RJHS 11(4).cdr COVID-19 vaccination acceptability among type 2 diabetes mellitus patients in a tertiary hospital in Southwest Nigeria: a cross-sectional study 1 1 1 2 1 Enikuomehin, A.C. , Junaid, O.A. , *Adejumo, O.A. , Ogundele, O.A. , Lawal, O.M. , 1 3 Akinbodewa, A.A. , Fakhraddeen, Y.M. Abstract Background: The mortality from COVID-19 is higher in diabetes mellitus (DM) patients compared to the general population, hence it is highly desirable that DM patients are vaccinated against COVID-19 infection. The aim was to determine the willingness of type 2 DM patients to accept COVID-19 vaccine and associated factors. Methods: This was a cross-sectional descriptive study that involved DM patients. Multivariable logistic regression was used to assess factors associated with willingness to be vaccinated. Results: A total of 302 DM patients participated in the study. About 90% of the respondents perceived COVID-19 to be a serious disease; however, 33.5% of the patients considered themselves to be at risk of contracting COVID-19 despite having DM. About 70.0% of the DM patients were willing to receive the vaccine. Factors associated with willingness to be vaccinated were perception of COVID-19 as a severe disease (Adjusted odds ratio (AOR), 6.09; 95% CI, 4.96- 12.27), previous vaccination (AOR, 1.58; 95% CI, 1.04- 2.98), and higher education (AOR, 2.36; 95% CI, 1.04- 6.86). Conclusion: About a third of the study participants were not willing to receive COVID-19 vaccination. There is need to educate the at-risk population about the importance of COVID-19 vaccination. Keywords: COVID-19, Vaccine, acceptance, type 2 diabetes, Nigeria *Corresponding Author Adejumo, O.A. Email: oluseyiadejumo2017@gmail.com 1 Department of Medicine, University of Medical Sciences, Ondo, Nigeria 2 Department of Community Medicine, University of Medical Sciences, Ondo State, Nigeria 3 Department of Medicine, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria A structured questionnaire was used for data collection. ORCID-NO: https://orcid.org/0000-0002-0111-2843 Received: December 5, 2022 Accepted: May 16, 2023 Published: December 15, 2023 Original Article Research Journal of Health Sciences Res. J. Health Sci. Vol 11(4), December 2023 344 Research Journal of Health Sciences subscribed to terms and conditions of Open Access publication. Articles are distributed under the terms of Creative Commons Licence (CC BY-NC-ND 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.7 COVID-19 acceptabilité de la vaccination chez les patients atteints de diabète sucré de type 2 dans un hôpital tertiaire du sud-ouest du Nigéria : une étude transversale 1 1 1 2 1 Enikuomehin, A.C. , Junaid, O.A. , *Adejumo, O.A. , Ogundele, O.A. , Lawal, O.M. , 1 3 Akinbodewa, A.A. , Fakhraddeen, Y.M. Résumé Objectif de l'étude: La mortalité par COVID19 est plus élevée chez les patients diabétiques par rapport à la population générale, il est donc hautement souhaitable que les patients DM soient vaccinés contre l'infection par COVID-19. L'objectif est de déterminer la volonté des patients atteints de diabète de type 2 d'accepter le vaccin COVID-19 et les facteurs associés. Méthodes: Il s'agissait d'une étude descriptive transversale qui impliquait des patients DM. Une régression logistique multi variée a été utilisée pour évaluer les facteurs associés à la volonté de se faire vacciner. Résultat de l'étude: Au total, 302 patients atteints de diabète ont participé à l'étude. Environ 90 % des répondants percevaient le COVID-19 comme une maladie grave ; cependant, 33,5% des patients se considéraient comme à risque de contracter le COVID-19 malgré le diabète. Environ 70,0 % des patients atteints de diabète étaient disposés à recevoir le vaccin. Les facteurs associés à la volonté de se faire vacciner étaient la perception du COVID-19 comme une maladie grave (rapport de cotes ajusté (RCA), 6,09 ; IC à 95 %, 4,96 à 12,27), une vaccination antérieure (RCA, 1,58 ; IC à 95 %, 1,04 à 2,98) et l'enseignement supérieur (RCA, 2,36 ; IC à 95 %, 1,04-6,86). Conclusion : Environ un tiers des participants à l'étude n'étaient pas disposés à recevoir le vaccin COVID-19. Il est nécessaire d'éduquer la population à risque sur l'importance de la vaccination contre la COVID-19. Mots-clés : COVID-19, vaccin, acceptation, diabète de type 