Influenza Vaccination in UAE

This research report investigates the level of awareness and promotion of influenza vaccination among the population of the UAE. It examines the current state of influenza vaccination, identifying challenges hindering successful vaccination programs. The study explores public perception of influenza and vaccination, focusing on the risks associated with low vaccination rates, particularly among children. The research employs a descriptive design with a quantitative approach, utilizing a survey questionnaire administered to healthcare workers, pregnant women, school staff, and the general public. Key findings reveal low awareness, misconceptions, and the influence of lay beliefs and family support on vaccination uptake. Recommendations include providing free workplace vaccinations, strengthening educational programs for school staff, establishing a prevention culture, educating pregnant women, and implementing a robust tracking system for children's vaccinations. The report concludes that addressing these factors is crucial to improving influenza vaccination rates and public health in the UAE.

Running head: Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among
Population Of UAE
UNDERSTANDING THE LEVEL OF AWARENESS AND
PROMOTION OF INFLUENZA VACCINATION AMONG
POPULATION OF UAE
STUDENT NAME:
STUDENT ID:

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 2
Abstract
This research study provides an overview of the level of awareness among people of UAE
regarding the influenza vaccination. It also provides an overview about the various factors which
are affecting the process of vaccination. This research study helps the readers to gain knowledge
about the factors affecting vaccination against influenza and the ways in which it can be
mitigated. From the findings it has been observed that province of UAE in the Middle East
along with Kuwait and Oman are worst affected by influenza and the level of vaccination uptake
among its population is also less. Findings from this study indicate that, awareness of vaccination
uptake against influenza and the benefits associated with it have improved considerably.
However, this improvement rate is not enough to prevent the entire population from pandemic
influenza viruses. Several vaccination programs and initiatives have been taken by government
of UAE in order to promote vaccination process against influenza virus. Despite of such
attempts, a major portion of people are yet to avail vaccination against influenza. It has been
found that health workers, adults above 30 years of age and older people are at high risk of being
affected by impact of influenza viruses. Studies have also indicated that children are the best
carrier of influenza viruses and help in their spreading. Thus it was necessary for UAE
government to vaccinate the children as this will help in preventing spread of such
communicable disease to a considerable extent. Furthermore it has also been observed that
government authorities are not having proper data indicating number or percentage of
vaccination uptake by population of UAE. No records are present with government based on
which it can estimate the population that has been vaccinated. The availability of records helps
government in understanding and evaluating the perception and adaption of people against
vaccination of influenza. As per study, some of the prominent factors affecting the vaccination
uptake among people are low family support, social influence, lay beliefs and excess work
pressure. On the basis of findings it has been observed that a major part of UAE population that
is aware of the significance associated with vaccination process are unable to adopt vaccination
because they are too busy with their work and they are unable to make out time or schedule in
order to immunize themselves against influenza viruses. This enables researcher to recommend
ways in which rate of vaccination among UAE population can be enhanced.

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 3
Acknowledgement
Conducting this research has been one of my best experiences in my life. This research has
helped me to develop knowledge and various analytical skills. I would like to acknowledge with
gratitude and with my debt of thanks to all the people who have helped me to conduct this
research and make it a successful one. I would especially thanks to my supervisor without whom
I could not have conducted this research. His proper guidance and assistance has helped me
during this research study. Finally I would like to thanks the healthcare workers and medical
students, the pregnant woman, general public of UAE and also the school healthcare department
whose effective participation in survey has helped me to conduct this research study and gather
authentic information.
Yours Sincerely,

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 4
Table of Contents
Chapter 1: Introduction..................................................................................................................10
1.1. Background of the problem.................................................................................................10
1.2. Background of the study.....................................................................................................11
Chapter 2: Objectives of the study.................................................................................................14
2.1. Problem statement...............................................................................................................14
2.2. Objectives of the study........................................................................................................15
2.3. Hypothesis statement..........................................................................................................16
2.4. Research questions..............................................................................................................16
2.5. Limitations..........................................................................................................................16
Chapter 3 Literature review...........................................................................................................18
3.1. Chapter introduction...........................................................................................................18
3.2 Significance of Influenza Vaccination.................................................................................18
3.3 Present Scenario of vaccination uptake in UAE..................................................................21
3.4 The burden associated with seasonal influenza...................................................................24
3.5 Lay beliefs based on influenza vaccination process and immunisation of influenza virus. 24
3.6 Influenza as a concern..........................................................................................................27
3.7 Need for vaccination uptake in UAE...................................................................................28
3.8 Factors hindering vaccination process against influenza.....................................................30
3.9 Risk among children for low vaccination uptake.................................................................32
3.10 Existing literature...............................................................................................................33
3.11 Gap analysis.......................................................................................................................35
3. 12 Summary...........................................................................................................................35
Chapter 4: Collection of primary data...........................................................................................37

