Hussein Mohamed F, Ibrahim Sarah A, Abdel-Rahman Suzan, Elshabrawy Abdelhamid, Nasr Haqema A A, Yazbek Saja, Jabbar Abdul, Albadri Cinaria T, Alsanafi Mariam, Aji Narjiss, Youssef Naglaa, Hammad Hammad M, Abdullah Fatimah S A, Elrewany Ehab, Tahoun Mohamed M, Tolba Mahmoud, Abo Salama Mohamed K, Ghazy Ramy M
Occupational Health and Industrial Medicine Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
Biostatistics and Demography Department, Faculty of Graduate Studies for Statistical Research, Cairo University, Cairo, Egypt.
J Egypt Public Health Assoc. 2024 Dec 4;99(1):31. doi: 10.1186/s42506-024-00175-7.
The World Health Organization (WHO) stresses the importance of worldwide vaccine coverage of coronavirus-19 (COVID-19) vaccination. This study fills a critical gap in the literature by providing empirical evidence on the factors influencing COVID-19 vaccine hesitancy and inequity in the Middle East and North Africa (MENA) region. This study investigated the determinants of psychological antecedents and other factors behind COVID-19 vaccination and their role in vaccine coverage in MENA.
An anonymous online cross-sectional survey was conducted in 11 MENA countries (Egypt, Sudan, Kuwait, Saudi Arabia, Morocco, Iraq, Yemen, Lebanon, Libya, Afghanistan, and Pakistan). The minimum required sample size from each country was 307, which was increased to 330 to accommodate a non-response rate of 7%. A multilevel logistic regression model was used to capture the clustering of observations in each country and estimate the explanatory variables' effects on each item of the 5C components of the psychological antecedents scale namely (confidence, constraints, complacency, calculation, and collective responsibility).
The total number of respondents was 3630, 40.5% of them were between the ages of 18 and 25 years, 61.1% were females, 54.0% completed university education, 55.8% were unmarried, 19.5% had chronic diseases, 43.7% reported a previous COVID-19 and 42.4% had relatives who died from COVID-19. Much of the variation in the log of the odds in each item of the 5Cs was due to heterogeneity between different countries (intraclass correlation > 0.05). Therefore, this variability confirms the various effects of psychological antecedents on vaccination coverage, stimulating vaccination inequity among them. Increasing confidence in vaccines and collective responsibility towards relatives and the community is related to increasing acceptance of the COVID-19 vaccine. The reduction in complacency, calculations, and constraints was found to be associated with acceptance of the COVID-19 vaccine.
This study is novel in shedding light on the importance of psychological determinants as hidden causes of vaccine inequities by using a multilevel logistic regression model for COVID-19 vaccination intention. The findings suggest that targeted interventions addressing socio-demographic factors, psychological antecedents, and accessibility barriers are essential to mitigate vaccine inequity and improve vaccination rates.
世界卫生组织（WHO）强调全球新冠病毒 19（COVID - 19）疫苗接种覆盖率的重要性。本研究通过提供关于影响中东和北非（MENA）地区 COVID - 19 疫苗犹豫和不平等因素的实证证据，填补了文献中的一个关键空白。本研究调查了 COVID - 19 疫苗接种背后心理前因和其他因素的决定因素及其在 MENA 地区疫苗接种覆盖率中的作用。
在 11 个 MENA 国家（埃及、苏丹、科威特、沙特阿拉伯、摩洛哥、伊拉克、也门、黎巴嫩、利比亚、阿富汗和巴基斯坦）进行了一项匿名在线横断面调查。每个国家所需的最小样本量为 307，为了适应 7%的无回应率，将其增加到 330。使用多水平逻辑回归模型来捕捉每个国家观察值的聚类情况，并估计解释变量对心理前因量表 5C 成分（即信心、限制、自满、算计和集体责任）各项的影响。
受访者总数为 3630 人，其中 40.5%年龄在 18 至 25 岁之间，61.1%为女性，54.0%完成了大学教育，55.8%未婚，19.5%患有慢性病，43.7%报告曾感染 COVID - 19，42.4%有亲属死于 COVID - 19。5C 各项的优势比对数中的大部分变异是由于不同国家之间的异质性（组内相关系数>0.05）。因此，这种变异性证实了心理前因对疫苗接种覆盖率的各种影响，加剧了其中的疫苗接种不平等。对疫苗的信心增强以及对亲属和社区的集体责任感增强与对 COVID - 19 疫苗的接受度提高有关。发现自满、算计和限制的减少与接受 COVID - 19 疫苗有关。
本研究具有创新性，通过使用针对 COVID - 19 疫苗接种意愿的多水平逻辑回归模型，揭示了心理决定因素作为疫苗不平等隐藏原因的重要性。研究结果表明，针对社会人口因素、心理前因和可及性障碍的有针对性干预对于减轻疫苗不平等和提高疫苗接种率至关重要。
