OR Zambia*[tiab])\u003c/p\u003e \u003cp\u003eA search specifically targeting vaccine hesitancy among HCPs:\u003c/p\u003e \u003cp\u003e(vaccine*[tiab] OR immunization*[tiab]) AND (hesitancy OR resistance OR reluctance OR skepticism OR doubt*[tiab]) AND (healthcare professional*[tiab] OR health worker*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab] OR Nigeria*[tiab] OR Kenya*[tiab] OR Ghana*[tiab] OR South Africa*[tiab] OR Ethiopia*[tiab] OR Uganda*[tiab] OR Tanzania*[tiab] OR Zimbabwe*[tiab] OR Malawi*[tiab] OR Zambia*[tiab])\u003c/p\u003e \u003cp\u003eA search incorporating a date restriction to limit results to the pandemic period:\u003c/p\u003e \u003cp\u003e(vaccine*[tiab] OR immunization*[tiab]) AND (hesitancy OR acceptance) AND (healthcare professional*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab]) (2020\u0026ndash;2024)\u003c/p\u003e \u003cp\u003eA search excluding animal studies to refine the results:\u003c/p\u003e \u003cp\u003e(vaccine*[tiab] OR immunization*[tiab]) AND (hesitancy OR uptake) AND (healthcare professional*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab]) NOT (animal*[tiab] OR rat*[tiab] OR mouse*[tiab] OR mice*[tiab])\u003c/p\u003e \u003cp\u003eA combined search focusing on specific healthcare roles and excluding in vitro or cell culture studies:\u003c/p\u003e \u003cp\u003e(vaccine*[tiab] OR immunization*[tiab] OR vaccination*[tiab]) AND (hesitancy OR acceptance OR refusal OR uptake) AND (nurse*[tiab] OR midwife*[tiab] OR physician*[tiab]) AND (COVID-19 OR SARS-CoV-2) AND (sub-sahara africa*[tiab] OR Nigeria*[tiab] OR Ghana*[tiab]) NOT (in vitro OR cell culture)\u003c/p\u003e \u003cp\u003eThese search strategies were adapted and refined as needed based on the initial search results and the specific focus of the review. While each article\u0026rsquo;s title and abstract (from the outcomes) were screened by the remaining two reviewers (2 of 4), working independently and different from those who ran the search. This was done so as to reduce individual bias and also to allow for a thorough consideration of the content of the studies, thereby ensuring that no potentially eligible studies were overlooked. Full texts of selected articles were then retrieved and assessed for inclusion based on pre-defined criteria. Disagreements or inconsistencies were resolved by consulting with a fourth reviewer.\u003c/p\u003e\n\u003ch3\u003eIdentification of Relevant Studies\u003c/h3\u003e\n\u003cp\u003eThe review only considered peer-reviewed articles published between 2019 and 2024 in the English language. The duplicates and titles not in the English language were excluded. The search included studies related to the knowledge, attitude, and perception of COVID-19 vaccines and vaccine hesitancy among health professionals in SSA. Exclusions were made for those articles that were focused on populations other than health professionals or were from any other geographical region and unrelated to vaccine topics of vaccines.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTo establish eligibility using the inclusion criteria, the PICOS framework (Participants, Intervention, Context, Outcomes, and Study Design) was employed\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eParticipants: Health professionals.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIssue: Assessment of knowledge, attitude, and perception regarding COVID-19 vaccination uptake and hesitancy.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eContext: Sub-Saharan Africa.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOutcomes: Evidence-based insights into the factors that determine vaccine uptake and hesitancy.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudy Design: A quantitative, qualitative, or mixed-method study.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSelection of Relevant and Reliable Studies\u003c/h2\u003e \u003cp\u003eThe selection of studies was done in several stages: 1. Title and Abstract Screening: Initial screening of studies based on titles and abstracts. 2. Full-text inclusion: The inclusion criteria was employed to select studies that were reviewed in full text for final inclusion. This review process was done by three different researchers, and during the stages of selection, no conflict came up that would have required additional reviewers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Extraction\u003c/h2\u003e \u003cp\u003eA structured extraction of data was performed with Microsoft Excel, based on key information listed in the data extraction form below:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eDate and Time of Extraction\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eReviewer(s)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudy Author and Year\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMain Objective of the Study\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudy Settings and Design\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIssue(s)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eContext of the study\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \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\u003eSample of Data Extraction Form\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCriteria For Extraction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExtracted Information\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\u003e1.