COVID-19 Vaccine Acceptance and Hesitancy among Pregnant Women: A Knowledge, Attitude, and Perceived Risks Survey in Lusaka, Zambia — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
COVID-19 Vaccine Acceptance and Hesitancy among Pregnant Women: A Knowledge, Attitude, and Perceived Risks Survey in Lusaka, Zambia
Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
,
Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
,
Department of Agriculture, Technical Institute of Suwaria, Middle Technical University, Baghdad, Iraq
,
Medicines Management and Pharmacy Services, St. James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
1 Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
2 Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
3 Department of Agriculture, Technical Institute of Suwaria, Middle Technical University, Baghdad, Iraq
4 Medicines Management and Pharmacy Services, St. James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
<b>Introduction: </b>The coronavirus disease 2019 (COVID-19) is an infectious disease of the respiratory tract caused by SARS-CoV-2. Since its emergence, there have been increased rates of transmission and spread, morbidity and mortality which led to the development of COVID-19 vaccines to address the pandemic. This study assessed acceptance, knowledge, attitude, and perceived risks regarding COVID-19 vaccines among pregnant women attending antenatal care at two First-Level Hospitals in Lusaka, Zambia. <b>Materials and Methods: </b>This was a cross-sectional study that was conducted among 241 pregnant women using a questionnaire from August 2023 to October 2023 in two First-Level Hospitals in Lusaka district, Zambia. The collected data were analyzed using IBM Statistical Package for Social Sciences (SPSS) version 22.0. Statistical analysis was performed using a Chi-square test. The statistical significance was set at a 95% confidence level. <b>Results:</b> Of the 241 participants, 107 (42.7%) were aged between 24 and 34 years. Overall, 64.3% accepted the COVID-19 vaccines, of which 122 (50.6%) were already vaccinated. Further, 203 (84.6%) of the pregnant women had good knowledge, and 199 (82.6%) had positive attitudes towards COVID-19 vaccines. However, 58.5% thought COVID-19 vaccines were not safe and could cause infertility. Alongside this, 70.1% thought that COVID-19 vaccines were harmful during pregnancy. Having good knowledge of COVID-19 vaccines was associated with age (p = 0.049), education status (p = 0.001), and employment status (p = 0.001). Having a positive attitude towards COVID-19 vaccines was associated with education status (p = 0.001) and employment status (p = 0.001). <b>Conclusion: </b>This study found that most pregnant women had good knowledge, and positive attitudes, and the majority accepted the COVID-19 vaccine. Encouragingly, most of the pregnant women who accepted the COVID-19 vaccines were already vaccinated. Most pregnant women thought that COVID-19 vaccines had side effects, were not safe, and could be harmful during pregnancy. Consequently, this could have contributed to the hesitancy to receive a vaccine among some participants. The findings of this study demonstrate the need to provide pregnant women with continuous educational programs on the benefits of vaccinations for themselves and their children.
Asres, F. and Umeta, B. (2022) COVID-19 Vaccines: Awareness, Attitude and Acceptance among Undergraduate University Students. Journal of Pharmaceutical Policy and Practice , 15, Article No. 32. https://doi.org/10.1186/s40545-021-00397-6
Gwasupika, J., Daka, V., Chileshe, J., Mukosha, M., Mudenda, S., Mukanga, B., et al . (2023) COVID-19 Positive Cases among Asymptomatic Individuals during the Second Wave in Ndola, Zambia. African Journal of Laboratory Medicine , 12, A2119. https://doi.org/10.4102/ajlm.v12i1.2119
Chileshe, M., Mulenga, D., Mfune, R.L., Nyirenda, T.H., Mwanza, J., Mukanga, B., et al . (2020) Increased Number of Brought-in-Dead Cases with COVID-19, Is It Due to Poor Health-Seeking Behaviour among the Zambian Population? The Pan African Medical Journal , 37, Article No. 136. https://doi.org/10.11604/pamj.2020.37.136.25967
Mudenda, S. (2020) Letter to Editor: Coronavirus Disease (COVID-19): A Global Health Problem. International Journal of Pharmaceutics & Pharmacology , 4, Article No. 141. https://doi.org/10.31531/2581-3080.1000141
Kasanga, M., Mudenda, S., Gondwe, T., Chileshe, M., Solochi, B. and Wu, J. (2020) Impact of COVID-19 on Blood Donation and Transfusion Services at Lusaka Provincial Blood Transfusion Centre, Zambia. The Pan African Medical Journal , 35, Article No. 74. https://doi.org/10.11604/pamj.supp.2020.35.2.23975
Rothe, C., Schunk, M., Sothmann, P., Bretzel, G., Froeschl, G., Wallrauch, C., et al . (2020) Transmission of 2019-NCoV Infection from an Asymptomatic Contact in Germany. The New England Journal of Medicine , 382, 970-971. https://doi.org/10.1056/NEJMc2001468
