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 coronavirus disease 2019 (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 postvaccination 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.Predictors Sociodemographic characteristics, clinical comorbidities, prior COVID-19, sources of vaccine information, and exposure to vaccinated or infected relatives.Outcomes 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 nondialysis controls (58.2% vs 96.2%). Fear of side effects was the most common reason for refusal (39.3%). Postvaccination complications were less frequent among patients receiving HD (22.3% vs 44.3%). Hesitancy was more common among women, younger participants, and those with comorbidities or no prior COVID-19. Having vaccinated or previously infected relatives was associated with a greater willingness to receive future doses.Limitations Cross-sectional design limits causal inference. Nonprobability sampling and unmatched controls may limit generalizability. COVID-19 cases may have been underreported because of 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.