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDate and Time of Extraction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11/11/2024 (8:28 pm)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eReviewer(s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdegbore, Sholabi, and Adewole\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStudy Author and Year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMadzorera, I. et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBurkina Faso, Ethiopia, Nigeria, Tanzania, and Ghana\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMain Objective of the Study\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo understand the extent of COVID-19 vaccine hesitancy among health care providers (HCP) and its contributing factors in sub-Saharan Africa.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStudy Settings and Design\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA repeated cross-sectional telephone survey (quantitative)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePopulation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,499 health care providers (HCP) across five African countries\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIssue (s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConcerns about vaccine effectiveness, side effects, and fear of unsafe/experimental vaccines drive COVID-19 vaccine hesitancy among HCP.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eContext\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSub-Saharan Africa\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevalence: 45.7% vaccine hesitancy in Burkina Faso, 25.7% in Tanzania, 9.8% in Ethiopia, 9% in Ghana, and 8.1% in Nigeria.\u003c/p\u003e \u003cp\u003eFactors reducing hesitancy: Belief in vaccine effectiveness (RR: 0.21) and older age (45\u0026thinsp;+\u0026thinsp;years, RR: 0.65).\u003c/p\u003e \u003cp\u003eNurses were more likely to be hesitant (RR: 1.38) compared to doctors.\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\u003eStudy design (quantitative, qualitative, or mixed methods).\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis scoping review considered all types of primary studies that were either quantitative, qualitative, or mixed methods\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSearch Outcomes\u003c/h2\u003e \u003cp\u003eFrom the five databases, a total of 7,022 records were produced. This includes PubMed (1,236 articles), AJOL (2,710 articles), CINAHL (1,042 articles), Scopus (94 articles), Google Scholar (1,050 articles), and an additional 1,060 records from other sources (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After removing duplicates, the remaining records for screening were 1,094. Following the screening of titles and abstracts, only 129 full-text articles were available for full-text review, which excluded 2 studies due to insufficient data or irrelevance. The remaining 127 studies were subjected to eligibility assessment, leaving only 22 studies that were included in the qualitative synthesis after further refinement and data extraction. This process ensured a comprehensive review of the scope of the literature on COVID-19 vaccine hesitancy and uptake among healthcare professionals in SSA (See Appendix 1).\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\u003eFirst Search Outcome (Identification and Screening of Title and Abstract)\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDatabase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eData Limit Applied\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSearch Strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNumber of Articles Retrieve from Search\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePubMed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2019\u0026ndash;2024\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\"COVID-19 Vaccines\"[MeSH] OR \"SARS-CoV-2 vaccine\") AND (\"vaccine hesitancy\" OR \"vaccine uptake\") AND (\"healthcare professionals\" OR \"health workers\") AND (\"Sub-Saharan Africa\" OR \"Africa South of the Sahara\")\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,236\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAJOL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2019\u0026ndash;2024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\"COVID-19 vaccines\" OR \"SARS-CoV-2 vaccine\") AND (\"vaccine hesitancy\" OR \"vaccine uptake\") AND (\"healthcare professionals\" OR \"health workers\") AND (\"Sub-Saharan Africa\").\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCINAHL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2019\u0026ndash;2024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\"COVID-19 Vaccines\"[MeSH] OR \"SARS-CoV-2 vaccine\") AND (\"vaccine hesitancy\" OR \"vaccine uptake\") AND (\"healthcare professionals\" OR \"health workers\") AND (\"Sub-Saharan Africa\").\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScopus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2019\u0026ndash;2024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\"COVID-19 vaccines\" OR \"SARS-CoV-2 vaccine\") AND (\"vaccine hesitancy\" OR \"vaccine uptake\") AND (\"healthcare professionals\" OR \"health workers\") AND (\"Sub-Saharan Africa\").\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGoogle Scholar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2019\u0026ndash;2024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\"COVID-19 vaccines\" OR \"SARS-CoV-2 vaccine\") AND (\"vaccine hesitancy\" OR \"vaccine uptake\") AND (\"healthcare professionals\" OR \"health workers\") AND (\"Sub-Saharan Africa\").