Cross-Sectional Study on COVID-19 Prevention and Vaccination Status of Veterinary Colleges in Southeast Nigeria

COVID-19 vaccination and compliance with the established prevention protocols are integral to curbing the spread of the COVID-19 virus; however, there is a paucity of information on compliance with these measures among veterinary schools within southeast Nigeria. To fill this gap, we evaluated the vaccination status and individual’s perception of the preventive measures against COVID-19 infections. A cross-sectional study using a self-reported internet-based questionnaire was employed to obtain responses from students and staff of the veterinary colleges in southeast Nigeria. Multivariate binary logistic regression analysis was used to identify significant factors associated with vaccination status and compliance with the COVID-19 prevention protocols by the respondents. A total of 183 individuals participated in the online survey. Although 75% (138/183) of the respondents revealed a willingness to take the COVID-19 vaccine, only 25.1% (46/183) of the respondents had received one or more doses of the COVID-19 vaccine. We observed that male respondents (28 ± 4.4% (95% CI 19–37)) had a higher percentage of vaccinated individuals than female respondents. Furthermore, the academic staff of the veterinary colleges were 39.70 (95% CI 2.50–630.65; 
 
 p
 =
 0.01
 
 ) times more likely to get vaccinated than undergraduate students. The educational status of the respondent greatly contributed to the willingness to get vaccinated, and individuals within the age bracket of 31 to 40 years were 10.2 ± 1.07 (95% CI 1.33–92.25; 
 
 p
 =
 0.03
 
 ) times less likely to comply with the COVID-19 prevention protocols. Although a high proportion of the respondents had a good perception of the COVID-19 prevention protocols, only 25.1% of the members of the veterinary colleges in southeast Nigeria had been vaccinated. Therefore, there is a need to create better awareness channels to improve the vaccination status of members of veterinary colleges in southeast Nigeria.


Introduction
Coronavirus disease  is the greatest pandemic of the 21 st century, with over 500 million cases reported globally as of June 2022 since its onset [1]. It is a transmissible disease caused by the SARS-CoV-2 virus that exists in respiratory and air droplets [2]. Te virus belonging to the family Coronaviridae is highly pathogenic, especially in immunocompromised individuals [3,4]. Notable symptoms of the disease range from mild pneumonia to severe respiratory failure and multiple organ failure, with some patients requiring oxygen therapy and intensive care. Notwithstanding, there is also evidence of asymptomatic cases with patients showing no recognisable symptoms [5,6]. Severe and prolonged illness, especially in patients sufering from long COVID, could result in long-term health challenges [7,8]. Hence, there is an urgent need for the promotion of worldwide vaccination coverage to mitigate the devastation.
In the past, coronaviruses were of little signifcance to human health. Te onset of coronavirus outbreaks such as the severe acute respiratory syndrome (SARS) epidemic became a public health concern in the human population; however, in the poultry industry, the virus causes huge economic losses. Globally, the avian coronavirus causes infectious bronchitis (IB), a highly contagious disease of birds that results in large-scale deaths and is a burden on poultry producers due to huge losses [9][10][11]. In the 1950s, mass vaccination was instrumental in managing the IB crisis [12]. Similarly, vaccine development was imperative to curb the spread of COVID-19, improve herd immunity, and decrease the death rate [13,14]. However, the awareness level of diseases that are vaccine-preventable does not correlate with real compliance and acceptance of the vaccination, according to Murele et al. [15]. As observed worldwide, certain factors appeared to infuence personal views on the uptake of COVID-19 vaccination. Tese factors are not limited to educational status, religion, misinformation, poor coverage, cost, mistrust of the government, and vaccine safety concerns [16][17][18]. In Nigeria, it was observed that health professionals were more knowledgeable and willing to be vaccinated as compared to nonhealth professionals [16,19]. In addition, the public's mistrust of government and religious beliefs often played a role in people's nonchalance to participate in routine vaccination programmes, as observed in the boycott of polio vaccination in northern Nigeria, which led to high polio cases recorded in the recent past [20,21]. Recently, the principal source of information has been the media. Anorue et al. [22] concluded that the safety of COVID-19 vaccine communication through the media was very low, neither convincing nor sufcient, leading to negative perceptions of the vaccine in Southeast Nigeria. In addition, misconceptions about the efects of the vaccine continued to propagate on social media, largely contributing to the vaccination hesitancy observed around the world [23]. (Salem 2021). Across India and China, it was observed that women were more reluctant to be vaccinated, and this was due to misinformation suggesting vaccine uptake was associated with infertility, despite claims that these concerns were unconfrmed [24][25][26]. Although vaccine acceptance rates in the UK and USA were relatively lower compared to some Asian nations, the unwillingness to take the vaccines was based on a lack of confdence in their safety and efectiveness [27]. Currently, just over 46 million people are vaccinated in Nigeria, representing less than 25% of the general population [28]. Tis is worrisome because herd immunity can only be achieved when over 70% of the population is vaccinated [14]. Surprisingly, the COVID-19 infection rate continues to rise slowly compared to Europe and America, where vaccination has been strategically implemented and efective. However, it is probable that the low number of positive cases recorded in Nigeria could be a result of poor disease reporting and surveillance.
At the onset of the pandemic, before the advent of a vaccine, there was a demand for alternative ways to prevent infection. Tis need fuelled an increase in research for possible methods to prevent the spread of the virus. Although recommended protective strategies against COVID-19, such as the use of face masks, physical distancing, restrictions on social gatherings, and constant hand washing, were efective to an extent, vaccination proved to be more efective [29,30]. Unfortunately, the COVID vaccine misconceptions also pushed the demand for nonpharmaceutical remedies. For instance, in some communities, the consumption of dietary supplements and herbal concoctions intensifed [31][32][33][34][35]. Arguably, it is also likely that vaccine safety concerns, as well as vaccine cost and misinformation [36,37], further drove the demand for alternative medicine as a more desirable and reliable option for preventing COVID-19 infection [38]. Additionally, one of the challenges with COVID-19 vaccination was the emergence of SARS-CoV-2 variants that appear to be immune evasive. Some studies show that vaccine efectiveness is signifcantly improved after 2 doses; however, the omicron variant can elude immune response. Immune evasiveness reduces vaccine efectiveness; hence, it is expedient to mitigate the transmission of new variants [39][40][41]. Our study aims to evaluate the vaccination status and individual perceptions of preventive measures against COVID-19 infection in veterinary schools in Southeast Nigeria.

