Factors associated with post-pandemic acceptance of COVID-19 vaccines among students in three Nigerian universities

Adaobi Uchenna Mosanya; Adaeze Ezekwelu; Ezinwanne Jane Ugochukwu; Blessing Onyinye Ukoha-Kalu

doi:10.1371/journal.pone.0312271

Peer Review History

Original SubmissionApril 27, 2024
3 Jul 2024 Decision Letter - David Chibuike Ikwuka, Editor PONE-D-24-14109Factors associated with post-pandemic acceptance of COVID-19 vaccines among students in three Nigerian UniversitiesPLOS ONE Dear Dr. Ukoha-kalu, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 17 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have studied an important issue that continues to plaque control of infectious diseases through vaccination in particular, and for a no less important condition as COVID-19. Background: The authors need to review other local studies on this subject and situate them in the background to the study and discussion. (Amuzie CI, Odini F, Kalu KU, Izuka M, Nwamoh U, Emma-Ukaegbu U et al. COVID-19 vaccine hesitancy among healthcare workers and its socio-demographic determinants in Abia State, Southeastern Nigeria: a cross-sectional study. Pan Afr Med J. 2021 Sep 3;40: 10.; COVID-19 vaccine hesitancy and willingness to pay: emergent factors from a cross-sectional study in Nigeria. Vaccine X. 2021 Dec;9: 100112; Njoga EO, Mshelbwala PP, Abah KO, Awoyomi OJ, Wangdi K, Pewan SB et al. COVID-19 vaccine hesitancy and determinants of acceptance among healthcare workers, academics and tertiary students in Nigeria. Vaccines (Basel). 2022 Apr 15;10(4): 626.; Amuzie CI, Odini F, Kalu KU, Izuka M, Nwamoh U, Emma-Ukaegbu U et al. COVID-19 vaccine hesitancy among healthcare workers and its socio-demographic determinants in Abia State, Southeastern Nigeria: a cross-sectional study. Pan Afr Med J. 2021 Sep 3;40: 10; Uzochukwu IC, Eleje GU, Nwankwo CH, Chukwuma GO, Uzuke CA, Uzochukwu CE et al. COVID-19 vaccine hesitancy among staff and students in a Nigerian tertiary educational institution. Ther Adv Infect Dis. 2021 Nov 1;8: 20499361211054923.) Methods: What constitutes good knowledge and perception needs to be outlined. Results: The p-values in the tables should be placed in a separate column, not under the characteristics. Percentages of teh gender under knowledge added up to 1279%. It is not clear hwy this should be so. Discussion: Finally, the discussion needs depth. Results from this study and other referenced studies were merely quoted with little attempt to critically appraise the findings and situate them within the context of this study and referenced works. Feeble attempt was made to provide plausible explanation for most findings from this study. Conclusion: The authors have left out the main finding form this study, low COVID-19 uptake. Modifiable factors that affect this needs to be mentioned, as a way of recommendation. Others: Few edits and comments are made in the attached manuscript. Reviewer #2: INTRODUCTION The introduction provides a concise overview of the COVID-19 pandemic, its impact, and the importance of vaccines. The purpose of the study is well-defined and aligned with the background information. The introduction provides context about the pandemic in Nigeria and the significance of vaccine acceptance among university students. However, the introduction covers a broad range of topics, including the pandemic's global impact, vaccine hesitancy, and Nigeria's vaccination efforts. While relevant, some information could be omitted or summarized to maintain focus. The introduction presents numerous statistics, which, although important, may overwhelm the reader. Some statistics could be saved for the results section or summarized in a table. The introduction jumps abruptly from discussing the pandemic's impact to the study's objective, without a clear connection between the two. While the introduction mentions vaccine hesitancy and acceptance, it does not explicitly identify a research gap that the study aims to address. Suggestions 1. Streamline the introduction to focus on the study's objective and the specific context of university students in Enugu state, Nigeria. 2. Summarize or omit some statistics to maintain a clear and concise narrative. 3. Provide a clearer transition between the background information and the study's objective. 4. Identify a specific research gap that the study aims to address, and explain how the findings will contribute to the existing literature. RESULT The study achieved a good response rate, indicating a representative sample of the target population. The results provide a clear picture of the participants' demographic characteristics, such as age, gender, and admission route. The study assessed the participants' knowledge and perception of the COVID-19 vaccine, providing valuable insights into their understanding and attitudes. The study employed appropriate statistical tests (Chi-square) to determine associations between variables. Although the response rate was high, the actual sample size (1,143) was lower than the estimated sample size (1,537), which might affect the precision of the results. The study only included students from three universities in Enugu State, Nigeria, which might not be representative of all university students in Nigeria. The study lacked a control group to compare the results with, which would have strengthened the findings. I would recommend to Include additional variables, such as socioeconomic status, religious beliefs, and access to healthcare, to gain a more comprehensive understanding of the factors influencing vaccination decisions and to consider using more advanced statistical analysis techniques, such as logistic regression, to identify predictors of COVID-19 vaccine acceptance. METHOD The study is a cross-sectional survey with non-probability purposive and convenience sampling technique was used to obtain the data. Overall, the method section is technically sound, and the instruments and