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 5
4.1. Methodology.......................................................................................................................37
4.2. Research design...................................................................................................................37
4.2. a. Type of research..........................................................................................................40
4.2. b. Design of the research instrument...............................................................................40
4.2. c. Sample selection..........................................................................................................41
4.3. Research execution.............................................................................................................42
4.4. Analysis of data...................................................................................................................43
4.4. a. Profile of respondents (if survey)................................................................................43
4.4. b. Analysis of responses..................................................................................................43
Chapter 5 Analysis and conclusion................................................................................................45
5.1. Hypothesis testing...............................................................................................................45
5.2. Intermediate conclusion(s)..................................................................................................72
Chapter 6: Conclusions and recommendations..............................................................................79
6.1. Summary of findings...........................................................................................................79
6.2. Overall conclusion..............................................................................................................80
6.3. Recommendations...............................................................................................................82
6.4. Lessons learned...................................................................................................................89
6.5. Ethical implications.............................................................................................................91
Reference List................................................................................................................................92
Bibliography..................................................................................................................................99
Appendix......................................................................................................................................106

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 6
Table of figures
Figure 3.1: Pandemic influenza in Abu Dhabi, UAE....................................................................19
Figure 3.2: 50 Number of people is still unaware of the significance of influenza vaccination...22
Figure 3.3: Lower level of coverage in various age groups by vaccination programs in UAE.....23
Figure 3.4: Showing various factors over which vaccination uptake decision depends...............29
Figure 5.1: Number of respondent’s beliefs with influenza vaccination intake............................46
Figure 5.2: Number of respondent’s beliefs with effectiveness of influenza vaccination.............47
Figure 5.3: Number of Respondents working as a healthcare worker in vaccination field...........48
Figure 5.4: Number of respondent’s beliefs towards the necessity to uptake influenza vaccination
.......................................................................................................................................................49
Figure 5.5: Number of respondent’s beliefs towards negligence to uptake influenza vaccination
.......................................................................................................................................................50
Figure 5.6: Number of respondent’s beliefs toward prevention in influenza vaccination uptake
due to lay beliefs............................................................................................................................51
Figure 5.7: Number of respondent’s beliefs towards low support from family as a factor
hindering vaccination uptake.........................................................................................................52
Figure 5.8: Number of respondent’s beliefs towards social influence acting as a major role
affecting vaccination uptake..........................................................................................................53
Figure 5.9: Number of respondents towards the need of vaccination uptake in major parts of
UAE...............................................................................................................................................54
Figure 5.10: Number of respondent’s beliefs with effectiveness of influencing people through
governmental programs to uptake vaccination..............................................................................55
Figure 5.11: Number of respondent’s beliefs towards influenza vaccination important for
children..........................................................................................................................................56
Figure 5.12: Number of respondent’s beliefs towards children being the main carrier of influenza
virus...............................................................................................................................................57
Figure 5.13: Number of respondent’s beliefs with effectiveness in taking influenza vaccination
during pregnancy...........................................................................................................................59
Figure 5.14: Number of respondent’s beliefs towards influenza vaccination being neglected by
pregnant woman.............................................................................................................................60

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 7
Figure 5.15: Number of respondent’s beliefs towards lay beliefs is preventing pregnant woman to
uptake influenza vaccination.........................................................................................................61
Figure 5.16: Number of respondent’s beliefs towards low support from family as a factor
hindering vaccination uptake for pregnant woman.......................................................................62
Figure 5.17: Number of respondent’s beliefs towards social influence acting as a major role
affecting vaccination uptake for pregnant woman.........................................................................63
Figure 5.18: Number of respondent’s beliefs towards vaccination against influenza might affect
baby................................................................................................................................................64
Figure 5.19: Number of respondent’s beliefs towards influenza being a serious disease.............65
Figure 5.20: Number of respondent’s beliefs regarding influenza can be cured using traditional
measures........................................................................................................................................66
Figure 5.21: Number of respondent’s beliefs regarding effectiveness of vaccination to fight
influenza........................................................................................................................................67
Figure 5.22: Number of respondent’s beliefs regarding UAE getting affected in vaccination
uptake for misconception...............................................................................................................68
Figure 5.23: Number of respondent’s beliefs regarding effectiveness of vaccination programs
organized in schools......................................................................................................................69
Figure 5.24: Number of respondent’s beliefs regarding parents having positive perception about
vaccination against influenza in schools........................................................................................70
Figure 5.25: Number of respondent’s beliefs regarding parents not willing to send their children
for vaccination uptake in school....................................................................................................71
Figure 5.26: Number of respondent’s beliefs regarding lack of family support and misconception
preventing students from up taking influenza vaccination............................................................72