2, Nigéria *Corresponding Author Adejumo, O.A. Email: oluseyiadejumo2017@gmail.com 1 Department of Medicine, University of Medical Sciences, Ondo, Nigeria 2 Department of Community Medicine, University of Medical Sciences, Ondo State, Nigeria 3 Department of Medicine, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria Received: December 5, 2022 Accepted: May 16, 2023 Published: December 15, 2023 Un questionnaire structuré a été utilisé pour la collecte des données. ORCID-NO: https://orcid.org/0000-0002-0111-2843 Article Original Research Journal of Health Sciences Res. J. Health Sci. Vol 11(4), December 2023 345 Research Journal of Health Sciences subscribed to terms and conditions of Open Access publication. Articles are distributed under the terms of Creative Commons Licence (CC BY-NC-ND 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.7 MATERIALS AND METHODS This was a cross-sectional descriptive study carried out between April and June 2022 at the University of Medical Sciences Teaching Hospital Complex, Ondo State located in Southwest Nigeria. The minimum sample size for this study was calculated by using Leslie Kish formula for sample calculation in cross-sectional study (13). This was determined by using a prevalence of willingness of diabetic patients to accept COVID-19 vaccine from a previous study carried out in Saudi Arabia (14) reported to be 36.2%; 95% confidence interval and a sample error of 5%. The minimum sample size following inclusion of an attrition rate of 10% is 390. Inclusion criteria for this study were DM patient, willingness to give informed consent and age above 18 years. Study participants that fulfilled inclusion criteria were consecutively recruited into the study from the medical out- patient clinic in the Ondo and Akure complexes of the hospital. Data were collected through an interviewer-administered questionnaire which had 3 sections. The first section on socio- demographic characteristics of the participants such as age, gender, level of education, occupation, marital status, religion, ethnicity and monthly income. The second section assessed the risk of contracting COVID-19 while the third section assessed the perception about COVID 19 vaccine and willingness to accept the vaccine. Perception about COVID-19 was assessed using 5-point Likert scale to capture the full range of opinions. Ethical Consideration Ethical clearance was obtained from the Ethics and Research Committee of the University of Medical Sciences, Ondo. Informed consents w e r e o b t a i n e d f r o m p a r t i c i p a n t s . A l l questionnaires were coded (without names) and confidentiality was ensured throughout the study Data Analysis Data entry and analysis were made, using Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA). Socio-demographic variables were presented as frequency and percentages. The willingness to receive COVID-19 vaccine was presented as bar graph. Bivariate association between socio-demographic variables, other variables, and willingness to receive the COVID- 19 vaccine were assessed using the chi-square test. Multivariate logistic regression analysis was INTRODUCTION The coronavirus disease (COVID-19) outbreak started in Wuhan, China in December 2019 (1). The virus was declared a pandemic by the World Health Organization (WHO) in March 2020 (2). Since its onset, 632 million cases and 6.5 million deaths recorded globally as at 13th November, 2022 (1). Protective measures along with efficacious vaccines form the best strategy to combat COVID-19 infection as definitive treatment is still being investigated (3) . Vaccination has been shown to decrease the spread and severity of COVID-19 infection, as well as reduced the need for hospital and intensive care admission (4,5). There are different vaccines currently in use against COVID-19 globally. In fact, as at March, 2022, 11,056,690, 967 doses of vaccines have been administered globally (1). Therefore, sufficient vaccine coverage and a high acceptance rate will b e n e e d e d f o r s u c c e s s f u l C O V I D - 1 9 immunization. However, the biggest challenge faced by most governments is vaccine acceptability. COVID-19 acceptance by the public is affected by citizens' mistrust towards health authorities, governments, health professionals, and the misinformation about