Mudenda, S., Botha, M., Mukosha, M., Daka, V., Chileshe, M., Mwila, K., et al . (2022) Knowledge and Attitudes towards COVID-19 Prevention Measures among Residents of Lusaka District in Zambia. Aquademia , 6, ep22005. https://doi.org/10.21601/aquademia/12210
Güner, R., Hasanoğlu, İ. and Aktaş, F. (2020) Covid-19, Prevention and Control Measures in Community. Turkish Journal of Medical Sciences , 50, 571-577. https://doi.org/10.3906/sag-2004-146
Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S.C. and Di Napoli, R. (2020) Features, Evaluation and Treatment Coronavirus (COVID-19). StatPearls Publishing, Treasure Island. http://www.ncbi.nlm.nih.gov/pubmed/32150360
Phiri, N.M., Banda, M., Mudenda, S., Ngazimbi, M., Hangoma, J.M., Mufwambi, W., Mutati, R.K. and Muungo, L. (2020) Coronavirus Disease 2019 (COVID-19): The Role of Pharmacists in the Fight against COVID-19 Pandemic. International Journal of Pharmaceutics & Pharmacology , 4, Article No. 143. https://doi.org/10.31531/2581-3080.1000143
Zambia
Mudenda, S. (2021) The Second Wave of COVID-19 and Risk of the Third Wave: Factors Affecting the Continuous Transmission, Spread of, and Increased Mortality Associated with Coronavirus Disease 2019 (COVID-19). European Journal of E n vironment and Public Health , 5, em0081. https://doi.org/10.21601/ejeph/11056
Sohrabi, C., Alsafi, Z., O’Neill, N., Khan, M., Kerwan, A., Al-Jabir, A., et al . (2020) World Health Organization Declares Global Emergency: A Review of the 2019 Novel Coronavirus (COVID-19). International Journal of Surgery , 76, 71-76. https://doi.org/10.1016/j.ijsu.2020.02.034
Mudenda, S., Witika, B.A., Sadiq, M.J., Banda, M., Mfune, R.L., Daka, V., et al . (2020) Self-Medication and Its Consequences during & after the Coronavirus Disease 2019 (COVID-19) Pandemic: A Global Health Problem. European Journal of Environment and Public Health , 5, em0066. https://doi.org/10.29333/ejeph/9308
Mudenda, S., Chabalenge, B., Lindizyani Mfune, R., Nyoni, M., Mumba, A., Haanyanga, T., et al . (2023) Impact of COVID-19 on the Mental Health of Academic Staff: A Cross-Sectional Study at a Higher Education Institution in Lusaka, Zambia. Scholars Academic Journal of Pharmacy , 12, 307-314. https://doi.org/10.36347/sajp.2023.v12i12.008
Helle, K.B., Sadiku, A., Zelleke, G.M., Ibrahim, T.B., Bouba, A., Obama, H.C.T., et al . (2021) Is Increased Mortality by Multiple Exposures to COVID-19 an Overseen Factor When Aiming for Herd Immunity? PLOS ONE , 16, E0253758. https://doi.org/10.1371/journal.pone.0253758
Semenzato, L., Botton, J., Drouin, J., Cuenot, F., Dray-Spira, R., Weill, A., et al . (2021) Chronic Diseases, Health Conditions and Risk of COVID-19-Related Hospitalization and In-Hospital Mortality during the First Wave of the Epidemic in France: A Cohort Study of 66 Million People. The Lancet Regional Health — Europe , 8, Article ID: 100158. https://doi.org/10.1016/j.lanepe.2021.100158
Dagnino, P., Anguita, V., Escobar, K. and Cifuentes, S. (2020) Psychological Effects of Social Isolation Due to Quarantine in Chile: An Exploratory Study. Frontiers in Psychiatry , 11, Article ID: 591142. https://doi.org/10.3389/fpsyt.2020.591142
Irfan, M., Shahudin, F., Hooper, V.J., Akram, W. and Abdul Ghani, R.B. (2021) The Psychological Impact of Coronavirus on University Students and Its Socio-Economic Determinants in Malaysia. Inquiry , 58, 1-7. https://doi.org/10.1177/00469580211056217
Yoosefi Lebni, J., Abbas, J., Moradi, F., Salahshoor, M.R., Chaboksavar, F., Irandoost, S.F., et al . (2020) How the COVID-19 Pandemic Effected Economic, Social, Political, and Cultural Factors: A Lesson from Iran. International Journal of Social Psychiatry , 67, 298-300. https://doi.org/10.1177/0020764020939984
Evans, O. (2020) Socio-Economic Impacts of Novel Coronavirus: The Policy Solutions. BizEcons Quarterly , 7, 3-12. https://ideas.repec.org/a/ris/buecqu/0013.html
Ndofirepi, A. and Hungwe, J.P. (2022) A Crisis like No Other: Disruptions of the Covid-19 Pandemic in the Neoliberal African Higher Education Era. South African Journal of Higher Education , 36, 85-100. https://doi.org/10.20853/36-4-5200
Mudenda, S., Chabalenge, B., Matafwali, S., Daka, V., Chileshe, M., Mufwambi, W., et al . (2022) Psychological Impact of COVID-19 on Healthcare Workers in Africa, Associated Factors and Coping Mechanisms: A Systematic Review. Advances in I n fectious Diseases , 12, 518-532. https://doi.org/10.4236/aid.2022.123038
Mudenda, S., Chomba, M., Mukosha, M., Daka, V., Chileshe, M., Okoro, R.N., et al . (2022) Psychological Impact of Coronavirus Disease (COVID-19) on Health Professions Students at the University of Zambia: A Cross-Sectional Study. The Pan African Medical Journal , 42, Article No. 237.
