University of Khartoum

Faculty of Medicine
Department of community medicine

Covid-19 Vaccines acceptability

Hesitancy and Side Effects among
Vaccinated Individuals in Altalbab
Village in Aljazeera State – Sudan
2022
‘A research submitted in partial fulfillment of the degree of MBBS’

By:
Sara Hassan Ahmed Altraifi
4th year medical student
Supervisor:
DR.Amani Abdelrahman Sidahmed
MBBS, MSC, MD

[Type here]
 ‫بسم هللا الرحمن الرحيم‬

‫قال تعالى‬:
َ ُّ‫ق*ا ْق َرْأ َو َرب‬
(‫ك‬ ٍ َ‫ان ِم ْن َعل‬ َ ‫ق اِإْل ْن َس‬ َ َ‫ق* َخل‬ َ َ‫ك الَّ ِذي َخل‬ َ ِّ‫ا ْق َرْأ بِاس ِْم َرب‬
‫ان َما لَ ْم يَ ْعلَ ْم‬َ ‫)اَأْل ْك َر ُم*الَّ ِذي َعلَّ َم بِ ْالقَلَ ِم* َعلَّ َم اِإْل ْن َس‬.
5-1 :‫ آية‬،‫سورة العلق‬

DEDICATION

This study is wholeheartedly dedicated to my beloved parents, who have been my source of inspiration and
gave me strength when i thought of giving up, who continually provide their moral, spiritual, emotional, and
financial support.

In memory of my uncle Daffaallah, and to every soul lost because of this pandemic,

ii
 To my brother and sisters who always looked out for me, and to luji, meme and baby -Blank- who I will
always look out for them.

To my identical twin, hajer - who would have killed me if I didn't write this- Thank you for always reminding
me that I never have to go through anything alone. And Thank you for just going with it when someone calls
you by my name.

And to whom I love and care about the most..

And more importantly for my 11 years me, I guess this something worth writing about in our yearly gernal..

ACKNOWLEDGMENTS

iii
 Content page NO.
Cover page i

Dedication iii

Acknowledgments iv

Table of contents v

List of tables & Figures vi

iv
Abstract vii

CHAPTER ONE :INTRODUCTION

1.1 background 2

1.2 problem statement 2

1.3 Justification 4

1.4 Objectives 6

CHAPTER TWO: LITERATURE REVIEW 8

CHAPTER THREE: METHODOLOGY 20

3.1 study design 21

3.2 study area 21

3.3 study population 21

3.4 sample size 21

3.5 sampling methods 22

3.6 data collection methods and tools 22

3.7 data collection management and analysis 23

3.8 Ethical consideration 23

CHAPTER FOUR : RESULTS 25

CHAPTER FIVE : DISCUSSION 37

Conclusion and Recommendations 40- 41

References & Annexes 42 – 50

v
 LIST OF TABLES:

Table NO. Description page NO.

(1) Socio-demographic characteristics of the participant's in Altalbab village of

Aljazeera state, 2022.

(2) General knowledge of the participant's about covid-19 in Altalbab

vi
 village of Aljazeera state, 2022.

(3) COVID-19 vaccination status among the participants, in Altalbab

village of Aljazeera state, 2022.

(4) COVID-19 vaccination side effects among the participants, in Altalbab

village of Aljazeera state, 2022.

LIST OF FIGURES:

figure NO. Description page NO.

(1) Histogram of the age distribution of the participants,

Altalbab village of Aljazeera state,2022 (n=363)

Bar chart for the reasons for not being vaccinated

(2) among the participants, in Altalbab village of
Aljazeera state, 2022.

Bar chart for the rumors heard about the

(3) vaccine among the participants, in Altalbab
village of Aljazeera state, 2022.

A pie chart for the sources of heard rumors

(4) among the participants of Altalbab village of
Aljazeera state, 2022

Clustered bar chart for the association of the

(5) vaccination status of the participants and
the occupation among the participants,
in Altalbab village of Aljazeera state, 2022.

Clustered bar chart (of percentages) showing the

(6) Association of the vaccination status of the
participants and the educational level among the
participants, in Altalbab village of Aljazeera state, 2022.

ABSTRACT
‘ Covid-19 Vaccines acceptability, Hesitancy and Side Effects
Among Vaccinated Individuals in Altalbab Village in Aljazeera
State – Sudan 2022’

vii
 BACKGROUND: Covid-19 poses an unprecedented risk to public
health and many aspects of life, and while more individuals
countrywide begin to advocate vaccination as stated by WHO 1. This
begs the issue of why people are reticent to get vaccinated and if
geographical dispersion influences their adoption of the vaccine.
 METHODS: This was a cross sectional community based study
conducted at Altalbab village in Aljazeera state. The sample
consisted of 362 participants. Data was collected by using
questionnaire designed for this study. Data analysis was performed
using statistical package for Social Sciences (SPSS).
 RESULTS: the study revealed that (51%) of participants have been
vaccinated. The most common vaccine type used was AstraZeneca.
(30.9%) the participants who were vaccinated did not experience any
side effects. (6.6%) experienced side effects on day 1. (11.3%)
experienced fever after the 1st dose; it lasted for 24 hour, while 6.1 %
of the participants had headache after the 2nd dose which lasted for
24 hours. The most common reason for not receiving the vaccine was
the disturbing rumors about the vaccine of which (13.8 %) due to its
ability to cause infertility. (15.2%) of these rumors were heard from
the social media.
 CONCLUSION: The majority of Altalbab village people were
vaccinated with at least one dose of the vaccine, and the majority of
them did not experience any adverse effects. The most common
negative effects reported were headache, fever, and soreness at the
injection site. And the most prevalent reasons for vaccination
postponement is rumors, particularly the vaccine's tendency to
induce infertility.
 KEYWORDS: Acceptance; COVID-19; Coronavirus; Vaccine; side
effects; hesitancy.

