Evaluation of the Knowledge and Attitude of COVID-19 Vaccines Among Pilgrims
Omar Bashir Ahmed1*, Atif Hussain Asghar1, Majid Abdullah Bamaga1, Fayez Saeed Bahwerth2, Sumyya Hashim Hariri3, Mutasim Elhadi Ibrahim4
1Department of Environmental and Health Research, The Custodian of the Two Holy Mosques Institute for Hajj and Umrah Research, Umm Al-Qura University, Makkah, Saudi Arabia. 2King Faisal Hospital, Makkah, Ministry of Health, Makkah, Saudi Arabia. 3Department of Microbiology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia. 4Department of Basic Medical Sciences (Microbiology Unit), College of Medicine, University of Bisha, Bisha, Saudi Arabia.
Abstract
Although vaccines are recognized as one of the most successful public health measures, some individuals consider vaccination unsafe, ineffective, and unnecessary. The study aimed to evaluate knowledge and attitude of COVID-19 vaccines among pilgrims at a Hajj event (pilgrimage). A survey was conducted to assess knowledge and attitude toward COVID-19 vaccines among 251 pilgrims in Makkah City, Saudi Arabia. The results showed a moderate level of knowledge, with a mean of 76.1%. The majority (94.8%) of the participants know that “the COVID-19 vaccines are effective” followed by their knowledge “about the purpose of the vaccine” (84.5%). There was poor knowledge regarding the different types of COVID-19 vaccines (66.1%) and how they should be stored (66.1%). There was a strong agreement about the effectiveness of COVID-19 vaccines and to be taken during pilgrimage with a mean value of 4.4382 and 4.2311 respectively. Most pilgrims (46.6%) get awareness about COVID-19 vaccines from the official media, and social media (29.0%). There was a significant association between gender and the type of vaccines (P < 0.05). The Pfizer BioNTech vaccine was the most common vaccine used during the Hajj event (50.4%), followed by AstraZeneca (29.0%), Johnson & Johnson (24.7%), and Moderna (23.1%). It was concluded that there was a moderate level of knowledge and positive attitude regarding COVID-19 vaccines. Also, there was a strong agreement among pilgrims about the effectiveness of COVID-19 vaccines and the fact that they should be taken by all pilgrims.
Keywords: Knowledge, Attitude, COVID-19, Vaccines, Pilgrims
INTRODUCTION
The Hajj (pilgrimage) is considered one of the largest human gatherings in the world, as millions of Muslims from all over the world gather annually to perform this duty. Reports from the Kingdom of Saudi Arabia (KSA) indicate that some pilgrims may be exposed, while performing the rituals, to some infectious diseases that usually abound in the Hajj event such as influenza and colds, gastroenteritis, cholera, and food poisoning [1, 2]. Infectious diseases and epidemics such as coronavirus disease (COVID-19) are among the most important health risks in large communities. Since the outbreak of the COVID-19 pandemic, which was first reported in Wuhan, China, on December 31, 2019, until the end of January 2023, it has infected approximately 67 million cases while over 6.8 million deaths have been reported globally [3] suggesting the importance of vaccination to stop virus infection. As a result, the health authorities in KSA requested those who wished to perform Hajj must complete the necessary vaccinations for COVID-19, in addition to other vaccines against other infectious diseases such as meningitis and the seasonal influenza vaccine. A vaccine is a biological preparation that typically contains a weakened pathogen or a micro-organic-like component of the same infection-causing organism [4]. It is one of the active aspects of immunity acquired against infectious diseases in general, whether bacterial or viral (COVID-19) [5]. Vaccines have been shown to reduce the severity of the disease and prevent hundreds of deaths per day. They also reduce the possibility of community transmission of COVID-19 among individuals or the public [6, 7]. Despite minor effects, vaccination is very important because non-vaccination increases the risk of infectious and other diseases and their transmission to others, as is the case in the COVID-19 pandemic. The COVID-19 vaccines have saved the global economy significant human and financial losses and helped control the pandemic.
