Health care workers intention to accept COVID-19 vaccine and associated factors in southwestern Ethiopia, 2021

Abiy Tadesse Angelo; Daniel Shiferaw Alemayehu; Aklilu Mamo Dachew

doi:10.1371/journal.pone.0257109

. 2021 Sep 3;16(9):e0257109. doi: 10.1371/journal.pone.0257109

Health care workers intention to accept COVID-19 vaccine and associated factors in southwestern Ethiopia, 2021

Abiy Tadesse Angelo ^1,^*, Daniel Shiferaw Alemayehu ¹, Aklilu Mamo Dachew ¹

Editor: Livia Melo Villar²

PMCID: PMC8415602 PMID: 34478470

Abstract

Introduction

Health care workers are the most affected part of the world population due to the COVID-19 pandemic. Countries prioritize vaccinating health workers against COVID-19 because of their susceptibility to the virus. However, the acceptability of the vaccine varies across populations. Thus, this study aimed to determine the health care worker’s intentions to accept the COVID-19 vaccine and its associated factors in southwestern Ethiopia, 2021.

Methods

A facility-based cross-sectional study was conducted among health care workers in public hospitals in southwestern Ethiopia from March 15 to 28, 2021. A simple random sampling method was used to select 405 participants from each hospital. Data were collected using self-administered questionnaires. Descriptive statistics, such as frequency and percentage, were calculated. Multivariable logistic regression was also performed to identify factors associated with health care worker’s intention to accept the COVID-19 vaccine. Statistically significant variables were selected based on p-values (<0.05) and the adjusted odds ratio was used to describe the strength of association with 95% confidence intervals.

Result

Among the respondents, 48.4% [95% CI: 38.6, 58.2] of health care workers intended to accept COVID-19. Intention to accept COVID-19 vaccination was significantly associated with physicians (AOR = 9.27, 95% CI: 1.27–27.32), professionals with a history of chronic illness (AOR = 4.07, 95% CI: 2.02–8.21), perceived degree of risk of COVID-19 infection (AOR = 4.63, 95% CI: 1.26–16.98), positive attitude toward COVID-19 prevention (AOR = 6.08, 95% CI: 3.39–10.91) and good preventive practices (AOR = 2.83, 95% CI: 1.58–5.08).

Conclusion

In this study, the intention of health care workers to accept the COVID-19 vaccine was low. Professional types, history of chronic illness, perceived degree of risk to COVID-19 infection, attitude toward COVID-19 and preventive practices were found to be factors for intention to accept COVID-19 vaccine in professionals. It is important to consider professional types, history of chronic illness, perceived degree of risk to COVID-19, attitude of professionals and preventive behaviors to improve the intention of professionals’ vaccine acceptance.

Introduction

Covid-19 is a pandemic acute respiratory disease that was first detected and identified in late December in China in 2019 [1]. Due to increased concerns because of cases outside China and increased incidence in China, the World Health Organization (WHO) declared the disease as a pandemic and public health emergency [2]. Since its emergence, the number of daily confirmed cases of COVID-19 worldwide has increased dramatically. The virus causes morbidity in many millions of people and has taken the lives of many millions since its emergence [3]. The situation was similar in Ethiopia; soon after the first case was detected (March 13, 2020), the incidence increased. In countries such as Ethiopia, the transmissibility of the virus is high due to overcrowding and poor socioeconomic status. The possibility of pandemics in Ethiopia is more likely due to poor infrastructure, weak health systems, large household size, inadequate sanitation, population turnover from site to site or increased mobility. The number of COVID-19 cases in Ethiopia has continued to increase. For instance, the total number of COVID-19 cases within a country by January 20, 2021, was 275,194. The mortality from the disease within a country is also high, with an estimated 3174 deaths attributed to the disease [4, 5]. However, the total number of cases detected in Ethiopia may have been underestimated because of insufficient testing capacity [6].

The pandemic is overwhelming in various economic sectors [7]. The health care sector is greatly impacted by the pandemic, with increased health care costs for medical supplies, increased demand for protective equipment, and a shortage of accommodating intensive care units and ventilation machines [8]. Front-line fighters, primarily health professionals, are at a high risk for the disease. Their susceptibility to diseases has many implications for health care systems. Their morbidity and mortality can cause severe crises in health care personnel shortages. In other words, as these professionals are always frontline for any case and are contacting clients frequently, they have the potential to infect others [7, 9].

Countries put different precautionary measures to prevent COVID-19 in accordance with WHO guidelines, including frequent hand washing, social distancing, wearing a face mask, movement limitation to crowded areas, and avoidance of consumption of raw meat to prevent cross-contamination [10]. However, adherence to these strict measures is very low in Ethiopia. A study conducted in the southern part of Ethiopia indicated that only 12.3% of the population adhered to preventive measures against COVID-19 [11].

Vaccine development was also considered to tackle the pandemic and overcome the negative consequences in different sectors [12, 13]. Despite this attempt, vaccine hesitancy and unwillingness to accept the COVID-19 vaccine is a challenge across the world [14].The unwillingness to accept the COVID-19 vaccine in Ethiopia is expected to be high. For instance, a study found that only 31.4% of the population were willing to take the COVID-19 vaccine [15]. Readiness to receive COVID-19 vaccine among professionals is also challenging; for example, only 27.7% of health care workers were intended to take COVID-19 in the Democratic Republic of the Congo. Factors identified for the intention to receive the vaccine were sex, professional type, attitude, and vaccine safety [16].

Developing countries, such as Ethiopia, are gaining COVID-19 vaccines from different donating countries to vaccinate high-risk groups such as health care professionals. Ethiopia received 2.2 million COVID-19 vaccines from the COVAX facility. Although Ethiopia is gaining vaccines, the intention of healthcare professionals to accept COVID-19 vaccination and the factors affecting it are not known. The findings from these professionals would help policy makers in the health sector to improve vaccine acceptance, which would contribute to the control of COVID-19 pandemics. Therefore, this study was undertaken to assess the intentions of health care workers and the factors associated with accepting the COVID-19 vaccine in south western Ethiopia.

Materials and methods

Study setting and design

The study was conducted at the Mizan Tepi University Teaching Hospital (MTUTH) and Gebre Tsadik Shawo General Hospital (GTSGH). MTUTH, located in the Bench Sheko zone, is a teaching hospital that also delivers treatment services within four adult outpatient departments (OPDs), one pediatric OPD, one emergency department, one chronic disease OPD, two adult medical wards, two adult surgical wards, one pediatric ward, one obstetrics and gynecology ward, anti-retroviral treatment, and tuberculosis treatment center. This hospital is located 568 km from the country’s capital. A total of 418 health care workers were in the MTUTH. GTSGH is a public hospital located in the Kaffa zone in the southern region, located 456 km from the capital of the country. In this setting, there were 259 health care workers who delivered care in different departments. Health care workers in these settings are comprised of medical doctors, nurses, midwives, laboratory technicians, pharmacists, psychiatrists, and radiologists. A facility-based cross-sectional study was conducted among health care workers from March 15 to, 28/2021.

