Muchangi Josphat Martin, Moraro Rogers, Omogi Jarim, Alasmari Abrar, Simiyu Sheillah, Bolio Ana, Kanyangi Lennah, Mwema Rehema, Bukania Rose, Kosgei Sarah
Department of Population Health and Environment, Amref Health Africa, Nairobi, Kenya.
Department of Community Health, Amref International University, Nairobi, Kenya.
Front Public Health. 2024 Dec 12;12:1472677. doi: 10.3389/fpubh.2024.1472677. eCollection 2024.
Access and uptake of COVID-19 vaccine by persons with disabilities remains largely unknown in low-and middle-income countries, despite the unique barriers they face, their special vulnerabilities and higher risk to severe outcomes. We aimed to identify behavioral and social predictors of COVID-19 uptake among persons with disability in Kenya. A convergent parallel mixed method study design was conducted among 792 persons with disability in four regions (counties) in Kenya. Purposive sampling was used to identify the respondents from the National Council for Persons with Disabilities Registration database. Quantitative data were analyzed using STATA statistical analysis software (version 14). Chi-square ( ) and Fisher's exact tests were used to test for differences in categorical variables; and multivariate regression analysis done to ascertain the factors that influence the uptake of COVID-19 among persons with disabilities in Kenya. Qualitative data from 7 Focus Group Discussions and 4 Key Informant Interviews were transcribed and themes developed using the Behavioral and Social Drivers of vaccination framework by the World Health Organization. Approximately 59% of persons with disabilities reported to be fully vaccinated with significant disparities noted among those with cognition (34.2%) and self-care (36.6%) impairments. Key predictors of vaccine uptake included confidence in vaccine benefits (Odds ratio [OR]; 11.3, 95% CI[5.2-24.2]), health worker recommendation (OR; 2.6 [1.8-3.7]), employment (OR; 2.1 [1.4-3.1]), perceived risk (OR; 2.0 [1.3-3.1]), age 18-24 years (OR; 0.18 [0.09-0.36]), and rural area of residence (OR; 0.48 [0.29-0.79]). The primary reasons for low uptake included perceived negative vaccine effects and lack of adequate information. Qualitative findings revealed unique motivations for vaccination among persons with disabilities (PWDs), including safeguarding against risks from assistive devices and the influence of political leaders. Barriers included perceived vaccine effects, transportation challenges, and limited access to trusted information, highlighting the need for targeted sensitization, improved healthcare worker engagement, and collaboration with PWD organizations. Subsequent vaccination deployments should map and reach people in all disability domains through relevant institutions of PWDs and localized vaccination campaigns. Related communication strategies should leverage the credibility and trust in health workers and behavior change techniques that inspire confidence in vaccines to improve vaccine uptake.
在低收入和中等收入国家，残疾人接种新冠疫苗的情况和接种率在很大程度上仍不为人所知，尽管他们面临独特的障碍、具有特殊的脆弱性且出现严重后果的风险更高。我们旨在确定肯尼亚残疾人接种新冠疫苗的行为和社会预测因素。在肯尼亚四个地区（县）的792名残疾人中开展了一项聚合平行混合方法研究设计。采用目的抽样法从国家残疾人理事会登记数据库中确定受访者。使用STATA统计分析软件（版本14）对定量数据进行分析。卡方检验和费舍尔精确检验用于检验分类变量的差异；并进行多变量回归分析以确定影响肯尼亚残疾人接种新冠疫苗的因素。对7次焦点小组讨论和4次关键信息人士访谈的定性数据进行了转录，并使用世界卫生组织的疫苗接种行为和社会驱动因素框架确定了主题。约59%的残疾人报告已完全接种疫苗，在认知障碍（34.2%）和自我护理障碍（36.6%）者中存在显著差异。疫苗接种的关键预测因素包括对疫苗益处的信心（优势比[OR]；11.3，95%置信区间[5.2 - 24.2]）、医护人员的推荐（OR；2.6 [1.8 - 3.7]）、就业情况（OR；2.1 [1.4 - 3.1]）、感知风险（OR；2.0 [1.3 - 3.1]）、18 - 24岁年龄组（OR；0.18 [0.09 - 0.36]）以及农村居住地区（OR；0.48 [0.29 - 0.79]）。接种率低的主要原因包括认为疫苗有负面作用以及缺乏足够信息。定性研究结果揭示了残疾人接种疫苗的独特动机，包括防范辅助设备带来的风险以及政治领导人的影响。障碍包括对疫苗作用的认知、交通挑战以及获取可靠信息的机会有限，这突出表明需要有针对性的宣传、改善医护人员的参与以及与残疾人组织的合作。后续的疫苗接种部署应通过残疾人相关机构和本地化的疫苗接种活动，覆盖所有残疾领域的人群。相关的沟通策略应利用对医护人员的可信度和信任以及能激发对疫苗信心的行为改变技巧，以提高疫苗接种率。