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 8
List of Tables
Table 5.1: Response towards influenza vaccination intake...........................................................45
Table 5.2: Response about effectiveness of influenza vaccination...............................................46
Table 5.3: Working period of healthcare workers.........................................................................47
Table 5.4: Response about necessity for healthcare workers to uptake influenza vaccination.....48
Table 5.5: Response about negligence to uptake influenza vaccination........................................49
Table 5.6: Response based on prevention in influenza vaccination uptake due to lay beliefs......50
Table 5.7: Response towards low support from family as a major factor hindering vaccination
uptake.............................................................................................................................................51
Table 5.8: Response towards social influence acting as a major role affecting vaccination uptake
.......................................................................................................................................................52
Table 5.9: Response towards vaccination uptake is still needed by major parts of UAE.............53
Table 5.10: Responses towards effectiveness of influencing people through governmental
programs to uptake vaccination.....................................................................................................54
Table 5.11: Response towards necessity of influenza vaccination for children............................56
Table 5.12: Response about children being the main carrier of influenza virus...........................57
Table 5.13: Response about effectiveness in taking influenza vaccination during pregnancy......58
Table 5.14: Response about influenza vaccination being neglected by pregnant woman.............59
Table 5.15: Response based on prevention in influenza vaccination uptake by pregnant woman
due to lay beliefs............................................................................................................................60
Table 5.16: Response towards low support from family as a major factor hindering vaccination
uptake for pregnant woman...........................................................................................................61
Table 5.17: Response towards social influence acting as a major role affecting vaccination
uptake for pregnant woman...........................................................................................................62
Table 5.18: Response based on vaccination against influenza might affect baby.........................63
Table 5.19: Response of people about influenza being a serious disease.....................................64
Table 5.20: Response based on influenza can be cured using traditional measures......................65
Table 5.21: Response based on effectiveness of vaccination to fight influenza............................66
Table 5.22: Response based on UAE getting affected in vaccination uptake for misconception. 67
Table 5.23: Response based on effectiveness of vaccination programs organized in schools......68

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 9
Table 5.24: Response based on parents having positive perception about vaccination against
influenza in schools.......................................................................................................................69
Table 5.25: Response based on parents not willing to send their children for vaccination uptake
in school.........................................................................................................................................70
Table 5.26: Response based on lack of family support and misconception preventing students
from up taking influenza vaccination............................................................................................71

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 10
Chapter 1: Introduction
1.1. Background of the problem
According to the findings of McCarthy et al. (2015), it has been observed that seasonal influenza
is considered to be a major cause of death across the world. As per study, it is routine
immunization of children which is capable of mitigating the problem influenza and reduces
deaths through direct and indirect protection. According to Pagliusi et al. (2016), influenza is
found to be a common disease which is affecting most of the countries across the world.
Provision of vaccination to children has been identified as an effective way to reduce impacts of
influenza. This so because it because prevention at lower is much more effective and children as
per findings are major contributors in transmission of such viruses. According to Worasathit et
al. (2015), several vaccination programs have been identified by government of various states to
mitigate influenza illness. However, a lot of effort needs to put in for making the initiative
successful. The reason for such saying involves presence of several barriers that are affecting
implementation of vaccination program that intends to develop immunization amongst children
against this disease which is acting as a major carrier for spread of such disease. Talking about
the United Arab Emirates, it can certainly be said that influenza vaccination process needs to be
identified on a larger scale in this region. On the basis of study it has been observed that
population of UAE are major sufferers of seasonal influenza. It has also been obtained from the
study that despite high influenza rate among people, uptake of influenza vaccination is
comparatively less. As per the findings, it is evident that several influenza viruses like H1N1 and
H9N2 prevalent in region of UAE and efforts are being given by government to find vaccine that
will help in mitigating the effect of such influenza virus. According to Ditsungnoen et al. (2016),
several vaccination policies and vaccination program have been identified by government of
UAE in order to make vaccination a necessary action for its population. However, various factors
are there which is affecting the proper implementation and vaccination uptake by population of
UAE. According to Leewongtrakul et al. (2017), it has been found that health care workers in
UAE are a part of its population that are yet to adopt vaccination uptake against influenza. It is
being found that health care workers are the ones which are more prone to be affected by