Source population

All health care workers working in the Mizan Tepi University teaching and Gebre Tsadik Shawo General Hospitals were the source population.

Study participants

Sampled health care workers from the two hospitals during the time of data collection were the study participants.

Inclusion and exclusion criteria

Health care workers in two hospitals aged ≥ 18 years who were involved in the direct contacts with patients (nurses, physicians, midwifes, pharmacists, laboratory technicians, radiology technicians, psychiatry professionals) and who agreed to participate in the study were included in the study, while health care workers who were absent at the time of data collection were excluded from the study.

Sample size and sampling technique

The sample size determined for this study was determined by a single population proportion formula, with the assumption of 50% acceptability of vaccination against COVID-19, a 95% confidence interval, 5% margin of error, and addition of 10% non-response rate. Therefore, the sample size for this study was 423. The first two hospitals, namely MTUTH and GTSGH, were selected from a total of four hospitals located in southwestern Ethiopia (Bench Sheko, Kaffa, Sheka, and West Omo zones) using the lottery method. A predetermined sample size was allocated to each hospital. The total number of health care professionals in both hospitals was 677. Of these, 418 were in MTUTH, and 259 health care workers were in GTSGH. To obtain representative samples from both hospitals, proportional allocation was performed. Thus, 261 samples were allocated to MTUTH and 162 were allocated to GTSGH. A simple random sampling method was used to select participants from both hospitals.

Data collection tool, quality control, and procedure

The tool used to collect data for this study was developed and designed in a local context after reviewing relevant studies [16–20]. The tool was designated in English and provided to the participants, as all participants could understand the questionnaire well since the working and educational language was English. The tool essentially contained seven parts; part I assessed socio-demographic characteristics, part II assessed health status and COVID-19 experience, part III assessed participants’ knowledge about COVID-19, part IV assessed participants’ attitude towards COVID 19, part V assessed COVID-19 Prevention Practices among healthcare workers, part VI assessed vaccine hesitancy and part VII assessed willingness to accept COVID-19 vaccine. A one-day orientation of data collection was given to four lecturers who collected the data. Pretesting was performed on 21 health care workers working in Wacha Hospital, which is different from the actual study sites. Based on the pretest results, necessary modifications were made to the questionnaires. The questionnaire was self-administered (paper survey) and all data collectors and supervisors strictly adhered to the WHO and national standards of COVID-19 prevention protocols. The data collectors were worn face masks, gloved their hands, maintained distance, and sanitized their hands between each questionnaire administration.

Nineteen items were used to assess the knowledge of health care workers regarding COVID-19. The questions focused on the clinical manifestation, case suspicion, incubation period, mode of transmission, and prevention methods. Participants’ responses related to knowledge items were scored by assigning one for correct answers and zero for incorrect answers including "I don’t know" responses. In such a way that participants’ knowledge score may range from zero to nineteen. To categorize participants as having good knowledge and poor knowledge, the knowledge means sore was computed and participants with knowledge scores greater than or equal to the knowledge mean score were considered as having good knowledge and otherwise having poor knowledge [21].

Seven items were used to assess the attitudes of the participants toward COVID-19 preventive measures. Participants’ responses were scored by giving one point to “yes" and zero to “no” and “not sure” responses. Responses to reversed question was reversed when assigning the points (yes = zero, not sure = zero and no = one). In this way, participants’ total attitude scores ranged from zero to seven [22]. The mean attitude score was computed and participants were considered to have a positive attitude if the attitude score was ≥ mean attitude score [21]. The internal consistency of seven attitude items was checked and Cronbach’s alpha became 0.818.

The practice was assessed by five questions and scored by assigning one point to a yes response and zero to no response. The mean practice score was computed and participants were considered to have good practice if the practice score was greater than or equal to the mean practice score [21].

We evaluated self-reported vaccine hesitancy of participants according to the WHO definition by three adapted questions asking, “Have you ever refused a vaccine for yourself or a child because you considered it as useless or dangerous?” “Have you ever postponed a vaccine recommended by a physician because of doubts about it?”, and “Have you ever had a vaccine for a child or yourself despite doubts about its efficacy [23]?” If participants’ responses were yes to at least one of the three questions, participants were considered vaccine-hesitant.

HCWs’ intention to accept the COVID-19 vaccine was assessed by one question asking “will you get the COVID-19 vaccine if it is available?” Participants’ responses were dichotomized into “yes” and “no.”

Data processing and analysis

Data were entered into Epidata version 3.1, after a manual check for completeness. The entered data were exported to SPSS version 23 and both descriptive and inferential statistics were used. Statistical significance was set at p < 0.25 in bivariate logistic regression analysis to identify candidate variables for multivariable logistic regression analysis. In the multivariable analysis, a significant association was found with a p-value of less than 0.05. The associations were presented with an adjusted odds ratio (AOR) and corresponding 95% CI.

Ethical considerations

This study was approved by the ethical review committee of the Mizan Tepi University, College of health sciences. The letter was submitted to both hospital administrates to begin the study. The confidentiality of the respondents was secured by excluding respondent’s identifiers such as names from the data collection format. Written Informed consent was obtained from all the participants. The right of participants to withdraw from the study at any time was clearly stated for the participants.

Results

Socio-demographic characteristics of the respondents

A total of 405 filled self-administered questionnaires were returned with a response rate of 96.0%. The majority of the respondents were below the age of 30 (72.5%), male (50.4%), and married (57.3%). Of the total HCWs, 59.8% were Nurses and 65.2% were first-degree holders. Regarding economic status, 55.6% of the participants earned 91.3–182.4 USD (Table 1).

Table 1. Socio-demographic characteristics of the health care workers, hospitals of south western Ethiopia, 2021 (n = 405).

Variables	Category	Frequency	Percentage
Age category (in years)	<30	294	72.6
	31–40	95	23.5
	41–50	8	2.0
	>60	8	2.0
Sex	Male	204	50.4
Sex	female	201	49.6
Marital status	Single	156	38.5
	married	232	57.3
	other¹	17	4.2
Profession type	Physicians	25	6.2
	Nurse	242	59.8
	Midwifery	52	12.8
	Medical laboratory	34	8.4
	Pharmacist	34	8.4
	Others²	18	4.4
Highest qualification level	Diploma	127	31.4
	Degree	264	65.2
	Masters	14	3.5
Monthly salary in USD	68.4–91.2	149	36.8
	91.3–182.4	225	55.6
	>182.4	31	7.7
Number of people in a household	1	138	34.1
	2	71	17.5
	3–4	157	38.8
	5–6	29	7.2
	>7	10	2.5

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¹ Widowed and Divorced

² Radiology technicians, Psychiatry professionals

Health status and COVID-19 experience of health care workers

Among the respondents, 285(70.4%) had no history of chronic illness. The majority, 337(83.2%) perceived that they were at a higher risk of COVID-19 infection, and 9(2.2%) reported a previous COVID-19 infection. In addition, 209(51.6%) knew of friends, neighbors, or colleagues infected by coronaviruses (Table 2).

