Factors associated with full COVID-19 vaccination among persons living with diabetes mellitus in Uganda – A Cross-sectional Study

Abstract

<title>Abstract</title> <bold>Background:</bold>Diabetes mellitus (DM) is associated with severe coronavirus disease (COVID-19) outcomes, including death. COVID-19 vaccination is the mainstay for preventing infection and severe disease in the general population, but most importantly, among high-risk populations such as persons with DM. However, while COVID-19 vaccination uptake in the general population is regularly tracked, information on vaccination behavior specific to persons with DM is scarce.<italic>This study sought to identify factors associated with the uptake of full COVID-19 vaccination among persons living with DM at Kiruddu National Referral Hospital (KRH).</italic><bold>Methods:</bold>We used a cross-sectional study design to identify factors associated with receiving a full COVID-19 vaccination among persons with DM attending Kiruddu National Referral Hospital between March 08 and May 25, 2023. We used a systematic sampling technique to select a random sample of 340 participants for whom an interviewer-administered questionnaire was administered. We used a modified Poisson regression model to identify the factors associated with full COVID-19 vaccination and adjusted prevalence ratios with their 95% confidence intervals are presented. The data were analyzed in STATA version 14.0.<bold>Results:</bold>A total of 340 participants, 75% (255/340) of whom were female, completed the interview. The mean age of the participants was 52 years (±12 years) and the median duration of diabetes mellitus was 5 years (±7.3 years). Overall, 195/340 participants (57.35%) completed the last dose in the primary series of a COVID-19 vaccine. The likelihood of receiving full vaccination was higher when a health provider advised one to receive a vaccine [aPR=1.91 (95% CI 1.2-3.02)] when one reported having a comorbidity [aPR=1.26 (95% CI: 1.06-1.53)], and when one had a strong perceived benefit of vaccination [aPR=1.76 (95% CI: 1.23-2.53)]. However, having a strong perceived barrier to vaccination was negatively associated with the likelihood of being fully vaccinated [aPR=0.71 (95% CI: 0.6-0.84)].<bold>Conclusion:</bold>Approximately 43% of persons living with DM in Uganda have incomplete COVID-19 vaccination. The Ugandan Ministry of Health (MoH) needs to implement a provider-initiated vaccination strategy in diabetic clinics using the healthcare providers who regularly attend to DM patients to boost their uptake of full COVID-19 vaccination.