\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1,060\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e7,022\u003c/b\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 \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCollating, Summarising, and Reporting the Findings\u003c/h2\u003e \u003cp\u003eThe included twenty-two (22) studies were synthesised using the narrative synthesis analysis method because of the heterogeneity of the studies\u0026rsquo; methodologies. The findings were summarized narratively to allow for comparison across the patterns and themes of the included studies, due to the differences in study designs and outcome measures.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the Reviewed Articles\u003c/h2\u003e \u003cp\u003eThe characteristics of the studies that were included show that 70% were published between 2022 and 2024, while the remaining 30% were published between 2020 and 2022, which were all between the years that research on COVID-19 vaccine were trending. Out of the total 22 included studies, 20 were conducted as mono-country studies, while two were multi-country studies, with Nigeria (18%) and Ethiopia (18%) having the highest frequency of studies with four each, followed by South Africa (14.5%) with three studies. Kenya (9%) and Ghana (9%) have two studies each, while Guinea (4.5%), Malawi (4.5%), Sierra Leone (4.5%), Tanzania (4.5%), and Uganda (4.5%) have 1 study each to complete 22 (100%) studies (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eThematic Findings on Knowledge, Attitudes, and Perceptions of COVID-19 Vaccine Uptake and Hesitancy Among Healthcare Professionals in Sub-Saharan Africa\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe narrative synthesis conducted on the twenty-two included studies yielded four emergent overarching themes presented below. Each of the themes addresses the core objectives of the review. The factors influencing the knowledge, attitude, and perceptions of COVID-19 vaccine uptake, the extant vaccine uptake rate, and hesitancy rate were integrated within the umbrella themes without separating them, as the factors were intricately interwoven within the main variables. The four themes were discussed below:\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 1: Varying High Level of Knowledge of COVID-19 Vaccines Among Healthcare Professionals in Sub-Saharan Africa\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNine out of twenty-two studies presented findings on knowledge among healthcare professionals (HCPs) in SSA reveal significant variability. In Nigeria, Imediegwu et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) (20) and Ejeh et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) (21) reported high knowledge levels (78% and 88.75%, respectively), with social and traditional media as primary information sources. Egbuniwe et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (22) found an even higher rate of 92.4%. The variations were more pronounced in many of the studies, as Berhe et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (23) identified factors such as intra-professional misinformation and limited training as key hindrances among HCPs, such as the Ethiopian health extension workers, while Brackstone et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (24) highlighted insufficient vaccine-related information as a major cause of hesitancy in Ghana.\u003c/p\u003e \u003cp\u003eRegional disparities were also reported as one of the factors causing the variation that is evident. Ekpenyong et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (25), Madzorera et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (26), and Mudhune et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) (27) were some of the studies that reported on factors that bring about variations, as some found that rural Kenyan HCPs had lower knowledge levels (50%) than their urban counterparts, how HCPs have better knowledge than Non-HCPs, and how confidence in the vaccine also influences interest in knowledge-practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Positive Attitudes Toward COVID-19 Vaccination Campaigns\u003c/h2\u003e \u003cp\u003eThe review shows that HCPs had positive attitudes toward COVID-19 vaccination campaigns, as nine of the twenty-two studies included studies towards this assertion. The included studies reported that HCPs have a positive attitude and translated to HCPs' willingness to recommend the vaccine to their colleagues and family, while also having confidence in supporting the distribution of the vaccine for disease prevention and control among the larger population Adeniyi et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, (28) and Seid \u0026amp; Gebremeskel (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (29). Mohammed et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), Amuzie et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), Brackstone et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (24), and Toure et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (30) also reported similar findings of positive attitude; they collectively reported potential factors that may undermine confidence, which include mistrust in governments and vaccine providers and misinformation. Additionally, Ejeh et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) (21), Balegha et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (31), and Slivesteri et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (32) collectively noted that the positive attitudes reported may be hindered by the potential frustration of logistical and resource constraints that weaken campaign effectiveness when the HCPs are involved, while cultural and religious beliefs are also other fundamental factors that may impact HCPs ' attitudes on COVID-19 in the SSA region.