Although COVID-19 vaccines are recognized as one of the most successful public health measures, an increasing number of individuals consider vaccination unsafe and unnecessary [8]. In addition, anxiety associated with COVID-19 vaccines, health concerns, and various side effects that appeared for some vaccines were associated with frequency or acceptance of vaccines, while fear of social, economic, and psychological consequences showed the same result [9, 10]. Thus, conspiracy theories and misinformation about the COVID-19 vaccine could lead to an increase in the number of vaccine hesitators [10-12]. As pilgrims from different countries with different knowledge and attitudes toward COVID-19 vaccination, there may be a divergence of opinions on COVID-19 vaccines, about the effectiveness and the fact that vaccination may be harmful. Lack of confidence among pilgrims in vaccines may pose a threat to the success of pilgrimage trips due to the COVID-19 infection. Therefore, the present study was conducted to assess knowledge and attitude of COVID-19 vaccines among a sample of pilgrims during Hajj season 1443 (2022) in Makkah City, Saudi Arabia.
MATERIALS AND METHODS
A cross-sectional survey was conducted for pilgrims about their knowledge, and attitude toward COVID-19 vaccines from September to October 2022. The draft questionnaire was tested on a small sample of pilgrims through face-to-face interviews, during which participants were first asked to complete the questionnaires alone. Questionnaires were finalized and digitalized to be completed on mobile devices after adjusting the contents and wording based on the feedback collected from interviewees. The study participants were offered the questionnaire in one of two languages: Arabic and English. The questionnaire covered 3 domains: (i) Demographics and Practices among pilgrims, (ii) Knowledge of pilgrims regarding the COVID-19 Vaccine, and (iii) Attitudes of pilgrims regarding the COVID-19 Vaccine. Knowledge had three options: Yes/No/somewhat. Similarly, the attitude section had 5 options on the Likert scale (strongly agree to strongly disagree). Knowledge questions had the following scoring system: correct answer (Yes) =2 and wrong answer (No) =0. Partial answer (somewhat) =1. The contents evaluated in Knowledge of, the importance, effectiveness, side effects, content doses, and recipients' ages of COVID-19 vaccines. Evaluation knowledge, and attitude, of COVID-19 vaccines among pilgrims was assessed on a 5-point Likert scale (1: Strongly disagree, 2: disagree, 3: neutral, 4: agree, 5: Strongly agree). The questions used a five-point Likert scale on knowledge and attitudes about COVID-19 vaccines. The mean in the domains of the five-point Likert scale was as follows; From 1 to 1.80 (Strongly disagree), from 1.81 to 2.60 (disagree), from 2.61 to 3.40 (neutral), from 3.41 to 4.20 (agree), from 4.21 to 5.0 (Strongly agree). Verbal consent was obtained from each participant. The confidentiality and privacy of the subjects were maintained.
Data Analysis
SPSS (Statistical Package for the Social Sciences version 22) software was used for data analysis. Descriptive statistics including frequency, mean, and standard deviation were used to describe different characteristics. The chi-square test was used to test whether the demographic variables are related to each other. A p-value of less than 0.05 was considered "statistically significant.
RESULTS AND DISCUSSION
Table 1 shows the demographical characteristics of a total of 251 respondents (Table 1). The sample of the study was composed of 189 (75.3%) male respondents and 62 (24.7%) female respondents. Of the 251 respondents, the most participating age group was the group (41-60) years (55%), followed by the age group (21-40) (38.6%) and the “above 60 years” category (6%). The most popular nationalities that participated in this study were Saudi Arabia (30.3%), followed by Egyptian (16.3%), Indian (13.6%), Sudanese (6.8%), and Bangladeshi (6%). The highest level of education among the participating groups was the graduate (university) level (57.8%), followed by the secondary level (30.7%) and post-graduate level (10.8%). Almost all (except the unknown one) the respondents were also vaccinated (97.6%). Table 2 shows the demographics of participants.
