Skip to main content
  • Research article
  • Open access
  • Published:

An assessment of healthcare professionals’ knowledge about and attitude towards influenza vaccination in Freetown Sierra Leone: a cross-sectional study



Vaccinating healthcare professionals against influenza is considered an effective infection control measure. However, there is a low uptake of influenza vaccine among healthcare professionals around the globe. Currently, it is unknown whether healthcare professionals in Sierra Leone are aware of, and have been vaccinated against influenza. Also, there is a paucity of research evidence on their level of knowledge and attitude toward influenza vaccination. This study assessed healthcare professionals’ current influenza vaccine uptake rate, reasons for not getting vaccinated as well as their awareness, knowledge of, and attitude towards influenza vaccination in Freetown Sierra Leone.


A cross-sectional study was conducted between February and April 2016 among healthcare providers working in four public and two private health facilities in Freetown Sierra Leone. Linear regression analysis, one-way ANOVA and independent t-test were employed for data analysis.


Among 706 respondents that participated in the study more than half were females 378 (53.6%), nurses 425 (60.4%), and the majority were between the age group of 20-39 years 600 (85.3%). Only 46 (6.5%) were vaccinated against influenza. Key reasons for not vaccinated against influenza were less awareness about influenza vaccination among HCPs 580 (82.73%) with (β = 0.154; CI 0.058–0.163), the high cost of influenza vaccines and therefore not normally purchased 392 (55.92%) having (β = 0.150; CI 0.063–0.186). More than half believed that HCPs are less susceptible to influenza infections than other people. Also, majority 585 (84.3%) of HCPs thought that influenza disease could be transmitted after symptoms appear. In addition, 579 (83.2%) of HCPs felt that symptoms usually appear 8–10 days after exposure. Close to half 321 (46.0%) of HCPs were not aware of the influenza immunisation guidelines published by the Advisory Committee on Immunization Practices and Centre for Disease Control.


Influenza vaccine coverage among healthcare professionals in Freetown Sierra Leone was low. High cost, inadequate knowledge about influenza and its vaccine as well as the lack of awareness of vaccine availability were key barriers. Increasing access to influenza vaccine and the use of appropriate educational interventions to increase knowledge and awareness are required to improve influenza vaccination coverage among HCPs.

Peer Review reports


As a cause of high morbidity and mortality especially among vulnerable groups, influenza is recognised as a public health threat [1]. Vaccination against this disease is considered an effective infection control strategy [2]. For instance, influenza vaccines are known to be 60% protective among healthy people and decrease illness duration and severity in symptomatic individuals [3]. Because of their working environment, healthcare professionals (HCPs) are known to be at risk of contracting influenza virus from their patients and at the same time, act as a source of transmission to patients under their care. Such nosocomial transmission has the potential to trigger an epidemic within the hospital setting [4, 5]. The risk of transmission increases when HCPs continue to work after fallen sick [5]. Therefore, influenza vaccination does not only protect HCPs and thus contribute to maximizing their productivity [6], it also prevents patients from becoming sicker by providing additional protection by herd immunity [7,8,9]. In recognition of this fact, health institutions such as the World Health Organisation and the Advisory Committee on Immunization Practices (ACIP) recommend that HCPs should be vaccinated [10, 11]. Rigorous immunisation campaigns targeting vulnerable groups like HCPs have been conducted to prevent influenza-related illness and deaths in the healthcare setting [4, 12]. Despite such public health interventions, influenza vaccination coverage among HCPs around the world continues to be low [13,14,15,16,17,18,19]. Reasons for the low uptake of influenza vaccine among HCPs are the unavailability of the vaccine, misconception of vaccine safety and effectiveness and inadequate knowledge about the disease [16, 17, 20,21,22,23]. A clear insight of the limiting factors responsible for low vaccination coverage will contribute to developing workable interventions that will help increase influenza vaccine acceptance and uptake among HCPs.

In Sierra Leone, acute respiratory infections are one of the leading causes of morbidity and mortality [24]. The paucity of epidemiological data, especially on influenza has been a huge challenge to fully understand its public health impact. Notwithstanding, in 2011, the World Health Organization funded the Strengthening Influenza Sentinel Surveillance in Africa (SISA) project established a national influenza sentinel surveillance system integrated within the existing national integrated disease surveillance and response (IDSR) system [25]. Between the months of August and December 2011, 12.9% and 6.7% of all consultations in the sentinel sites accounted for influenza-like illness and severe respiratory infections respectively. Of the 473 samples collected, 12.7% tested positive for influenza virus with 55 (91.7%) were of the (H3N2) subtype and 6.7% had H1N1 subtype A [25]. Currently, influenza vaccination is not part of the national routine immunization program, and hitherto, there is no guideline on influenza vaccination for HCPs in Sierra Leone [26]. Also, there is the absence of research evidence that specifically looks at HCPs’ attitude and knowledge towards influenza vaccination. Therefore, this study was conducted to assess HCPs’ current influenza vaccine uptake rate, reasons for not getting vaccinated as well as their awareness, knowledge of, and attitude about influenza vaccination in Freetown Sierra Leone.