Study Design.
To achieve our objectives, a crosssectional study using a self-reported internet-based questionnaire (Google form), as a survey tool, was employed. Te Google form was distributed to the target population within the veterinary schools in Southeast Nigeria. Te inclusion criteria include the members of staf and students in the veterinary schools in Southeast Nigeria while the exclusion criteria included the nonveterinary staf and students. Currently, there are two veterinary schools located within the Southeast geopolitical zone: the University of Nigeria Nsukka in Enugu State and the Michael Okpara University of Agriculture Umudike in Abia State ( Figure 1).

Questionnaire Design and Data
Collection. Te English language (British) was used as the medium for data collection in this study. Te survey instrument was a structured questionnaire comprising a total of 29 open-and closedended questions grouped into four segments, each directed towards a specifc objective of the study. Te frst segment gave a brief description of the objectives of the survey and included a statement of confdentiality and a request for the respondent's consent to participate in the study, while the second segment was tailored to elicit responses on the sociodemographic characteristics of the respondents. Te third segment was designed to elicit responses on the respondent's travel history, vaccination status, perception, and compliance to the WHO nonpharmaceutical COVID-19 prevention protocol/intervention (use of a face mask, washing of hands, use of hand sanitizers, physical distance, and self-isolation). Te questionnaire was face-validated by an experienced statistician. Tis was followed by a 3-month content validation by six-man panel assessors, which included two potential respondents, two public health experts, and two statisticians. Te survey instrument, which was assessed for clarity and relevance, had a validity index of 0.9. However, the construct validity study was not done due to logistical limitations.
A pilot study was conducted on the survey instrument, and the feedback from the pilot study on each of the items in the questionnaire was taken, and the questions were modifed accordingly. Te link to the Google form was distributed through social media platforms, mainly via staf and students' WhatsApp group platforms. One-on-one sharing of the link was also carried out by the researchers, which helpedreach more participants. Te survey was available online for four weeks to enable the target audience to participate in the survey. Data obtained from the online Google form survey were collated and analysed between May and June 2022.
Little or no difculty was encountered in flling out the online form in the course of the survey since the target population was university academics and college students, who are literate and have Internet exposure.

Data Analysis.
Te responses to the Google forms were downloaded as a Microsoft Excel Worksheet (.xlsx) and imported into R version 4.2.0 [42] using the readxl package [43]. Data cleaning and sorting were accomplished with the dplyr package [44], and a graphical representation of the results was done with the ggplot2 package [45]. Other R packages used for the analysis and model training include psych [46], Stat2Data [47], and caret [48].

