Determinants of vaccine acceptance, knowledge, attitude, and prevention practices against COVID‐19 among governmental healthcare workers in Addis Ababa and Adama, Ethiopia: A cross‐sectional study

Abstract Background and Aims COVID‐19 vaccines are vital tools for infection prevention and control of the pandemic. However, coronavirus immunization requires acceptance among healthcare workforces and by the community. In Ethiopia, studies focused on determinants of vaccine acceptance, knowledge, attitude, and prevention practices (KAP) contrary to the novel coronavirus among healthcare staff are limited. Hence, closing this gap requires research. Methods A cross‐sectional study was conducted on 844 governmental healthcare workers. A stratified, simple random sampling technique was used to select the respondents. Data were collected using a structured questionnaire. Binary and multivariable logistic regression statistical models were used to analyze the data. Results This study indicated that only 57.9% of the participants had good COVID‐19 vaccine acceptance, meaning they took at least a dose of the vaccine themselves. We found that 65%, 60.9%, and 51.3% of the participants had good knowledge, prevention practices, and attitude against the pandemic. The novel coronavirus vaccine acceptance rate was 2.19 times more likely among females (adjusted odds ratio [AOR] = 2.19 with 95% confidence interval [CI]: 1.54–3.10) than among male participants. Further, respondents who did not report having any chronic diseases were 9.40 times higher to accept COVID‐19 vaccines (AOR = 9.40 with 95% CI: 4.77, 18.53) than those who reported having a chronic condition. However, healthcare workers who had a habit of chewing khat at least once per week were 4% less likely to take the vaccine (AOR = 0.04 with 95% CI: 0.01, 0.32) than those who had no habit of chewing khat. Conclusion Many core factors influencing COVID‐19 vaccine acceptance were identified. A significant number of participants had poor vaccine acceptance, KAP against COVID‐19. Therefore, the government should adopt urgent and effective public health measures, including public campaigns to enhance public trust in COVID‐19 vaccines. In addition, continuous, timely, and practical training should be provided to healthcare workers.


| INTRODUCTION
Coronavirus vaccines are life-saving therapeutics that prevent or minimize COVID infections and aid in reducing global transmission. [1][2][3][4] Vaccines provide immunity and prevent or reduce the level of morbidity and mortality in vaccine recipients. Moreover, infections in unvaccinated individuals are minimized once herd immunity is reached. 5 To achieve this, healthcare workers and other relevant agencies actively participate in prevention and control measures. 6 However, a successful vaccination campaign requires healthcare workers and community acceptance for successful control and prevention. 7,8 Because the pandemic infected more than 397 million people and resulted in over 5.7 million deaths. 9 COVID-19 vaccination is needed at all health system levels, particularly among healthcare workers. 10 However, many healthcare workers favored delaying until others have taken the vaccine, 11,12 perhaps due to fear of side effects and safety and efficacy concerns. Additionally, miss perception and belief about the coronavirus were crucial factors affecting vaccine acceptance. 13 Furthermore, age, gender, trust in government, training, education, and various socioeconomic variables were identified as determinants of vaccine acceptance. [14][15][16][17][18] Due to these and other unknown factors, the novel coronavirus vaccine acceptance will be a huge challenge to address, particularly in lowand middle-income countries. 12 Healthcare workers are critical in providing instruction and factual information to clients, patients, and communities about the threats and benefits of the coronavirus vaccines. 19 Also, their vaccination helps them to become a role model for patients and communities and increases immunization coverage. 12 Therefore, knowing the uptake of coronavirus vaccines by healthcare workers is essential for developing appropriate strategies to promote community awareness and uptake of the vaccine. 20 Despite insufficient research, assessing healthcare workers' knowledge, attitudes, and prevention practices (KAP) against COVID-19 is essential to reduce the pandemic.
These parameters also influence vaccine uptake and the likelihood of recommending vaccines to patients and clients. 21 While Ethiopia has been tackling the pandemic since March 2020, when COVID-19 entered the country, many challenges are associated with prevention and control activities. As part of prevention activities, the government started COVID- 19 vaccination in March 2021. The COVID vaccine was offered to all healthcare workers and high-risk groups. However, little is known about the factors affecting coronavirus vaccine acceptance and the KAP of healthcare workers against the disease. Hence, closing this gap requires research.