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Predominantly High Vaccine Uptake Among Healthcare Professionals\u003c/h2\u003e \u003cp\u003eThe analysis of the included studies revealed that there is a generally high vaccine uptake among HCPs in the SSA region, although it varies due to regional differences, access, and sociocultural factors. In this review, ten studies out of the twenty-two presented findings that supported this assertion. Starting with Adeniyi et al.'s (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (28) study in South Africa, which reported the highest COVID-19 acceptance at 90.1%, followed by Ejeh et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) (21) in Nigeria (72%), and Mudhune et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) (27) in Kenya (72%) and (40%) among HCPs in urban and rural regions, respectively. Madzorera et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (26), in South Africa, also reported 67%, and both Toure et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (30) in Guinea and Seid \u0026amp; Gebremeskel (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (29) in Ethiopia, documented moderate uptake rates of 65%. Amour et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) (33) in Tanzania reported 53.4%, while Amuzie et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (34) in Nigeria found only 35% uptake among nurses and pharmacists.\u003c/p\u003e \u003cp\u003eThe factors responsible for the reported uptake, as reported by the collective included studies is shaped by a mix of systemic, cultural, and trust-related factors. In countries like South Africa, where confidence in health systems and communication was stronger, uptake reached impressive levels, while a contrasting case is highlighted with a report of how uptake was shaped by mistrust in government and vaccine providers. All these show clearly that vaccine uptake is not simply about supply or availability, but also depends on trust, clear communication, and equitable access to healthcare across the board.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Vaccine Hesitancy and Determinants\u003c/h2\u003e \u003cp\u003eTwelve out of twenty-two (12/22) studies identified different levels and determinants of vaccine hesitancy among HCPs in the SSA region. The reported rate was as high 60% as in Mohammed et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (35) study in Ethiopia, and as low as 35% in Amuzie et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (34) study in Nigeria. The Key drivers of hesitancy include vaccine safety concerns (36, 22), mistrust in governments and providers (35, 30, 34), and fears of long-term effects (37). Adane et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (13) directly linked negative attitudes to refusal.\u003c/p\u003e \u003cp\u003eMisinformation spread about the vaccine was also reported to play a crucial role, as Brackstone et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (24) study found that false narratives in Ghana reduced vaccine acceptance by 60%. Cultural beliefs and access issues were also noted by Berhe et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (23) in Ethiopia and Slivesteri et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (32) in Uganda. George et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) (38) study highlighted that South African allied health professionals were more hesitant than doctors due to efficacy concerns. In contrast, Nkambule \u0026amp; Mbakaya (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (39) in Malawi found that increased vaccine availability significantly reduced hesitancy, emphasising logistical challenges.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe outcomes of this scoping review reveal critical insights into COVID-19 vaccine knowledge, uptake, hesitancy, and attitudes among healthcare professionals (HCPs) in SSA, while also aligning with and diverging from global trends. The adequate COVID-19 vaccine knowledge among HCPs in SSA, as reported by (20), (22), and (21), are consistent with findings from other regions. Some of those include those conducted by Gadoth et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (40) and Mathur et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (41) in the US and India, respectively, where more than 8 out of 10 HCPs in both studies were reported to have good knowledge regarding COVID-19 vaccines. Although the factors responsible for the good knowledge in both studies were not the same, as Gadoth's study reported that the HCPs assessed sourced their information from professional medical journals and government health websites, while those from Marthur\u0026rsquo;s attributed their good knowledge to frequent professional training sessions.\u003c/p\u003e \u003cp\u003eThe similarity in findings with comparative studies and current review findings points to the critical role that HCPs play a role in pandemic response, which necessitates continuous professional training and education for them to be able to discharge their duties. However, the dissimilarities noted were specifically reported in the study conducted among Nigerian HCPs, where television and social media were cited as their information sources on the COVID-19 vaccine due to inadequate professional training (21). In contrast, studies in high-income countries revealed that professional training is the formal source of information on COVID-19 for HCPs (40). Despite the difference in the source of information that influenced their level of knowledge, both groups of studies reported that the HCPs have a good level of knowledge, which highlights the role and importance of formal professional training in high-income countries and the opportunity and usefulness of digital platforms for impacting professional knowledge in low-resource settings.