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 11
influenza virus. This is so because they need to deal with several patients and spread of virus is
most expected thing.
According to Owusu et al. (2015), example of Japan can be taken into consideration which used
vaccination initiative to immunize children against influenza and indirectly protect adults from
effect of this virus. As per findings, children were found to be major contributors in transmission
of influenza viruses (Onlamoon et al. 2013). In Japan children were given routine vaccination
against influenza in between year of 1962 and 1987. This was done in order to give a major fight
back to such viruses from spreading further. Reports suggest that this approach benefitted a large
section of population indirectly (Ditsungnoen et al. 2016). One of the major reasons for selecting
children to be vaccinated against vaccination deals with the fact that these vaccinations are more
effective in children of selected age group rather than being applied on high risk adults. As per
findings it has been observed that, adults above the age group of 30 and elderly people are more
prone to be affected by such viruses.
Major problem identified in this process involves lack of awareness among people about benefits
associated with use of vaccination. Another basic problem lingering in effective implementation
of vaccination programs deals with lay belief among population related to vaccination process
against influenza (Seesarn et al. 2015). There are various factors acting as a challenge and
hindering vaccination process against influenza in UAE. In this research all such barriers are
identified and its causes are studied in order to provide effective recommendations, application
of which will help in eliminating the existing problems.
1.2. Background of the study
This research study is based on understanding the level of awareness and promotion of influenza
vaccination among population of UAE. This topic have been selected for research study, the
reason involves influenza becoming a common disease in most part of the world and very few
attempt being taken by government developing and underdeveloped countries to mitigate such
health risks. According to the findings, developing as well as developed countries are major
target which has been adversely affected by influenza. Of the several developing countries UAE
is one such nation which is facing problem of influenza on wide scale. As per the findings it has
been observed that several measures have been taken by government of UAE in order to provide
complete vaccination against influenza virus to its entire population. However, it is the common

Understanding The Level Of Awareness And Promotion Of Influenza Vaccination Among Population Of UAE 12
belief among people and misconception about the vaccination process which is hindering its
uptake. According to Leewongtrakul et al. (2017), UAE is a major region of Middle East that has
suffered most from influenza virus. From the study it has been observed people especially health
care workers living in this region are still unaware of benefits associated with vaccination against
influenza. Moreover, health care workers despite of having knowledge about the consequence
are reluctant or less serious about vaccination process (Hickey et al. 2014). The alarming rise in
rate of population being affected by influenza and no measures taken to mitigate occurrence of
such outbreak have proposed selection of such topic for research study. Apart from this
Influenza is considered to be a serious problem related to global public health that accounts for
around 3 to 5 million cases of critical illness and around 300000 deaths approximately each year.
Findings also indicate that children below age group of 60 months are at a risk of being affected
by this virus most. On the basis of study it has been obtained that influenza vaccination facilities
are present in UAE since long time back. However, people are unable to understand the
significance of influenza vaccination process. It has been found that older people along with
health care workers are reluctant over taking influenza vaccine. However accessibility of these
vaccinations has been seen as a major concern. As per findings, vaccination against seasonal
influenza and other influenza viruses prevailing in UAE have been introduced by the
government. However, these vaccines are yet to reach in various medical care units. This can be
seen as a factor hindering the effectiveness of vaccination process in UAE. Apart from this it is
the lay belief of people and misconception of health care workers which are preventing them
from uptake of vaccination process against influenza (WHO, 2017). The older people and health
care workers are at high risk of getting affected by influenza virus thus, it is necessary for
government as well as population of UAE to think of ways and develop positive perception
respectively in order to fight against influenza virus.
On the basis of studies and data, it has been found that decision of people over receiving or non
receiving of influenza vaccination are still complex. This complexity in decision making process
is a result of various psychological and physical factors which are taking a toll in the effective
implementation of such process. Cases were witnessed were older people stated influenza to be
cause of death however; very few considered themselves to be at risk due to being affected by
chronic disease (Jennings et al. 2013). This chronic disease is capable of increasing
complication to death attributes on coming in contact with influenza virus. As a result of such