viii
CHAPTER ONE
INTRODUCTION

1
 1. INTRODUCTION
1.1 BACKGROUND:
Covid-19 has been a worldwide health concern since it had been
identified as an acute respiratory outbreak within the late 2019, and
as a pandemic in march 11 the of 2020. This pandemic has led to an
enormous loss in lives worldwide and present an unprecedented
challenge to public health, food systems and therefore the world of
work. The economic and social disruption caused by the pandemic is
overwhelming, and whilst more people nationwide began to urge
vaccination as reported by WHO (On the first of September 2021, a
total of 5,289,724,918 vaccine doses have been administered
worldwide1 ) . In Sudan, a total of 829,682 vaccine doses have been
administered on 21 August 2021, but only 186,113 of the population
in Sudan are fully vaccinated. As the pandemic has progressed, the
proportion of individuals desiring to be vaccinated decreased and
also the percentage of individuals intending to refuse vaccination
increased2, a similar study was done in Bangladesh and they
established a high prevalence of vaccine refusal and hesitancy was
observed in rural people3 . This raise some crucial questions in mind;
why are people hesitant of getting vaccinated and does the
geographical distribution affects their acceptance to the covid-19
vaccine?
1.2 PROBLEM STATEMENT:
Science-based safety data along with high public acceptance and
population coverage are required for vaccination programs to be
successful. Uncertainty or complacency regarding vaccination might
lead to delaying or refusing to be vaccinated despite the fact that
services are available. Although The COVID-19 vaccines impact
varies from person to person, The WHO is still unable to predict who
may experience negative effects1 . Antiviral immunity is boosted by
2
 the vaccination; which boosts the immune system; Side symptoms
such as fever, chills, and headache might occur as a result. In a study
of Arabs, there was a greater level of vaccination hesitation among
Arabs in and out Arabic regions (83% and 81%, respectively).
mostly due to mistrust and worries about adverse effects 4. Similar
results were discovered by a Global Social Listening Study 5 , which
revealed that COVID-19 vaccination hesitancy is widespread
throughout the world and that the opinions and believes against the
vaccine are more likely to be shared on social media (Among social
media users, 36.4% (571/1568) in New York, 51.3% (738/1440) in
London, 67.3% (144/214) in Sao Paulo, 69.8% (726/1040) in
Mumbai, and 76.8% (2128/2770) in Beijing) . Vaccine hesitancy, or
the refusal to accept vaccines when vaccination services are
available and accessible, is one of the most serious risks to world
health. Vaccine reluctance has persisted for decades among a tiny
fraction of the population, but its negative consequences are
expected to be more evident during the COVID-19 pandemic than
ever before. COVID-19 vaccine hesitancy will offer substantial
consequences to both those who delay or refuse to get vaccinated
and the general public. It will prevent communities from achieving
the coverage levels required for herd immunity against COVID-19.
It is easy to forget that illnesses such as smallpox, polio, yellow
fever, and others formerly caused millions of deaths and disabilities
in many regions of the globe that are now (nearly) free of these
diseases, owing primarily to vaccination 6 , 7 , 8 .
1.3 JUSTIFICATIONS :
The covid-19 epidemic has led to a variety of changes throughout the
world. About 3.3 billion people throughout the world are at risk of

losing their jobs1. Workers in the informal economy are more

susceptible because they lack social security, have limited access to
excellent health care, and have lost control to productive assets,

3
making them extremely vulnerable. This effect is much more
pronounced in low- and middle-income nations, where Covid-19
management is a major issue, ICU beds are few, as are healthcare
resources. Only a restricted number of RT-PCR tests are performed,
and the therapy choices are quite limited. therefore, the low-cost
options remained prevention, as studies have demonstrated a
substantial reduction in infection with the use of face masks9, as well
as maintaining at least a 1-metre barrier between oneself and others,
disinfecting, and immunization. In fact, some vaccines have reported
more than 90% efficacy10. In order to protects souls, children, and the
entire society, vaccinations specially during life changing pandemics
are essential. the reasons why people resist vaccinations must be
addressed in order to prevent the loss of life. A research was
conducted to investigate the determinants of health-related, quality-of-
life in rural and urban populations, and it was discovered that the
quality of life ratings in participants differed by region. Psychological
discomfort in rural individuals may explain for lower quality of life
ratings in rural subjects11 . This might be a cause of vaccine
reluctance; moreover, a lack of excellent health centers and the
expenses of traveling to vaccination sites could stymie the
immunization program. The findings of this study may shed light on
the challenges that the immunization program faces, as well as the
threat of covid-19 vaccine reluctance in the Altalabab community. It
can assist in giving methods to counteract false narratives as well as
providing the data required to expand the immunization program
further out from the capital. It can also aid in the planning of future
vaccination programs around the country, boosting general human
health and the prevention of communicable illnesses.

1.4 OBJECTIVES:
 General objectives:

4
To assess Altalbab village citizens acceptance, causes of hesitancy
and the commonest side effects among vaccinated individuals,
2022.
 Specific objectives:
1. To calculate the proportion of those who received the vaccine
and the number of doses received.
2. To the address most prevalent adverse effects of the covid-19
vaccination in immunized participants at a known dose.
3. To address the main reasons why people, choose to postpone or
refuse vaccines.

5
 CHAPTER TWO
LITERATURE REVIEW

2. LITERATURE REVIEW:

Since the World Health Organization (WHO) designated the

COVID-19 outbreak a pandemic in March 2020, the virus has
caused more than 2.5 million deaths worldwide, with laboratory
testing confirming up to 113 million cases (March 2021). The
epidemic has had an influence on practically every aspect of life,

6
forcing global economies to stop, altering how we work and connect
with our loved ones, and pushing healthcare systems to their
breaking point. To stop the spread of the virus, governments
throughout the world have been obliged to impose severe limitations
on human activities. COVID-19 immunization is now providing a
path out of this phase of the epidemic. Many experts believe that
without them, natural herd immunity would not have been able to
return society to its original state, resulting in high mortality. Many
health agencies, including the WHO, have repeated this sentiment.
This chapter reviews the available literature regarding Covid-19
vaccine acceptability, and hesitancy, and the side effects among
vaccinated individuals.
2.1VACCINE ACCEPTANCE IN THE ERA OF COVID-19:
The coronavirus disease 2019 (COVID-19) pandemic has imposed a
significant illness burden over the world. Since immunization is one
of the most efficient and cost-effective health strategies for preventing
infectious illnesses, vaccines against COVID-19 are regarded as
critical for preventing and controlling COVID-19 as a described in
two studies conducted in May 2020 in China 12,13.
It was also found that Sputnik V, Sinopharm, and AstraZeneca
vaccines are beneficial for gaining herd immunity. Enough time
intervals (at least 3 weeks/21 days) must be considered to achieve

enough neutralizing antibody titers. What is critical is that vaccination

with each of the aforementioned three vaccinations be increased in
order to acquire herd immunity in a shorter period of time because all
three vaccines give 100% protection of severe COVID-19 as
addressed in a study in June 2021 14.
Although the Reports on the acceptance and uptake of pandemic
vaccines, such as for the 2009 H1N1 pandemic, have shown
unsatisfying results, as the willingness to receive the 2009 H1N1
pandemic vaccine among the general public ranged from 17% to 67%

7
across studies from Australia, America, Greece, the UK and
France during the period from 2009-2010 15, 16 ,17 ,18, 19 ,20, 21 ,22 .
 A cross-sectional online survey in Indonesia was conducted between
March and April 2020, showed Among 1,359 responders, (93.3%)
(1,268/1,359) would prefer to get vaccinated for a (95%) effective
vaccine, however this acceptability fell to (67.0%) (911/1,359) for a
(50%) effective vaccine. Being a healthcare professional and having a
greater perceived risk of COVID-19 infection were linked with higher
acceptability for a (95%) effective vaccination, but being retired was
associated with lower acceptance. Being a healthcare worker was also
connected with better acceptability for a (50%) effective vaccination.
Acceptance of a COVID-19 vaccine was heavily impacted by the
baseline efficacy of the vaccine23 .
Comparing the above mentioned cross-sectional study in Indonesia to
Another study done in 2020 that found a considerable percentage of
vaccination reluctance among Arabs living inside and outside the
Arab area (83% and 81%, respectively). Concerns about side effects
and scepticism in health-care systems, vaccine rapid manufacturing,
published research, and vaccine producing firms are the most often
mentioned reasons for hesitation4 .
A study conducted in china in 2020 revealed that there was a high
degree of acceptability of COVID-19 immunization among the adult
population in China and the majority of participants (91.3%) stated
that they expected to acquire COVID-19 vaccine if it was successfully
developed and approved for listing in the future. More than half
(52.2%) of respondents in the vaccine accept group wished to be
vaccinated as quickly as possible when it became available, while
others (47.8%) would wait until the vaccine's safety was established24.