\u003c/p\u003e \u003cp\u003eThis review also revealed that positive attitudes toward vaccination campaigns were generally predominant among HCPs in the SSA region, as reported by (31) and (29), which aligns with a study in Canada, where 90% of HCPs had a positive attitude towards and supported vaccination campaigns as a way of protecting vulnerable populations for achieving herd immunity (42). Similarly, another study also reported how HCPs in Australia viewed vaccination campaigns as essential for pandemic control within the general population (43).\u003c/p\u003e \u003cp\u003eThis review reported high vaccine uptake rates among HCPs in SSA between the ranges of 60% and 90%, which is above average and comparable to the global rate trends. This is corroborated by a study in Brazil by Machado et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (44), where more than 80% of the HCPs in the study had received the COVID-19 vaccine, likewise the 65% reported in Martin et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) among UK HCPs. Despite the report that vaccine uptake rates are comparatively high among HCPs in the SSA region and in comparative studies conducted in high-income countries, yet, there were different factors responsible for the reported findings. In the UK, professional cadres were reported in Barry et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (45) and Martin et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (46) studies, as both studies reported that doctors, compared to nurses, had a higher percentage of uptake, while workplace mandates and fear of infection influence the COVID-19 vaccine rate in Brazil (44).\u003c/p\u003e \u003cp\u003eDespite all the high rates of uptake reported in this review, the findings also reported urban-rural disparities as a factor that hinders even distribution of the vaccine, as it was highlighted in a study conducted among rural HCPs in Kenya by (27). This low uptake is different from vaccine hesitancy because of the difference in their meaning, as disparities reduce access, while hesitancy speaks to behavioural refusal despite availability. The rate of vaccine hesitancy reported in this review shows that the HCPs have concerns about safety, potency, and potential side effects that may come from taking the vaccines (26, 34, 24). Other studies in high-income countries also exhibit similar reasons for vaccine hesitancy, as some of the HCPs in the US and India expressed hesitancy due to concerns about whether there were poor ethical and clinical practices due to the speed at which the vaccines were developed (concern about rapid vaccine development) (46, 41, 26, 38).\u003c/p\u003e \u003cp\u003eThe findings from this SSA regional review present interesting insights as they align with existing findings from global studies and those studies across other continents. This shows that the knowledge levels that were high were a result of many contextual but diverse factors that are peculiar to the systemic circumstances of healthcare systems in different geographical locations. This has created an opportunity for future research to cover these regional disparities and gaps by focusing on region-specific strategies to enhance HCPs vaccine acceptance and accessibility, as well as their roles in promoting COVID-19 vaccines across the general population.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStudy Implications\u003c/h2\u003e \u003cp\u003eThis review has significant positive implications for both professional and practice in the area of implementing effective public health policies for disease prevention and health promotion in SSA. Healthcare professionals' role in disease prevention starts with tailored communication strategies to help overcome misinformation about vaccination and other behavioural changes that prevent disease. Having a clear understanding of their KAP regarding vaccines, as revealed in this review, will put the interventions involving them in a better perspective. This review also presented findings on how systemic barriers influence logistic challenges for COVID-19 vaccine distribution, which will have implications for planning and implementation policies that will enhance the delivery of COVID-19 vaccines by effectively managing supply chains and addressing logistical challenges; training programs will also be provided to health professionals so that they acquire appropriate knowledge and skills for effective dissemination at community levels. These findings have also provided insights into the need for interventions in this regard to consider sociocultural and regional contexts that contribute to vaccine hesitancy if the interventions are to be truly effective and sustainable.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings from this review indicate generally an adequate knowledge, and favourable attitudes and perceptions of COVID-19 vaccination among health professionals in Sub-Saharan Africa. The good knowledge, positive perception, and attitude also translated to high vaccine uptake; however, vaccine hesitancy is still high due to many factors that hinge on cultural beliefs, inherent inequity in healthcare system service provision, and misinformation among professionals and at community levels. These factors were believed to negatively impact COVID-19 vaccine coverage in the region; therefore, these factors require holistic interventions, such as collaborative vaccine communication strategies, strengthening supply chains, and providing region-specific training for HCPs to promote vaccine acceptance and uptake. These are thereby recommended for achieving high COVID-19 coverage.