Table 2. Health status and COVID-19 experience of health the professionals working at hospitals of southwestern Ethiopia, 2021 (n = 405).

Variables	Category	Frequency	Percentage
Previously diagnosed with chronic diseases	Yes	120	29.6
Previously diagnosed with chronic diseases	No	285	70.4
Do you have any of the following diseases? (Type 2 diabetes mellitus, Chronic Obstructive Pulmonary Disease (COPD), Cancer, Kidney Failure, Heart diseases, Sickle Cell Anemia)	Yes	78	19.3
	No	327	80.7
Do you have any of the following diseases? (Type 1 diabetes mellitus, Hypertension, Bone marrow transplant, Cerebrovascular diseases or stroke, Cystic Fibrosis, Asthma, Taking steroids or immunosuppressant drugs, Hepatic diseases, Thalassemia, Lung fibrosis)	Yes	52	12.8
	No	353	87.2
Perceived risk to COVID-19 infection	High	337	83.2
	Medium	34	8.4
	Low	34	8.4
Personal history of COVID-19 infection	Yes	9	2.2
Personal history of COVID-19 infection	No	396	97.8
Know any friends, neighbors, or colleagues infected by Coronavirus	Yes	196	48.4
	No	209	51.6

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COVID-19 knowledge of the health care workers

The mean knowledge score was 13.62 (±3.77). More than half, 249(61.5%), of the respondents, had good knowledge about COVID-19 whereas, 156(38.5%) had poor knowledge. More than two-thirds of the study participants, 321 (79.3%), the SARS-COV-2 virus spreads via the respiratory droplets of an infected individual. The majority, 331(81.7%), knew that the main symptoms of COVID-19 were fever, fatigue, dry cough, and myalgia. In addition, 253(62.5%) of them mentioned that PPE such as respiratory protection, cannot effectively protect users from COVID-19 unless it is properly and consistently worn (Table 3).

Table 3. COVID-19 knowledge of the HCWs working at hospitals of southwestern Ethiopia, 2021 (n = 405).

Variables	Category	Frequency	Percentage
A suspected case is a patient with acute respiratory illness and recent history of travel.	True	289	71.4
	False	61	15.1
	I don’t know	55	13.6
A person with laboratory confirmation of COVID 19 infection, irrespective of clinical signs and symptoms is a confirmed case.	True	305	75.3
	False	65	16
	I don’t know	35	8.6
A suspected case is any patient with fever and at least cough or shortness of breath.	True	372	91.9
	False	29	7.2
	I don’t know	4	1
Any patient with a history of contact with a confirmed or probable COVID 19 case in the last 14 days before symptom onset is a suspected case.	True	312	77
	False	40	9.9
	I don’t know	53	13.1
The main clinical symptoms of COVID-19 are fever, fatigue, dry cough, and myalgia	True	331	81.7
	False	68	16.8
	I don’t know	6	1.5
Unlike symptoms of common cold, stuffy nose, running nose, and sneezing are less common in persons infected with the SARS-COV-2.	True	216	53.3
	False	95	23.5
	I don’t know	94	23.2
Eating Monkey, Bat or contacting wild animals would result in the infection by the SARS-COV-2.	True	262	64.7
	False	106	26.2
	I don’t know	37	9.1
Patients with COVID-19 cannot spread the virus to others when they do not show signs and symptoms of the disease.	True	131	32.3
	False	252	62.2
	I don’t know	22	5.4
The SARS-COV-2 virus spreads via respiratory droplets of infected individual.	True	321	79.3
	False	42	10.4
	I don’t know	42	10.4
The incubation period of COVID-19 lasts up to 14days.	True	358	88.4
	False	30	7.4
	I don’t know	17	4.2
Children and young adults are less likely to be infected with COVID 19 thus, precautionary measures are not necessary to prevent the infection.	True	197	48.6
	False	190	46.9
	I don’t know	18	4.4
Not all patients infected with COVID-19 will develop severe cases.	True	265	65.4
	False	128	31.6
	I don’t know	12	3
Patients with underlying chronic disease conditions are at higher risk of infection and death from COVID 19.	True	350	86.4
	False	36	8.9
	I don’t know	19	4.7
Avoiding handshakes, crowded places, and public transportation could help to prevent COVID-19	True	317	78.3
	False	56	13.8
	I don’t know	32	7.9
Antibiotics are the first line of treatment when you suspect or have a confirmed case of COVID-19.	True	139	34.3
	False	244	60.2
	I don’t know	22	5.4
Early recognition and supportive treatment help most patients recover from the infection since there is no effective cure for COVID-19.	True	282	69.6
	False	97	24
	I don’t know	26	6.4
Isolation and treatment of people who are infected with the COVID-19 virus are effective ways to break the chain of transmission.	True	316	78
	False	50	12.3
	I don’t know	39	9.6
Personal protective equipment (PPE) like respiratory protection cannot effectively protect the users if it is not properly and consistently worn.	True	253	62.5
	False	100	24.7
	I don’t know	52	12.8
Wearing face masks are used to protect both the Health care Workers and the patient.	True	282	69.6
	False	69	17
	I don’t know	54	13.3
Overall knowledge status	Good knowledge	249	61.5
Overall knowledge status	Poor knowledge	156	38.5

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Attitude towards COVID-19 preventive measures

As stated in the methodology, the mean positive response was 4.9 (±1.6). Of the respondents, 273(65.6%) had a positive attitude toward COVID-19 prevention whereas, 143(34.4%) had a negative attitude. The majority, 364(89.9%), believed that social distancing and hand washing could prevent COVID-19 while 171(41.1%) reported that they had attended social events recently. Of the study participants, 233(57.5%) believed that the COVID-9 vaccine could prevent infection. Most of the HCWs, 321(79.3%) were confident in providing care to a suspected case of COVID-19 and 252(62.2%) said that the current preventive measures put in place by the Government could mitigate COVID-19 (Table 4).

Table 4. Attitude towards COVID-19 prevention among HCWs working at hospitals of southwestern Ethiopia, 2021 (n = 405).

Variables	Category	Frequency	Percentage
Do you believe that social distancing and hand washing could prevent COVID-19?	Yes	364	89.9
	No	35	8.6
	Not sure	6	1.5
Do you have confidence in the current preventive measures put in place by the Government to mitigate COVID 19?	Yes	252	62.2
	No	88	21.7
	Not sure	65	16.0
Have you attended any social events recently?^*	Yes	171	41.1
	No	205	49.3
	Not sure	29	7.0
Are you confident to provide care to a suspected case of COVID 19?	Yes	321	79.3
	No	63	15.6
	Not sure	21	5.2
Do you believe that the COVID-9 vaccine can prevent infection?	Yes	233	57.5
	No	110	27.2
	Not sure	62	15.3
Health insurance or incentives can motivate health care workers directly involved in the management of COVID 19 patients?	Yes	300	74.1
	No	83	20.5
	Not sure	22	5.4
Are you ready to participate in community sensitization on COVID 19?	Yes	311	76.8
	No	53	13.1
	Not sure	41	10.1
Overall attitude status	Positive attitude	273	65.5
Overall attitude status	Negative attitude	143	34.4

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*Reversed item and scoring was reversed for this item.