Study design

A cross-sectional study was carried out among the HCPs practising at public and private hospitals in Freetown between February and April 2016.

Study location

The study was conducted in Freetown, the capital city of Sierra Leone located along the West coast of Africa. We collected data for this study from HCPs in four public hospitals (Connaught teaching hospital, Princess Christian maternity hospital, Ola During paediatric hospital and 34 military hospitals) and two private hospitals (Chiothrams Memorial Hospital and Davidson Nicol Medical Centre). These health facilities were chosen to get a representative sample of all HCPs working in Freetown.

Ethical approval

Ethical approval was obtained from the research and ethics committee of the College of medicine and health sciences, University of Sierra Leone.

Sampling method

A convenience sampling method was adopted in which all HCPs working at these hospitals were invited to participate in the study. Five trained researchers were responsible for administering the questionnaires. The completed questionnaires were collected from the participants on the same day. Participation in the study was voluntary. Verbal consent was obtained from all participants after the rationale of the study was explained. We solicited verbal consent because the study did not pose any risk to participants. The research and ethics committee of the College of Medicine and Allied Health sciences, University of Sierra Leone approved such method of seeking consent to participate in the study.

Questionnaire items

A previously validated survey tool (Cronbach’s alpha = 0.87) that addressed the same research question [16] was used (Additional file 1). The questionnaire comprised of 31-items. It comprised of questions that looked at respondent’s demographics and their vaccination status with regards influenza or any other diseases. It also questions that inquire about the reasons for not vaccinating against influenza using a five - point Likert scale. In addition, the questionnaire assessed the knowledge about influenza and influenza vaccines using a nominal scale (correct and incorrect) to measure responses.

Statistical analysis

We coded all data from all completed questionnaires into nominal and ordinal variables. We used SPSS® version 22 for data analysis. Frequency and percentages were used to represent categorical variables. Linear logistic regression was employed to identify significant factors limiting influenza vaccination uptake (Q9-Q16) and those affecting knowledge and awareness (Q17-Q19) using profession as the covariate. Gender, years of experience and age were not included in this analysis due to wide confidence interval ranges. For question items (Q21-Q31), correct and incorrect responses for each statement was scored 1 and 0 respectively. Using summation of knowledge score as the dependent variable, and gender, profession and job experience as independent variables, one-way ANOVA test and independent sample t-test were used to determine contributing factors affecting the knowledge. A p-value less than 0.05 was considered statistically significant.


Among the health professionals (N = 706) approached for this survey, most were nurses N = 425 (60.4%), followed by Pharmacy Technicians 103 (14.6%) and physicians 46 (6.5%). More than half were females N = 378 (53.6%), between the age group 20-39 years 600 (85.3%). Close to half of HCPs, 349 (49.6%) had worked for 3–5 years. Only 108 (15.4%) of HCP’s were vaccinated in past 6–12 months for other diseases. Only 46 (6.5%) were vaccinated for influenza. Details are shown in Table 1.

Table 1 Demographics of respondents (N = 706)

Table 2 presents HCPs’ reasons for not being vaccinated against influenza using linear logistic regression. Linear logistic regression was applied with HCPs’ responses to the statements in Tables 2 and 5 taken as the dependent variables and profession taken as the independent variable. Beta coefficient (β) was used to compare the strength of the effect of dependent variables (reasons for not vaccinating against influenza) among the various cadres of HCPs (independent variable). The higher the β value, the stronger the relation. Physicians were set as a reference to compare the reasons for not vaccinating against influenza among health care professionals. Compared to physicians, other HCPs were 15% more likely not to get immunized against influenza due to the high cost of flu vaccine (β = 0.150; CI 0.063–0.186; p < 0.05) and their unfamiliarity with influenza vaccination (β = 0.154; CI 0.058–0.163; p < 0.05). Although statistically insignificant, insufficient staff to administer vaccine lack of proper storage area for influenza vaccines and concerns about vaccine safety were others barriers to influenza vaccine uptake among health care professional’s (details are shown in Table 2).

Table 2 Reasons for not vaccinating against influenza using profession as the independent variable

Addressing the knowledge of HCPs regarding influenza and its vaccine, 364 (51.6%) responded that HCPs are less susceptible to influenza infections than other people. Also, 585 (84.3%) HCPs believed that influenza could be transmitted after their symptoms appear. Also, 526 (75.6%) thought that the flu shot contains live viruses that may cause some people to get influenza. The majority of 454 (65.3%) believe that influenza is transmitted primarily by contact with blood and body fluids. Further, 579 (83.2%) of HCPs thought influenza disease has 8–10 days incubation period. See Table 3 for details.