Mudenda, S., Chileshe, M., Mukosha, M., Hikaambo, C.N., Banda, M., Kampamba, M., et al . (2022) Zambia’s Response to the COVID-19 Pandemic: Exploring Lessons, Challenges and Implications for Future Policies and Strategies. Pharmacology & Pharmacy , 13, 11-33. https://doi.org/10.4236/pp.2022.131002
Lahiri, A., Jha, S.S., Bhattacharya, S., Ray, S. and Chakraborty, A. (2020) Effectiveness of Preventive Measures against COVID-19, a Systematic Review of in Silico Modeling Studies in Indian Context. Indian Journal of Public Health , 64, S156-S167. https://doi.org/10.4103/ijph.IJPH_464_20
Rodrigues, C.M.C. and Plotkin, S.A. (2020) Impact of Vaccines; Health, Economic and Social Perspectives. Frontiers in Microbiology , 11, Article No. 1526. https://doi.org/10.3389/fmicb.2020.01526
Piret, J. and Boivin, G. (2021) Pandemics throughout History. Frontiers in Microb i ology , 11, Article ID: 631736. https://doi.org/10.3389/fmicb.2020.631736
Yang, Y., Peng, F., Wang, R., Yange, M., Guan, K., Jiang, T., et al . (2020) The Deadly Coronaviruses: The 2003 SARS Pandemic and the 2020 Novel Coronavirus Epidemic in China. Journal of Autoimmunity , 109, Article ID: 102434. https://doi.org/10.1016/j.jaut.2020.102434
Korang, S.K., Von Rohden, E., Veroniki, A.A., Ong, G., Ngalamika, O., Siddiqui, F., et al . (2022) Vaccines to Prevent COVID-19, a Living Systematic Review with Trial Sequential Analysis and Network Meta-Analysis of Randomized Clinical Trials. PLOS ONE , 17, e0260733. https://doi.org/10.1371/journal.pone.0260733
Taye, E.B., Taye, Z.W., Muche, H.A., Tsega, N.T., Haile, T.T. and Tiguh, A.E. (2022) COVID-19 Vaccine Acceptance and Associated Factors among Women Attending Antenatal and Postnatal Cares in Central Gondar Zone Public Hospitals, Northwest Ethiopia. Clinical Epidemiology and Global Health , 14, Article ID: 100993. https://doi.org/10.1016/j.cegh.2022.100993
Chanda, D., Hines, J.Z., Itoh, M., Fwoloshi, S., Minchella, P.A., Zyambo, K.D., et al . (2022) COVID-19 Vaccine Effectiveness against Progression to In-Hospital Mortality in Zambia, 2021-2022. Open Forum Infectious Diseases , 9, Ofac469. https://doi.org/10.1093/ofid/ofac469
Suthar, A.B., Wang, J., Seffren, V., Wiegand, R.E., Griffing, S. and Zell, E. (2022) Public Health Impact of Covid-19 Vaccines in the US: Observational Study. BMJ , 377, e069317. https://doi.org/10.1136/bmj-2021-069317
Di Lego, V., Sánchez-Romero, M. and Prskawetz, A. (2022) The Impact of COVID-19 Vaccines on the Case Fatality Rate: The Importance of Monitoring Breakthrough Infections. International Journal of Infectious Diseases , 119, 178-183. https://doi.org/10.1016/j.ijid.2022.03.059
Ikeokwu, A.E., Lawrence, R., Osieme, E.D., Gidado, K.M., Guy, C. and Dolapo, O. (2023) Unveiling the Impact of COVID-19 Vaccines: A Meta-Analysis of Survival Rates among Patients in the United States Based on Vaccination Status. Cureus , 15, E43282. https://doi.org/10.7759/cureus.43282
Rahmani, K., Shavaleh, R., Forouhi, M., Disfani, H.F., Kamandi, M., Oskooi, R.K., et al . (2022) The Effectiveness of COVID-19 Vaccines in Reducing the Incidence, Hospitalization, and Mortality from COVID-19, a Systematic Review and Meta-Analysis. Frontiers in Public Health , 10, Article ID: 873596. https://doi.org/10.3389/fpubh.2022.873596
Munro, A.P.S., Jones, C.E. and Faust, S.N. (2024) Vaccination against COVID-19—Risks and Benefits in Children. European Journal of Pediatrics , 183, 1107-1112. https://doi.org/10.1007/s00431-023-05380-8
Lurie, N., Saville, M., Hatchett, R. and Halton, J. (2020) Developing Covid-19 Vaccines at Pandemic Speed. The New England Journal of Medicine , 382, 1969-1973. https://doi.org/10.1056/NEJMp2005630
Kim, J.H., Marks, F. and Clemens, J.D. (2021) Looking beyond COVID-19 Vaccine Phase 3 Trials. Nature Medicine , 27, 205-211. https://doi.org/10.1038/s41591-021-01230-y
