Abstract
Background
Vaccination is important to prevent morbidity and mortality due to COVID-19 among older Syrian refugees. We aimed to elucidate the predictors of COVID-19 vaccine uptake among Syrian refugees aged 50 years or older in Lebanon and to understand their main reasons for not receiving the vaccine.
Methods
This was a cross-sectional analysis of a five-wave longitudinal study, conducted through telephone interviews between Sept 22, 2020, and March 14, 2022, in Lebanon. For this analysis, data were extracted from wave 3 (Jan 21–April 23, 2021), which included a question on vaccine safety and on whether participants intended to receive the COVID-19 vaccine, and wave 5 (Jan 14–March 14, 2022), which included questions on actual vaccine uptake. Syrian refugees aged 50 years or older were invited to participate from a list of households that received assistance from the Norwegian Refugee Council, a humanitarian non-governmental organisation. The outcome was self-reported COVID-19 vaccination status. Multivariable logistic regression was used to identify predictors of vaccination uptake. Validation was completed internally with bootstrapping methods.
Findings
2906 participants completed both wave 3 and 5; the median age was 58 (IQR 55–64) years and 1538 (52·9%) were male. 1235 (42·5%) of 2906 participants had received at least one dose of the COVID-19 vaccine. The main reasons for not receiving the first dose included being afraid of its side-effects (670 [40·1%] of 1671) or not wanting the vaccine (637 [38·1%] of 1671). 806 (27·7%) of 2906 participants received the second dose of the vaccine and 26 (0·9%) of 2906 received the third dose. The main reason for not receiving the second (288 [67·1%] of 429) or third dose (573 [73·5%] of 780) was waiting for a text message for an appointment. Predictors of receiving at least one dose of the COVID-19 vaccine included younger age (odds ratio 0·97; 95% CI 0·96–0·98), being male (1·39; 1·19–1·62), living inside informal tented settlements (1·44; 1·24–1·66), having elementary (1·23; 1·03–1·48) and preparatory education or above (1·15; 0·95–1·40), and having a pre-existing intention to receive the vaccine (1·29; 1·10–1·50). After adjusting for optimisation, the final model, which includes these five predictors of receiving at least one dose of the COVID-19 vaccine, showed moderate discrimination (C-statistic 0·605; 95% CI 0·584–0·624) and good calibration (c-slope 0·912; 95% CI 0·758–1·079).
Interpretation
There is an ongoing need to address COVID-19 vaccine uptake among older Syrian refugees by improving deployment planning and raising awareness about the importance of vaccination.
Vaccination is important to prevent morbidity and mortality due to COVID-19 among older Syrian refugees. We aimed to elucidate the predictors of COVID-19 vaccine uptake among Syrian refugees aged 50 years or older in Lebanon and to understand their main reasons for not receiving the vaccine.
Methods
This was a cross-sectional analysis of a five-wave longitudinal study, conducted through telephone interviews between Sept 22, 2020, and March 14, 2022, in Lebanon. For this analysis, data were extracted from wave 3 (Jan 21–April 23, 2021), which included a question on vaccine safety and on whether participants intended to receive the COVID-19 vaccine, and wave 5 (Jan 14–March 14, 2022), which included questions on actual vaccine uptake. Syrian refugees aged 50 years or older were invited to participate from a list of households that received assistance from the Norwegian Refugee Council, a humanitarian non-governmental organisation. The outcome was self-reported COVID-19 vaccination status. Multivariable logistic regression was used to identify predictors of vaccination uptake. Validation was completed internally with bootstrapping methods.
Findings
2906 participants completed both wave 3 and 5; the median age was 58 (IQR 55–64) years and 1538 (52·9%) were male. 1235 (42·5%) of 2906 participants had received at least one dose of the COVID-19 vaccine. The main reasons for not receiving the first dose included being afraid of its side-effects (670 [40·1%] of 1671) or not wanting the vaccine (637 [38·1%] of 1671). 806 (27·7%) of 2906 participants received the second dose of the vaccine and 26 (0·9%) of 2906 received the third dose. The main reason for not receiving the second (288 [67·1%] of 429) or third dose (573 [73·5%] of 780) was waiting for a text message for an appointment. Predictors of receiving at least one dose of the COVID-19 vaccine included younger age (odds ratio 0·97; 95% CI 0·96–0·98), being male (1·39; 1·19–1·62), living inside informal tented settlements (1·44; 1·24–1·66), having elementary (1·23; 1·03–1·48) and preparatory education or above (1·15; 0·95–1·40), and having a pre-existing intention to receive the vaccine (1·29; 1·10–1·50). After adjusting for optimisation, the final model, which includes these five predictors of receiving at least one dose of the COVID-19 vaccine, showed moderate discrimination (C-statistic 0·605; 95% CI 0·584–0·624) and good calibration (c-slope 0·912; 95% CI 0·758–1·079).
Interpretation
There is an ongoing need to address COVID-19 vaccine uptake among older Syrian refugees by improving deployment planning and raising awareness about the importance of vaccination.
| Original language | English |
|---|---|
| Pages (from-to) | e219-e227 |
| Number of pages | 9 |
| Journal | The Lancet Healthy Longevity |
| Volume | 4 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - May 2023 |
Bibliographical note
This work was supported by ELRHA's Research for Health in Humanitarian Crisis (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the UK Foreign, Commonwealth and Development Office, Wellcome Trust, and the UK National Institute for Health Research. The views expressed herein should not be taken, in any way, to reflect the official opinion of the Norwegian Refugee Council or ELRHA. We thank Noura Salibi and Maria El Haddad for their support and expertise throughout all aspects of the research study, including data monitoring, cleaning, and analysis. We also acknowledge BOT (Bridge. Outsource. Transform) for their assistance in collecting the data required for the success of this study and the study participants for their participation.Funding
ELRHA's Research for Health in Humanitarian Crisis Programme.
Data Availability Statement
The anonymised data can be obtained upon reasonable request from the Norwegian Refugee Council (nrc@nrc.no) and the American University of Beirut (crph@aub.edu.lb).
Access to Document
- Zeid_etal_TLHL_Predictors_and_barriers_VOR
Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.