COVID-19 prevention practices among health care workers

The mean practice score was 3.9 (±1.3). Two hundred and seventy-nine (67.1%) respondents had good COVID-19 prevention practices. The majority, 356(87.9%) washed or sanitized their hands regularly and 327(80.7%) wore facemasks regularly at the point of care for the sick patients (Table 5).

Table 5. COVID-19 prevention practices among HCWs working at hospitals of southwestern Ethiopia, 2021 (n = 405).

Variables	Category	Frequency	Percentage
Do you wash your hands or sanitize your hands regularly?	Yes	356	87.9
Do you wash your hands or sanitize your hands regularly?	No	49	12.1
Do you regularly use facemask at point of care (when rendering service to sick patients)	Yes	327	80.7
	No	78	19.3
Do you use a facemask when you have flu-like symptoms?	Yes	316	78.0
Do you use a facemask when you have flu-like symptoms?	No	89	22.0
Do you use non-conventional remedies (Honey, garlic, ginger, and lime) when you have flu-like symptoms?	Yes	263	64.9
	No	142	35.1
In recent times, have you worn a face mask when leaving your home?	Yes	310	76.5
	No	95	23.5
Overall Practice status	Good Practice	279	67.1
Overall Practice status	Poor Practice	137	32.9

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Vaccine hesitancy and intention to accept COVID-9 vaccine

Among the HCWs, 212(52.3%) were found to be vaccine-hesitant (Table 6). The study showed that 196 (48.4% (95% CI: 38.6, 58.2)) of health care workers would intend to accept the COVID-19 vaccine, and the remaining 209 (51.6%) intended to not accept the vaccine.

Table 6. Vaccine hesitancy among HCWs working at hospitals of southwestern Ethiopia, 2021 (n = 405).

Variables	Response	Frequency	Percentage
Have you ever refused a vaccine for yourself or a child because you considered it useless or dangerous?	Yes	67(16.5)	16.5
	No	338(83.5)	83.5
Have you ever postponed a vaccine recommended by a physician?	Yes	91(22.5)	22.5
	No	314(77.5)	77.5
Have you ever had a vaccine for a child or yourself despite doubts about its efficacy?	Yes	91(22.5)	22.5
	No	314(77.5)	77.5
Vaccine hesitant	Yes	212(52.3)	52.3
Vaccine hesitant	No	193(47.7)	47.7

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Factors associated with HCW’s intention to accept COVID-19 vaccine

Only variables with p < 0.25 during bivariate analyses were entered in multivariable analysis. In the multivariable analysis type of profession, previous personal history of chronic illness, perceived degree of risk to COVID-19, Attitude toward COVID-19, and preventive practice toward COVID-19 were found to be significantly associated with HCW’s intention to accept the COVID-9 vaccine. According to this study’s findings, health care workers with a physician profession were 9 times more likely to have the intention to accept the COVID-19 vaccine than nurses (AOR = 9.27, 95% CI: 1.27–27.32). Health care workers with a history of chronic illness were 4 times more likely to have the intention to accept the COVID-19 vaccine than health care workers without a history of chronic illness (AOR = 4.07, 95% CI: 2.02–8.21) and health care workers who perceived their degree of risk medium were 5 times more likely to have intention to accept COVID-19 vaccine than health care workers who perceived their degree of risk to be low (AOR = 4.63, 95% CI: 1.26–16.98). Intention to accept the vaccine was 3 times more likely among those with good preventive practices than among those with poor practice (AOR = 2.83, 95% CI: 1.58–5.08), and the intention to accept was 6 times more likely among those with a positive attitude toward COVID-19 than among those with negative attitudes (AOR = 6.08, 95% CI: 3.39–10.91) (Table 7).

Table 7. Factors associated with health care workers intention to accept COVID-19 vaccine in southwestern Ethiopia, 2021.

Variables	Intention to accept COVID-19 vaccine		COR (95%CI)	AOR (95%CI)
Variables	No	Yes	COR (95%CI)	AOR (95%CI)
Type of profession
Physician	4(16%)	21(84%)	6.51(2.17–11.55)	9.27(1.27–27.32)^*
Midwifery	21(40.4%)	31(59.6%)	1.83(0.29–3.37)	2.44(0.38–5.34)
Medical laboratory	22(64.7%)	12(35.3%)	0.68 (0.32–1.43)	0.67(0.28–1.59)
Pharmacist	16(47.1%)	18(52.9%)	1.40(0.68–2.87)	1.28(0.47–3.49)
Others	12(66.7%)	6(33.7%)	0.62(0.22–1.71)	1.23(0.35–4.33)
Nurse	134(55.4%)	108(44.6%)	1	1
Monthly income
68.4–91.2 USD	77(51.7%)	72(48.3%)	0.44(0.19–1.01)	1.65(0.31–8.83)
91.3–182.4 USD	122(54.2%)	103(45.8%)	0.40(0.18–0.89)	1.04(0.20–5.42)
> 182.4 USD	10(32.3%)	21(67.7%)	1	1
Previously diagnosed with chronic illness
Yes	39(32.5%)	81(67.5%)	3.07(1.96–4.81)	4.07(2.02–8.21)^*
No	170(59.6%)	115(40.4%)	1	1
Perceived degree of risk to COVID-19
High	182(54.0%)	155(46.0%)	0.85(0.42–1.72)	2.39(0.88–6.51)
Medium	10(29.4%)	24(70.6%)	2.40(0.88–6.51)	4.63(1.26–16.98)^*
Low	17(50.0%)	17(50.0%)	1	1
Know any friends, neighbors, or colleagues infected by COVID-19
Yes	90(45.9%)	106(54.9%)	1.56(0.05–2.31)	1.70(0.27–2.87)
No	119(56.9%)	90(43.1%)	1	1
Attitude towards COVID-19
Positive Attitude	108(76.5%)	165(23.5%)	4.98(3.11–7.96)	6.08(3.39–10.91)^*
Negative Attitude	101(76.5%)	31(23.5%)	1	1
COVID-19 prevention Practice
Good practice	128(45.9%)	151(54.1%)	2.12(1.38–3.28)	2.83(1.58–5.08)^*
Poor practice	81(64.3%)	45(35.7%)	1	1
Vaccine hesitancy
Yes	116(54.7%)	96(45.3%)	0.77(0.52–1.14)	0.77(0.48–1.22)
No	93(48.2%)	100(51.8%)	1	1

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*Significant at p-value < 0.05

Discussion

Health care workers (HCWs) are the frontlines in combating COVID-19 infection, which makes them more vulnerable to infection than other parts of the society [24, 25]. Since the discovery of the novel coronavirus infection, thousands of health professionals have been infected and lost their lives because of the disease worldwide [26]. In this study, most respondents (83.2%) also perceived that they were at a higher risk of COVID-19 infection. Thus, it is crucial to implement preventive measures including vaccinations against the virus. Therefore the current study focused on the intention of HCWs to accept or not accept the COVID-19 vaccine.

