Widespread vaccination against COVID-19 is critical for controlling the pandemic. Despite the development of safe and efficacious vaccinations, low-and lower-middle income countries (LMICs) continue to encounter barriers to care owing to inequitable access and vaccine apprehension. This study aimed to summarize the available data on COVID-19 vaccine acceptance rates and factors associated with acceptance in LMICs. A comprehensive search was performed in PubMed, Scopus, and Web of Science from inception through August 2021. Quality assessments of the included studies were carried out using the eight-item Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies. We performed a meta-analysis to estimate pooled acceptance rates with 95% confidence intervals (CI). A total of 36 studies met the inclusion criteria and were included in the review. A total of 83,867 respondents from 33 countries were studied. Most of the studies were conducted in India (n = 9), Egypt (n = 6), Bangladesh (n = 4), or Nigeria (n = 4). The pooled-effect size of the COVID-19 vaccine acceptance rate was 58.5% (95% CI: 46.9, 69.7, I2 = 100%, 33 studies) and the pooled vaccine hesitancy rate was 38.2% (95% CI: 27.2–49.7, I2 = 100%, 32 studies). In country-specific sub-group analyses, India showed the highest rates of vaccine acceptancy (76.7%, 95% CI: 65.8–84.9%, I2= 98%), while Egypt showed the lowest rates of vaccine acceptancy (42.6%, 95% CI: 16.6–73.5%, I2= 98%). Being male and perceiving risk of COVID-19 infection were predictors for willingness to accept the vaccine. Increasing vaccine acceptance rates in the global south should be prioritized to advance global vaccination coverage.

Vaccination is undoubtedly one of the most effective strategies to halt the COVID-19 pandemic. The current study aimed to investigate the acceptance of COVID-19 vaccination and its associated factors using two health behavior change frameworks: the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). A total of 639 Bangladeshi adults (mean age: 24 years) participated in a cross-sectional online study between July and August 2021. The questionnaire covered questions regarding vaccine intentions, sociodemographic features, health status, perceived trust in/satisfaction with health authorities, reasons for vaccine hesitancy, and factors related to the health behavior change frameworks. Hierarchical logistic regression was employed to determine associations between these predictors and vaccine acceptance. The intention to get a COVID-19 vaccination was expressed among 85% of the participants. In fully adjusted models, students and respondents with more normal body weights reported higher intentions to get vaccinated. Respondents were also more likely to seek vaccination if they reported greater levels of perceived susceptibility, benefits, and cues to action, as well as lower levels of barriers and self-efficacy. Fear of future vaccine side effects was the most common reason for COVID-19 vaccine hesitancy and was expressed by 94% of the vaccine-hesitant respondents. These factors should be considered by health authorities in Bangladesh and perhaps other countries when addressing the plateauing COVID-19 vaccination rates in many populations.

BackgroundUniversity students’ knowledge, attitude, and practice (KAP) toward COVID-19 are vital to prevent the spread of the virus, especially in the context of developing countries. Consequently, the present study aimed to determine the KAP levels of university students and associated anxiety during the earlier stage of the pandemic in Bangladesh.MethodsA cross-sectional, online study with 544 university students was conducted during April 17–May 1, 2020. The questionnaire incorporated several KAP-related test items aligned with the World Health Organization (WHO) guidelines. Anxiety was measured with the 2-item Generalized Anxiety Disorder scale (GAD-2). Multivariable logistic regression analysis was performed to determine the association between KAP levels and anxiety adjusting for sociodemographic variables. Subgroup analyses included rerunning models stratified by gender and quarantine status.ResultsApproximately 50% of students showed high levels of knowledge about COVID-19 guidelines, 59% reported behavioral practices that aligned with COVID-19 guidelines, and 39% had negative attitudes toward COVID-19 guidelines. Attitudes differed by anxiety (χ2 = 23.55, p < 0.001); specifically, negative attitudes were associated with higher anxiety (OR: 2.40, 95% CI = 1.66–3.46, p < 0.001). Associations were significant for male (OR = 2.36; 95% CI = 1.45–3.84, p < 0.001) and female (OR = 2.45; 95% CI = 1.3–4.34; p < 0.001) students. Stratified analyses found non-quarantined students with negative attitudes had three times the chance of experiencing anxiety (OR = 3.14, 95% CI: 1.98–4.98, p < 0.001). Non-quarantined students with low levels of knowledge had half the chance of developing anxiety (OR = 0.49, 95% CI: 0.31–0.78, p < 0.01).ConclusionBased on these findings, it is recommended that university authorities continue to prioritize proactive and effective measures to develop higher levels of knowledge, more positive attitudes and better behavioral practices regarding COVID-19 for the mental health of their students.

Healthcare students are clinicians-in-training likely to come into contact with COVID-19 as much as other frontline healthcare professionals. It is therefore necessary to prioritize vaccinations for this group. We conducted a global systematic assessment of COVID-19 vaccine acceptance rates and related factors among healthcare students using the PubMed, Scopus, and Web of Science databases and keyword searches in March of 2022. We found 1779 articles with relevant information and 31 articles that matched our inclusion criteria. We performed a random-effects meta-analysis and quality assessment using the eight-item Joanna Briggs Institute Critical Appraisal test for cross-sectional studies. A total of 30,272 individuals from 16 countries were studied. Most of the studies were carried out in the U.S. (n = 6), China (n = 5), Poland (n = 5), India (n = 2), Italy (n = 2), and Israel (n = 2). The prevalence of the COVID-19 vaccine acceptance rate was 68.8% (95% confidence interval [CI]: 60.8–76.3, I2 = 100%), and the prevalence of the vaccine hesitancy rate was 25.8% (95% CI: 18.5–33.8, I2 = 99%). In country-specific analyses, Romania showed the highest acceptance rate (88.0%, 95% CI: 44.5–100%), while Iraq showed the lowest acceptance rate (66.2%, 95% CI: 35.5–90.8%). In time-trend analyses, we found that acceptance rates among healthcare students decreased over time. Students concerned about potentially serious side effects of the vaccine were less willing to accept the vaccine. National and international interventions should be adopted to reduce COVID-19 vaccination hesitancy rates among these important frontline workers.

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