|
Table 1. Demographics of the participants |
|||
|
% |
No. |
Variable |
|
|
75.3 |
189 |
Male |
Sex |
|
24.7 |
62 |
Female |
|
|
100 |
251 |
Total |
|
|
0.4 |
1 |
=< 20 years |
Age |
|
38.6 |
97 |
21-40 years |
|
|
55.0 |
138 |
41-60 years |
|
|
6.0 |
15 |
over 60 years |
|
|
100 |
251 |
Total |
|
|
0.8 |
2 |
Illiterate |
Education level |
|
30.7 |
77 |
secondary or less |
|
|
57.8 |
145 |
collegiate |
|
|
10.8 |
27 |
Postgraduate education |
|
|
100 |
251 |
Total |
|
|
30.3 |
76 |
Saudi |
Nationality |
|
16.3 |
41 |
Egypt |
|
|
13.6 |
34 |
India |
|
|
6.8 |
17 |
Sudan |
|
|
6.0 |
15 |
Bangladesh |
|
|
3.6 |
9 |
Yemen |
|
|
3.2 |
8 |
Algeria |
|
|
3.2 |
8 |
Syria |
|
|
2.8 |
7 |
Tunisia |
|
|
2.4 |
6 |
Malaysia |
|
|
2 |
5 |
Jordan |
|
|
2 |
5 |
Pakistan |
|
|
1.2 |
3 |
Nepal |
|
|
1.2 |
3 |
Turkish |
|
|
0.8 |
2 |
Somalia |
|
|
0.8 |
2 |
Sri Lanka |
|
|
0.8 |
2 |
Indonesia |
|
Table 2 shows COVID-19 vaccine knowledge among the participants (pilgrims sample). The participants in the study population expressed a moderate level of knowledge, with a mean of 76.1%. The majority (94.8%) of the participants know that “the COVID-19 vaccines are effective” followed by their knowledge “about the purpose of the vaccine” (84.5%) and that the vaccine is useful for all ages of people (78.9%). Also, the knowledge of participants was poor (less than 70%) in terms of the knowledge about (i) The different types of COVID-19 vaccines (66.1%); (ii) how should vaccines be stored (66.1%); and (iii) how the vaccine works (66.9%).
|
Table 2. COVID-19 vaccine knowledge among the pilgrims' sample |
||||||||
|
|
No |
Somewhat |
Yes |
Knowledge |
|
|||
|
|
% |
No. |
% |
No. |
% |
No. |
||
|
0.802 |
11.2 |
28 |
18.3 |
46 |
70.5 |
177 |
Do you know what is the vaccine in general? |
1 |
|
0.445 |
2.8 |
7 |
12.7 |
32 |
84.5 |
212 |
Do you know the purpose of the vaccine? |
2 |
|
0.717 |
22.7 |
57 |
8.4 |
21 |
68.9 |
173 |
Do you know how the vaccine works? |
3 |
|
0.786 |
10. 0 |
25 |
21.9 |
55 |
68.1 |
171 |
Do you know how should vaccines be stored? |
4 |
|
0.628 |
7.6 |
19 |
16.3 |
41 |
76.1 |
191 |
Do you know that vaccines are safe? |
5 |
|
0.521 |
4.8 |
12 |
21.1 |
53 |
74.1 |
186 |
Do you know the importance of the booster doses of COVID-19 vaccines? |
6 |
|
0.504 |
8.8 |
22 |
12.4 |
31 |
78.9 |
198 |
Do you know that the vaccine is useful for all ages of people? |
7 |
|
0.705 |
15.5 |
39 |
18.3 |
46 |
66.1 |
166 |
Do you know the different types of COVID-19 vaccines? |
8 |
|
0.519 |
0.8 |
2 |
4.4 |
11 |
94.8 |
238 |
Do you know that the COVID-19 vaccines are effective? |
9 |
|
0.649 |
11.2 |
28 |
14.7 |
37 |
74.1 |
186 |
Do you know the COVID-19 vaccine has low side effects? |
10 |
|
|
9.1 |
22.9 |
14.8 |
37.2 |
76.1 |
190.9 |
Mean |
|
|
Table 3. COVID-19 vaccine attitude among the pilgrims' sample |
|||||||||||
|
Strongly disagree |
Disagree |
Uncertain |
Agree |
Strongly agree |
Study variables |
||||||
|
% |
No. |
% |
No. |
% |
No. |
% |
No. |
% |
No. |
||
|
0.4 |