2.2 COVID-19 CHALLENGES IN SUDAN:

8
According to a prevalence survey conducted in Khartoum, Sudan,
selected Sudanese citizens had little understanding and inadequate
behaviors about COVID-19. Women and people aged 18 to 25 years
old, on the other hand, were more knowledgeable and had more
positive opinions regarding COVID-1925 . Also an online cross-
sectional study conducted in Sudan in October 2020 revealed that
health training programs aimed at improving COVID-19 knowledge
are beneficial to Sudanese individuals by creating good attitudes and
distributing knowledge about beneficial behaviors26 .
Vaccination is often regarded as one of the most efficient means of
combating infectious illnesses as reported in 2019 in a Finland 27. As
of January 13th, 2022, the number of suspected cases in Sudan was
93,390, with 50,621 confirmed cases of COVID-19 submitted to the
Federal Ministry of Health28; the need for vaccination raised. COVID-
19 immunizations was released in Sudan in March 2021, although the
level of acceptability has not been fully examined. Studies to fill this
gap were made. And one of them was a study published in April,
2022, and was conducted in a medical school in Sudan to investigate
medical students' acceptance and hesitation of the COVID-19
vaccination and related parameters. This study found a significant
degree of COVID-19 vaccination apprehension among medical
students. And recommended to offer efforts to spread accurate
information on the safety and effectiveness of the COVID-19
vaccination29.

A similar cross-sectional study (February 2022) on covid-19 vaccine

acceptance was also conducted, and showed that medical workers in
Sudan had adequate understanding and tolerance of COVID-19
vaccines. Sudan's healthcare workers were, on average, younger than
those in other countries. Concerns regarding safety and adverse
effects, like in many other nations, governed vaccine acceptance. The
majority of the survey population believed that healthcare personnel
should be the first to get vaccinated, followed by the elderly and
9
persons with chronic diseases. AstraZeneca and Pfizer were the most
well-known and widely used COVID-19 vaccines. This might be
affected by vaccination availability and national vaccine
administration policies. The dread of infection for themselves and
their family was an encouraging factor for immunization30.
Despite evidence that vaccinations have an essential role in improving
population health outcomes, the World Health Organization (WHO)
recognized vaccine hesitancy as one of the top ten dangers to world
health in 201931. A study was conducted in 2020 in Sudan, that
revealed that Sudan has several obstacles in successfully vaccinating
the population against the COVID-19 pandemic. In the midst of a
struggling economy, Sudan's cold chain system remains under-
resourced and unable to meet the anticipated increase in capacity
required to store additional doses obtained through COVAX, as well
as procure and mobilize new equipment, resulting in extremely slow
vaccine distribution outside Khartoum State 32.
Also a study in Darfur (2021), mentioned that the COVID-19
immunization campaign in Darfur is clearly constrained by various
constraints, making successful vaccination coordination difficult.
A lack of infrastructure for vaccine storage and delivery, a health
personnel deficit, inequalities in the distribution of health
facilities, and vaccination reluctance are among the issues
mentioned. As a result, there is an urgent need to develop solutions
to the highlighted challenges in partnership with all key parties,
including local health authorities, national authorities, and the
humanitarian sector33. A close research intended to discover
adverse effects reported by persons after receiving the Johnson &
Johnson vaccination, as well as variables related with such side
effects. The research was carried out in the Sudanese location of
Eastern Gezira. This study found a link between chronic illness
and vaccination adverse effects. And between sex and vaccination
side effects34.

10
2.3THE NEXT OBSTACLE IN THE FIGHT AGAINST
COVID-19 IS VACCINE HESITATION:

The World Health Organization (WHO) defined the vaccine

hesitancy as a behaviour, influenced by a number of factors
including issues of confidence (do not trust vaccine or provider),
complacency (do not perceive a need for a vaccine, do not value the
vaccine), and convenience (access). Vaccine hesitancy is a term that
is now commonly used in vaccination discussions. The growing
acceptance of this notion in academic and public health circles is
undermining previously held beliefs that individual immunization
attitudes and behaviors are simply a binary choice of accept or
reject.
Vaccine-hesitant individuals are a heterogeneous group who hold
varying degrees of indecision about specific vaccines or vaccination
in general. Vaccine-hesitant individuals may accept all vaccines but
remain concerned about vaccines, some may refuse or delay some
vaccines but accept others; some individuals may refuse all
vaccines35 .
COVID-19 vaccination adoption rates vary greatly between nations
and areas throughout the world. A significant number of studies
indicated COVID-19 acceptance rates of less than (60%), which
would provide a significant challenge to attempts to manage the
current COVID-19 epidemic. The Middle East, Eastern Europe, and
Russia had the lowest rates of COVID-19 vaccination adoption.
High acceptance rates in East and South East Asia would aid in
achieving adequate pandemic control. More research is needed to
evaluate the attitudes of the general population and healthcare staff
in Africa, Central Asia, and the Middle East, in addition to Central
and South America. Such research would aid in assessing COVID-
19 vaccination hesitancy and its possible effects in these places and
throughout the world. The key hurdles that might impede the
11
effective deployment of COVID-19 vaccination campaigns to
combat the unprecedented pandemic are vaccine mass manufacture,
equitable distribution throughout the world, and uncertainty about
long-term efficacy. However, vaccination reluctance may be a
major impediment to control attempts to mitigate the harmful
impacts of the COVID-19 pandemic, at least in some
countries/regions.
Because of the extensive incidence of COVID-19 vaccination
hesitancy, governments, health policymakers, and media outlets,
especially social media businesses, must work together. It is
advised that COVID-19 vaccination trust be built among the
general population by the dissemination of timely and unambiguous
information promoting the safety and efficacy of currently available
COVID-19 vaccines through trusted channels36. In January 2021, an
online poll in Arabic was performed. The study found a
considerable percentage of vaccination reluctance among Arabs
both inside and outside the Arab world. It was also shown that
female participants, those aged 30-59, those without chronic
conditions, those with a lesser level of academic knowledge, and
those who are unaware of the type of vaccine permitted in their
nations are more hesitant to undergo COVID-19 immunization.
Participants who routinely get the influenza vaccine, health care
workers, and those from countries with higher prevalence of

COVID-19 infections, on the other hand, had greater vaccination

willingness37.
Another global study in 2020 found that the global frequency of
COVID-19 vaccine reluctance was predicted to be 25%. It also
suggested specific treatments to reduce COVID-19 vaccination
hesitancy among unmarried persons, women, people with low
educational levels, the jobless, those living in homes with five or
more people, and those who feel COVID-19 vaccinations are
12
 harmful38. Another recent study, published in 2022, was titled two
large-scale global studies on covid-19 vaccine hesitancy Over
Time: Culture, Uncertainty Avoidance, and Vaccine side-effect
Concerns39. It mapped COVID-19 vaccination hesitancy throughout
the world by examining a daily survey of 979,971 people in 67
countries and another daily survey of over 11 million people in 244
countries. On a worldwide scale, it was discovered that those who
are female, younger, less educated, or live in nations with lax
government responsiveness showed more vaccination hesitation on
average. More crucially, it expanded a dynamic, cultural
psychology viewpoint and revealed how the cultural feature of
uncertainty avoidance may have contributed to vaccination
hesitancy: People in higher (vs. lower) uncertainty avoidance
nations showed more vaccination hesitation at first (late 2020) due
to larger side-effect worries, but these differences lessened over
time as COVID-19 vaccine adoption grew more widespread.
Overall, this study gives important insights on COVID-19 vaccine
reluctance and illustrates the significance of cultural psychology for
understanding global crises.
Age, education, gender, locality, family income, marital status,
religion, information source, access to vaccination and vaccine
equality, and other characteristics all have a role in determining
acceptance or ensuring hesitation among the people. Major
vaccination concerns, hurdles, and motivators were emphasized.

