Factors associated with uptake of the Ebola vaccine by frontline health workers during the 2019 vaccination campaign within at-risk districts in Uganda

Abstract

Introduction: The 10th Ebola Virus Disease (EVD) outbreak in the Democratic Republic of Congo (DRC) was declared on 1st Aug 2018. Close to a year later, on 11th June, 2019, Uganda detected an imported EVD case from the DRC. In response, a reactive EVD vaccination campaign was conducted among frontline health-workers (HWs) in EVD high risk districts of Uganda between November 2018 and October 2019. Administrative data indicates that only 27.6% of the targeted frontline HWs received the EVD vaccine. The reasons for this low-uptake are not known Objectives: To determine the proportion of targeted frontline Health Workers who received the Ebola vaccine, to determine the individual factors associated with receipt of the Ebola vaccine and to explore the health system factors that influenced the uptake of the Ebola vaccine among frontline health workers during the 2019 EBV vaccination campaign in high risk districts in Uganda. Methods: The study was conducted in 4 EVD high risk districts. A cross-sectional design was used. A random sample of 384 frontline HWs was surveyed. 6 key informants were interviewed about health system factors that affected EVD vaccination uptake. Proportions were calculated to describe respondent characteristics to answer objective one. For objective two and three logistic regression was conducted to determine the association between HW influences and EVD vaccination status. Audio recordings of the qualitative interviews which answer part of objective three were transcribed and analysed thematically. Qualitative data was presented using thematic summaries and representative quotes for each of the themes. Findings will be disseminated via academic papers, reports and conference presentations. Results: Of the 344 frontline health workers that were interviewed, 24.7%. (95% CI, 0.204 - 0.296) took up the vaccine. Working in Rubirizi district (OR 0.19, CI 0.48 -0.74) or Kasese (OR 3.5, CI 1.63 – 7.69), staying near a health centre, (OR 5.2, CI 1.06- 26) and living elsewhere (OR 0.5 CI 0.21 -1.01) were the individual factors significantly associated to uptake of the Ebola vaccine. The significant health system factors were full coverage of the target area, adequacy of the vaccinators and the scheduling of the vaccination campaign, availability of logistics and one on one sensitisation. Conclusion and recommendation: The uptake was of the Ebola was generally poor. The findings highlight the need to study in-depth the cause of persistent low vaccine uptake in Rubirizi district. They also bring out the need improve vaccine access during reactive vaccination campaigns.