Acceptability and uptake of COVID-19 vaccines among pregnant and lactating women seeking services at a tertiary public hospital in Kampala, Uganda

<title>Abstract</title> Background Globally, several vaccines, including COVID-19 vaccines, have been routinely recommended during pregnancy and lactation. However, data on COVID-19 vaccine acceptability and uptake among pregnant and lactating women are limited in Sub-Saharan Africa. While COVID-19 is no longer a public health emergency it is important to take stock of lessons learnt to prepare for future health threats including those that disproportionately affect pregnant/lactating women. We aimed to assess acceptability and uptake of COVID-19 vaccines among pregnant and lactating women in Uganda. Methods This was a cross-sectional study conducted among 424 pregnant and lactating women, who were seeking maternal and child health care at Kawempe National Referral Hospital in Kampala. We obtained data on vaccine acceptability defined as willingness to accept vaccines using interviewer-administered questionnaires. In addition, we assessed vaccination status. Factors associated with COVID-19 vaccine acceptability and uptake were evaluated using modified Poisson regression. Results The mean age of the respondents was 26.9 years (SD = 5.7), ranging from 14–45 years. Among 424 respondents, 51.7% had received at least one dose of COVID-19 vaccine, 94.1% had received tetanus toxoid vaccine, and 48.3% regardless of their vaccination status, were willing to receive COVID-19 vaccines. Only 5/212(2.4%) had received COVID-19 vaccines while lactating with none having been received during pregnancy. Factors associated with COVID-19 vaccine uptake included history of testing for COVID-19 (aPR = 1.92, CI:1.46–2.54) and having a vaccinated household member (aPR = 1.34, CI:1.03–1.84). COVID-19 vaccine willingness was significantly associated with being a household head (aPR = 2.2, CI:1.12–4.27) and having a vaccinated household member (aPR = 1.33, CI:1.04–1.76). Conclusion The uptake and willingness to receive COVID-19 vaccines among pregnant and lactating women were generally low, with no participants receiving COVID-19 vaccines during pregnancy and very few during lactation. In contrast, the majority had received tetanus toxoid vaccines, indicating a disparity in vaccine acceptance. Factors such as undergoing COVID-19 testing and having a vaccinated household member positively influenced COVID-19 vaccine uptake and willingness. These findings highlight the need for targeted interventions to improve the acceptance and uptake of COVID-19 vaccines, during pregnancy and lactation.