According to the current study, most HCWs (61.5%) possessed good knowledge about COVID-19. This finding was lower than that of two studies in Ethiopia [27, 28], and that of Pakistan [29] in which previous studies stated that more than three quarters of the health professionals had satisfactory knowledge. This discrepancy might be due to differences in the methodology and study settings. However, the knowledge level of the respondents did not show an association with acceptance of the COVI-19 vaccine.

In this study 52.3% of HCWs were vaccine-hesitant and among respondents, 48.4% would intend to accept a COVID-19 vaccine. However, no association was found between vaccine hesitancy and the intention to accept the COVID 19-vaccine in the present study. This is not supported by a previous study from France which, concluded that there was a significant association between vaccine hesitancy and acceptance [30]. The possible reason for the vaccine hesitancy among health care workers in the present study might be vaccine misinformation about the adverse effects of the COVID-19 vaccine. This perception is one of the obstacles in accepting the vaccine [31]. The proportion of health care workers who intended to accept the COVID-19 vaccine was different from the study finding from France [30], which indicated that the COVID vaccine acceptance rate among health care providers was 76.9%. A possible reason for the discrepancy between the current and the previous study might be due to the difference in the study setting and the previous study was conducted a few months after the discovery of the disease but before the COVID-vaccine was introduced to the world.

The study also pointed out that the intention of nurses to accept the COVID-19 vaccine (44.6%) was relatively lower than other professionals such as pharmacists (52.9%), physicians (84%), and midwifery (59.6%). This finding is supported by a previous study that showed a lower rate of COVID-19 vaccine acceptance among nurses [30]. The lower acceptance rate in this profession is concerning because nurses are the largest workforce in the healthcare setup, have frequent contact with patients and spend more time caring than other professional categories [32].

In the current study, it was found that the intention to accept the COVID-19 vaccine was nearly fifteen times more likely among physicians than among other health professionals (radiology technicians and psychiatry). This finding was in line with another similar study finding that physicians were more prone to accept vaccination against COVID-19 than other health professionals [30]. HCWs are among the most affected groups of the population which makes them more sensitive to preventive measures particularly, the COVID-19 vaccine [24, 25]. Moreover, HCWs like physicians possess deeper knowledge about the disease and its vaccine than other parts of the population [33]. Physicians may have observed the fatality of the disease which may increase the odds of physicians having the intention to accept a COVID-19 vaccine.

COVID-19 vaccine acceptance was more likely among respondents who said their degree of risk to COVID-19 infection as ’medium’ than who said ’low’. This result was supported by another study finding that mentioned fear about COVID-19 and self-perceived risk of coronavirus infection were associated with COVID-19 vaccine acceptance among health workers [30]. In addition, healthcare workers with a history of chronic illness had increased odds of having the intention to accept the COVID-19 vaccine than participants without chronic illness. A possible reason might be due to the reason that, most (86.4%) of the study participants knew that patients with underlying chronic disease conditions were at a higher risk of infection and death from COVID-19.

In the current study, two-thirds of the respondents (65.6%) had a positive attitude toward COVID-19 prevention, and 57.5% believed that the COVID-9 vaccine could prevent infection. Intention to accept the COVID-19 vaccine was more likely among those with a positive attitude toward COVID-19 prevention than their counterparts. In line with this finding, studies have indicated that COVID-19 vaccine hesitancy is associated with a negative attitude toward COVID-19 and its preventive measures [34].

Among the study participants, 67.1% had good COVID-19 prevention practices, 87.9% washed or sanitized their hands regularly and 80.7% wore facemasks regularly at the point of care for sick patients. Intention to accept the vaccine was found to be more likely among those with good preventive practices.

Conclusion

The intention to accept the COVID-19 vaccine was relatively low. In addition, the vaccine hesitancy observed in this study was high. HCWs’ intention to accept the COVID-19 vaccine was significantly associated with the type of health professionals, personal history of chronic illness, perceived degree of risk to COVID-19 infection, attitude toward COVID-19 prevention, and preventive practice. Strategies for enhancing the acceptance of the COVID-19 vaccine by considering categories of professionals, chronic illness history, perceived risks of disease, attitude towards disease prevention and preventive behaviors among health workers are crucial. Health sector managers should stress awareness creation to alleviate misinformation about COVID-19 vaccines in health professionals to overcome COVID-19 hesitancy through different strategies.

Limitation of the study

Our study has the following limitations; first, the study was cross-sectional and couldn’t identify causality. Second, the study was conducted in governmental hospitals and may not represent health care workers outside the governmental hospital (private hospitals). Third, the study is conducted in two hospitals out of hospitals found in southwestern Ethiopia and the study explores the attitudes in these two hospitals. Despite these limitations the study highlights the intention of health care workers and associated factors to accept the COVID-19 vaccine in Ethiopian health care workers.

Supporting information

S1 Questionnaire. English version of the survey questionnaire.

(DOCX)

Click here for additional data file.^{(27KB, docx)}

Acknowledgments

We would like to thank all the respondents, data collectors, and supervisors for the realization of this study.

Data Availability

The data underlying the results contain the potential identification of our study participants and have some ethical restrictions as set by the ethical review committee of Mizan Tepi University, College of Health Sciences. However, the row datasets will be available from the chairman of ethics committee of college of health science, Mizan Tepi University on a reasonable request(wesenniguse770@gmail.com).

Funding Statement

The authors received no specific funding for this work.

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PLoS One. doi: 10.1371/journal.pone.0257109.r001

Decision Letter 0

Livia Melo Villar

22 Jun 2021

PONE-D-21-13549

Health Care Workers Intention to Accept COVID-19 Vaccine and Associated Factors in Southern Western Ethiopia, 2021

PLOS ONE

Dear Dr. Angelo,

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I have read the paper and comments of the reviewers. Based on these comments, I suggest major revision of the paper,

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Reviewer #1: Dear Editor,

The manuscript entitled “Health Care Workers Intention to Accept COVID-19 Vaccine and Associated Factors in Southern Western Ethiopia, 2021” by Angelo et al. has merit, However, some points should be addressed to improve the quality of the paper.

Abstract:

The conclusion repeated some the results but did not provide new insights or ideas on the topic addressed.

Introduction:

Page 10, line 3: Please, correct the sentence “...cases outside a China”

Page 11, line 8-10 (last paragraph of ‘introduction’ section): Please, make clear the aouthor’s hipothesis.