Existing data was utilized to demonstrate how each element

influenced acceptance and hesitation of the COVID-19 vaccination 40.

2.4 POST-VACCINATION SIDE-EFFECTS:

Multiple vaccines against the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) virus, which causes coronavirus
disease 2019 (COVID-19), were developed within a year following

13
the pandemic, which is exceptional and an enormous feat. Many
produced vaccinations have outperformed predictions, and there is
great optimism that the pandemic will be over shortly. Nonetheless,
significant obstacles persist. Vaccinations are far from complete in
rich countries and have just recently begun in many developing
countries, implying that obtaining global herd immunity against the
virus might take many years. There is also a rising issue of
vaccination reluctance, particularly among the young, who
normally tolerate COVID-19 with minimal or no effects.
Furthermore, it is well recognized that COVID-19 vaccinations can
have significant adverse effects; indeed, in some cultures, dread of
these side effects may rival fear of SARS-CoV-2 infection itself.
Pfizer and Moderna's mRNA-based vaccines have attracted the
greatest attention in terms of vaccination adverse effects, owing to
their quick development and manufacture41 42. As with other
vaccinations, these symptoms may be the consequence of delayed-
onset, local allergic responses on rare occasions. The most common
symptom, however, is a combination of fever, headache, myalgia,
and general malaise, which affects (60%) of patients after the
second dose of vaccinations.
a cross-sectional survey-based study (April 2021) was done Among
Czech healthcare professionals, and the result was the most
prevalent adverse effects of the Pfizer-BioNTech COVID-19
vaccination were injection site discomfort, weariness, headache,
muscle soreness, cold, and joint pain. In terms of their relationship
with the younger age group and the second dosage, they were very
compatible with the manufacturer's data. The overall frequency of
several local and systemic adverse effects was greater than reported
by the manufacturer, which might be due to the unique
demographic involved in the trial43.
A self-reported study in 2021 also revealed that vaccine recipients
with prior COVID-19 reported more, but no more serious, side
14
effects than naive participants44. a similar result was published on
an online survey study in Saudi Arabia (April 2021), the majority of
the observed adverse effects were found consistent with Pfizer's fact
sheet for patients and caregivers. Injection site soreness, headaches,
flu-like symptoms, fever, and weariness were the most prevalent
complaints. The study discovered a considerable rise in the
frequency of females who experienced vaccination adverse effects
as compared to males. Breathing difficulties were noted more
frequently among recipients who had previously been infected with
the coronavirus than among those who had not previously been
affected.
The short-term side effects of both vaccinations (Pfizer-BioNTech
and Oxford-AstraZeneca) were modest in frequency, low in
severity, and short-lived, according to a prospective observational
research (July 2021). Adverse effects are more common in younger
people, women, and those who have previously had COVID-19.
Post-vaccination effects (both systemic and local) often persist 1-2
days after the injection.45 .
The outcomes of a one-month cross-sectional questionnaire-based
online survey was conducted among participants who had received
at least one dose of Covid-19 vaccine at KIMS Hospital in Hubballi,
Karnataka were that Fever, headache, and generalized body soreness
were the most prevalent adverse effects46 .

Another community-based cross-sectional online survey study was

done to investigate the side effects of the two COVID-19
vaccinations. The research began in June 2021, at Hail University in
Hail, Saudi Arabia. The most common outcomes Following the first
dosage of the Pfizer vaccine were headaches, followed by muscle
discomfort, fever, and joint pain. Those who received the
AstraZeneca vaccination experienced a few additional negative
15
effects. the most prevalent adverse effect recorded following the
first dose was fever, followed by headache, muscular discomfort,
and weariness47 .
Unfortunately, in Sudan, a third-world nation, there are little studies
and data on covid-19 vaccines, particularly in rural and remote
locations, and I believe that this study will provide a groundwork
and good statistical measurements for present and future
researchers.

16
 CHAPTER THREE
METHODOLOGY

3. METHADOLOGY:

3.1 STUDY DESIGNS:

This study is a community based Cross-sectional Study.

17
 3.2 STUDY AREA:
The research was carried out at Altalbab village in Aljazeera state,
which is located to the north east of Aljeezra state, from
September 23rd to September 30th, 2022. The study region
contains one primary health facility that follows Alhasahesa
locality and the ministry of health, and in March 2021, a program
for covid-19 immunization was implemented, with 3-4 months
between the first and second doses. The third dose of
immunization began on November 1, 2022. There were no
corporations or health education programs regarding covid-19
vaccinations, and citizens were informed about it via social media
and mosques.

3.3 STUDY POPULATION:

Population of Altalbab village. The population is with low-
economic statues. And most of them working as Free lancers.
Unfortunately No records or data for the exact population number
was found, but an estimation of 7500 was obtained by the local
resistance committee.
3.3.1 INCLUSION CRITERIA:
Any individual above the age of 18 years old.
3.3.2 EXCLUSION CRITERIA:
1. Any individuals who refused to participate in this study.
2. Any individuals with language prior (didn’t understand Arabic
or English).

3.4 SAMPLING:

18
SAMPLE SIZE:
Equation
Sample size n = [DEFF*Np(1-p)]/ [(d2/Z21-α/2*(N-1)+p*(1-p)]

Variables:
 (n): sample size.
 (N): population size ( 7500 ).
 (p): hypothesized % frequency outcome factor in population
correction factor or fpc 50%+/-5.
 (d): Confidence limits as % of 100 (absolute +/- %).
 (Design effect (for cluster surveys-DEFF): 1.

Sample Size(n) for Various Confidence Levels

Confidence Level(%) Sample Size
95% 366

3.5 SAMPLE METHOD:

The total number of the village population was provided by
Altalbab resistance committee, I randomly selected the first home
and then went clockwise from house to house, including in the
study all individuals who were eligible until the sample size was
reached.

3.6 DATA COLLECTION METHODS AND TOOLS:

After explaining the questionnaire and obtaining written informed
consent from each participant, the self-administered approach was
implemented. The questionnaire was divided into four sections,
with a total of 30 multiple- choice questions. The first section was
concerned with sociodemographic information, the second with

19
general knowledge of covid-19, the third with those who had
received at least one dose of vaccination, and the fourth with those
who had not received any dose of vaccination.
The survey was intended for 366 Altalbab village residents.
Between the 23rd of September 2022 and the 30th of September
2022. After explaining the questions to each participant,
participants were given adequate time to complete the survey
anonymously. Because not all surveys were completely completed,
363 questionnaire results were analyzed in the study.

