Knowledge, Attitudes and Practices of High-Risk Groups Towards COVID-19 Vaccination in Kampala, Uganda
Authors: Bitariho Kakuru Glet , Muhoozi David , Lakor Opiyo Felix , Okello Justine , Zalwango Sarah , Ochola Martin Okoth , Kankya Clovice , Majalija Samuel 
Published: August 2023

Abstract
The uptake of the COVID-19 vaccine remains low in less wealthy countries especially in Africa. Uganda’s initial vaccination campaigns targeted healthcare workers, teachers, the security forces, individuals with comorbidities, the elderly, and students, notwithstanding, the low uptake led to vaccine wastage. Available literature indicates an association between knowledge, attitudes and uptake of health services including vaccination, however, such studies are limited as regards COVID-19. This study therefore assessed the knowledge, attitudes, and practices of selected groups at high risk of COVID − 19 infection towards COVID-19 vaccination in Kampala, Uganda. A cross-sectional study using mixed methods of data collection was conducted in Kampala, Uganda among 576 groups. Multistage sampling was used to select the participants and a digitized semi-structured questionnaire was used to elicit data, that was analyzed in Stata 14. Descriptive statistics were presented as means, medians and the standard deviation for continuous variables while proportions were used for categorical variables and presented in frequency tables and figures. The modified Poisson regression model was used to establish the associations between predictor and outcome variables, while content analysis was used for the qualitative findings. Overall, 576 respondents were interviewed; 53.1% (306/576) were males, 48%(278/576) were aged 18–29 years and 63.5%(366/576) attained tertiary education. About 63.5% (366/576) had a high knowledge of COVID-19 vaccines and vaccination, 70.5% (406/576) had a good attitude towards COVID-19 vaccines and vaccination. A total of 443 (76.9%) ( had received a COVID-19 vaccine, mainly AstraZeneca, 63.2% (280/443) than Pfizer 26% (115/443) or other vaccines. Over 60.1% (266/443) experienced side effects following vaccination. Sex, attitude towards, holding a leadership position, having convinced peers to receive the vaccine, having been convinced by peers to receive the vaccine and having been convinced by peers not to take COVID-19 vaccine were significantly associated with COVID-19 vaccination status. Females (adj. PR = 0.97; 95%CI: 0.89, 1.06) had a 3% likelihood of not being vaccinated compared with the males. Poor attitudes (adj. PR = 1.12; 95%CI: 1.12, 1.25) were associated with a 12% chance of not being vaccinated compared to those with a good attitude. Not holding a leadership position (adj. PR = 0.8; 95%CI: 0.72, 0.88) was associated with a 20% likelihood of not being vaccinated. Not having convinced peers to receive the vaccine (adj. PR = 0.52; 95%CI: 0.42, 0.64), not having been convinced by peers to receive the vaccine (adj. PR = 0.99; 95%CI: 0.88, 1.10) and not having been convinced by peers not to take Covid-19 vaccine (adj. PR = 0.92; 95%CI: 0.85, 0.99) were associated with a 48%, 1% and 8% less likelihood of being vaccinated. A substantial gap in the knowledge and attitudes towards COVID-19 vaccines and vaccination, which was associated with the low vaccine. Sex, attitude, holding a leadership position, having convinced peers to receive the vaccine, having been convinced by peers to receive the vaccine and having been convinced by peers not to take COVID-19 vaccine were predicted COVID-19 vaccination status. This study recommends specific interventions targeting this high-risk group at the community level to address the gaps in knowledge and attitudes towards COVID-19 vaccines and the address negative peer influence inhibiting uptake.