| Study setting
The Addis Ababa city administration and the Adama city were the study areas. These cities are the most central for visitors and references for patient referrals and are suspected of having a high patient flow in the country. The reason for performing the study in both cities was these assumptions. Addis Ababa is the political and economic center of Ethiopia. 22,23 It has an estimated total population of 3.65 million people. 24 Furthermore, according to the unpublished report of 2020 of the Addis Ababa Food, Medicine, Health Care Administration, and Control Authority, the city has 1957 governmental and private health institutions. Furthermore, the city has four federal referral hospitals and six regional governmental hospitals. Also, there are 10 subcity health offices and 100 functional governmental healthcare centers. Adama city is located southeast of Addis

| Design and period
A cross-sectional study was accomplished in Addis Ababa and Adama city, Ethiopia, between July and August 2021.

| Source and study population
All governmental healthcare workers found in the study areas were the source population. Additionally, all randomly selected healthcare workers were the study participants. Healthcare workers included anyone who worked in healthcare. These include frontline healthcare workers, such as nurses, midwiferies, physicians, public health officers, pharmacists, laboratory professionals, dentists, and other non-health professionals, such as finance officers, human resources personnel, cleaners, and guardians. However, workers who had a severe illness and presented on annual or maternity leave were excluded from the investigation.

| Sample size and sampling procedure
The required sample size for the study was computed using a single tion, and those who scored below the average value were assumed to be facing a disabling condition to take the COVID-19 vaccine.
To assess the COVID-19-related knowledge of the participants, 17 questions having two choices were prepared. A right response was given a score of 1, while a score of 0 was given for a wrong reply.
Total individual responses were summed to calculate the overall knowledge score. Participants who scored above or equal to the average value of the total score were assumed to have good knowledge, and those who scored below the average value were supposed to have poor knowledge. Six questions with two choices were prepared to evaluate the participants' attitudes. A right response was given a score of 1, while a score of 0 was given for a wrong reply. Individual responses were summed for the overall attitude score. Respondents who scored ≥to the average value of the total score were assumed to have a good attitude and those who scored <the average value were considered to have a poor attitude.
Seven questions with two choices were prepared to measure the COVID-19-related prevention practice of participants. A right response was given a score of 1, while a score of 0 was given for a wrong reply. Individual responses were summed up for the overall preventive practice score. Respondents who scored ≥to the average value of the total score were assumed to have good COVID-19 prevention practices, and those who scored below the average value were supposed to have poor practices.
The study's ethical clearance was assured in June 2021 by the Ethiopian Public Health Institute with a reference number EPHI 613/ 138. Written consent was acquired from all participants. The secrecy and privacy of participants were safeguarded all over the investigation process.

| Analysis
In the first stage, the data were cleaned and checked for completeness. Since our data were categorical, a Pearson goodness-of-fit test was used to check model adequacy, 28 and we approved that all the expected values were fitted with the observed data. Binary and multivariable logistic regression statistical models were used to assess the association between the coronavirus vaccine acceptance and predictor variables. Having p < 0.05 at 95% confidence interval (CI) with a two-tailed test was statistically significant.

ACKNOWLEDGMENTS
The authors want to thank the Ethiopian Public Health Institute for its financial sustenance and the coordinators and study participants.

CONFLICT OF INTEREST
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
The study's all writers have read and approved the final version of the manuscript. Also, the authors confirm that the data backup of the current study results is accessible within the article and/or its extra resources.

TRANSPARENCY STATEMENT
The lead author Aderajew M. Girmay affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.