3.7. DATA COLLECTION MANAGEMENT & ANALYSIS:

Questionnaires were carefully refined and managed, and
completeness was checked before data entry. The data collected on
the questionnaires was numbered and entered after cleaning and
refined for statistical analysis using the Statistical Package for
Social Science (SPSS) ® version No. 23 software.
Simple descriptive statistics: Frequency tables, mean and standard
deviation, chi squire test for association, histogram for the
distribution of the age groups and clustered bar charts and pie charts
were used. and a P value less than 0.05 was found.

3.8. ETHICAL CONSIDERATIONS:

• Ethical clearance was obtained by the department of community
medicine, faculty of medicine, Khartoum university.
• Before taking part in the study questionnaire, each participant was
required to provide informed written consent.
• The participants' confidentiality was protected.
20
• The researcher certifies that there are no conflicts of interest.

21
 CHAPTER FOUR
RESULTS

4. RESULTS:
4.1. Socio-demographic characteristics of the study
population:
In total 363 participants filled out the questionnaire during the
study period. The respondent's distribution according to their
social demographic characteristics are included in table 1.

22
Table (1): socio-demographic characteristics of the participants
acceptability and willingness to receive COVID-19 vaccine, in
Altalbab village of Aljazeera state,2022.
Characteristics Number Percent
Gender
Male 191 52.6
Female 171 47.1
Total (missing) 362 (1) 99.7
Age
(mean ± SD) 40.2 ± 15.7
Occupation
Work in healthcare 16 4.4
Other governmental sector 21 5.8
Free lancing 134 36.9
Teacher 24 6.6
Student 91 25.1
Housewife 75 20.7
Total (missing) 361 (2) 99.4
educational level
Illiterate 18 5
Kindergarten 2 0.6
Primary school 45 12.4
Secondary school 133 36.6
University education 143 39.4
Higher education 21 5.8
Total (missing) 362 (1) 99.7
Monthly income
< 50,000 SDG 218 60.1
50,000 – 100,000 thousand SDG 87 24
> 100,000 SDG 46 12.7
Total (missing) 351 (12) 96.7

23
 Most of the participants were males 52.6% with a mean age of 40
years working as Freelancers with a University education and a
monthly income of less than 50,000 SDG. The histogram of the age
distribution is shown in Figure 1.

Figure (1): Histogram of the age distributon of the participants,

Altalbab village of Aljazeera state,2022 (n=363)

24
 4.2 The general knowledge about covid-19 among Altalbab
village residents:
(98.6%) of the participants have heard about covid-19 mostly from
the TV (81.8%). The vast majority of them knew how covid-19 is
transmitted and how it is prevented.
Only (14.3%) have been infected with covid-19 and from those
(48%) were confirmed by Laboratory test

Table (2): general knowledge of the participants acceptability and

willingness to receive COVID-19 vaccine, in Altalbab village of
Aljazeera state,2022.
Characteristics Number Percent
Have you ever heard about COVID-19 before?
Yes 358 98.6
No 5 1.4
Sources of knowledge( multiple responses )
Neighbors and local area 169 46.6
TV 297 81.8
Social media 189 52.1
Radio 109 30
Medical personnel 151 41.6
Do you know how COVID-19 is transmitted?
Yes 316 87.1
No 42 11.6
Do you know how COVID-19 is prevented?
Yes 316 87.1
No 42 11.5
Have you been infected with COVID-19?
Yes 52 14.3
No 305 84
Was it confirmed by a lab test?
Yes 25 48.1
No 27 51.9
Total (infected) 52 100

4.3 vaccination status of the participants:

25
 Most of the participants (93.1%) have heard about covid-19 vaccine
and (51%) have been vaccinated. (39.1%) of them had no chronic
illnesses before receiving the vaccine. The most common vaccine
type used was AstraZeneca, and 25.6% of the participants received
two doses. (16.5%) of the participants did not receive the third dose.
Table (3): COVID-19 vaccination status among the participants, in Altalbab
village of Aljazeera state,2022.
Characteristics Number Percent
Have you ever heard about COVID-19 VACCINE
Yes 334 92
No 23 6.3
Total (missing) 357 (1) 98.3
Were you vaccinated?
Yes 184 50.7
No 174 47.9
Total (missing) 358 100
Health condition (chronic illness) before taking the
vaccine( multiple responses )
No chronic illness 141 39.1
Hypertension 18 5
Asthma 6 1.7
Heart disease 5 1.4
Diabetes 14 3.6
Total (vaccinated) 184 100
Type of vaccine
AstraZeneca 65 17.9
Pfizer 26 7.2
Johnson 48 13.2
I don’t know 44 12.1
Total (missing) 183 (1) 99.4
Number of doses
1 dose 67 18.5
2 doses 92 25.3
3 doses 22 6.1
I don’t know 4 0.8

Total 184 100

Time between each dose
1 month 50 14

26
2 months 22 6.1
3 months 20 5.5
I don’t know 22 6.1
Total (those took between 2 -3 doses) 115 100

4.4 Side effects following covid-19 vaccine:

30.9% the participants who were vaccinated did not experience any side
effects. 6.6% experienced side effects on day 1. 11.3% experienced
fever after the 1st dose; it lasted for 24 hour, while 6.1 % of the
participants had headache after the 2nd dose which lasted for 24 hours.

Table (4): COVID-19 vaccination side effects among the participants, in

Altalbab village of Aljazeera state,2022.

Numbe
Characteristics Percent
r
Did you experience any side effects after COVID-19
VACCINE
Yes 72 39.1
No 112 60.9
Total 184 100
Onset of side-effects
< 24 hrs. 19 5.2
1 day 24 6.6
2 days 13 3.6
3 days 4 1.1
I don’t remember 12 3.3
Total 72 100
Side effects after 1 dose( multiple responses )
st

Pain at injection site 34 9.4

Fatigue/malaise 23 6.3
Headache 34 9.4
Muscle pains 9 2.5
Thrombosis 1 0.3
Fever 41 11.3
No side effects appeared 7 1.9
Duration of 1 dose side effects
st

< 24 hrs. 8 2.2

1 day 24 6.6
27
2 days 14 3.9
3 days 11 3
I don’t remember 8 2.2
Total 65 100
Side effects after 2nd dose( multiple responses )
Didn’t receive 2nd dose 23 6.3
Pain at injection site 14 3.9
Fatigue/malaise 10 2.8
Headache 22 6.1
Muscle pains 6 1.7
Thrombosis 1 0.3
Fever 21 5.8
No side effects appeared 12 11
Duration of 2nd dose side effects
< 24 hrs. 3 8
1 day 14 3.9
2 days 7 1.9
3 days 5 1.4
I don’t remember 7 1.9
Total 36 100
Side effects after 3rd dose( multiple responses )
Didn’t receive 3rd dose 60 16.5
Pain at injection site 1 .3
Fatigue/malaise 1 .3
Headache 4 1.1
Muscle pains 2 .6
Thrombosis 0 0
Fever 1 .3
No side effects appeared 5 1.4
Duration of 3rd dose side effects
< 24 hrs. 3 0.8
1 day 2 0.6
2 days 0 0
3 days 0 0
I don’t remember 0 0
Were you aware about a number to call when side effects
appeared?
Yes 23 6.3
No 22 6.1
Did you contact COVID-19 call center when the side effects
appeared?