procedures are well-defined. However, some improvements could be made to increase the validity and generalizability of the study findings. DISCUSSION The discussion section appropriately interprets the findings, highlighting the level of knowledge, perception, and acceptance of the COVID-19 vaccine among undergraduate students and supports the findings with evidence from previous studies, demonstrating a good understanding of the topic. The study acknowledges its limitations, such as the non-probability sampling technique and the limited generalizability of the findings and provides recommendations for future research, such as increasing the sample size and conducting pilot testing. However, the discussion section could have demonstrated more critical thinking, exploring potential biases and limitations in the study and include clearer implications for policy, practice, or future research. Also include the potential impact of the study's findings on public health initiatives and vaccination campaigns. Reviewer #3: The topic is good and the work has been written well. Check Reference number 9. Analysis portion is good. Discussion has been written well. The findings and implications have been written well. The modal age category for this study was 18-24 years on what basis? ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-24-14109_.pdf https://doi.org/10.1371/journal.pone.0312271.r001
Revision 1
31 Jul 2024 Author Response School of Medicine, University of Nottingham, Nottingham, United Kingdom. July 31, 2024. The Editor-in-Chief, PLOS ONE. Dear Sir, A point-by-point response to Reviewers’ comments Please find below our response to the points raised by the reviewers. Best wishes, Blessing Onyinye Ukoha-Kalu; BPharm, MPharm, PharmD, PhD, FHEA Title: “Factors associated with post-pandemic acceptance of COVID-19 vaccines among students in three Nigerian Universities” RESPONSE TO REVIEWERS REVIEWER 1 1. The authors need to review other local studies on this subject and situate them in the background to the study and discussion. Thank you for your review and the suggestions of local studies to be included in the background and discussion. We have incorporated them on pages … 2. What constitutes good knowledge and perception needs to be outlined. The respondents with scores equal or more than the median score have good knowledge while those having scores equal or above the median are categorized as having a positive perception. This statement has been inserted in the revised version of the manuscript. 3. The p-values in the tables should be placed in a separate column, not under the characteristics. Percentages of teh gender under knowledge added up to 1279%. It is not clear hwy this should be so. We have corrected the observations. Actually we made use of the percentages within each category of the variables to give a true picture of the proportions. 4. Finally, the discussion needs depth. Results from this study and other referenced studies were merely quoted with little attempt to critically appraise the findings and situate them within the context of this study and referenced works. Feeble attempt was made to provide plausible explanation for most findings from this study. The discussion has been rewritten considering your comments above. A critical appraisal and plausible explanation of most findings from the study were made within the context of the study and referenced works. 5. The authors have left out the main finding form this study, low COVID-19 uptake. Modifiable factors that affect this needs to be mentioned, as a way of recommendation. We have commented in the conclusion of the manuscript the need to modify the influencing factors that may increase the uptake of vaccine. 6. Few edits and comments are made in the attached manuscript. The edits were accepted while other minor corrections were effected in the revised version of the manuscript. REVIEWER 2 Introduction Suggestions 1. Streamline the introduction to focus on the study's objective and the specific context of university students in Enugu state, Nigeria. Thank you for this suggestion. We have tried to focus more on the study’s objective. 2. Summarize or omit some statistics to maintain a clear and concise narrative. We have expunged some statistics as well as made the narrative concise. 3. Provide a clearer transition between the background information and the study's objective. We have provided a clearer transition between the background information and the study’s objective. 4. Identify a specific research gap that the study aims to address, and explain how the findings will contribute to the existing literature. We have identified a specific research gap that the study aims to address and also explained how the findings will contribute to the existing literature. Results I would recommend to Include additional variables, such as socioeconomic status, religious beliefs, and access to healthcare, to gain a more comprehensive understanding of the factors influencing vaccination decisions and to consider using more advanced statistical analysis techniques, such as logistic regression, to identify predictors of COVID-19 vaccine acceptance. Thank you very much for this suggestion. Unfortunately, we would not be able to incorporate them. However, we shall make reference to them under limitations of the study. Method some improvements could be made to increase the validity and generalizability of the study findings. Thank you for the suggestions. There was an error in the method section. We meant to say face validation and not content validation. This will be included in the limitations of the study. There was no content validation analysis. Discussion However, the discussion section could have demonstrated more critical thinking, exploring potential biases and limitations in the study and include clearer implications for policy, practice, or future research. Also include the potential impact of the study's findings on public health initiatives and vaccination campaigns. We have tried to write the discussion section demonstrating more critical thinking and exploring potential biases and limitations in the study as well as clearer implications for policy, practice or future research. REVIEWER 3 1. Check Reference number 9. 2. The modal age category for this study was 18-24 years on what basis? 1. Please, It is not clear what you wanted us to check about reference number 9. 2. The modal age category meant that majority of the respondents fell within this age range. However, since previous reviewers have queried the relevance of this to the objectives of the study, we have expunged it from the discussion section. Attachments Attachment Submitted filename: RESPONSE TO REVIEWERS.pdf https://doi.org/10.1371/journal.pone.0312271.r002