1 |
0.4 |
1 |
4.4 |
11 |
44.6 |
112 |
50.1 |
126 |
The vaccines are effective against COVID-19 |
1 |
|
0.8 |
2 |
6 |
15 |
8 |
20 |
39.8 |
100 |
45.4 |
114 |
All pilgrims should have COVID-19 vaccine |
2 |
|
3.2 |
8 |
8.0 |
20 |
14.7 |
37 |
49 |
123 |
25.1 |
63 |
The side effects of the COVID-19 vaccine are not serious |
3 |
|
2.4 |
6 |
7.6 |
19 |
21.5 |
54 |
42.2 |
106 |
26.3 |
66 |
COVID-19 vaccines do not affect fertility |
4 |
|
0.4 |
1 |
5.6 |
14 |
13.9 |
35 |
47.4 |
119 |
32.7 |
82 |
More than one vaccine can be taken for COVID-19 |
5 |
|
0.4 |
1 |
4.8 |
12 |
14.3 |
36 |
48.2 |
121 |
23.3 |
81 |
Those who have taken the COVID-19 vaccine can get infected |
6 |
|
1.2 |
3 |
6.4 |
16 |
16.3 |
41 |
41.8 |
105 |
34.3 |
86 |
A booster (additional) dose of COVID-19 vaccines is important |
7 |
|
2.8 |
7 |
6.0 |
15 |
12.4 |
31 |
46.6 |
117 |
32.3 |
81 |
In general, the vaccine is useful for people of all ages |
8 |
|
2.4 |
6 |
8.8 |
22 |
18.3 |
46 |
35.9 |
90 |
34.7 |
87 |
COVID-19 vaccines do not contain a live version of the COVID-19 virus |
9 |
|
4.8 |
12 |
15.1 |
38 |
19.1 |
48 |
35.1 |
88 |
25.9 |
65 |
COVID-19 vaccine may cause fever |
10 |
|
2.8 |
7 |
15.9 |
40 |
18.3 |
46 |
35.9 |
90 |
27.1 |
68 |
COVID-19 vaccine may cause musle pain |
11 |
Table 4 shows that awareness about COVID-19 vaccines among the respondents was from the official media (46.6%), followed by social media (29.0%) and the Ministry of Health websites (7.2%). Most of the participants used the Pfizer BioNTech vaccine against COVID-19 (50.4%), followed by AstraZeneca (29.0%), Johnson & Johnson (24.7%), and Moderna (23.1%).
|
Table 4. Practices of COVID-19 vaccines among the participants |
|||
|
|
|
No |
% |
|
Received the vaccination |
Yes |
246 |
97.9 |
|
No |
6 |
2.4 |
|
|
Total |
|
251 |
100 |
|
COVID-19 Vaccine type |
Total |
|
|
|
Pfizer BioNTech |
126 |
50.2 |
|
|
AstraZeneca |
73 |
29.0 |
|
|
Johnson & Johnson |
62 |
24.7 |
|
|
Moderna |
58 |
23.1 |
|
|
Other |
45 |
17.9 |
|
|
The main information sources of COVID-19 vaccine |
Official media |
117 |
46.6 |
|
Social networking |
76 |
30.3 |
|
|
Ministry of Health website |
18 |
7.2 |
|
|
others |
42 |
16.7 |
|
Table 4 shows a strong agreement of the participants’ agreement with the effectiveness of COVID-19 vaccines and the necessity to have them with a mean value of 4.4382 and 4.2311 respectively. There was an overall agreement regarding; the possibility of a vaccinated person getting infected (with a mean of 4.0717), the possibility of taking two different vaccines (with a mean of 4.0637), the importance of booster dose of COVID-19 vaccines (with a mean of 4.0159), the usefulness of the vaccine for all ages (with mean= 3.9960), COVID-19 vaccines lack live version of the virus (with mean= 3.9163), the low side effects of COVID-19 vaccines (with mean= 3.8486), uneffectiveness to fertility (with mean= 3.8247), COVID-19 vaccine may cause musle pain (with mean= 3.6853), and COVID-19 vaccine may cause fever (mean= 3.6215).
