Factors associated with COVID-19 vaccine uptake among people with type 2 diabetes in Kenya and Tanzania: A mixed-methods study

Binyaruka, P., Mtenga, S. M., Mashasi, I., Karugu, C. H., Mohamed, S. F., Asiki, G., Mair, F. S. and Gray, C. M. (2023) Factors associated with COVID-19 vaccine uptake among people with type 2 diabetes in Kenya and Tanzania: A mixed-methods study. BMJ Open, 13(12), e073668. (doi: 10.1136/bmjopen-2023-073668)

Abstract

Background People with type 2 diabetes (T2D) are at increased risk of poor outcomes from COVID-19. Vaccination can improve outcomes, but vaccine hesitancy remains a major challenge. We examined factors influencing COVID-19 vaccine uptake among people with T2D in two sub-Saharan Africa countries that adopted different national approaches to combat COVID-19, Kenya and Tanzania. Methods A mixed-methods study was conducted in February-March 2022, involving a survey of 1000 adults with T2D (500 Kenya; 500 Tanzania) and 51 in-depth interviews (21 Kenya; 30 Tanzania). Determinants of COVID-19 vaccine uptake were identified using a multivariate logistic regression model, while thematic content analysis explored barriers and facilitators. Results COVID-19 vaccine uptake was lower in Tanzania (26%) than in Kenya (75%), which may reflect an initial political hesitancy about vaccines in Tanzania. People with college/university education were four times more likely to be vaccinated than those with no education (Kenya AOR=4.25 (95% CI 1.00 to 18.03), Tanzania AOR=4.07 (1.03 to 16.12)); and people with health insurance were almost twice as likely to be vaccinated than those without health insurance (Kenya AOR=1.70 (1.07 to 2.70), Tanzania AOR=1.81 (1.04 to 3.13)). Vaccine uptake was higher in older people in Kenya, and among those with more comorbidities and higher socioeconomic status in Tanzania. Interviewees reported that wanting protection from severe illness promoted vaccine uptake, while conflicting information, misinformation and fear of side-effects limited uptake. Conclusion COVID-19 vaccine uptake among people with T2D was suboptimal, particularly in Tanzania, where initial political hesitancy had a negative impact. Policy-makers must develop strategies to reduce fear and misconceptions, especially among those who are less educated, uninsured and younger.

• Item Type: Articles
• Additional Information: Funding: Medical Research Council (MRC) and the National Institute for Health Research (NIHR) [MR/V035924/1].
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Gray, Professor Cindy and Mair, Professor Frances and Mtenga, Dr Sally
• Authors: Binyaruka, P., Mtenga, S. M., Mashasi, I., Karugu, C. H., Mohamed, S. F., Asiki, G., Mair, F. S., and Gray, C. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Social Scientists working in Health and Wellbeing; College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Copyright Holders: Copyright: © Author(s) (or their employer(s)) 2023
• First Published: First published in BMJ Open 13(12): e073668
• Publisher Policy: Reproduced under a Creative Commons licence