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col\u003e\n \u003cli\u003eHCPs- Healthcare Professionals\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCOVID-19- Coronavirus Disease-2019\u003c/li\u003e\n \u003cli\u003ePRISMA-ScR- Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSARS-CoV-2 \u0026ndash; Severe Acute Respiratory Syndrome Coronavirus 2\u003c/li\u003e\n \u003cli\u003eSSA- Sub-Saharan Africa\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sharing does not apply to this article, as no datasets were generated during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.O. and M.M. conceived the research idea and worked as the project coordinators. 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Expert Rev Vaccines. 2022;21:549\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/14760584.2022.2023355\u003c/span\u003e\u003cspan address=\"10.1080/14760584.2022.2023355\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19 Vaccine Hesitancy, Healthcare Professionals, Sub-Saharan Africa, Vaccine Uptake and Misinformation","lastPublishedDoi":"10.21203/rs.3.rs-9170267/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9170267/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The COVID-19 pandemic is one of the most profound global health emergencies of the 21st century that affected all and sundry, thereby causing a global disruption that exposed deep socioeconomic challenges, while increasing the burden of infections that overwhelmed healthcare systems. Due to the novel nature of the disease, vaccination emerged as a critical tool in mitigating the spread of the pandemic and paving the way towards recovery. This requires the cooperation and participation of healthcare professionals (HCPs) who are the first-line responders. Yet, vaccine hesitancy has been previously reported to be predominant among this target population, which is a significant barrier to achieving high vaccination coverage in Sub-Saharan Africa. This scoping review was designed to explore the knowledge, attitudes, and perceptions of COVID-19 vaccine uptake and hesitancy among HCPs in Sub-Saharan Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The review adopted the PRISMA-ScR framework for searching, reporting, and analysing relevant peer-reviewed articles extracted from five databases, including PubMed, Google Scholar, Africa Journals Online, CINAHL, and Scopus. The review analysed 22 studies from various countries in the Sub-Saharan region, and those studies included different methodologies, including cross-sectional surveys, qualitative studies, and mixed-methods approaches.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The findings revealed that the HCPs generally exhibited good knowledge and positive attitude towards COVID-19 vaccines, and the good knowledge actually translates to high but significantly varied vaccine uptake rates ranging between 90-53% across different countries, within the Sub-Saharan African region. The uptake variations were significantly influenced by factors such as misinformation, socio-cultural beliefs, urban-rural disparities, and logistical challenges. At the same time, the reported hesitancy rate also reflected concerns about vaccine safety and efficacy, as well as mistrust in government and pharmaceutical companies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis review revealed that HCPs in the Sub-Saharan African region had good knowledge and positive attitudes towards the COVID-19 vaccine, which reflected in the high rate of its uptake. Although there was a report of vaccine hesitance among the same target population, it was low compared to the rate of uptake. Adopting collaborative vaccine communication strategies, strengthening supply chains, and providing region-specific training for HCPs that has the potential of promoting vaccine acceptance and uptake is recommended for achieving high COVID-19 coverage.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitude, and Perception of COVID-19 Vaccine Uptake and Hesitancy among Healthcare Professionals in Sub-Saharan Africa: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-06 11:58:29","doi":"10.21203/rs.3.rs-9170267/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T15:03:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-06T07:43:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142072130856314957489081651575410805017","date":"2026-05-06T06:33:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96493263027094671001055136546195370012","date":"2026-04-30T18:24:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-28T09:01:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-07T11:22:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T06:30:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-06T06:30:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-19T13:47:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03008d90-60f8-410e-b0b6-a1e45ba0d32d","owner":[],"postedDate":"May 6th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T15:03:25+00:00","index":66,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-06T07:43:03+00:00","index":62,"fulltext":""},{"type":"reviewerAgreed","content":"142072130856314957489081651575410805017","date":"2026-05-06T06:33:40+00:00","index":61,"fulltext":""},{"type":"reviewerAgreed","content":"96493263027094671001055136546195370012","date":"2026-04-30T18:24:45+00:00","index":42,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T11:58:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-06 11:58:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9170267","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9170267","identity":"rs-9170267","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}