Omer, S.B., Yildirim, I. and Forman, H.P. (2020) Herd Immunity and Implications for SARS-CoV-2 Control. JAMA : Journal of the American Medical Association , 324, 2095-2096. https://doi.org/10.1001/jama.2020.20892
Kwok, K.O., Lai, F., Wei, W.I., Wong, S.Y.S. and Tang, J.W.T. (2020) Herd Immunity—Estimating the Level Required to Halt the COVID-19 Epidemics in Affected Countries. Journal of Infection , 80, E32-E33. https://doi.org/10.1016/j.jinf.2020.03.027
Suryawanshi, Y.N. and Biswas, D.A. (2023) Herd Immunity to Fight against COVID-19: A Narrative Review. Cureus , 15, E33575. https://doi.org/10.7759/cureus.33575
Samannodi, M. (2021) COVID-19 Vaccine Acceptability among Women Who Are Pregnant or Planning for Pregnancy in Saudi Arabia: A Cross-Sectional Study. P a tient Preference and Adherence , 15, 2609-2618. https://doi.org/10.2147/PPA.S338932
Pairat, K. and Phaloprakarn, C. (2022) Acceptance of COVID-19 Vaccination during Pregnancy among Thai Pregnant Women and Their Spouses: A Prospective Survey. Reproductive Health , 19, Article No. 74. https://doi.org/10.1186/s12978-022-01383-0
Sculli, M.A., Formoso, G. and Sciacca, L. (2021) COVID-19 Vaccination in Pregnant and Lactating Diabetic Women. Nutrition , Metabolism and Cardiovascular Diseases , 31, 2151-2155. https://doi.org/10.1016/j.numecd.2021.04.012
Riley, L.E. and Jamieson, D.J. (2021) Inclusion of Pregnant and Lactating Persons in COVID-19 Vaccination Efforts. Annals of Internal Medicine , 174, 701-702. https://doi.org/10.7326/M21-0173
Piekos, S.N., Hwang, Y.M., Roper, R.T., Sorensen, T., Price, N.D., Hood, L., et al . (2023) Effect of COVID-19 Vaccination and Booster on Maternal-Fetal Outcomes: A Retrospective Cohort Study. The Lancet Digital Health , 5, E594-E606. https://doi.org/10.1016/S2589-7500(23)00093-6
Ciapponi, A., Berrueta, M.P.K., Parker, E., Bardach, A., Mazzoni, A., Anderson, S.A., et al . (2023) Safety of COVID-19 Vaccines during Pregnancy: A Systematic Review and Meta-Analysis. Vaccine , 41, 3688-3700. https://doi.org/10.1016/j.vaccine.2023.03.038
Chekol Abebe, E., Ayalew Tiruneh, G., Asmare Adela, G., Mengie Ayele, T., Tilahun Muche, Z., Behaile, T., Mariam, A., et al . (2022) COVID-19 Vaccine Uptake and Associated Factors among Pregnant Women Attending Antenatal Care in Debre Tabor Public Health Institutions: A Cross-Sectional Study. Frontiers in Public Health , 10, Article ID: 919494. https://doi.org/10.3389/fpubh.2022.919494
Sallam, M., Dababseh, D., Eid, H., Hasan, H., Taim, D., Al-Mahzoum, K., et al . (2021) Low COVID-19 Vaccine Acceptance Is Correlated with Conspiracy Beliefs among University Students in Jordan. International Journal of Environmental R e search and Public Health , 18, Article No. 2407. https://doi.org/10.3390/ijerph18052407
Babatope, T., Ilyenkova, V. and Marais, D. (2023) COVID-19 Vaccine Hesitancy: A Systematic Review of Barriers to the Uptake of COVID-19 Vaccine among Adults in Nigeria. Bulletin of the National Research Centre , 47, Article No. 45. https://doi.org/10.1186/s42269-023-01017-w
Ackah, B.B.B., Woo, M., Fazal, Z.A., Stallwood, L., Okpani, A. and Adu, P.A. (2022) COVID-19 Vaccine Hesitancy in Africa: A Scoping Review. Global Health Research and Policy , 7, Article No. 21. https://doi.org/10.1186/s41256-022-00255-1
Yasmin, F., Najeeb, H., Moeed, A., Naeem, U., Asghar, M.S., Chughtai, N.U., et al . (2021) COVID-19 Vaccine Hesitancy in the United States: A Systematic Review. Frontiers in Public Health , 9, Article ID: 770985. https://doi.org/10.3389/fpubh.2021.770985
Alemu, D., Diribsa, T. and Debelew, G.T. (2023) COVID-19 Vaccine Hesitancy and Its Associated Factors among Adolescents. Patient Preference and Adherence , 17, 1271-1280. https://doi.org/10.2147/PPA.S400972
Fridman, A., Gershon, R. and Gneezy, A. (2021) COVID-19 and Vaccine Hesitancy: A Longitudinal Study. PLOS ONE , 16, e0250123. https://doi.org/10.1371/journal.pone.0250123