COVID-19 on social media (6). WHO listed vaccine hesitancy as one of the ten major threats to health globally (7). Generally, patients with diabetes mellitus are more prone to infectious diseases (8). Also, these infections are more likely to be serious and are associated with fatal outcome in them (8). Reports have shown that COVID-19 infection is more severe in diabetic patients compared to the general population (9-12). Diabetic patients with COVID-19 are more likely to have respiratory failure, require intensive care admission, have long ventilator dependence and spend longer time on admission. The mortality from COVID-19 is higher in Diabetes mellitus (DM) patients compared to the general population (11,12). Hence, it is highly desirable that diabetic patients are vaccinated against COVID-19 infection in order to reduce their risk of contracting the disease and having devasting consequences from the infection. The aim of this study is to determine the willingness of type 2 DM patients to accept COVID-19 vaccine and the factors that influence their decision. The findings from this study will provide useful information to address their concerns about COVID-19 vaccines and this may eventually improve the vaccine uptake. Res. J. Health Sci. Vol 11(4), December 2023 346 COVID-19 vaccination acceptability among type 2 diabetes mellitus patients Enikuomehin et al. done to identify the predictors of respondents' willingness to accept COVID-19 vaccine. Using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). The outcome variable for both the bivariate and multivariate analyses was willingness to accept COVID-19 vaccine dichotomize into 'yes' or 'no' responses. The level of significance was set at p < 0.05. RESULTS A total of 302 Diabetic Mellitus (DM) patients participated in the study. The majority (65.9%) were 60 years and above, mostly male (68.9%) and married (67.9%). Nearly half of the respondents had tertiary education (48.7), while more than half (5.3%) were self-employed and of Yoruba extraction in southwest Nigeria. [Table1]. More than half (n=165; 54.6%) has systemic hypertension, while (n=80; 26.5%) had been vaccinated 2 years earlier. In all (n=270; 89.4%) of the respondents perceived COVID-19 to be a serious disease; however, only 33.5% of the patients considered themselves to be at risk of contracting COVID-19 despite being diabetic, while 25.3% agreed that visiting the hospital increases their risk of contracting the disease. Regarding participants' acceptance of the COVID-19 vaccine, 70.2% of the DM patients were willing to receive the vaccine. On bivariate analysis, to assess the factors associated with the willingness to be vaccinated, 76.3% of those who perceived COVID-19 as a serious disease were willing to receive the vaccine compared to those that did not perceived it as a serious (p< 0.001). Equally, 61.2% of those who had previous vaccination two years earlier were also willing to receive the vaccine (p< 0.041). [Table 2]. The level of education, was also significantly associated with the willingness to receive the vaccine, 60% of those with secondary education and above showed willingness to receive the vaccine (p<0.006). However, age (p=0.367), marital status (p=0.292), religion (p=0.3570 and participants occupation (p=0.468) were not significantly associated with the willingness to receive COVID-19 vaccine. [Table 2]. On multivariate analysis for predictors of willingness to receive the vaccine, perceived seriousness of COVID-19 infection, previous vaccination 2 years earlier and level of education were found to be predictors of willingness to receive vaccination. Participants who perceived COVID-19 to be a serious disease were six times more likely to receive the vaccination (Adjusted odds ratio (AOR), 6.09; 95% CI, 4.96- 12.27), in addition, those who had vaccination 2 years earlier were one and half times more likely to accept the vaccination (AOR, 1.58; 95% CI, 1.04- 2.98), and also, those having secondary education and above were also more likely to same. (AOR, 2.36; 95% CI, 1.04- 6.86). [Table 3] DISCUSSION Our study assessed the willingness to receive COVID-19 vaccine among DM patients, a group of individuals at risk of developing severe COVID-19 infection because of their underlying comorbid condition. In the study, majority (65.9%) of the 302 participants were older than 60 years with the least group being those between the ages of 20 and 39, a finding that reflects the increased prevalence of diabetes mellitus with age (15). The higher male prevalence reported in this study has been supported by a higher male preponderance of DM especially in previous studies and this has been attributed to a larger amount of visceral fat found in men compared to women(16,17) and the distinctiveness in lifestyle and behavioral pattern in both genders (18). Higher male prevalence in the hospital may also be indicative of males more empowered to be in the hospital and participate in the study than female (19). Level of education has had variable impact on the willingness to receive the COVID 19 vaccination according to previous studies. This study found that 6 out of every 10 participants with secondary education and higher showed willingness to receive the vaccine. This finding is similar to report from a study conducted in Ontario which found that those with less than tertiary education were more likely to be unwilling to receive COVID-19 vaccine (20). In contrary, low level of education was reported has having a favorable effect on the willingness to receive COVID-19 vaccine in a cross-sectional study among the Southwestern Ethiopian residents (21). Majority (89.4%) of our respondents perceive COVID-19 to be a serious infection; however, only about a third of the study population considered themselves at risk despite being diabetic. Our study found that participants who perceived COVID 19 to be a serious disease were six times more likely to receive the vaccinations. In addition, those who had been received other types of vaccine in the past were found to be one and a half times more likely to receive COVID-19 vaccination. Studies have shown increased susceptibility to severe COVID 19 illness among diabetic patient (patients) (9- 12,22). They have been found to be at a higher Res. J. Health Sci. Vol 11(4), December 2023 347 COVID-19 vaccination acceptability among type 2 diabetes mellitus patients Enikuomehin et al. risk of hospitalization and death(11,12). Optimal glycemic control alone has not consistently shown favorable outcomes in hospitalized COVID-19 infected diabetic patients (23), and COVID-19 vaccines remain the most effective way to alleviate COVID-19 related potential disaster in DM patients (24). Previous report (24) has established that a perception of higher susceptibility to the infection and more dire consequences tend to favor higher COVID 19 vaccine uptake among diabetic patients and also showed that concerns about safety and side effects portend a negative attitude towards the vaccine uptake (25). This is in keeping with our finding in which 76.3% of those who perceived COVID-19 infection to be a serious disease were willing to take the vaccine compared to those who had no such viewpoint. Perceived seriousness of the infection, previous vaccination 2 years earlier and level of education predicted the willingness to receive the COVID 19 vaccination on multivariate analysis in this study. Previous vaccination as a factor predicting willingness to vaccination in this study is similar to a study finding in which previous pneumonia vaccinated subjects were more willing to be vaccinated (26). Although this study did not record any significant association between religion and COVID 19 vaccine uptake, religious affiliations have been found to influence people's attitude towards the vaccine (27,28). CONCLUSION Individuals with underlying conditions like diabetes are likely to develop severe COVID 19 infection. Vaccination remains a potent weapon to fight the infection. Perceived seriousness of the infection, level of education and previous vaccination predict the willingness to receive the COVID 19 vaccine. There is need to educate diabetic patients on the safety and efficacy of COVID 19 vaccine to improve vaccination rates in this group of patients. Acknowledgement: We hereby acknowledged the support of Residents, Nurses and Patients in the Department of Medicine for their support in this research. Conflict of Interest: no conflict of interest REFERENCES 1. WHO Situation Report on COVID-19. Available from: https://www.who.int/ emergencies/ diseases/novel-coronavirus-2022/situation- th