28
Yes 8 2.2
No 37 10.2

4) reasons behind postponing the vaccination:

The most common reason for not receiving the vaccine was the
disturbing rumors about the vaccine (26.20%) of which (13.8 %) due
to its ability to cause infertility. (15.2%) of these rumors were heard
from the social media.

26.20%

20.10%

15.40%

9.10%

3.90%
1.40%

y s s s ns e
rb is t e ct es so in
ne
a ex eff en cc
e v ea va
bl
e as id
e
ec
ti
usr he
la se fs eff io tt
vai di ro e lig ou
a e in re
un th fe
a
cc s ab
e d a or
ci n ce tv
c vin ou ru
m
va co
n a b
ng
t
ce
d bi
no ur
nvin di
s t
co e
t th
no

Figure (2): bar chart for the reasons for not being vaccinated
among the participants, in Altalbab village of Aljazeera
state,2022.(n = 178)

29
 13.80%

7.40%
5.50%
4.40%

ity h) on
s ce
til tra ati li en
f er (F
i
ai
in ie
s rm rv
s
nc fo e
se e al rs
c au nd lm s fo
te a ip
in
e
te f et ch
cc na es c
va i n us ni
r ca tro
you e e c
s in el
ge cc n
an va ai
nt
ch c o
e e
c cin c cin
va va

Figure (3): bar chart for the rumors heard about the vaccine
among the participants, in Altalbab village of Aljazeera state,2022.
(n = 178)

Series 1
0.3;
1%
2.8; 7%

Neighbors and local area

13.8; 36% tv
Social media
Radio
15.2; 39%
medical personnel

6.6; 17%

Figure (4): A pie chart for the sources of heard rumors among the
participants of Altalbab village of Aljazeera state,2022

30
Chi-square test showed a significant association between vaccination
status and educational level and occupation.

vaccination status by occupation

(p =0.000)

vaccinated not vaccinated

80
70 66.7
58.2 61.1
60 50 50 50 50 52
48
50 41.8 38.9
40 33.3
30
20
10
0
re or er er nt if e
hca e ct nc ch de w
lt ls la te
a
st
u e
a ta e us
n
he en fre ho
ki nm
or ver
w
r go
he
ot

Figure (5): Clustered bar chart for the association of the vaccination
status of the participants and the occupation among the participants, in
Altalbab village of Aljazeera state,2022.

31
 vaccination status by educational level
(p=0.01)
vaccinated not vaccinated

100

83.3
71.4

53.3 54.5 51 49
46.7 45.5

28.6
16.7

0
illitrate kind garden 1ry school 2ndry school university higher education

Figure (6): Clustered bar chart (of percentages) showing the association of
the vaccination status of the participants and the educational level among
the participants, in Altalbab village of Aljazeera state,2022.

32
CHAPTER FIVE
DISCUSSION

33
 5.DISCCUSION:
This study aimed to address Covid-19 vaccines acceptability,
willingness and hesitancy in Altalbab village of Aljazeera statue, and
the side effects among vaccinated individuals. This study was
conducted in in Altalbab village of Aljazeera statue, and consisted of
a calculated sample size of (366) but the number of participants who
completed the questionnaire was 363, in which (191) were males and
(171) were females, the highest number of people who participated
were in the (20-60) years of age category. (98.6%) of individuals had
heard about covid-19, with (81.8%) hearing about it via television.
The significant majority of them understood how covid-19 spreads
and how it may be avoided. And only a (1.4%) of the participants
hadn't have information about covid-19. The most common pre-
existing chronic diseases among the participants were diabetes (3.6%)
but (39.1%) of them free from preexisting chronic diseases. The
results shows most of participants (60.6%) did not suffer from side
effects, this result is opposite of those of similar study that was
conducted in n Ruffaa city, Gezira, Sudan January (2022) 28 . Perhaps
the reason for this is that AstraZeneca was widely used in my study
area (Altalbab village) in comparison to Johnson vaccine which is
used in the other study, and a (39.1%) of my participants were free of
preexisting chronic diseases compared to a (74%) in the opposite
study, which may have led to a mix-up of the symptoms of their
preexisting chronic diseases and the side effects of the vaccine.
(Keeping in mind that the number of participants in both research was
fairly close). The majority of individuals (93.1%) had heard of the

34
covid-19 vaccination and (51%) had been vaccinated. AstraZeneca
was the most often used vaccine type (17.9%) followed by Johnson
and Johnson (13.5%), with (25.6%) of individuals receiving two
doses. (18.5%) received one dose and only (6.1%) received three
doses. (30.9%) the participants who were vaccinated did not
experience any side effects. (6.6%) experienced side effects on day
one. The main side effects experienced after the first does is fever
(11.3%) followed by headache (9.4%) and pain at site of injection
(9.4%), that lasted for 1 day (6.6%). And concerning the main side
effects experienced after the second does is headache (6.1%) followed
by fever (5.8%) and lasted for one day (3.9%). Lastly (16.5%) of the
participants did not receive the third dose but in those who did (1.4%)
of them did not experience any side effects. Similar results were
addressed in a cross sectional study of Side-effects of COVID-19
vaccines among the Saudi population 41 . The most common reason for
not receiving the vaccination was because of the rumours about the
vaccine's tendency to induce infertility, which was cited by (13.8%)
of those who did not receive it. (15.2%) of these rumours were spread
via social media, while (13.8%) were spread by neighbours and local
residents.
The The data supported that there is a significant link between
vaccination status, educational level, and profession. Covid-19
vaccination was related with employees in the other governmental
sector (66.7%) and free lancers (58.2%) (p0.0001), secondary school
educational level (54.4%), and higher education (71.4%) (p=0.01)
LIMTATIONS OF THE STUDY:

 The study relied on participant self-report.

 demonstrated the general side-effects experienced after taking
the vaccination, regardless of vacation type, and widely

35
 addressed the length of the overall symptoms following
vaccinations without specification to any of them.
 because of the lacking of the data, a proper list of the village
residents was missing, a proper data collection method could
not be conducted.
this study provides a database to inform individuals about potential
adverse effects and the primary reasons for vaccine hesitation.
However, further researches is needed to have a better knowledge of
developing adverse effects and the type of immunization utilized.
CONCLUSION:
In conclusion, the majority of Altalbab village people were
vaccinated with at least one dose of the vaccine, and the majority of
them did not experience any adverse effects. However, the most
common negative effects reported by individuals who received it were
headache, fever, and soreness at the injection site. According to the
data, the most prevalent reasons for vaccination postponement and
rejection are rumors, particularly the vaccine's tendency to induce
infertility, and fear of adverse effects.

RECOMMENDATIONS:
Based on the findings and conclusions presented the following
recommendation are suggested:
1. More emphasis should be placed on health education on the
covid-19 vaccine through social media, television, and health
institutions in order to dispel false rumors about the vaccine.
2. Because the most prevalent side effects addressed by participants
are mild and unconcerning, steps should be taken by health
institutions, medical personnel, and us as a community to
distribute proper medical information and encourage the
community to get vaccination.

36
3. considering the close proximity of the percentages of
vaccinated and unvaccinated participants A call to action for
governments and non-governmental groups to work together to
overcome issues associated with vaccination. Furthermore,
increased public and health professional knowledge is required
to combat vaccination reluctance.

