COVID-19 vaccine uptake and associated risk factors among first antenatal care attendees in Zambia, 2021-2022: a repeated cross-sectional study

Abstract

ABSTRACTIntroductionPregnant women are considered a high-risk group for COVID-19, and a priority for vaccination. Routine antenatal (ANC) care provides an opportunity to track trends and factors associated with vaccine uptake. We sought to evaluate COVID-19 vaccine uptake among pregnant women attending ANC in Zambia.MethodsWe conducted a repeated cross-sectional study in 39 public health facilities in four districts in Zambia from September 2021 to September 2022. Pregnant women who were aged 15-49 years were enrolled during their first ANC visit. Every month, ∼20 women per facility were interviewed during individual HIV testing and counseling. We estimated vaccine uptake as the proportion of eligible participants who self-reported having received the COVID-19 vaccine.ResultsA total of 9,203 pregnant women were screened, of which 9,111 (99%) were eligible and had vaccination status. Of the 9,111 included in the analysis, 1,818 (20%) had received the COVID-19 vaccine during the study period, with a trend of increasing coverage with time (0.5% in September 2020, 27% in September 2022). Conversely, 3,789 (42%) reported not being offered a COVID-19 vaccine. We found that older age, education, employment status, and prior COVID-19 infection were significantly associated with vaccine uptake.ConclusionCOVID-19 vaccine uptake among pregnant women was lower than estimates from the general population (27% across the four districts in September 2022), pointing to missed opportunities to protect this high-risk group. ANC visits were a viable point for conducting COVID-19 surveillance. Incorporating the vaccine as part of the routine ANC package might increase coverage in this group.Teaser key messageAntenatal care clinics could be an easy and sustainable platform for increasing COVID-19 vaccine uptake among pregnant women.Key FindingsDespite evidence that COVID-19 vaccines are safe in pregnancy, vaccine uptake was low among pregnant women in Zambia through the end of 2022.Various demographic characteristics were associated with the uptake of COVID-19 vaccines.Key ImplicationsIt is acceptable and feasible to assess COVID-19 vaccination uptake and hesitancy among pregnant women attending ANC. ANC may provide an easy, sustainable platform for routinely monitoring COVID-19 and other disease outbreaks.Key vaccination messages and mass vaccination strategies can be designed and adopted for pregnant women to reduce vaccine hesitancy and consequently, increase vaccine uptake.COVID-19 vaccination could be incorporated into routine antenatal care to help increase vaccination coverage among pregnant women seeking antenatal care services.