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

PLOS Glob Public Health. 2024 Oct 24;4(10):e0003028. doi: 10.1371/journal.pgph.0003028. eCollection 2024.

Abstract

Pregnant women are considered a high-risk group for COVID-19, and a priority for vaccination. Routine antenatal care (ANC) 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 and assess the factors associated with vaccine in Zambia. We 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 counseling and testing. We estimated vaccine uptake as the proportion of eligible participants who self-reported having received the COVID-19 vaccine. A 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 women aged 40-49 years, had no education or attained some primary school education, were not employed, and had prior COVID-19 infection were significantly associated with vaccine uptake. COVID-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.

Grants and funding

Assessing SARS-CoV-2 Seroprevalence during Routine Antenatal Care Visits in Zambia” was supported by the US Centers for Disease Control and Prevention (CDC) under the terms of award number NU2GGH002251. The award was granted to IS. The terms of this arrangement have been reviewed and approved by the Centers for Disease Control and Prevention in accordance with its policy on objectivity in research. The sponsor’s website can be accessed via https://www.cdc.gov/index.html. The funder did not play any role in designing the study, data collection and analysis, decision to publish, and, preparation for the manuscript.