37
REFERENCES

38
1
“Who Coronavirus (COVID-19) Dashboard.” World Health
Organization, World Health Organization, 22 Oct. 2022,
https://covid19.who.int/.
2
Robinson E, Jones A, Lesser I, Daly M. International estimates of
intended uptake and refusal of COVID-19 vaccines: A rapid
systematic review and meta-analysis of large nationally representative
samples. Vaccine. 2021 Apr 8;39(15):2024-2034. doi:
10.1016/j.vaccine.2021.02.005. Epub 2021 Feb 6. PMID: 33722411;
PMCID: PMC7867398.
3
Abedin M, Islam MA, Rahman FN, Reza HM, Hossain MZ, Hossain
MA, Arefin A, Hossain A. Willingness to vaccinate against COVID-
19 among Bangladeshi adults: Understanding the strategies to
optimize vaccination coverage. PLoS One. 2021 Apr
27;16(4):e0250495. doi: 10.1371/journal.pone.0250495. PMID:
33905442; PMCID: PMC8078802
4
Qunaibi EA, Helmy M, Basheti I, Sultan I. A high rate of COVID-19
vaccine hesitancy in a large-scale survey on Arabs. Elife. 2021 May
27;10:e68038. doi: 10.7554/eLife.68038. PMID: 34042047; PMCID:
PMC8205489.
5
Hou Z, Tong Y, Du F, Lu L, Zhao S, Yu K, Piatek SJ, Larson HJ,
Lin L. Assessing COVID-19 Vaccine Hesitancy, Confidence, and
Public Engagement: A Global Social Listening Study. J Med Internet
Res. 2021 Jun 11;23(6):e27632. doi: 10.2196/27632. PMID:
34061757; PMCID: PMC8202656.
6
Meyer H, Ehmann R, Smith GL. Smallpox in the Post-Eradication
Era. Viruses. 2020;12(2):138. Published 2020 Jan 24.
doi:10.3390/v12020138
7
Minor P. The polio endgame. Hum Vaccin Immunother.
2014;10(7):2106-2108. doi:10.4161/21645515.2014.981115
8
Pagliusi S, Dennehy M, Kim H; DCVMN AGM Organizing
Committee. Vaccines, inspiring innovation in health. Vaccine.
2018;36(48):7430-7437. doi:10.1016/j.vaccine.2018.05.035
9
Tabatabaeizadeh SA. Airborne transmission of COVID-19 and the
role of face mask to prevent it: a systematic review and meta-analysis.
Eur J Med Res. 2021;26(1):1. Published 2021 Jan 2.
doi:10.1186/s40001-020-00475-6
10
https://www.gavi.org/news/media-room/new-collaboration-makes-
further-100-million-doses-covid-19-vaccine-available-low
11
Oguzturk O. Differences in quality of life in rural and urban
populations. Clin Invest Med. 2008;31(6):E346-E350. Published 2008
Dec 1. doi:10.25011/cim.v31i6.4920
Lurie, N.; Saville, M.; Hatchett, R.; Halton, J. Developing Covid-19
12

Vaccines at Pandemic Speed. N. Engl. J. Med. 2020, 382, 1969–1973.

13
Yang, Y.; Peng, F.; Wang, R.; Guan, K.; Jiang, T.; Xu, G.; Sun, J.;
Chang, C. The deadly coronaviruses: The 2003 SARS pandemic and
the 2020 novel coronavirus epidemic in China. J. Autoimmun. 2020,
109, 102434.
14
Ghiasi N, Valizadeh R, Arabsorkhi M, Hoseyni TS, Esfandiari K,
Sadighpour T, Jahantigh HR. Efficacy and side effects of Sputnik V,
Sinopharm and AstraZeneca vaccines to stop COVID-19; a review and
discussion. Immunopathol Persa. 2021;7(2):e31. DOI:10.34172/
ipp.2021.31.
15
Eastwood, K.; Durrheim, D.N.; Jones, A.; Butler, M. Acceptance of
pandemic (H1N1) 2009 influenza vaccination by the Australian public.
Med. J. Aust. 2010, 192, 33–36
16
Maurer, J.; Harris, K.M.; Parker, A.M.; Lurie, N. Does receipt of
seasonal influenza vaccine predict intention to receive novel H1N1
vaccine: Evidence from a nationally representative survey of U.S.
adults. Vaccine 2009, 27, 5732–5734
Schwarzinger, M.; Flicoteaux, R.; Cortarenoda, S.; Obadia, Y.;
17

Moatti, J.-P. Low Acceptability of A/H1N1 Pandemic Vaccination in

French Adult Population: Did Public Health Policy Fuel Public
Dissonance? PLoS ONE 2010, 5, e10199.
18
Maurer, J.; Uscher-Pines, L.; Harris, K.M. Perceived seriousness of
seasonal and A(H1N1) influenzas, attitudes toward vaccination, and
vaccine uptake among U.S. adults: Does the source of information
matter? Prev. Med. 2010,
19
Sypsa, V.; Livanios, T.; Psichogiou, M.; Malliori, M.; Tsiodras, S.;
Nikolakopoulos, I.; Hatzakis, A. Public perceptions in relation to
intention to receive pandemic influenza vaccination in a random
population sample: Evidence from a cross-sectional telephone survey.
Eurosurveillance 2009, 14, 19437.
Raude, J.; Caille-Brillet, A.-L.; Setbon, M. The 2009 pandemic
20

H1N1 influenza vaccination in France: Who accepted to receive the

vaccine and why? PLoS Curr. 2010, 2, rrn1188.
Rubin, G.J.; Potts, H.; Michie, S. The impact of communications
21

about swine flu (influenza A H1N1v) on public responses to the

outbreak: Results from 36 national telephone surveys in the UK.
Health Technol. Assess. 2010, 14.
22
Seale, H.; Heywood, A.E.; McLaws, M.; Ward, K.F.; Lowbridge,
C.P.; Van, D.; MacIntyre, C.R. Why do I need it? I am not at risk!
Public perceptions towards the pandemic (H1N1) 2009 vaccine. BMC
Infect. Dis. 2010, 10, 99.
https://www.frontiersin.org/articles/10.3389/fpubh.2020.00381/full
23

24
Wang, J.; Jing, R.; Lai, X.; Zhang, H.; Lyu, Y.; Knoll, M.D.; Fang,
H. Acceptance of COVID-19 Vaccination during the COVID-19
Pandemic in China. Vaccines 2020, 8, 482.
https://doi.org/10.3390/vaccines8030482
https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-
25

2019-ncov/resource/fr/covidwho-619542?lang=en
26
https://www.ajol.info/index.php/sjms/article/view/200467
 Karlsson L. C., Lewandowsky S., Antfolk J., et al. The association
27

between vaccination confidence, vaccination behavior, and willingness

to recommend vaccines among Finnish healthcare workers. PLoS
One . 2019;14(10):p. e0224330. doi: 10.1371/journal.pone.0224330.
 World Health Organization. Federal Ministry of Health. SUDAN
28

