Factors associated with the COVID-19 vaccine hesitancy in the Western North Region, Ghana

Introduction: Vaccines are one of the most effective tools developed for reducing the spread and mitigating the impact of outbreaks such as the COVID-19 pandemic. However, vaccination campaigns have been met with hesitancy, fear, and concerns about safety, coupled with anti-vaccine messages, which significantly compromise willingness to accept the vaccine. This study aimed to examine the factors associated with vaccine hesitancy in the Western North Region of Ghana, which had been recording low COVID-19 vaccination coverage after several rounds of vaccination campaigns Methods: A cross-sectional survey of 450 unvaccinated or partially vaccinated individuals was conducted in the Western North Region of Ghana using a multi-stage cluster sampling design. Data were collected with a validated questionnaire adapted from the WHO SAGE Vaccine Hesitancy scale. Descriptive statistics, bivariate and multivariate logistic regression were employed to identify factors associated with COVID-19 vaccine hesitancy. Ethical approval was obtained from the Ghana Health Service Ethics Review Committee. Results: Out of the 450 participants in the Western North Region of Ghana, 60.22% demonstrated COVID-19 vaccine hesitancy. The study population was predominantly female (61.6%), self-employed (53.1%), and rural-dwelling (72.0%). Bivariate analysis revealed significant associations between hesitancy and both employment status (p<0.001) and educational attainment (p=0.035). The multivariate model identified three independent predictors: compared to no formal education, primary (aOR=2.92; 95% CI:1.37-6.22) and secondary education (aOR=2.17; 95% CI:1.04-4.50) significantly increased odds of hesitancy. Conversely, self-employment reduced odds by 40% versus unemployment (aOR=0.60; 95% CI:0.38-0.93), and urban residence reduced odds by 36% versus rural areas (aOR=0.64; 95% CI:0.40-1.00). Primary concerns driving hesitancy were side effects (33.54%) and concerns on fertility (31.06%). Despite high information exposure (96.2%), mainly through television (67.90%) and radio (20.32%), this did not translate to high acceptance. Notably, 42.7% preferred home-based vaccination, suggesting accessibility remains a crucial barrier. Conclusion: This study reveals that COVID-19 vaccine hesitancy in the Western North Region of Ghana is influenced by concerns regarding side effects, fertility, and sociodemographic factors such as education and employment. Effective communication and community-based strategies are essential to address misinformation and improve vaccine confidence and acceptance.