Prevalence of COVID-19 Vaccine Hesitancy in a Rural Setting: A Case Study of DIMAMO Health and Demographic Surveillance Site, Limpopo Province of South Africa

Abstract

Background: The primary purpose of introducing the COVID-19 vaccine was to fight the pandemic. However, the vaccine was not well received worldwide. This challenge has threatened the effective implementation and roll-out of COVID-19 immunization campaigns. The challenge of vaccine hesitancy was reported to be more prevalent in rural areas due to various factors such as cultural beliefs, misinformation, poverty, lack of education, and distrust of vaccines. Yet there seems to be a scarcity of studies determining the prevalence of vaccine hesitancy in deep rural areas of Limpopo. Purpose: The study aimed to explore the prevalence of COVID-19 hesitancy among the rural black population in South Africa. Study Methods: A longitudinal quantitative study was conducted with data from the DIMAMO Health and Demographic Surveillance Site (HDSS) database for 2020 to 2022. A non-probability total sampling technique was used to select the respondents. Trained fieldworkers collected data using an electronic data capture questionnaire. A comparison of categorical variables was performed using Chi-Square in SPSS version 26 and the statistical significance was set at p < 0.05, with a 95% confidence interval to analyze the data. Results: The limited availability of vaccination sites in Limpopo Province, South Africa, was associated with a reduced certainty that the vaccine would be accepted, as reported in the current study. The prevalence of visiting traditional healers was significantly higher in non-vaccinated than vaccinated participants among the rural black population, indicating a different cultural belief among the rural black population that existed before and during the COVID-19 pandemic. Conclusion: The present study findings show diverse factors of concern associated with vaccination hesitancy for COVID-19 among rural black people. Lack of education, gender, not being diagnosed with COVID-19, not being a Christian, visiting traditional healers, vaccine mistrust, unknown side effects, and a lack of confidence in the vaccine itself. Conspiracy theories were factors that impacted vaccine acceptance among black people living in rural areas. The prevalence of visiting traditional healers was significantly higher in non-vaccinated than vaccinated participants. Therefore, the present study findings emphasize the need to collectively integrate and utilize the traditional healers in the South African healthcare system.