COVID-19 Vaccine Knowledge, Practice, and Attitudes Among Hemodialysis Patients in Egypt, Kenya, and Cameroon: A Multicenter Study

Rationale & Objective Patients receiving hemodialysis (HD) are at increased risk of severe COVID-19 and were prioritized for vaccination, yet vaccine hesitancy remains common. We assessed COVID-19 vaccine knowledge, acceptance, and attitudes among patients receiving HD in Egypt, Kenya, and Cameroon, and identified factors associated with vaccine acceptance, prior infection, willingness to receive future doses, and post-vaccination complications. Study Design Multicenter cross-sectional survey study. Setting & Participants Between March 2021 and April 2022, 765 patients receiving maintenance HD and 196 non-dialysis controls were recruited from dialysis centers in Egypt, Kenya, and Cameroon. Predictor(s) Sociodemographic characteristics, clinical comorbidities, prior COVID-19 infection, sources of vaccine information, and exposure to vaccinated or infected relatives. Outcome(s) COVID-19 vaccine acceptance, willingness to receive future doses, prior infection, and post-vaccination complications. Analytical Approach Structured questionnaires assessed knowledge, practices, and attitudes toward COVID-19 vaccination. Multivariable logistic regression identified factors independently associated with study outcomes. Results Vaccine acceptance was lower among patients receiving HD than non-dialysis controls (58.2% vs. 96.2%). Fear of side effects was the most common reason for refusal (39.3%). Post-vaccination complications were less frequent among HD patients (22.3% vs. 44.3%). Hesitancy was more common among women, younger participants, and those with comorbidities or no prior COVID-19 infection. Having vaccinated or previously infected relatives was associated with greater willingness to receive future doses. Limitations Cross-sectional design limits causal inference. Non-probability sampling and unmatched controls may limit generalizability. COVID-19 cases may have been underreported due to limited testing. Conclusions COVID-19 vaccine hesitancy among patients receiving HD is driven by fear, misinformation, and sociodemographic factors. Targeted education and improved access to reliable vaccine information may help increase uptake in this population.