Magadmi, R.M. and Kamel, F.O. (2021) Beliefs and Barriers Associated with COVID-19 Vaccination among the General Population in Saudi Arabia. BMC Pu b lic Health , 21, Article No. 1438. https://doi.org/10.1186/s12889-021-11501-5
Kumari, A., Mahey, R., Kachhawa, G., Kumari, R. and Bhatla, N. (2022) Knowledge, Attitude, Perceptions, and Concerns of Pregnant and Lactating Women Regarding COVID-19 Vaccination: A Cross-Sectional Survey of 313 Participants from a Tertiary Care Centre of North India. Diabetology Metabolic Syndrome , 16, Article ID: 102449. https://doi.org/10.1016/j.dsx.2022.102449
Sutton, D., D’Alton, M., Zhang, Y., Kahe, K., Cepin, A., Goffman, D., et al . (2021) COVID-19 Vaccine Acceptance among Pregnant, Breastfeeding, and Nonpregnant Reproductive-Aged Women. American Journal of Obstetrics & Gynecology MFM , 3, Article ID: 100403. https://doi.org/10.1016/j.ajogmf.2021.100403
Goncu Ayhan, S., Oluklu, D., Atalay, A., Menekse Beser, D., Tanacan, A., Moraloglu Tekin, O., et al . (2021) COVID-19 Vaccine Acceptance in Pregnant Women. Inte r national Journal of Gynecology & Obstetrics , 154, 291-296. https://doi.org/10.1002/ijgo.13713
Skjefte, M., Ngirbabul, M., Akeju, O., Escudero, D., Hernandez-Diaz, S., Wyszynski, D.F., et al . (2021) COVID-19 Vaccine Acceptance among Pregnant Women and Mothers of Young Children: Results of a Survey in 16 Countries. European Journal of Epidemiology , 36, 197-211. https://doi.org/10.1007/s10654-021-00728-6
Mitchell, S.L., Schulkin, J. and Power, M.L. (2023) Vaccine Hesitancy in Pregnant Women: A Narrative Review. Vaccine , 41, 4220-4227. https://doi.org/10.1016/j.vaccine.2023.05.047
Dinga, J.N., Sinda, L.K. and Titanji, V.P.K. (2021) Assessment of Vaccine Hesitancy to a COVID-19 Vaccine in Cameroonian Adults and Its Global Implication. Va c cines , 9, Article No. 175. https://doi.org/10.3390/vaccines9020175
Gunawardhana, N., Baecher, K., Boutwell, A., Pekwarake, S., Kifem, M., Ngong, M.G., et al . (2022) COVID-19 Vaccine Acceptance and Perceived Risk among Pregnant and Non-Pregnant Adults in Cameroon, Africa. PLOS ONE , 17, E0274541. https://doi.org/10.1371/journal.pone.0274541
Orangi, S., Pinchoff, J., Mwanga, D., Abuya, T., Hamaluba, M., Warimwe, G., et al . (2021) Assessing the Level and Determinants of COVID-19 Vaccine Confidence in Kenya. V accines , 9, Article No. 936. https://doi.org/10.3390/vaccines9080936
Licata, F., Pelullo, C.P., Della Polla, G., Citrino, E.A. and Bianco, A. (2023) Immunization during Pregnancy: Do Healthcare Workers Recommend Vaccination against Influenza? Frontiers in Public Health , 11, Article ID: 1171142. https://doi.org/10.3389/fpubh.2023.1171142
Triunfo, S., Perossini, S., Burdin, E., De Angeli, E.C., Francesi, M., Garolfi, A., et al . (2023) Increasing Vaccine Uptake during Pregnancy by Using Prenatal Education Classes: An Effective Tool for Health Communication and Promotion. Children , 10, Article No. 1466. https://doi.org/10.3390/children10091466
Razai, M.S., Mansour, R., Goldsmith, L., Freeman, S., Mason-Apps, C., Ravindran, P., et al . (2023) Interventions to Increase Vaccination against COVID-19, Influenza and Pertussis during Pregnancy: A Systematic Review and Meta-Analysis. Journal of Travel Medicine , 30, Taad138. https://doi.org/10.3390/children10091466
Mudenda, S., Mukosha, M., Godman, B., Fadare, J.O., Ogunleye, O.O., Meyer, J.C., et al . (2022) Knowledge, Attitudes, and Acceptance of COVID-19 Vaccines among Secondary School Pupils in Zambia: Implications for Future Educational and Sensitisation Programmes. Vaccines , 10, Article No. 2141. https://doi.org/10.3390/vaccines10122141
Mudenda, S., Daka, V., Matafwali, S.K., Skosana, P., Chabalenge, B., Mukosha, M., et al . (2023) COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers in Lusaka, Zambia; Findings and Implications for the Future. Vaccines , 11, Article No. 1350. https://doi.org/10.3390/vaccines11081350