28 Aug 2024 Decision Letter - David Chibuike Ikwuka, Editor PONE-D-24-14109R1Factors associated with post-pandemic acceptance of COVID-19 vaccines among students in three Nigerian UniversitiesPLOS ONE Dear Dr. Ukoha-kalu, Thank you for submitting the revised manuscript to PLOS ONE. We appreciate the efforts to address the previous concerns. However, after careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we request further revisions to enhance the manuscript quality. ============================== Specifically, we ask you to: 1. Provide more justification for selecting three institutions from the possible 30 in Enugu State. Please clarify the sampling technique used and the selection criteria. 2. Revise the conclusion to focus on the most important results and their significance. Clearly state the study's contributions, implications, and provide a final thought or call to action (around 100-150 words). 3. Proofread the manuscript to correct spelling errors, ensure clarity and precision in your writing. ============================== Please submit your revised manuscript by Oct 12 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, David Chibuike Ikwuka, Ph.D. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0312271.r003
Revision 2
3 Sep 2024 Author Response The Editor-in-Chief, PLOS ONE. Dear Sir, A point-by-point response to Reviewers’ comments Please find below our response to the points raised by the reviewers. Best wishes, Blessing Onyinye Ukoha-Kalu; BPharm, MPharm, PharmD, PhD, FHEA Title: “Factors associated with post-pandemic acceptance of COVID-19 vaccines among students in three Nigerian Universities” RESPONSE TO REVIEWERS REVIEWER 1 1. Provide more justification for selecting three institutions from the possible 30 in Enugu State. Please clarify the sampling technique used and the selection criteria. Thank you for your comment. We have now provided more justification for selecting three institutions. Please see page 4: “…These institutions were chosen based on their large student populations, diverse academic offerings, and significant geographical coverage within the state. We prioritized institutions with large and diverse student bodies to ensure that our sample would be representative of the broader student population in Enugu State. To capture a range of perspectives and experiences, we selected institutions that differ in their academic focus and type (a federal university, a state university, and a polytechnic). The selected institutions are strategically located in different parts of Enugu State, ensuring that the study captures data from students in various urban and rural settings… … This study employed a non-probability purposive and convenience sampling technique to recruit the participants.” 2. Revise the conclusion to focus on the most important results and their significance. Clearly state the study's contributions, implications, and provide a final thought or call to action (around 100-150 words). Thank you for your comment. We have now revised the conclusion to focus the most important results and their significance. Please see page 8: “This study provides valuable insights into the post-pandemic acceptance of COVID-19 vaccines among university students in Enugu State, Nigeria. Despite a moderate level of knowledge and generally positive perceptions towards the vaccine, acceptance rates remained low, influenced significantly by the students' perceptions rather than their knowledge alone. The findings underscore the importance of targeted educational interventions that not only disseminate accurate information but also actively address misconceptions and enhance positive perceptions. This approach could be instrumental in improving vaccine uptake among this demographic. Our study highlights the critical role of perception in vaccine acceptance, suggesting that future public health campaigns should prioritize shifting perceptions through culturally sensitive, institution-specific strategies. These findings contribute to the ongoing dialogue on vaccine hesitancy and suggest actionable steps for increasing vaccine acceptance in similar contexts.” 3. Proofread the manuscript to correct spelling errors, ensure clarity and precision in your writing. Thank you for your comment. We have now proofread the manuscript using an English editing service. Attachments Attachment Submitted filename: RESPONSE TO REVIEWERS.pdf https://doi.org/10.1371/journal.pone.0312271.r004
13 Sep 2024 Decision Letter - David Chibuike Ikwuka, Editor Factors associated with post-pandemic acceptance of COVID-19 vaccines among students in three Nigerian Universities PONE-D-24-14109R2 Dear Dr. Ukoha-kalu, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, David Chibuike Ikwuka, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0312271.r005
Formally Accepted
11 Oct 2024 Acceptance Letter - David Chibuike Ikwuka, Editor PONE-D-24-14109R2 PLOS ONE Dear Dr. Ukoha-kalu, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr David Chibuike Ikwuka Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0312271.r006

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