Outbreaks
Dashboard . 2022. https://fmoh.shinyapps.io/Outbreaks/ [Ref list]
29
Raja, S. M., Osman, M. E., Musa, A. O., Hussien, A. A., & Yusuf,
K. (2022). COVID-19 vaccine acceptance, hesitancy, and associated
factors among medical students in Sudan. PLOS ONE, 17(4),
e0266670. https://doi.org/10.1371/journal.pone.0266670
Eman Omer Mohamed Yassin, Haybat Awad Allah Faroug, Zainab
30

Bushra Yousif Ishaq, Mustafa Mohammed Alfaki Mustafa,

Mohammed Meshal Abdulkareem Idris, Samah Elnour Khalifa
Widatallah, Ghada Omer Hamad Abd El-Raheem, Maha Y. Suliman,
"COVID-19 Vaccination Acceptance among Healthcare Staff in
Sudan, 2021", Journal of Immunology Research, vol. 2022, Article ID
3392667, 11 pages, 2022. https://doi.org/10.1155/2022/3392667
31
World Health Organization. Ten threats to global health. 2019.
Available from: https://www.who.int/emergencies/ten-threats-to-
global-health-in-2019
32
Mohamed Babiker Musa, Osman Kamal Osman Elmahi, Mohamed
Abdul Kareem Adam Modber, Fatima Elbasri Abuelgasim
Mohammed Yagoub, Alaa Abusufian Elkabashi Dafallah, Shuaibu
Saidu Musa, Allan Kangwerema, Emmanuella Nzeribe, Alanood
Elnaeem Mohamed, Nora Alnaeem Mohamed, Irfan Ullah, Don Eliseo
Lucero-Prisno,
The fight against the COVID-19 pandemic: Vaccination challenges in
Sudan,Public Health in Practice,Volume 2,2021,100205, ISSN 2666-
5352, https://doi.org/10.1016/j.puhip.2021.100205.
(https://www.sciencedirect.com/science/article/pii/
S2666535221001300)
Mohamed AE, Elhadi YAM, Mohammed NA, Ekpenyong A,
33

Lucero-Prisno DE. Exploring Challenges to COVID-19 Vaccination in

the Darfur Region of Sudan. Am J Trop Med Hyg. 2021 Nov
10;106(1):17-20. doi: 10.4269/ajtmh.21-0782. PMID: 34758448;
PMCID: PMC8733522.
34
Susan Ali Zroog 1, *, Yassin HM Nor- Aldaiem 2, Mohamed AM
Gebralla 3 and Abdelhakam H. Ali 4 Common side effects of Johnson
and Johnson COVID-19 vaccine in Ruffaa city, Gezira, Sudan January
(2022) 10.53430/ijsru.2022.4.1.0109
DOI url: https://doi.org/10.53430/ijsru.2022.4.1.0109
35

https://www.sciencedirect.com/topics/medicine-and-dentistry/vaccine-
hesitancy
Sallam, M. COVID-19 Vaccine Hesitancy Worldwide: A Concise
36

Systematic Review of Vaccine Acceptance Rates. Vaccines 2021, 9,

160. https://doi.org/10.3390/vaccines9020160
Qunaibi EA, Helmy M, Basheti I, Sultan I. A high rate of COVID-19
37

vaccine hesitancy in a large-scale survey on Arabs. Elife. 2021 May

27;10:e68038. doi: 10.7554/eLife.68038. PMID: 34042047; PMCID:
PMC8205489.
38
Fajar, J.K.; Sallam, M.; Soegiarto, G.; Sugiri, Y.J.; Anshory, M.;
Wulandari, L.; Kosasih, S.A.P.; Ilmawan, M.; Kusnaeni, K.; Fikri, M.;
Putri, F.; Hamdi, B.; Pranatasari, I.D.; Aina, L.; Maghfiroh, L.;
Ikhriandanti, F.S.; Endiaverni, W.O.; Nugraha, K.W.; Wiranudirja, O.;
Edinov, S.; Hamdani, U.; Rosyidah, L.; Lubaba, H.; Ariwibowo, R.;
Andistyani, R.; Fitriani, R.; Hasanah, M.; Nafis, F.A.D.; Tamara, F.;
Latamu, F.O.; Kusuma, H.I.; Rabaan, A.A.; Alhumaid, S.; Mutair,
A.A.; Garout, M.; Halwani, M.A.; Alfaresi, M.; Al Azmi, R.; Alasiri,
N.A.; Alshukairi, A.N.; Dhama, K.; Harapan, H. Global Prevalence
and Potential Influencing Factors of COVID-19 Vaccination
Hesitancy: A Meta-Analysis. Vaccines 2022, 10, 1356.
https://doi.org/10.3390/vaccines10081356
Lu, J. G. (2022). Two large-scale global studies on COVID-19
39

vaccine hesitancy over time: Culture, uncertainty avoidance, and

vaccine side-effect concerns.Journal of Personality and Social
Psychology. Advance online publication.
https://doi.org/10.1037/pspa0000320
40

https://www.researchgate.net/profile/John-Teibo/publication/3625520
95_COVID-
19_Vaccine_Acceptance_and_Hesitancy_A_Continental_Review/
links/62fb9539aa4b1206fab6aee3/COVID-19-Vaccine-Acceptance-
and-Hesitancy-A-Continental-Review.pdf
41
M. Wadman, Public needs to prep for vaccine side
effects. Science 370, 1022 (2021).
42
A. Remmel, COVID vaccines and safety: What the research
says. Nature 590, 538–540 (2021).
Riad, A.; Pokorná, A.; Attia, S.; Klugarová, J.; Koščík, M.; Klugar,
43

M. Prevalence of COVID-19 Vaccine Side Effects among Healthcare

Workers in the Czech Republic. J. Clin. Med. 2021, 10, 1428.
https://doi.org/10.3390/jcm10071428
Tissot N, Brunel AS, Bozon F, Rosolen B, Chirouze C, Bouiller K.
44

Patients with history of covid-19 had more side effects after the first
dose of covid-19 vaccine. Vaccine. 2021 Aug 23;39(36):5087-5090.
doi: 10.1016/j.vaccine.2021.07.047. Epub 2021 Jul 22. PMID:
34332800; PMCID: PMC8295016.
El-Shitany NA, Harakeh S, Badr-Eldin SM, Bagher AM, Eid BG,
45

Almukadi HS, Alghamdi BS, Alahmadi AA, Hassan NA, Sindi N,

Alghamdi SA, Almohaimeed HM, Mohammedsaleh ZM, Al-Shaikh
TM, Almuhayawi MS, Ali SS, El-Hamamsy M. Minor to Moderate
Side Effects of Pfizer-BioNTech COVID-19 Vaccine Among Saudi
Residents: A Retrospective Cross-Sectional Study. Int J Gen Med.
2021;14:1389-1401
https://doi.org/10.2147/IJGM.S310497
Andanigoudar KB, Bant DD, H S, U O. Covid Vaccine Side Effects
46

and Covid Infection after Vaccination- A Cross Sectional Study in

Hubballi, Karnataka. Natl J Community Med [Internet]. 2022 Jan. 31
[cited 2022 Oct. 8];13(01):22-6. Available from:
https://njcmindia.com/index.php/file/article/view/53
47
Almughais ES, Alharbi AH, Aldarwish HA, et al. Side-effects of
COVID-19 vaccines among the Saudi population: A cross-sectional
study. Saudi Med J. 2022;43(4):386-393.
doi:10.15537/smj.2022.43.4.20210905