Material and Methods:

What abouth the ethics? Please, provide more informations.Did the participants sign the free informed consent?

Page 12, ‘Sample Size and Sampling Technique’ section: How do the authors estimated the vaccine acceptance in 50%? Please, provide the reference for this assumption.

Page 13, lines 2-3: The sentence " The lists of all health care workers were obtained from both hospitals, and the lottery method was used to select 261 samples from MTUTH and 162 from GTSGH.” is redundant. Please, remove it.

Results:

‘Sociodemographic characteristics of the respondents” section and table 1: Please, present the participant’s monthly salary in US dollars. It is more informative.

Discussion:

It would be interesting to deepen the discussion about if (and how) socio-cultural characteristics of the population could be related to the hesitancy to take the COVID-19 vaccine. In addition, insights on how to overcome this hesitancy should be proposed at the end of the discussion or in the conclusion.

In addition, some formatting errors, such as parentheses and capital letters, need to be corrected

Reviewer #2: Intro:

It would be nice to have more data regarding the current situation in Ethiopia and the situation around the time of the study. Had cases continued to rise at that time? How bad was the area surveyed hit?

Are there any data regarding public immunization willingness in Ethiopia?

How well did the residents of Ethiopia accept public health recommendations for things like masks etc? This would help better frame the research.

Also- what is the current vaccine avaialbility in Ethiopia? Are any vaccine available?

General: Recommend better editing for English throughout.

COVID-19 should be capitalized throughout

Abstract: Methods should be clear that this is a survey of healthcare workers at two hospitals.

Methods: How was the survey conducted? Was it anonymous? Was it a paper survey or administered in person?

What types of healthcare workers were eligible? Beyond Nurses, what other types of healthcare workers were eligible to be included? Please also give more information on what "first degree holders" are. Given that "Others" are the reference population, we need more information about that others" actually are. Consider making nurses or a different, larger, group the reference group.

Reviewer #3: This cross-sectional study examined the prevalence and factors associated with acceptance of COVID-19 vaccine in 405 health care workers recruited in 2 public hospitals in Southern Ethiopia in March 2021. I have the following comments for the authors to consider and improve the analyses and the clarity of the findings:

1. The authors are suggested to give more details on the context/ development of COVID-19 in (Southern) Ethiopia near the data collection period (March 2021), which could influence HCW’s acceptance of the vaccine.

2. The scoring of COVID-19 attitude seemed problematic. I could not understand why the responses were ranked from positive (3 points), negative (2 points) to not sure (1 point). Should “not sure” score 2 points while negative 1 point? Furthermore, since there were 7 items, the total scores should range from 7 to 21, not 7 to 18. Can the authors show the internal consistency of these 7 items? In the Methods, please also make it clear that these measures are referring to attitude toward COVID-19 preventive measures.

3. Responses to the question of COVID-19 vaccine hesitancy were dichotomised to “yes” and “no”. Can the authors presented the original scale of the responses?

4. The logistic regression models used in the study appeared to be “multivariable” (1 dependent variable, multiple independent variables) instead of “multivariate” (multiple dependent variables). Please correct.

5. In the abstract the sample size was 423, whereas in the main text it was 405. Please correct.

6. Table 2: Was there any particular reason to divide the chronic diseases into the two categories listed?

7. Table 4: Please indicates the correct answers for the questions on COVID-19 knowledge

8. Table 5: I have doubts on the question “Do you use non-conventional remedies (Honey, garlic, ginger, and lime) when you have flu-like symptoms?” as a measure of COVID-19 prevention practice. This dose not seem a proven/ recommended practice to prevent COVID-19.

9. Please shows the overall prevalence with 95% CI of COVID-19 vaccine acceptance in the results and in the abstract.

10. Table 7: The percentages shown appeared to be cell percentages (rows and columns add up to 100%), which are not useful nor straightforward to interpret. The authors should use row percentages (percentages in the same row add up to 100%) to show the prevalence of vaccine acceptance in each subgroup of variables. Also, it seems more meaningful to use “Nurse” as the reference group instead of “Others” for the variable “Type of Profession”. Please also show the association of vaccine hesitancy and COVID-19 vaccine acceptance (not presented in the table) and which variables were adjusted in the adjusted models.

11. Discussion 3rd paragraph: It is surprising to see that vaccine hesitancy was not associated with COVID-19 vaccine acceptance, since many prior studies have shown vaccine hesitancy/ previous vaccination history to be strongly associated with vaccine acceptance. I could not interpret the results because they were not presented (see comment 10).

12. The vaccine acceptance among nurses appeared to rather low relative to other healthcare workers (~45% vs 54% based on the numbers presented in table 7). This is concerning because nurses constitute the largest health care workforce and have frequent contacts with patients. Can the authors discuss the finding?

13. The authors should elaborate the implications of their findings/ How their findings could be used to improve COVID-19 vaccine acceptance?

14. The authors should discuss the limitations of their findings, which are absent in the article

15. The article would be much benefited from English editing.

**********

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: TT Luk

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PLoS One. 2021 Sep 3;16(9):e0257109. doi: 10.1371/journal.pone.0257109.r002

Author response to Decision Letter 0

7 Jul 2021

We would like to extend our thanks for valuable comments from the editor.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

We have ensured that our manuscript is written in the journal’s style requirements, including for file naming.

We have added additional details regarding participant consent in revised manuscript. Our study doesn’t include minors and we have added “ethics statement” during the submission of the revised manuscript.

We have uploaded questionnaire as supporting information.

The data underlying the results contain the potential identification of our study participants and have some ethical restrictions as set by the ethical review committee of Mizan Tepi University, College of Health Sciences. However, the row datasets will be available on reasonable request after requesting abiyutad@mtu.edu.et .

Comments to reviewers

Reviewer #1

1. The conclusion repeated some the results but did not provide new insights or ideas on the topic addressed.

Thank you reviewer for this important observation. We have made conclusion based on your comments in the revised manuscript.

2. Introduction Page 10, line 3: Please, correct the sentence “...cases outside a China”

We have corrected the sentences with in the revised manuscript.

3. Page 11, line 8-10 (last paragraph of ‘introduction’ section): Please, make clear the authors' hypothesis.

Good observation dear reviewer. We have corrected it accordingly.

4. What about the ethics? Please, provide more information. Did the participants sign the free informed consent?

Thank you reviewer for such comments, and we have provided more information like the form of informed consent in the revised manuscript.

5. Page 12, ‘Sample Size and Sampling Technique’ section: How do the authors estimated the vaccine acceptance in 50%? Please, provide the reference for this assumption

We used the proportion of vaccine acceptance in professionals as 50% because; during sample size estimation we didn’t find any study that identified the proportion of COVID-19 vaccine acceptance in Ethiopia. Therefore we used a proportion of vaccine acceptance of 50 % which could provide the minimum sample size for our study.

6. Page 13, lines 2-3: The sentence “The lists of all health care workers were obtained from both hospitals, and the lottery method was used to select 261 samples from MTUTH and 162 from GTSGH.” is redundant. Please, remove it.