Data Classifcation and
Scoring. Summary statistics were derived using "veterinary colleges" (MOUAU, UNN), "sex," and "group" (academic staf, nonteaching staf, undergraduate students, and postgraduate students-Figure2) as grouping variables. "Perception" and "compliance" with COVID-19 prevention protocols were scored on a 5-point Likert scale, where a score of "1" was regarded as "very poor" and a score of "" was regarded as "excellent." An average score of "<3" was regarded as "poor," while a score of "≥3" was regarded as "good," which served as cut-ofs for bivariate analysis. In addition, a score of "5" was allotted to vaccinated individuals, whereas a score of "1" was given because vaccination status was regarded as an important indication of COVID-19 compliance. Compliance with COVID-19 prevention protocols was accessed under two broad categories: (1) Nonpharmaceutical protocols, which included the use of face masks, proper and regular hand-washing, use of hand sanitizers, and observing social distancing. (2) Reception of COVID-19 vaccine.
Te average score on compliance with nonpharmaceutical methods accounted for 50% of respondents' compliance scores. Te remaining 50% was allocated to the vaccination status of the respondent because vaccine reception is regarded as the most important compliance practice. Compliance scores derived from both protocols were regarded as "adjusted" compliance scores because they were calculated with more weight allocated to the vaccination status.

Statistical Tests and Model Training.
Hypothesis testing was carried out using a chi-squared test for independence (categorical variables) and a multivariate binary logistic regression analysis was also performed using all independent variables to determine probable predictors for "compliance" with COVID-19 prevention protocols in the primary model. Ordinal variables were entered as nominal variables. To derive the fnal model, multivariate binary ogistic analysis was repeated using only signifcant predictors from the primary model of various predictors of "compliance" with COVID-19 prevention protocols using only statistically signifcant predictors from the primary model. Furthermore, a Wald test was performed on the statistically signifcant residuals from the secondary model to verify the predictive power of the residuals. Te fnal model was trained for internal cross-validation using the K-fold validation (Stone, 1974) with ten iterations to determine the predictive accuracy of the fnal model. All hypothesis tests were carried out at an alpha level of 0.05.

Assumptions
Testing. Te data set was checked for compliance with the basic assumptions for binomial logistic regression [49]. Tere was one set of dichotomous independent variables (good compliance and poor compliance) and sets of categorical "predictor" variables (educational status, age group, category, frequency of travel, veterinary college, and sex) ( Figure 2). Polytomous variables were treated as factors using the "as.factor" function in R so that ordinal variables such as age class would be computed as nominal entries. Tis was done because of the relatively limited sample sizes of the categories and thus eliminated the need for comparing the linearity of independent variables with the log odds. Te responses were screened for outliers using Cook's distance analysis [50].

Demographic Features of Respondents.
A total of 183 individuals, comprising 76 females (41.53%) and 107 males (58.47%) from the two veterinary colleges in Southeast Nigeria, responded to the online survey. Te sociodemographic distribution of the respondents within each of the veterinary colleges as presented in Figure 3 revealed variations in the ratio of male to female participation in all the 8.19 MOUAU, ABIA    Figure 5). We also observed that about 80% (37/46) of the respondents who had been vaccinated had taken a booster second dose of COVID-19 vaccines (Table 3). Te two predominant COVID-19 vaccine brands used within the study area were Moderna/Spikevax and Oxford/AstraZeneca/Vaxzervria ( Figure 5). To further understand the pattern of distribution of vaccinated Veterinary Faculty members, we cross-tabulated the binary outcomes with the dependent variables (      Advances in Public Health 7 seen in Figure 7. Te compliance of the various study groups to COVID-19 prevention protocols was below 50%. To further explain the various predictors of the adjusted compliance, we subjected the data to multivariate binary logistic analysis (Table 6). Te analysis revealed that those without a history of traveling are 5 ± 0.68 (95% CI     To derive the fnal model, a multivariate binary logistic analysis of various predictors of "adjusted" compliance to COVID-19 prevention protocols was performed using only the statistically signifcant predictors from the primary model. A Wald test performed on the residuals from the secondary model also indicated that Age group (X 2 � 17.8, df � 4, p � 0.0013) and role (χ 2 � 15.4, df � 3, p � 0.0015) signifcantly contribute to the prediction of compliance (Table 7). Te secondary model was further trained for internal cross-validation using the K-fold validation (K � 10, n � 183). Te results showed that our secondary model (Log(C/1 − C) � 3.152 (undergraduate student) − 1.513 (travel history � yes) + 2.179 (age group 31-40) + 1.778 (Age group 41-50), where C � probability of being noncompliant to COVID-19 preventive protocols) predicts compliance with 73% accuracy (Table 8).

