DOI: 10.5061/dryad.zcrjdfnms
title: Prevalence and individual level enablers and barriers for COVID-19 vaccine uptake among adult tuberculosis patients attending selected clinics in Nairobi County, Kenya

description: Although vaccination is a cost-effective, equitable, and impactful public
 health intervention in curbing the spread of infectious disease, low
 uptake is a significant concern, especially among high-risk population
 groups. Nearly half of the population is unvaccinated in Nairobi, yet
 there is a shortage of vaccination information on vulnerable tuberculosis
 (TB) patients. The interplay of factors influences uptake, and protecting
 this vulnerable group and the general population from severe disease,
 hospitalization, and deaths is worthy. The purpose of this study is to
 determine the prevalence and individual-level enablers and barriers to
 COVID-19 vaccine uptake among adult TB patients attending selected clinics
 in Nairobi County, Kenya. This cross-sectional mixed-method study was
 conducted at TB clinics across six sub-counties in Nairobi County. It
 included 388 participants sampled from each clinic’s TB register.
 Quantitative data was collected using a questionnaire, and qualitative
 data was collected through key informant interviews and focus group
 discussions. Quantitative data was analyzed using descriptive statistics
 (frequencies and percentages for categorical variables and mean standard
 deviation for continuous variables) and inferential statistics (logistic
 regression). Qualitative data was analyzed through deductive coding and
 thematic analysis. The prevalence of COVID-19 vaccination was 46.1%, with
 38.1% receiving complete vaccination. Mistrust in vaccine management
 (adjusted odds ratio (aOR)= 0.075, 95% confidence interval (CI):
 0.025-0.229, p &lt;0.001) was a significant barrier to COVID-19
 vaccine uptake. Perceived covid-19 susceptibility (aOR = 2.901, 95% CI:
 1.258-6.688, p = 0.012) and perceived covid-19 seriousness (aOR = 3.294,
 95% CI: 1.130-9.604, p = 0.029) were significant enablers of COVID-19
 vaccine uptake. Qualitative themes related to individual-level barriers
 and enablers of COVID-19 vaccine uptake were fear of side effects, stigma,
 myths, and mistrust in the messaging for barriers and desire to protect
 others and risk perception as enablers. The study revealed critical
 individual-level factors related to COVID-19 vaccine uptake.
description: Design and setting The study was an
 analytical cross-sectional study based on a mixed method (quantitative and
 qualitative) approach. Research assistants started with collecting
 quantitative data and later assisted investigators in conducting the
 interviews. The study was conducted at six sites in Nairobi County,
 Kenya.  Sample and sampling The
 study targeted adult TB patients receiving treatment between certain
 months in 2023, EPI logisticians, and TB coordinators. Those eligible
 consented participants were helped to fill out the electronic
 questionnaires and focus group discussions (FGD) with different
 participants later. The EPI logisticians and TB coordinators were the main
 targets for key informant interviews. The study excluded newly diagnosed
 TB patients or those initiated on TB treatment on the day of data
 collection, patients who refused or were unable to state their vaccination
 status, and patients who were too unwell to participate. The Cochran
 formula was used to calculate the sample size. Proportion sampling (PPS)
 was used to allocate proportions to health facilities in Nairobi County.
 Purposive sampling was employed to identify facilities with high TB
 patient numbers across the six sub-counties. Proportion sampling (PPS) was
 used to allocate proportions to each health facility. Simple random
 sampling was used to select participants for the FGDs, and purposive
 sampling for the Key Informant Interview (KII). Data
 collection tools A semi-structured electronic
 questionnaire was used to collect quantitative data. It had sections A
 (social demographic information and vaccination details) and B
 (individual-level factors and COVID-19 vaccine uptake). Pre-testing of the
 tool was done using 12 TB patients at [redacted] which assisted in the
 re-ordering of questions, replacement of ambiguous words, and kobo
 installations on research assistants' phones. This site had
 population characteristics similar to those of the study sites. A KII
 guide and an FGD guide were used to collect qualitative data. Both guides
 have open-ended questions focusing on themes related to the study
 objectives. Data collection Eight
 research assistants administered the semi-structured electronic
 questionnaire face-to-face with participants during their clinic visits.
 Two research assistants were allocated to [redacted] and [redacted]
 because of the number of participants, and one research assistant was
 assigned to the other four facilities. Participants provided informed
 consent before answering the questionnaire. Each research assistant had
 their smartphone with the questionnaire accessed via the Kobo collect
 application and responses were entered as provided by the participants.