Mudenda, S., Meyer, J.C., Fadare, J.O., Ogunleye, O.O., Saleem, Z., Matafwali, S.K., et al . (2023) COVID-19 Vaccine Uptake and Associated Factors among Adolescents and Youths: Findings and Implications for Future Vaccination Programmes. PLOS Global Public Health , 3, e0002385. https://doi.org/10.1371/journal.pgph.0002385
Mudenda, S., Hikaambo, C.N., Daka, V., Chileshe, M., Mfune, R.L., Kampamba, M., et al . (2022) Prevalence and Factors Associated with COVID-19 Vaccine Acceptance in Zambia: A Web-Based Cross-Sectional Study. PAMJ , 41, Article No. 112. https://doi.org/10.11604/pamj.2022.41.112.31219
Mudenda, S., Mukosha, M., Nang’Andu, C., Meyer, C.J., Fadare, J., Kampamba, M., et al . (2022) Awareness and Acceptance of COVID-19 Vaccines and Associated Factors among Pharmacy Students in Zambia. Malawi Medical Journal , 34, 273-280. https://doi.org/10.4314/mmj.v34i4.8
Mudenda, S., Moonga, B., Kasanga, M., Daka, V., Muzondo, N.V., Mfune, R.L., et al . (2024) COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers at a Teaching Hospital in Zambia: Findings and Implications. SSRN Electronic Journal . https://doi.org/10.2139/ssrn.4736905
Charan, J. and Biswas, T. (2013) How to Calculate Sample Size for Different Study Designs in Medical Research? Indian Journal of Psychological Medicine , 35, 121-126. https://doi.org/10.4103/0253-7176.116232
Khan, S., Sohan, K., Mohammed, Z.C.M. and Bachan, V. (2023) COVID-19 Vaccine Uptake, Acceptance, and Reasons for Vaccine Hesitancy: A Cross-Sectional Study among Pregnant Women in Trinidad, West Indies. International Journal of Wo m en ’ s Health , 15, 343-354. https://doi.org/10.2147/IJWH.S396884
Miraglia Del Giudice, G., Della Polla, G., Folcarelli, L., Napoli, A., Punzo, R., Peracchini, M., et al . (2023) Midwives’ Knowledge, Attitudes, and Practice Regarding COVID-19 Vaccination for Pregnant Women: A Nationwide Web-Based Survey in Italy. Vaccines , 11, Article No. 222. https://doi.org/10.3390/vaccines11020222
Ashour, H.A., Alhinti, S.F., Hawsaoi, S.A., Alsuwailem, A.A., AlFarhan, A. and Abdulmajeed, I. (2023) Knowledge, Attitude, and Practice (KAP) of COVID-19 Vaccine among Saudi Mothers. Cureus , 15, E36826. https://doi.org/10.7759/cureus.36826
Tefera, Z. and Assefaw, M. (2022) A Mixed-Methods Study of COVID-19 Vaccine Acceptance and Its Determinants among Pregnant Women in Northeast Ethiopia. Patient Preference and Adherence , 16, 2287-2299. https://doi.org/10.2147/PPA.S374217
Mudenda, S., Tembo, G., Lindizyani Mfune, R., Banda, P., Kasanga, M., Phiri, M., et al . (2024) Knowledge, Attitude, Acceptance, and Perceived Risks of COVID-19 Vaccines among Pregnant Women: Findings and Implications. Scholars Academic Journal of Pharmacy , 10, 9-19. https://doi.org/10.36347/sasjm.2024.v10i01.002
Rikard-Bell, M., Elhindi, J., Lam, J., Seeho, S., Black, K., Melov, S., et al . (2023) COVID-19 Vaccine Acceptance among Pregnant Women and the Reasons for Hesitancy: A Multi-Centre Cross-Sectional Survey. Australian and New Zealand Jou r nal of Obstetrics and Gynaecology , 63, 335-343. https://doi.org/10.1111/ajo.13622
Getachew, T., Balis, B., Eyeberu, A., Debella, A., Nigussie, S., Habte, S., et al . (2022) COVID-19 Vaccine Acceptance among Pregnant Women Attending Antenatal Care in Public Hospitals in Eastern Ethiopia: A Multi-Center Facility-Based Cross-Sectional Study. Public Health in Practice , 4, Article ID: 100338. https://doi.org/10.1016/j.puhip.2022.100338
Hoque, A.M., Buckus, S., Hoque, M., Hoque, M.E. and Van Hal, G. (2020) COVID-19 Vaccine Acceptability among Pregnant Women at a Primary Health Care Facility in Durban, South Africa. European Journal of Medical and Health Sciences , 2, 1-6. https://doi.org/10.24018/ejmed.2020.2.5.493