Discussion
With the biggest global health crisis of the 21 st century still ravaging the world, it is imperative to intensify research eforts across varied strata of the population. Our study was conceptualized from the need to assess what is on the ground around the two veterinary schools in Southeast Nigeria, centered on COVID-19 vaccination, perception, and compliance among the respondents. For most infectious diseases with a high magnitude of infection rate as well as mortality, mass vaccination is a key public health approach towards protection, prevention of spread, and control of such diseases [51]. Currently, the COVID-19 vaccine remains the most efective means to control this pandemic, and the goal should be that it be accepted by a good number of the population, comprising 70% of the world's population, for the pandemic to be combated [52]. Arising from the background of the dearth of information on COVID-19 vaccination status in veterinary schools in Nigeria, this study explored a close kit population of MOUAU and UNN. Te fndings will form a baseline study for the assessment of other veterinary schools in the diferent regions of Nigeria.
In this cross-sectional study, an overall low COVID-19 vaccine acceptability of 25% among the respondents was recorded, although diferent percentages when assessed according to age, gender, education status, role categories, and other demographic variables were observed. Comparing the fndings from this study with several types of research conducted within and outside Nigeria, there is a level of similarity with the outcome of this study. In a review conducted by [17], a 20.0%-58.2% acceptance rate was calculated among Nigerians, which invariably showed a COVID-19 vaccine hesitancy rate of 41.5%-80%. Consequently, in some surveys carried out in some African countries, low COVID-19 acceptance rates of 13.5%, 31.4%, and 39.3% were recorded in Egypt, Ethiopia, and Ghana, respectively. On the contrary, some African countries like Uganda, the Democratic Republic of Congo, and South Africa recorded appreciable acceptance rates of 53.6%, 55.9%, and 63.3%, indicating a low hesitancy rate [53]. In a larger population like India, COVID-19 vaccine hesitancy provides a cause of worry. A nationwide survey that indicated myriads of reasons for nonacceptance of the vaccine [25] attributed concerns about the vaccine to safety and side efects, efectiveness, and the rapidness of COVID-19 vaccine development as major reasons why Indians were reluctant to be vaccinated. Females tend to be less disposed to accepting COVID-19 vaccination in the majority of studies, including this particular survey [17,25]. Te reasons are speculations that their fertility will be afected, causing them to be sterile or genetically afecting their children after birth [54]. Tese are all part of unfounded conspiracy theories without scientifc backing, which have bedeviled vaccination programmes for long [55,56]. Among other factors, the hesitation of the Nigerian populace to accept the vaccination against COVID-19 may be largely due to misconceptions about the efects of the vaccine on social media [23] (Salem 2021).
Te result from this study supports previous fndings on gender, where higher male respondents were vaccinated against COVID-19 than female respondents [25,57]. Even when booster dose acceptability was assessed in India, 71% of the female population (n = 462) were unwilling to take the COVID-19 booster dose [58]. Out of the seven approved COVID-19 vaccine types in Nigeria, Moderna/Spikevax and Oxford/AstraZeneca/Vaxzervria remained the most used by respondents in this study which might be an of-shoot of more availability of these particular vaccines in Nigeria [59]. Another striking fnding among the respondents in the veterinary colleges in Southeast Nigeria was that the older the age group, the higher the percentage number of vaccinated individuals. Several researchers have reported similar fndings [27,60,61]; however, on the contrary, El-Elimat et al. [62] reported that in Jordan, age groups >35 years were found to be less likely to accept COVID-19 vaccines. Also, in the survey conducted by [25], the younger population showed more willingness to be vaccinated. No factor could be attributed to these variations in the age variable concerning vaccine acceptance. With an increase in COVID-19 vaccine acceptability, ranging from students to academic staf, one could deduce that maturity and enlightenment are integral to the refusal in accepting misinformation, disbelief, and fear of the unknown, which are some of the factors mitigating vaccine acceptance [52,63]. Furthermore, most academic staf have reasons to travel for conferences, seminars/workshops, or further study, hence the need to get vaccinated. Another factor for consideration in the demography of the respondents is the travel history, which revealed from this study that individuals who travel more often were more likely to be vaccinated. Ban on travel for unvaccinated people became a top priority strategy to curb the spread of COVID-19 worldwide. Tis prompted people who travel for diferent purposes to quickly accept to be vaccinated [64][65][66]. International travel has been identifed as a key factor in the spread of COVID-19, for