Thank you for good observation, and we have removed the redundant sentence.

7. ‘Socio-demographic characteristics of the respondents” section and table 1: Please, present the participant’s monthly salary in US dollars. It is more informative.

We have changed the monthly salary of professionals stated in Ethiopian Birr to USD.

8. It would be interesting to deepen the discussion about if (and how) socio-cultural characteristics of the population could be related to the hesitancy to take the COVID-19 vaccine. In addition, insights on how to overcome this hesitancy should be proposed at the end of the discussion or in the conclusion.

Thank you reviewer for important idea but identifying the association between socio-cultural characteristics and vaccine hesitancy was not objective of the study. Dear reviewer we have added the insights on how to overcome vaccine hesitancy in the conclusion.

9. In addition, some formatting errors, such as parentheses and capital letters, need to be corrected

We have edited our manuscript in revised manuscript.

Reviewer # 2

1. It would be nice to have more data regarding the current situation in Ethiopia and the situation around the time of the study. Had cases continued to rise at that time? How bad was the area surveyed hit?

Thank you reviewer for important observation. We have incorporated this comment with in the revised manuscript. You can see under introduction part starting from line 8.

2. Are there any data regarding public immunization willingness in Ethiopia?

Thank you dear reviewer for important insight. We have included the data regarding public willingness to COVID-19 vaccine in main manuscript in the introduction section. The findings regarding public willingness showed that willingness is low.

3. How well did the residents of Ethiopia accept public health recommendations for things like masks etc? This would help better frame the research.

We have incorporated this comment with in revised manuscript. Dear reviewer you can get this in line 28 of introduction part.

4. Also- what is the current vaccine availability in Ethiopia? Are any vaccine available?

We have incorporated this with in revised manuscript. It is located in the last paragraph of the introduction part.

5. General: Recommend better editing for English throughout.

Thank you dear reviewer for good recommendation. We have edited the revised manuscript.

6. COVID-19 should be capitalized throughout

We have corrected it accordingly.

7. Abstract: Methods should be clear that this is a survey of healthcare workers at two hospitals.

Tank you dear reviewer important insight. Our study is facility based cross-sectional study and it is not survey. The study was conducted in two hospitals and participants were selected randomly by lottery methods after proportional allocation to each hospitals based on their professional numbers.

8. How was the survey conducted? Was it anonymous? Was it a paper survey or administered in person?

Thank you dear reviewer for interesting questions. Data were collected by self-administered questionnaire. First participants were selected randomly by lottery method in both hospitals and data collectors provided questionaries’ to selected professionals.

9. What types of healthcare workers were eligible? Beyond Nurses, what other types of healthcare workers were eligible to be included? Please also give more information on what "first degree holders" are.

Thank you dear reviewer for important observations. Health care workers who involved in health care and direct contact with patients were eligible for the study. Beyond nurses all professionals including physician, midwifery, medical laboratory technologist, pharmacist, radiology technicians and psychiatry professionals were eligible and included within the study. First degree holder in our study is to mean those professional who have bachelors of Science degree (First degree) in any field of health like medicine, nursing, midwifery or others field.

10. Given that "Others" are the reference population, we need more information about that others" actually are. Consider making nurses or a different, larger, group the reference group.

Thank you dear reviewer for important insight. Others included radiology technicians and psychiatry professionals. We have changed the reference category based on your recommendation and in the revised manuscript we put nurses as a reference group.

Reviewer # 3

Thank you dear reviewer for good observation. We have included the situation of COVID -19 in Ethiopia in the revised manuscript. It is located within the introduction part starting from line 7 of introduction part.

We appreciate dear reviewer for important observation. It was mistakenly written with in old version of the manuscript and your insight was correct. During analysis of the result, attitude responses was scored as follows (yes = 1, no = 0 and not sure = 0). And responses to reversed questions were reversed when assigning the points (Yes=0, not sure = 0 and No=1). As stated within the result, the attitude score ranged from 0 to 7. This scoring is consistent with previous study conducted in Healthcare Workers’ Attitude toward COVID-19. Dear reviewer this is link to access the previous study (https://doi.org/10.2147/JMDH.S287156). The mean attitude score (4.9 �1.6) was computed and participants' were considered as having a positive attitude if the attitude score ≥ mean attitude score. We have corrected the scoring of attitude items which was consistent with our result of attitude responses within revised manuscript. We have also included statements referring to attitude toward COVID-19 preventive measures in method parts.

The internal consistency of 7 attitude items was 0.818 and we have uploaded the SPSS output of reliability in response letterer.

3. Responses to the question of COVID-19 vaccine hesitancy were dichotomized to “yes” and “no”. Can the authors presented the original scale of the responses?

Thank you reviewer for important observation. We have evaluated self-reported vaccine hesitancy of the participants according to the WHO definition using previously adapted three questions. We have classified participants’ response to vaccine hesitancy to yes and no which is consistent to previous study (.DOI:https://doi.org/10.1016/j.jhin.2020.11.020).

Thank you for important comment. We have changed it in the revised manuscript.

5. In the abstract the sample size was 423, whereas in the main text it was 405. Please correct.

We have corrected it with in the abstract part of the revised manuscript.

6. Table 2: Was there any particular reason to divide the chronic diseases into the two categories listed?

Thank you dear reviewer for important observation. We categorized chronic disease that professionals’ had for description purpose.

7. Table 4: Please indicates the correct answers for the questions on COVID-19 knowledge.

Thank you for good review. We have presented the correct knowledge responses (bold) in the response letter.

Good observation. These none-conventional remedies may increase the immunity of individuals in fighting the infection. The question is consistent with previous published literature (https://doi.org/10.2147/JMDH.S287156).

9. Please shows the overall prevalence with 95% CI of COVID-19 vaccine acceptance in the results and in the abstract.

Thanks for important observation. We have included the 95% CI of COVID-19 vaccine acceptance in abstract and result.

Thank you dear reviewer for important observation. We have corrected the percentage of variables that’s sum to be give 100 %. We have also put nurse as reference category and association between vaccine hesitancy and COVID -19 vaccine acceptance.

We have corrected this in our revised manuscript.

We are thankful for important observation. We have discussed this in the revised manuscript under discussion part.

13. The authors should elaborate the implications of their findings/ How their findings could be used to improve COVID-19 vaccine acceptance?

We have incorporated this in the introduction and conclusion part of the revised manuscript.

14. The authors should discuss the limitations of their findings, which are absent in the article.

We thanks for important recommendation. We have added this within revised manuscript.

15. The article would be much benefited from English editing.

We have corrected this in our revised manuscript.