reports Accessed 26 April 2023 2. WHO Director General's opening remarks at media briefing on COVID-19 on March 11, 2020 A v a i l a b l e f r o m : https://www.who.int/dg/speeches/detail/who- director-general-s-opening-remarks-at-the- media-briefing-on-covid-19---11-march-2020 3. H o w t o p r o t e c t y o u r s e l f a n d others.https://www.cdc.gov/coronavirus/2019- ncov/prevent-getting-sick/prevention.html th access 26 April 2023 4. Lin DY, Gu Y, Wheeler B, Young H, Holloway S, Sunny SK et al. Effectiveness of Covid-19 Vaccines over a 9-Month Period in North Carolina. N Engl J Med. 2022;386(10):933-941 5. Whittaker R, Kristofferson AB, Salamanca BV, Seppälä E, Golestani K, Kvåle R et al. Length of hospital stay and risk of intensive care admission and in-hospital death among COVID-19 patients in Norway: a register-based cohort study comparing patients fully vaccinated with an mRNA vaccine to unvaccinated patients. Clinical M icr o b io lo g y an d I n f ectio n . 2 0 2 2 J u n 1;28(6):871-8. 6. Palamenghi L, Barello S, Boccia S, Graffigna G. Mistrust in biomedical research and vaccine hesitancy: the forefront challenge in the battle against COVID-19 in Italy. European Journal of Epidemiology. 2020;35(8):785-8. 7. T h r e a t - e m e rg i n g - r e - e m e rg i n g - i n f e c t i o u s - d i s e a s e s - g l o b a l : h t t p s : / / w w w. w e f o r u m . o rg / a g e n d a /2019/01/10-global-health-threats-to-watch-in- 2019-accesed 30th April 2023 8. Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab. 2012;16 (Suppl1):S27-36. 9. Espiritu AI, Chiu HH, Sy MC, Anlacan VM, Jamora RD. The outcomes of patients with diabetes mellitus in The Philippine CORONA Study. Scientific reports. 2021 Dec 24;11(1). https://doi.org/10.1038/s41598-021-03898-1 (30th April 2023) 10. Sonmez A, Demirci I, Haymana C, Tasci I, Dagdelen S, Salman S et al. Clinical characteristics and outcomes of COVID-19 in patients with type 2 diabetes in Turkey: A nationwide study (TurCoviDia). J Diabetes. 2021;13(7):585-595. 11. Rastad H, Karim H, Ejtahed HS, Tajbakhsh R, Noorisepehr M, Babaei M et al. Risk and predictors of in-hospital mortality from COVID- 19 in patients with diabetes and cardiovascular disease. Diabetol Metab Syndr. 2020;12:57. doi: 10.1186/s13098-020-00565-9. 12. Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 p a t i e n t s . D i a b e t e s R e s C l i n P r a c t . 2 0 2 0 ; 1 6 6 : 1 0 8 2 9 3 . d o i : 10.1016/j.diabres.2020.108293 13. Kish L. Survey sampling. American Political Science Review, Cambridge University Press, vol. 59(4), 1025-1025 . Res. J. Health Sci. Vol 11(4), December 2023 348 COVID-19 vaccination acceptability among type 2 diabetes mellitus patients Enikuomehin et al. Res. J. Health Sci. Vol 11(4), December 2023 349 14. Aldossari KK, Alharbi MB, Alkahtani SM, Alrowaily TZ, Alshaikhi AM, Twair AA. COVID- 19 vaccine hesitancy among patients with diabetes in Saudi Arabia. Diabetes Metab Syndr. 2021 Sep-Oct;15(5) :102271. 15. Halter JB, Musi N, Horne FMF, et al. Diabetes and Cardiovascular Disease in Older Adults: Current Status and Future Directions. Diabetes. 2014;63(8):2578. doi:10.2337/DB14-0020 16. Nordström A, Hadrévi J, Olsson T, Franks PW, Nordström P. Higher prevalence of type 2 diabetes in men than in women is associated with differences in visceral fat mass. J Clin Endocrinol M e t a b . 2 0 1 6 ; 1 0 1 ( 1 0 ) : 3 7 4 0 - 3 7 4 6 . doi:10.1210/jc.2016-1915 17. Siddiqui MA, Khan MF, Carline TE. Gender Differences in Living with Diabetes Mellitus. M a t e r S o c i o m e d . 2 0 1 3 ; 2 5 ( 2 ) : 1 4 0 . doi:10.5455/MSM.2013.25.140-142 18. Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. E n d o c r R e v . 2 0 1 6 ; 3 7 ( 3 ) : 2 7 8 . doi:10.1210/ER.2015-1137 19. Ostlin P. Gender inequalities in occupational health. Boston: Harvard University; 2000. p. 5. 20. Syan SK, Gohari MR, Levitt EE, et al. COVID-19 Vaccine Perceptions and Differences by Sex, Age, and Education in 1,367 Community Adults in Ontario. Front Public Heal. 2021;9:1244. doi:10.3389/FPUBH.2021.719665/BIBTEX 21. Jabessa D, Bekele F. Willingness to receive the COVID-19 vaccine and associated factors among residents of Southwestern Ethiopia: A cross- sectional study. Patient Prefer Adherence. 