Factors associated with COVID-19 vaccine acceptance among refugee women at Dzaleka refugee camp in Malawi

Vaccine. 2026 Jun 23;88:128862. doi: 10.1016/j.vaccine.2026.128862. Online ahead of print.

ABSTRACT

BACKGROUND: In 2020, the COVID-19 pandemic had a significant impact on healthcare systems worldwide, with varying effects depending on location and socioeconomic status. Two of the challenges faced were the limited availability of COVID-19 vaccines and the slow uptake of those vaccines. Women refugees are uniquely vulnerable during migration, experiencing gender-based violence, which is associated with poor health outcomes related to gender inequality. However, there is limited literature on COVID-19 vaccination decision-making among refugee women in refugee camps, particularly in African countries such as Malawi. The purpose of this analysis was to examine COVID-19 vaccination acceptance and to explore factors associated with COVID-19 vaccination status among refugee women of childbearing age.

METHODS: This was a descriptive-correlational study conducted at Dzaleka Refugee Camp in Malawi. We recruited 296 women of childbearing age. A survey was used to collect data on participant characteristics, COVID-19 vaccination status, and the reasons for their immunization status. We used descriptive statistics to analyze participants’ characteristics and vaccine status. We used regression analysis to examine the characteristics of participants associated with their COVID-19 vaccination status.

RESULTS: Results showed that 76% of the women had received at least one COVID-19 vaccine, with more than half fully vaccinated. Vaccine hesitancy was associated with having fewer children and less education. Open-ended questions revealed that women feared of infertility, death, unknown adverse effects, and partner influence were among the factors that deterred them from receiving the COVID-19 vaccine.

CONCLUSION: Refugee women in Malawi had high COVID-19 vaccine uptake. Malawi’s high immunization rates are the result of successful, informative immunization campaigns and supportive healthcare workers, who have positively influenced COVID-19 vaccine uptake among refugee women of childbearing age. Despite having high COVID-19 vaccination rates, barriers to vaccine uptake persist due to a lack of accurate information and concerns about the safety of the new vaccine. Healthcare workers must continue to engage communities in information dissemination campaigns to foster trust and ensure that accurate information is shared.

PMID:42335759 | DOI:10.1016/j.vaccine.2026.128862