instance, in less than two months after the frst case of COVID-19 was reported in mainland China, international fights brought COVID-19 cases to 26 countries [67]. Terefore, many efforts were channelled to border control measures to prevent the further spread of COVID-19. One such measure is ensuring that individuals are fully vaccinated before leaving their home country and are screened upon arrival in the next country. It was not surprising to identify that about 50% of the individuals who had received the COVID-19 vaccines had a history of traveling either more than 10 times outside of the base or have embarked on international travel. Individuals with no travel history (p � 0.008) were signifcant negative predictors of the adjusted compliance to COVID-19 prevention protocol in this study.
Interestingly, assessment on perception and compliance in the context of this study elucidated good outcome, indicatting that about 80% of the respondents demonstrated good perception. It was identifed that respondents within the age group of 31−40 years were 10.2 times less likely to be compliant with the COVID-19 prevention protocols. Tis may probably explain why this age group has been identifed as the most vulnerable age group by the Nigerian Centre for Disease Control [68]. In addition, individuals who have not travelled abroad in the past 24 months were 5 times less likely to be compliant with the COVID-19 protocols than those who have. Tis fnding depicts that the regulations governing international travel, force individuals to be compliant with the COVID-19 prevention protocols.
Although recommended protective strategies against COVID-19 include the use of face masks, physical distancing, restrictions on social gatherings, and constant hand washing, were efective to an extent; more innovative interventions such as vaccination should be emphasized on [29,30]. Several studies have outlined the factors that facilitate the willingness of individuals to get vaccinated with the COVID-19 vaccines. Tese factors include but are not limited to age, sex, educational status, gender, income, residency, occupation, marital status, race/ethnicity, perceived risk of COVID-19, trust in the health system, health insurance, norm, attitude towards vaccine, perceived benefts, perceived severity of COVID-19, perceived efectiveness of COVID-19 vaccine, beliefs, and online conspiracies [53,69,70].
In this study, we identifed that above 70% of the respondents had a good perception of the established COVID-19 prevention measures, which include the use of face mask, hand washing/use of hand sanitizer, keeping social distance, self-isolation, and COVID-19 vaccination. Consistent with our fndings, studies in Ethiopia and Nigeria, revealed that high perception rate among respondents towards COVID-19 vaccines are associated with willingness to receive the vaccine and comply with the COVID-19 prevention protocols [71,72]. Conversely, it was observed that though the respondents in this study had a good perception of COVID-19, they exhibited a poor compliance attitude. Tis may not be unrelated to the myths associated with the conspiracy theories propagated on the Internet [69].
Generally, the result of vaccine acceptance of 25% recorded in this survey was below the national average of 50% vaccination coverage reported by the Nigerian Honourable Minister of Health in March 2021 [70]. Our fnding was also below the 29% of individuals vaccinated against COVID-19 reported by Njoga et al. [72]. Terefore, more insight has been created as a result of this study, and it is advocated that support and encouragement should be given for widespread surveys of this nature to bring to limelight the actual situation on the ground, especially in the hinterlands where electronic/internet-based surveys are limited. It is imperative to note that creating better awareness and increasing COVID-19 vaccination coverage will play a major role in mitigating the efects of other variants (Omicron and Delta strains) and slowing down the mutation process that may herald the emergence of virulent future strains [73].  Advances in Public Health 11

Conclusion
In summary, our study showed that only 25.1% of the respondents from the veterinary colleges in Southeast Nigeria had been vaccinated with the COVID-19 vaccine. We also established that the most vulnerable age group (31-40 years), as identifed by the NCDC, had 10 times the odds of noncompliance with the COVID-19 prevention protocols. Although the perception of the COVID-19 prevention protocol was good, compliance with the protocol was poor among the respondents. Hence, there is a need to employ a holistic measure through community networks to create awareness and channels for dialogue on COVID-19 prevention measures among faculty members in veterinary colleges in southeast Nigeria.

Data Availability
Te data used to support the fndings of this study are included within the article. More detailed data used to support the fndings of this study are available through the given link: https://forms.gle/a1kKt9X7j2dBYPk2A.

Ethical Approval
Ethical approval for the conduct of this study was sought on January, 2022. After fulflling all the necessary conditions, the approval was granted in March 2022 (Ref No: VPH/ REC/201/021).