2022;16:1177. doi:10.2147/PPA.S362264 22. Aldossari KK, Alharbi MB, Alkahtani SM, Alrowaily TZ, Alshaikhi AM, Twair AA. COVID- 19 vaccine hesitancy among patients with diabetes in Saudi Arabia. Diabetes Metab Syndr. 2 0 2 1 ; 1 5 ( 5 ) : 1 0 2 2 7 1 . doi:10.1016/J.DSX.2021.102271 23. Cariou B, Hadjadj S, Wargny M, Pichelin M, Al- Salameh A, Allix I, et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. D i a b e t o l o g i a . 2 0 2 0 ; 6 3 ( 8 ) : 1 5 0 0 - 1 5 1 5 . doi:10.1007/S00125-020-05180-X/TABLES/6 24. Omar SM, Khalil R, Adam I, Al-Wutayd O. The Concern of COVID-19 Vaccine Safety Is behind Its Low Uptake among Patients with Diabetes Mellitus in Sudan. Vaccines 2022, Vol 10, Page 5 2 7 . 2 0 2 2 ; 1 0 ( 4 ) : 5 2 7 . doi:10.3390/VACCINES10040527 25. Xu J, Chen S, Wang Y, Duan L, Li J, Shan Y, et al. Prevalence and Determinants of COVID-19 Vaccination Uptake Were Different between Chinese Diabetic Inpatients with and without Chronic Complications: Cross-Sectional Survey. V a c c i n e s . 2 0 2 2 ; 1 0 ( 7 ) : 9 9 4 . doi:10.3390/vaccines10070994 26. Wu L, Wang X, Li R, Huang Z, Guo X, Liu J, Yan H, Sun X. Willingness to Receive a COVID-19 Vaccine and Associated Factors among Older Adults: A Cross-Sectional Survey in Shanghai, China. Vaccines (Basel). 2022 Apr 21;10(5):654. 27. H a s s e n H D , We l d e M , M e n e b o M M . Understanding determinants of COVID-19 vaccine hesitancy; an emphasis on the role of religious affiliation and individual's reliance on traditional remedy. BMC Public Heal 2022 221. 2022;22(1):1-11. doi:10.1186/S12889-022- 13485-2 28. Osuagwu UL, Langsi R, Ovenseri-Ogbomo G, Mashige KP, Abu EK, Envuladu EA et al. Analysis of Perception, Reasons, and Motivations for COVID-19 Vaccination in People with Diabetes across Sub-Saharan Africa: A Mixed- Method Approach. Int J Environ Res Public H e a l t h . 2 0 2 2 ; 1 9 ( 1 3 ) : 7 8 7 5 . doi:10.3390/IJERPH19137875 COVID-19 vaccination acceptability among type 2 diabetes mellitus patients Enikuomehin et al. Res. J. Health Sci. Vol 11(4), December 2023 350 Table 1. Socio-demographic characteristic of the study participants. Variable Frequency N=302 Percent (%) Age (years) 20-39 8 2.6 40-59 95 31.5 60 and above 199 65.9 Sex Male 208 68.9 Female 94 31.1 Marital Status Single 12 4.0 Married 205 67.9 Divorced 5 1.7 Widowed 80 26.5 Education No formal education 27 8.9 Primary 73 24.2 Secondary 55 18.2 Tertiary 147 48.7 Religion Christianity 288 95.4 Islam 11 3.6 Traditional religion 3 1.0 Occupation Government employed 70 23.2 Self employed 167 55.3 Unemployed 65 21.5 Ethnicity Yoruba 282 93.4 Igbo 18 5.9 Hausa 2 0.7 COVID-19 vaccination acceptability among type 2 diabetes mellitus patients Enikuomehin et al. Res. J. Health Sci. Vol 11(4), December 2023 351 Table 2. Factors associated with willingness to accept vaccination among DM patients Willingness to accept vaccine N=302 Variable Yes n (%) No n (%) P-value Perceived seriousness of COVID- 19 Yes 206(76.3) 64(23.7) P<0.001 No 6(18.8) 26(81.2) Previous vaccination in the past ` Yes 49(61.2) 31(38.8) P<0.041 No 163(73.4) 59(26.6) Age 20-49 27(64.3) 15(35.7) P=0.367 =50 185(71.2) 75(28.8) Sex Male 148(71.2) 60(28.8) P=0.301 Female 64(68.1) 30(31.9) Marital status Not married 72(74.2) 25(25.8) Married 140(68.3) 65(31.7) P=0.292 Level of education Secondary education and below 60(60.0) 40(40.0) Tertiary 152(75.2) 503(24.8) P=0.006 Religion Christianity 200(69.4) 88(30.6) Islam 9(81.8) 2(18.2) P=0.357 Traditional religion 3(100) 0(0.0) Occupation Employed 164(69.2) 73(30.8) Unemployed 48(73.8) 17(26.2) P=0.468 COVID-19 vaccination acceptability among type 2 diabetes mellitus patients Enikuomehin et al. Res. J. Health Sci. Vol 11(4), December 2023 352 Table 3: Predictors of willingness to accept COVID -19 vaccination among DM patients Category of Variables AOR(95%CI) P-Value Perceived seriousness of COVID-19 No (Ref) 1 Yes 6.09(4.96-12.27) <0.001 Previous vaccination in the past = No (Ref) =Yes 1 1.58(1.04– 2.98) 0.002 Marital Status Not married (Ref) Married 1 1.05(0.55 – 2.02) 0.866 Sex Female (Ref) Male 1 0.66(0.34 – 1.27) 0.213 Educational Level Secondary and below (Ref) Tertiary 1 2.36(1.40- 6.86) 0.018 Occupation Employed (Ref) Unemployed 1 0.84(0.41-1.74) 0.636 Age (years) 20-49 (Ref) =50 1 0.89 (0.35-1.80) 0.584 COVID-19 vaccination acceptability among type 2 diabetes mellitus patients Enikuomehin et al.