Ghamri, R.A., Othman, S.S., Alhiniah, M.H., Alelyani, R.H., Badawi, A.M. and Alshahrani, A.A. (2022) Acceptance of COVID-19 Vaccine and Associated Factors among Pregnant Women in Saudi Arabia. Patient Preference and Adherence , 16, 861-873. https://doi.org/10.2147/PPA.S357653
Mose, A. and Yeshaneh, A. (2021) COVID-19 Vaccine Acceptance and Its Associated Factors among Pregnant Women Attending Antenatal Care Clinic in Southwest Ethiopia: Institutional-Based Cross-Sectional Study. International Journal of General Medicine , 14, 2385-2395. https://doi.org/10.2147/IJGM.S314346
Tao, L., Wang, R., Han, N., Liu, J., Yuan, C., Deng, L., et al . (2021) Acceptance of a COVID-19 Vaccine and Associated Factors among Pregnant Women in China: A Multi-Center Cross-Sectional Study Based on Health Belief Model. Human Va c cines & Immunotherapeutics , 17, 2378-2388. https://doi.org/10.1080/21645515.2021.1892432
Colciago, E., Capitoli, G., Vergani, P. and Ornaghi, S. (2023) Women’s Attitude towards COVID-19 Vaccination in Pregnancy: A Survey Study in Northern Italy. I n ternational Journal of Gynecology & Obstetrics , 162, 139-146. https://doi.org/10.1002/ijgo.14506
Nikpour, M., Sepidarkish, M., Omidvar, S. and Firouzbakht, M. (2022) Global Prevalence of Acceptance of COVID-19 Vaccines and Associated Factors in Pregnant Women: A Systematic Review and Meta-Analysis. Expert Review of Vaccines , 21, 843-851. https://doi.org/10.1080/14760584.2022.2053677
Naqvi, S., Saleem, S., Naqvi, F., Billah, S.M., Nielsen, E., Fogleman, E., et al . (2022) Knowledge, Attitudes, and Practices of Pregnant Women Regarding COVID-19 Vaccination in Pregnancy in 7 Low-and Middle-Income Countries: An Observational Trial from the Global Network for Women and Children’s Health Research. BJOG , 129, 2002-2009. https://doi.org/10.1111/1471-0528.17226
Reifferscheid, L., Marfo, E., Assi, A., Dubé, E., MacDonald, N.E., Meyer, S.B., et al . (2022) COVID-19 Vaccine Uptake and Intention during Pregnancy in Canada. C a nadian Journal of Public Health , 113, 547-558. https://doi.org/10.17269/s41997-022-00641-9
Skirrow, H., Barnett, S., Bell, S., Riaposova, L., Mounier-Jack, S., Kampmann, B., et al . (2022) Women’s Views on Accepting COVID-19 Vaccination during and after Pregnancy, and for Their Babies: A Multi-Methods Study in the UK. BMC Pre g nancy Childbirth , 22, Article No. 33. https://doi.org/10.1186/s12884-021-04321-3
Mhereeg, M., Jones, H., Kennedy, J., Seaborne, M., Parker, M., Kennedy, N., et al . (2022) COVID-19 Vaccination in Pregnancy: Views and Vaccination Uptake Rates in Pregnancy: A Mixed Methods Analysis from SAIL and the Born-in-Wales Birth Cohort. BMC Infectious Diseases , 22, Article No. 932. https://doi.org/10.1186/s12879-022-07856-8
Hosokawa, Y., Okawa, S., Hori, A., Morisaki, N., Takahashi, Y., Fujiwara, T., et al . (2022) The Prevalence of COVID-19 Vaccination and Vaccine Hesitancy in Pregnant Women: An Internet-Based Cross-Sectional Study in Japan. Journal of Epid e miology , 32, 188-194. https://doi.org/10.2188/jea.JE20210458
Oluklu, D., Goncu Ayhan, S., Menekse Beser, D., Uyan Hendem, D., Ozden Tokalioglu, E., Turgut, E., et al . (2021) Factors Affecting the Acceptability of COVID-19 Vaccine in the Postpartum Period. Human Vaccines & Immunotherapeutics , 17, 4043-4047. https://doi.org/10.1080/21645515.2021.1972710
Kalpana, M.M., Sreenivas, S., Santhosh, S. and Sabeena, S. (2022) Knowledge, Attitude, and Practice Regarding Health Effects of COVID-19 Pandemic and Preventive Measures Including Vaccination among Pregnant Women from South India. Jou r nal of South Asian Federation of Obstetrics and Gynaecology , 14, 568-573. https://doi.org/10.5005/jp-journals-10006-2112
Alhamdi, J.A., Aljohani, W.N., Aljohani, L.Y., Saeed, A., Alsaiari, S., Jahdali, E., et al . (2021) COVID-19 Vaccines: Knowledge and Attitudes of Unvaccinated Pregnant Women in Saudi Arabia. International Journal of Medicine in Developing Cou n tries , 5, 2115-2122. https://doi.org/10.24911/IJMDC.51-1634320603