|
Table 5. Statistical analysis including mean, standard deviation, T-test, and direction of variables |
||||||
|
Order |
|
Mean |
Std. Dev. |
T-test |
% |
Direction |
|
1 |
The vaccines are effective against COVID-19 |
4.4382 |
.63810 |
35.709 |
88.764 |
Strongly agree |
|
2 |
All pilgrims should have COVID-19 vaccine |
4.2311 |
.89129 |
21.883 |
84.622 |
Strongly agree |
|
3 |
Those who have taken the COVID-19 vaccine can get infected |
4.0717 |
.83117 |
20.428 |
81.434 |
Agree |
|
4 |
Two different vaccines can be taken for COVID-19 |
4.0637 |
.85084 |
19.807 |
81.274 |
Agree |
|
5 |
A booster dose of COVID-19 vaccines is important |
4.0159 |
.93367 |
17.239 |
80.318 |
Agree |
|
6 |
In general, the vaccine is useful for people of all ages |
3.9960 |
.96953 |
16.276 |
79.92 |
Agree |
|
7 |
COVID-19 vaccines do not contain a live version of the virus. |
3.9163 |
1.04545 |
13.886 |
78.326 |
Agree |
|
8 |
The side effects of the COVID-19 vaccine are not serious |
3.8486 |
.99247 |
13.547 |
76.972 |
Agree |
|
9 |
COVID-19 vaccines do not affect fertility |
3.8247 |
.98445 |
13.272 |
76.494 |
Agree |
|
10 |
COVID-19 vaccine may cause musle pain |
3.6853 |
1.11738 |
9.716 |
73.706 |
Agree |
|
11 |
COVID-19 vaccine may cause fever |
3.6215 |
1.16111 |
8.480 |
72.43 |
Agree |
|
|
Total |
43.7131 |
6.94647 |
24.434 |
79.4784 |
Agree |
Table 5 shows degrees of association between participants' demographics and some analyzed variables. The findings reveal that gender is significantly associated with COVID-19 vaccine type and non-COVID-19 vaccine (P < 0.05). No significant association was found between education and age with the type of COVID-19 and non-COVID-19 vaccines, and the COVID-19 vaccine types (P > 0.05).
|
Table 6. Degrees of association between demographic and variables |
||||||
|
Pearson Chi-Square |
Gender |
Education |
Age |
|||
|
Value |
p-value |
Value |
p-value |
Value |
p-value |
|
|
COVID-19 vaccine type |
49.119 |
0.001 |
70.634 |
0.326 |
49.402 |
0.973 |
|
No of COVID-19 vaccines |
6.960 |
0.073 |
15.736 |
0.073 |
12.778 |
0.173 |
|
Non covid-19 vaccine |
21.286 |
0.00 |
10.929 |
0.091 |
1.323 |
0.970 |
The annual Hajj pilgrimage is one of the most known mass gathering events. During the COVID-19 pandemic, it was requested that the pilgrims must be under 65 years, must be fully vaccinated against COVID-19, and must have a negative PCR test [11]. One of the challenges that arise with the COVID-19 vaccine is its acceptability at both a country level and an individual level [12]. The present study was conducted to assess knowledge and attitudes of COVID-19 vaccines among pilgrims. Our sample was composed of 251, most of them were males (75.3%) and 55% of them belonged age group (41-60) years, 57.8% of them were graduate (University) level (57.8%). Similar studies found that 50% of the study participants belong to the age group 40-60 years and nearly most of them were educated [13, 14]. Also, our study found that the major source for knowledge and awareness about COVID-19 vaccines among the respondents was from the official media (46.6%), followed by social media (29.0%) and the Ministry of Health websites (7.2%). Oppositly one study found that 22.8% and 28.7% of the respondents had heard about the COVID-19 vaccine from their family members, friends, and neighbors respectively [15]. Another study showed that most of the participants used search engines (57.6%) to seek information about vaccines [16].
The present study expressed a moderate level of knowledge about COVID-19 vaccines, with a mean of 76.1%. The majority of the participants knew that the COVID-19 vaccines were effective and understood the purpose of the vaccines and their common usefulness for all ages of people. However, our study showed a low rate of knowledge among participants about the presence of different types, storage, and the work of COVID-19 vaccines.
