Attitude Towards Childhood and Adult Vaccination among Rural and Urban Caregivers in the Eastern Region of Ghana: A Comparative Cross-sectional Study
Richard Kwaku Essien *
Department of Public Health, Abuakwa South Municipal Health Directorate, Kyebi, Eastern Region, Ghana and Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
Jerdu Bin eranaa Nuhu
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
John Kwame Agbenyeavu
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
Rebecca Tricia Morrison
Department of Population and Reproductive Health, University of Port Harcourt, Port Harcourt, Nigeria.
Boaz Ahulu
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria and Department of Public Health, Community Health Nursing Training College, Akim Oda, Ghana.
Benjamin Kwasi Amoako
Department of Public Health, Disease Control Unit, Assin Fosu Municipal Health Directorate, Assin Fosu, Ghana.
Abubakar Alhassan
Department of Public Health, Federal University of Health Sciences, Azare, Bauchi State, Nigeria.
Porbilla Ewura Ofosu-Apea
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
Oscar Vetsi
Department of Public Health, Disease Control Unit, Ghana Health Service, Ada West District, Sege, Ghana.
Eric Addo Owusu
Department of Population and Reproductive Health, University of Port Harcourt, Port Harcourt, Nigeria.
Dadia Stephen
Department of Public Health, Ghana Health Service, Kpandai District Health Directorate, Kpandai, Ghana.
Brainard Ayisi Asare
Department of Public Health, Kwaebibirem Municipal Health Directorate, Kade, Ghana.
Best Ordinioha
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Caregiver attitudes can influence acceptance of childhood and adult vaccination and may differ between rural and urban communities.
Aim: This study compared vaccination attitudes among caregivers of children under five years in the Eastern Region of Ghana.
Methods: A comparative cross-sectional study was conducted among 1,400 caregivers selected through multistage sampling, with 700 participants from each of the rural and urban communities. Attitudes were assessed using 12 five-point Likert-scale items, including three negatively worded statements that were reverse-scored for the composite score. Total scores ranged from 12 to 60 and were classified as positive, neutral or negative. Rural and urban groups were compared using independent-samples t tests, chi-square tests and odds ratios.
Results: Mean attitude scores were 42.73 (SD 5.93) among rural caregivers and 44.10 (SD 5.72) among urban caregivers, indicating a small difference (Cohen's d = 0.24). Positive attitudes were observed in 39.3% of rural and 46.3% of urban caregivers, while 56.9% of all participants had neutral attitudes. Urban caregivers had higher odds of a positive attitude than rural caregivers. Both groups expressed confidence in vaccine effectiveness and local health workers, but also expressed concerns about vaccine safety and the administration of several vaccines on the same day. Adult vaccines were also considered less important than childhood vaccines.
Conclusion: Vaccination attitudes were predominantly neutral, with a small urban advantage. Immunisation communication should focus particularly on concerns about vaccine safety and the administration of multiple vaccines during a single visit.
Keywords: Vaccine hesitancy, attitude, childhood immunisation, adult vaccination, vaccine safety, rural–urban comparison