 Six KIIs were conducted with managers and leaders in charge of the
 selected TB clinics, and six FGDs were held with adult TB patients from
 the six TB clinics. A series of open-ended questions guided the KIIs and
 FGDs. The interviews and FDGs took between 20-60 minutes and were
 audio-recorded. The verbatim recordings were manually transcribed and
 organized for a thematic analysis approach. The results of the interviews
 were triangulated with quantitative data.
description: # **Prevalence and individual level enablers and barriers for COVID-19
 vaccine uptake among adult tuberculosis patients attending selected
 clinics in Nairobi County, Kenya** ---
 [https://doi.org/10.5061/dryad.zcrjdfnms](https://doi.org/10.5061/dryad.zcrjdfnms) The main parts of the data * General information including Questionnaire number, date of interview, name of interviewer, facility name, sub-county name, facility level, and facility type * Socio-demographic factors like gender, employment status, and level of education * Vaccination detail (heard of vaccine, trusted source, tested for COVID-19, hospitalized and received any dose, how many doses, type of vaccine, and status of vaccination) * Individual-level factors and uptake of covid-19 vaccine (fear of side effects, risk perception, protection of others, etc.) * Health facility level factors and uptake of COVID-19 vaccination (supply chain, accessibility, way government handled control measures) | Data | | | | :-------------------------------------------------------------- | :- | :------------------- | | **Value** | | **Label** | | What\_is\_your\_gender | 1 | Female | | | 2 | Male | | What\_is\_your\_hig\_t\_level\_of\_education | 1 | No Formal | | | 2 | Primary | | | 3 | Secondary | | | 4 | Tertiary | | What\_is\_your\_employment\_st | 1 | Unemployed | | | 2 | Self-employed | | | 3 | Formal Employment | | Have\_you\_heard\_about\_Covid\_vaccination | 1 | No | | | 2 | Yes | | Ever\_been\_Diagnosed\_of\_Covid\_19\_disease | 1 | Yes | | | 2 | No | | Ever\_been\_Hospitalized\_for\_Covid\_19 | 1 | Yes | | | 2 | No | | What\_do\_you\_con\_9\_Vaccination\_status | 1 | Not Vaccinated | | | 2 | Partially Vaccinated | | | 3 | Fully Vaccinated | | QB1\_Extent\_of\_concern\_with\_side\_effects\_fears | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | QB2\_Extent\_myths\_have\_influence\_Vaccintion\_decision | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | QB3\_To\_what\_extent\_h\_on\_COVID\_19\_vaccine | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Vaccine\_Mistrust | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Worries\_over\_Unforeseen\_side\_effects | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Concerns\_about\_commercial\_profiteering\_of\_vaccines | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Preference\_for\_natural\_immunity | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Positive\_attitudes\_towards\_alternative\_medicine | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Mistrust\_in\_government\_management\_of\_COVID19 | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | QB5\_Opinion\_to\_protect\_others\_influence\_Vaccination | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Perceived\_susceptibility\_to\_infectious\_diseases | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Perceived\_seriousness\_of\_Covid19 | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Perceived\_likelihood\_of\_more\_COVID19\_waves | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Tested\_positive\_for\_COVID19 | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Someone\_close\_tested\_Positive\_for\_covid19 | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Feeling\_TB\_increase\_Covid19\_risks | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Variety\_of\_Vaccines\_available | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Preferred\_vaccine\_type | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Opening\_hours\_of\_Vaccination\_center | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | QC2\_Extent\_HCP\_Influeneced\_decision\_on\_COVID\_19\_vaccine | 1 | Always Referred | | | 2 | Decline Referral | | | 3 | Never Referred | | QC3\_Extent\_distance\_to\_vaccination | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Awaiting | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Requirements\_before\_registration | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Privacy\_and\_confidentiality | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Health\_talks\_before\_vaccination | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Post\_vaccination\_observations | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Reassurance\_of\_Vaccine\_importance | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Consistent\_andaccurate\_reporting\_of\_vaccine\_safety | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Emphasis\_on\_social\_benefits | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Communicating\_and\_education\_of\_public\_on\_Covid19 | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Mandatory\_prove\_of\_certifiacte\_at\_workORTravel | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Curfews\_and\_lockdown | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Closure\_of\_hotels\_and\_bars | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Isolation\_and\_quarantine | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | | Burials\_by\_government\_personnel | 1 | Not at All | | | 2 | Small Extent | | | 3 | Large Extent | Note that columns BB through BK (labeled \_id to \_index) are data from Kobocollects tools which indicate that information was submitted by various research assistants from different study sites and phones. * id and uiid- the specific number generated by Kobocollect for specific senders (research assistants) * submission time- time data submitted to Kobo collect * validation status- whether data was validated by the investigator * submitted by- a research assistant * version, tags, and index- information generated by Kobo collect tool per submission ## Sharing/Access information NA