Nair Shanal, Tshabalala Khanyisile, Slingers Nevilene, Vanleeuw Lieve, Basu Debashis, Abdullah Fareed
Steve Biko Academic Hospital, Pretoria 0001, South Africa.
Department of Public Health Medicine, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa.
Diseases. 2024 May 24;12(6):113. doi: 10.3390/diseases12060113.
As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic.
Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments.
To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital.
Mixed-methods study using quantitative and qualitative methods.
Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% ( = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters.
This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient-clinician engagement about the benefits of vaccination is essential to reach highly vulnerable populations routinely attending hospital outpatient departments with an appropriate vaccination program.
与之前的疫情波次相比，在第四波和第五波疫情期间死亡率显著下降，南非的专家和公众都提出了关于新冠疫苗接种未来作用的问题。将注意力从现在被认为感染重症新冠疾病风险非常低的普通公众身上转移开，一种普遍的观点是，疫苗接种运动应仅关注那些仍然极易因新冠疫情而患上重症疾病和死亡的人群。这一群体中最主要的是在医院门诊部就诊的常见慢性病患者。我们假设，在一家中心医院现场提供新冠疫苗接种服务，将提高在疫情的奥密克戎阶段最需要疫苗的合并慢性疾病患者的接种率。
评估为综合医院门诊部患者设立的医院疫苗接种点的可接受性、需求和接种率。
评估在一家中心医院就诊人群的疫苗接种率、覆盖率和犹豫程度，确定与疫苗接种率相关和影响疫苗接种率的因素，并记录疫苗接种项目在医院工作人员和就诊人员中的实施情况并评估其可接受性。
采用定量和定性方法的混合方法研究。
在纳入该研究的317名参与者中，229人（72%）已经接种了至少一剂新冠疫苗。根据南非卫生部的指导方针，共有296名参与者有资格接种第一剂疫苗、额外剂量疫苗或加强针疫苗。在那些之前接种过疫苗的人中，65%的人在提供额外剂量疫苗的当天（同一天）选择接种。只有13名之前未接种过疫苗的参与者（占未接种过疫苗参与者的15%）选择接种疫苗，使至少接种一剂疫苗的覆盖率从72%提高到76%。所有参与者中约24%（n = 75）拒绝接种疫苗（对疫苗犹豫不决）。对与疫苗接种状态相关的变量进行测试后发现，年龄具有统计学意义。定性分析中出现的新主题包括对易感性的认知、对疫苗安全性和有效性的担忧、关于疫苗接种的信息差距、接种疫苗决策中便利性所起的作用以及健康促进者的作用。
本研究表明，在一家大型医院为患有慢性疾病的门诊患者设立疫苗接种点在后勤方面是可行的。这项服务也使陪同人员和医院工作人员受益。疫苗接种点的可及性和便利性会影响决策，增加了接种疫苗的机会。然而，疫苗犹豫现象普遍存在，在所有提供了疫苗接种服务的人中，近四分之一的人仍未接种。加强关于疫苗接种益处的健康教育以及患者与临床医生的沟通，对于通过适当的疫苗接种计划使经常前往医院门诊部的高风险人群接种疫苗至关重要。
