COLLEGE OF MEDICINE AND HEALTH SCIENCES, SCHOOL OF Public Health Covid 19 Vaccine Hesitancy and it`S Associated Factors in Awi Zone, North West Ethiopia A THESIS SUBMMITED TO BAHIR DAR UNIVERSITY COLLEGE OF MEDICINE AND HEALTH SCIENCES AS PARTIAL FULFILMENT OF THE REQUIRMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH. BY: Abdulkadir Ahimed (BSc HO) ADVISOR: Getasew T. (MPH) Habtamu A. (MPH) MARCH, 2022 BAHIRDAR, ETHIOPIA COLLAGE OF MEDICINE AND HEALTH SCIENCES, SCHOOL OF Name of investigator Name: Abdulkadir Ahimed (B.Sc.) Tell. no:+251 918 01 92 39 Email: abduahm28@Gmail.com Name of advisor Name: Getasew T. (MPH) Habtamu A. (MPH) Full title of the research Project Covid 19 vaccine hesitancy and its associated factors in Awi zone, North west Ethiopia, 2021 Duration of the study May to July 2021 Study area Awi zone, North west Ethiopia Total cost of the study 38,850 Birr PUBLIC HEAL March, 2022 BAHIRDAR, ETHIOPIA  ACKNOWLEDGEMENTS I would like to express my deepest gratitude to my advisers Mr. Getasew T. (MPH) and Mr. Habtamu A. (MPH) for their relevant and constructive comments in this thesis development. I also would like to acknowledge Awi Zone Health department and district health offices for their co-operation in giving relevant background information for this thesis development. Finally I would like to acknowledge Bahir dar University College Medicine and Health Sciences School of public health department of General public health for giving me this opportunity. Contents ACKNOWLEDGEMENTS iii LIST OF ACRONYMS vi List of Tables vii List of Figures vii Abstract viii 1. Introduction 1 1.1 Background 1 1.2 Statement of the problem 3 1.3. Significance of the study 4 2. Literature Review 5 2.1. Covid 19 pandemic and Vaccine hesitancy 5 2.2. Covid 19 vaccine hesitancy rates 6 2.2.1. The global trend 6 2.2.2. The trend in Africa 7 2.2.3. The trend in Ethiopia 8 2.3. Factors associated with vaccine hesitancy 8 2.3.1. Socio-demographic factors 8 2.3.2. Vaccine Confidence and the Impact of COVID-19 9 2.3.3. The role of media and communication 10 3. Conceptual framework 11 4. OBJECTIVES 12 4.1. General objective: 12 4.2. Specific objectives: 12 5. METHODOLOGY 12 5.1. Study area and period 12 5.2. Study design 13 5.3. Population 13 5.3.1. Source population 13 5.3.2. Study population 13 5.4. Eligibility Criteria 13 5.4.1. Inclusion Criteria 13 5.4.2. Exclusion Criteria 13 5.5. Sample size determination and sampling procedure 14 5.5.1 Sampling procedure 14 5.6. Principal research instruments 15 5.7. Variables of the study 15 5.8. Data collection 16 5.9. Data analysis 16 5.10 Ethical consideration 17 5.11 Dissemination and utilization of the result 17 6. Result 17 6.1 Scio-demographic characteristics 17 6.2 Covid 19 Vaccine hesitancy and its reason 18 6.3 Factors Associated with Acceptance of COVID-19 Vaccine 19 7. Discussion 21 8. Strength and Limitation of the study 23 9. Conclusion and Recommendations 23 10. References 24 11. ANNEXES I ENGLISH VERSION 28 I: Participant Information Sheet 28 II: Informed consent 29 III: Quantitative Interview questionnaires (English version) 30 ANNEXES II Amharic VERSION 35 የተሳታፊዎች መረጃ መስጫ ቅጽ-በአማርኛ 35 የስምምነት መግለጫ ፎርም - በአማርኛ 36 መጠይቅ - አማርኛ ቅጽ 37 LIST OF ACRONYMS African CDC: African Centre for Disease Control and prevention ANRS: Amhara national regional state APHI: Amhara public health institute Covid 19: Corona virus disease 2019 DR Congo: Democratic republic of Congo SARS: Severe Acute Respiratory Syndrome SARS-CoV-2: Severe acute respiratory syndrome coronavirus-2 SPSS: Statistical Package for Social Sciences WHO: World Health Organization NPIs: Non-pharmaceutical interventions ZHD: Zonal Health Department ODK: Open data kit SAGE: Strategic Advisory Group of Experts on immunization List of Tables Table 1: Socio-demographic characteristics of participants for the study Covid 19 vaccine hesitancy and its associated factors in Awi zone, Northwest Ethiopia, 2021 Table 2: Bivariate and multivariate logistic regression analysis of factors associated with COVID-19 vaccine hesitancy, in Awi zone, Northwest Ethiopia, 2021 List of Figures Fig 1: Conceptual framework of Covid 19 vaccine hesitancy in Awi zone Figure 2: Schematic presentation of the sampling procedure that was used in the study, Awi Zone, Ethiopia, 2021. Figure 3: Schematic presentation of the sampling procedure in Covid 19 vaccine hesitancy in Awi zone, Northwest Ethiopia. Figure 4: Reason for refusing to take Covid 19 vaccine in Awi zone, North West Ethiopia, 2021 Abstract Background: Since the emergence of COVID 19 in Wuhan, China, in December 2019 the disease has been declared as a global pandemic and has been associated with the deaths of more than 3 million people around the world. It continues to be a dynamic and evolving pandemic. Due to the development and initiation of vaccination, currently significant difference upon vaccine acceptance is seen between developed and developing countries. However, there are no data on the level of COVID-19 vaccine hesitancy and its associated factors in Awi zone. The overall objective of this study is to determine level of vaccine hesitancy and its associated factors in Awi zone, Amhara region, Ethiopia. Methods: A Community based cross-sectional study design conducted from September 1 to October 1, 2021 in Awi zone Northwest Ethiopia. A multi stage sampling method used to select Districts and kebeles. A total of 393 individuals participated in this study; each was drawn by multistage sampling technique. The data was collected using interviewer administered structured questioner with ODK Collect v1.23.3 and exported to SPSS 23 for analysis. Results: Out of the 393 people who took part in the survey, less than half 149 (37.9%) said they would not accept COVID-19 vaccines, and more than half (62.1%) said they would. Male sex (aOR= 1.73, 95% CI: 1.03, 2.91), rural residential place (aOR=2.80, 95% CI: 1.53, 5.12). Information source from social media (aOR=8.70, 95% CI: 2.64, 28.59) Information source from mass media (aOR=5.44, 95% CI: 1.81, 16.31), having Concern on safety of vaccine (aOR=1.44, 95% CI: 1.78, 2.64) and effectives of Covid 19 vaccines (aOR=6.40, 95% CI: 3.43, 11.95) were significantly associated with Covid 19 vaccine hesitancy. Conclusion: There is a growing trend of Covid 19 vaccine hesitancy; the government with different stakeholders should design interventions in terms of awareness campaigns via all types of multimedia to spread more transparent information about the safety and efficacy of the vaccines. Keywords: Vaccine hesitancy, Vaccine acceptance, anti-vaccination, Covid 19, Corona Virus