The present study showed a strong agreement between the participants’ knowledge of the effectiveness of COVID-19 vaccines and the necessity to have them. Many similar studies have shown that vaccines were effective and protective against infection, severe disease, hospitalization, and death [12, 17, 18]. Other studies showed that high knowledge was significantly associated with a more positive attitude and perception [19, 20]. The study showed an overall agreement regarding; the possibility of a vaccinated person getting infected, the possibility of taking two different vaccines, importance of booster doses of COVID-19 vaccines. In addition, our study showed a positive attitude towards the usefulness of the vaccine for all ages, the vaccines lack a live version of the virus, and the low side effects of COVID-19 vaccines. Other studies showed that the vast majority of participants received their vaccinations with an overall positive attitude toward the COVID-19 vaccination [21-23]. Similar studies showed the usefulness of the vaccine for small ages [24], COVID-19 vaccines lack a live version of the virus [25], and the low side effects of COVID-19 vaccines [26].
Furthermore, one study indicated that those who received the first dose of COVID-19 vaccines and were infected after three weeks had a lower risk of transmitting the virus to others by 38 percent to 49 percent compared to people who did not get the vaccine yet [27]. Although vaccines are not 100 percent effective in preventing severe symptoms or transmission of infection, they are necessary to help return to normal life, especially in crowds (Hajj). One study reported that a total of 677 participants (from 7563) showed an intention to refuse COVID-19 vaccination due to the fear of adverse reactions to the COVID-19 vaccine [16].
Our study showed that most of the participants used the Pfizer BioNTech vaccine, followed by AstraZeneca, Johnson & Johnson, and Moderna.
A study used sentiment analysis towards Pfizer/BioNTech, AstraZeneca/Oxford, and Moderna COVID-19 vaccines indicated that the sentiment regarding Pfizer/BioNTech and Moderna vaccines remained positively stable, whereas that of the AstraZeneca/Oxford vaccine seems to be decreasing in positivity [28]. Moreover, a study conducted in Saudi Arabia confirmed the low side effects of Pfizer-BioNTech which were the typical symptoms of most previous vaccines [29].
The most two available COVID-19 vaccines in the world are Pfizer and AstraZeneca which are highly effective with very rare side effects [30, 31]. It also found that using different vaccines produced a higher level of immune cells primed to attack the coronavirus than did giving two doses of the same vaccine [32, 33] in addition, the doses of COVID-19 vaccines can reduce the risk of transmission within the community [34]. Previous studies by the Public Health Authority in England have confirmed the effectiveness of the “Pfizer-Biontech” and “Oxford-AstraZeneca” vaccines in reducing COVID-19 infection among the elderly (over 60 years of age) and preventing a large number of deaths, including death for those over 60 years of age [35, 36]. Our findings there was a significant association of gender with COVID-19 vaccine type and non-COVID-19 vaccine (P < 0.05) which is very close to many studies [37, 38].
Generally, vaccination makes it possible to travel and feel safe, thus preventing and reducing health risks [39] that pilgrims may face. It prevents deaths due to COVID-19, saves time [9] and money on treatment, and vaccines help to return to normal life and feel safe [40] while performing rituals. Despite the great importance and benefits of vaccines, they are not 100 percent effective in preventing severe symptoms or transmission of infection [41].
CONCLUSION
It could be concluded that there was generally moderate knowledge and positive attitude of pilgrims towards COVID-19 vaccines. There was a strong agreement among pilgrims about the effectiveness of COVID-19 vaccines and hence should be taken by all pilgrims. The Pfizer BioNTech followed AstraZeneca vaccines were the most commonly used vaccines during the Hajj event. Gender was significantly associated with all types of vaccines (COVID-19 and non-COVID-19 vaccines) with P-value < 0.05).
ACKNOWLEDGMENTS: The authors would like to acknowledge the Custodian of the Two Holy Mosques Institute for Hajj and Umrah Research, at Umm Al-Qura University for supporting this work.
CONFLICT OF INTEREST: None
FINANCIAL SUPPORT: None
ETHICS STATEMENT: The study was approved by the Custodian of the two mosque institutes for Hajj and Umrah research at Umm Al-Qura University.
Copyright © 2024 - All Rights Reserved - Archives of Pharmacy Practice
Developed by Archives of Pharmacy Practice