Risqi Dewi Aisyah, F. (2022) Factors Related to the Attitude of Pregnant Women in Covid 19 Vaccination. STRADA Jurnal Ilmiah Kesehatan , 11, 146-152. https://doi.org/10.30994/sjik.v11i2.892
Mekuriaw, B.Y., Nigatu, D., Dessie, A.M. and Asresie, M.B. (2023) Intention to Take COVID-19 Vaccine and Associated Factors among Pregnant Women Attending Antenatal Care at Public Health Facilities in Bahir Dar City, Northwest Ethiopia. BMC Women ’ s Health , 23, Article No. 175. https://doi.org/10.1186/s12905-023-02331-1
Chaubey, I., Vijay, H., Govindaraj, S., Babu, H., Cheedarla, N., Shankar, E.M., et al . (2023) Impact of COVID-19 Vaccination on Pregnant Women. Pathogens , 12, Article No. 431. https://doi.org/10.3390/pathogens12030431
Li, Y.Y., Lok, W.Y., Poon, L.C., Kong, C.W. and To, W.W.K. (2023) Cross-Sectional Survey of Views on COVID-19 and Its Vaccines among Pregnant Women. Mate r nal - Fetal Medicine , 5, 80-87. https://doi.org/10.1097/FM9.0000000000000149
Marbán-Castro, E., Nedic, I., Ferrari, M., Crespo-Mirasol, E., Ferrer, L., Noya, B., et al . (2022) Perceptions of COVID-19 Maternal Vaccination among Pregnant Women and Healthcare Workers and Factors That Influence Vaccine Acceptance: A Cross-Sectional Study in Barcelona, Spain. Vaccines , 10, Article No. 1930. https://doi.org/10.3390/vaccines10111930
Uludağ, E., Serçekuş, P., Yıldırım, D.F. and Özkan, S. (2022) A Qualitative Study of Pregnant Women’s Opinions on COVID-19 Vaccines in Turkey. Midwifery , 114, Article ID: 103459. https://doi.org/10.1016/j.midw.2022.103459
Egloff, C., Couffignal, C., Cordier, A.G., Deruelle, P., Sibiude, J., Anselem, O., et al . (2022) Pregnant Women’s Perceptions of the COVID-19 Vaccine: A French Survey. PLOS ONE , 17, E0263512. https://doi.org/10.1371/journal.pone.0263512
Gianfredi, V., Berti, A., Stefanizzi, P., D’Amico, M., De Lorenzo, V., Moscara, L., et al . (2023) COVID-19 Vaccine Knowledge, Attitude, Acceptance and Hesitancy among Pregnancy and Breastfeeding: Systematic Review of Hospital-Based Studies. Vaccines , 11, Article No. 1697. https://doi.org/10.3390/vaccines11111697
Dhakal, R., Shapkota, S., Shrestha, P., Adhikari, P. and Nepal, S. (2023) Pregnant Women’s Awareness, Perception, and Acceptability of COVID-19 Vaccine Attending Antenatal Clinics in Bharatpur, Nepal. PLOS ONE , 18, E0278694. https://doi.org/10.1371/journal.pone.0278694
Simsekoglu, N., Akyuz, E., Guven, R. and Pasin, O. (2024) Attitudes toward COVID-19 Vaccines during Pregnancy and Breastfeeding. Frontiers in Public Health , 12, Article ID: 1286891. https://doi.org/10.3389/fpubh.2024.1286891
Shree, P., Verma, V., Patel, N., Gupta, R. and Yadav, K. (2024) Awareness and Safety of COVID-19 Vaccination in Pregnancy. The Journal of Obstetrics and Gyneco l ogy of India . https://doi.org/10.1007/s13224-023-01918-w
Omer, S.B., Benjamin, R.M., Brewer, N.T., Buttenheim, A.M., Callaghan, T., Caplan, A., et al . (2021) Promoting COVID-19 Vaccine Acceptance: Recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA. The Lancet , 398, 2186-2192. https://doi.org/10.1016/S0140-6736(21)02507-1
Aberese-Ako, M., Ebelin, W., Doegah, P.T., Kuatewo, M., Kpodo, L., Kpordorlor, A.G., et al . (2023) Promoting COVID-19 Vaccine Acceptance through Community Engagement: An Ethnographic Study in Ghana. Advances in Public Health , 2023, Article ID: 3626862. https://doi.org/10.1155/2023/3626862
Bardus, M., Assaf, S.A. and Sakr, C.J. (2023) Using Social Marketing to Promote COVID-19 Vaccination Uptake: A Case Study from the “AUBe Vaccinated” Campaign. Vaccines , 11, Article No. 459. https://doi.org/10.3390/vaccines11020459
Motta, M., Sylvester, S., Callaghan, T. and Lunz-Trujillo, K. (2021) Encouraging COVID-19 Vaccine Uptake through Effective Health Communication. Frontiers in Political Science , 3, Article ID: 630133. https://doi.org/10.3389/fpos.2021.630133