Attachment

Submitted filename: Response to editor and reviewers.docx

Click here for additional data file.^{(45.2KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0257109.r003

Decision Letter 1

Livia Melo Villar

12 Aug 2021

PONE-D-21-13549R1

Health Care Workers Intention to Accept COVID-19 Vaccine and Associated Factors in Southwestern Ethiopia, 2021

PLOS ONE

Dear Dr. Angelo,

Please submit your revised manuscript by Sep 26 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Livia Melo Villar

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear Author,

Thanks for sending the revised manuscript, reviewers suggested minor revision what I also agree,

Best regards,

Livia

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Reviewer #1: Dear authors,

Most of my queries were addressed, so I would like to reccomend this manuscript for publication.

Reviewer #2: The authors claim it is not a two hospital survey but then the methods explicity state the study was conducted in MTUTH and GTSGH- two hteaching hospitals. They randomly selected these two hospitals out of a total of four in the southwestern part of ethiopia, but it still was only two hospitals. Thus, this is a fairly limited study given that it only explores attitudes in two teaching hospitals. This should be described as a limitation.

I'm confused still on how the sutvey was administered. "self-administered" isn't very descriptive. Was it a paper survey or on a computer? Were responses anonymous?

More detail on the type of healthcare workers should be included in the main manuscript.

Finally, there are a lot of tables. I suggest condensing these down.

Reviewer #3: The authors mostly addressed my comments. I had the following suggestions to improve the clarity of the paper further:

1. Please include the internal consistency results of the 7 items on attitudes toward COVID-19 preventive measures in the methods.

2. In the abstract, some results (e.g., AOR=15.18) seem not consistent with those presented in the table 7. Please also indicate the reference group for physicians.

3. Please indicate which item is reversed code in Table 4

**********

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Tzu Tsun Luk

PLoS One. 2021 Sep 3;16(9):e0257109. doi: 10.1371/journal.pone.0257109.r004

Author response to Decision Letter 1

19 Aug 2021

1. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

We have ensured that our reference list is complete and correct.

Comments to reviewers

Reviewer # 2

1. The authors claim it is not a two hospital survey but then the methods explicity state the study was conducted in MTUTH and GTSGH- two hteaching hospitals. They randomly selected these two hospitals out of a total of four in the southwestern part of ethiopia, but it still was only two hospitals. Thus, this is a fairly limited study given that it only explores attitudes in two teaching hospitals. This should be described as a limitation.

Thank you reviewer for this important observation. We have included this in limitation part of the revised manuscript.

2. I'm confused still on how the sutvey was administered. "self-administered" isn't very descriptive. Was it a paper survey or on a computer? Were responses anonymous?

Thank you reviewer for an interesting question. The study was paper survey and anonymous. The name of the participants was not included in the paper. No person identifier information was included in the paper. We have included this in Data Collection Tool, Quality Control, and Procedure and Ethical Considerations parts of the revised manuscript.

3. More detail on the type of healthcare workers should be included in the main manuscript.

Thank you for important observation. We have added the types of health care worker included in the study in inclusion part of the revised manuscript.

4. Finally, there are a lot of tables. I suggest condensing these down

Thank you for such important suggestion. But as journal requirement there is no limitation for numbers of table. And for more clarity of the finding we prefer to present by table as many of questions we used are long.

Reviewer #3

1. Please include the internal consistency results of the 7 items on attitudes toward COVID-19 preventive measures in the methods.

Thank you dear reviewer for important insight. We have included for this in the methods parts of the revised manuscript.

2. In the abstract, some results (e.g., AOR=15.18) seem not consistent with those presented in the table 7. Please also indicate the reference group for physicians.

We appreciate for such vision. We have corrected it in the abstract part of the revised manuscript. The reference group was nurses.

3. Please indicate which item is reversed code in Table 4.

Thank you dear reviewer for such comment. We have indicated for reversed item during scoring in the table 4 of the revised manuscript by symbol *.

Attachment

Submitted filename: Response to editor and reviwers.docx

Click here for additional data file.^{(18.5KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0257109.r005

Decision Letter 2

Livia Melo Villar

24 Aug 2021

Health Care Workers Intention to Accept COVID-19 Vaccine and Associated Factors in Southwestern Ethiopia, 2021

PONE-D-21-13549R2

Dear Dr. Angelo,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Livia Melo Villar

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Author ,

Thanks for sending the revised version of this paper.

Sincerely

Livia Villar

Reviewers' comments:

PLoS One. doi: 10.1371/journal.pone.0257109.r006

Acceptance letter

Livia Melo Villar

27 Aug 2021

PONE-D-21-13549R2

Health Care Workers Intention to Accept COVID-19 Vaccine and Associated Factors in Southwestern Ethiopia, 2021

Dear Dr. Angelo:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Livia Melo Villar

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 Questionnaire. English version of the survey questionnaire.

(DOCX)

Click here for additional data file.^{(27KB, docx)}

Attachment

Submitted filename: Response to editor and reviewers.docx

Click here for additional data file.^{(45.2KB, docx)}

Attachment

Submitted filename: Response to editor and reviwers.docx

Click here for additional data file.^{(18.5KB, docx)}

Data Availability Statement

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PERMALINK

Health care workers intention to accept COVID-19 vaccine and associated factors in southwestern Ethiopia, 2021

Abiy Tadesse Angelo

Daniel Shiferaw Alemayehu

Aklilu Mamo Dachew

Roles

Abstract

Introduction

Methods

Result

Conclusion

Introduction

Materials and methods

Study setting and design

Source population

Study participants

Inclusion and exclusion criteria

Sample size and sampling technique

Data collection tool, quality control, and procedure

Data processing and analysis

Ethical considerations

Results

Socio-demographic characteristics of the respondents

Table 1. Socio-demographic characteristics of the health care workers, hospitals of south western Ethiopia, 2021 (n = 405).

Health status and COVID-19 experience of health care workers

Table 2. Health status and COVID-19 experience of health the professionals working at hospitals of southwestern Ethiopia, 2021 (n = 405).

COVID-19 knowledge of the health care workers

Table 3. COVID-19 knowledge of the HCWs working at hospitals of southwestern Ethiopia, 2021 (n = 405).

Attitude towards COVID-19 preventive measures

Table 4. Attitude towards COVID-19 prevention among HCWs working at hospitals of southwestern Ethiopia, 2021 (n = 405).

COVID-19 prevention practices among health care workers

Table 5. COVID-19 prevention practices among HCWs working at hospitals of southwestern Ethiopia, 2021 (n = 405).

Vaccine hesitancy and intention to accept COVID-9 vaccine

Table 6. Vaccine hesitancy among HCWs working at hospitals of southwestern Ethiopia, 2021 (n = 405).

Factors associated with HCW’s intention to accept COVID-19 vaccine

Table 7. Factors associated with health care workers intention to accept COVID-19 vaccine in southwestern Ethiopia, 2021.

Discussion

Conclusion

Limitation of the study

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Livia Melo Villar

Roles

Author response to Decision Letter 0

Decision Letter 1

Livia Melo Villar

Roles

Author response to Decision Letter 1

Decision Letter 2

Livia Melo Villar

Roles

Acceptance letter

Livia Melo Villar

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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