Table 3 Knowledge about influenza and the influenza vaccine

To investigate the HCP’s knowledge about Influenza vaccination, correct responses were scored. Physicians had a better knowledge and understanding of influenza vaccine (5.8 ± 1.51), followed by nurses (5.7 ± 1.34), pharmacist (5.7 ± 1.65). However, HCPs with 6–10 years of job experience have better knowledge (6.1 ± 1.25) as compared to others. Also, females had a better understanding (5.7 ± 1.14) as compared to male HCPs. A detailed comparison of profession, experience and gender with knowledge score is shown in Table 4.

Table 4 HCP score for Knowledge about Influenza vaccination

To further investigate differences in knowledge about influenza vaccine among HCPs we used linear logistic regression model (Q17-Q19) against the profession. Overall, other professions have less knowledge about influenza vaccination as compared to the physicians. Compared to physicians, other cadres were less aware of the guidelines published by the Advisory Committee on Immunisation Practices (ACIP) or Centre for Disease Control (CDC) for influenza immunisation β = 0.154 [0.038–0.107]. Details are presented in Table 5. On how often influenza vaccine should be administered, an equal number of HCPs thought that influenza vaccine is to be administered every year and for every six months respectively (see Fig. 1).

Table 5 Knowledge about influenza vaccination against profession
Fig. 1
figure 1

Responses on how often Flu vaccine should be administered?


To our knowledge, this is the first ever type of study in Sierra Leone and perhaps in Africa that looks at influenza vaccination status among healthcare workers as well as their knowledge and perception regarding influenza disease and vaccination. As influenza is recognised as a public health challenge, health care providers are considered as vulnerable groups and vectors of transmission. Influenza immunization in the healthcare setting has been shown to be beneficial in reducing patient and health provider morbidity and mortality and as well as productivity [7, 27, 28].

Analysis of our data revealed a low influenza vaccine uptake by HCP (6.5%). Our result is generally in line with other studies done elsewhere although much lower [18,19,20,21, 23, 29,30,31] but slightly higher than the result reported by Khan et al. [16] and Bali et al. [22]. The high cost of the vaccine, lack of awareness among HCP about of influenza vaccine and concerns about influenza vaccine safety were the key reasons for low flu vaccine rate put forward by respondents in this study. Similar reasons were reported elsewhere [20,21,22]. The reasons mentioned above are in contrast to the results reported in studies conducted in Pakistan [16], Qatar [15] and Saudi Arabia [17] in which fear of needle and fear of contracting the illness and misconception of not being at risk were the key reasons put forward by participants respectively. Fear of side effects of the vaccine, its ineffectiveness to prevent the disease, and lack of time are other reasons that have been reported in other studies [17, 20, 31, 32]. Although the lack of knowledge and scepticism about influenza vaccine safety and efficacy are reasons for low vaccine uptake shared by participants in our study and those conducted elsewhere, our own was also based on inaccessibility due to the high cost of the vaccine. A study in Kenya reported a discordance between willingness to be vaccinated and acceptance levels of HCPs towards the vaccine [33]. Further studies should investigate whether HCP’s willingness to be immunised is translated into higher vaccine uptake. However, considering HCP are in short supply in Sierra Leone [34], the need to safeguard and maximize their health and productivity is of importance in ensuring the health of its citizenry is improved. Programs that increase influenza vaccine accessibility and affordability, as well as educational interventions to improve HCPs’ awareness about influenza vaccination in Sierra Leonean hospitals, need to be considered.

As it has been reported in the literature [17, 20, 22, 35], our study has demonstrated knowledge gap among HCPs about influenza and its vaccine. Although high cost and low level of awareness were cited as key reasons for low vaccine uptake, awareness of the disease and the misconception of the vaccine might be a contributing factor. In our study, more than half of HCPs believed that they were less susceptible to influenza virus than non-HCP. Also, most of them were also of the notion that influenza can be only be transmitted by symptomatic patients. These results are similar to a study conducted in Pakistan [16] but in shape contrast to what was reported in Saudi Arabia [21]. Respondents in our study also believed that influenza vaccine could cause influenza- a notion shared by other HCPs in other countries [16, 21, 22, 35]. Also, most (84.3%) of HCP in our study believed that only symptomatic individuals could transmit the disease mirroring finding from a Turkish study [32] but contrasted with results from Saudi Arabia and Pakistan [16, 21]. According to the CDC, the symptoms of influenza usually appear 1—4 days (average: 2 days) [36]. However, most participants (83.2%) in our study lack knowledge about the incubation period of the virus which is inconsistent with findings from Pakistan [16] and Saudi Arabia [21]. The deficit in knowledge in our study was also observed as the majority of HCPs did not know how often influenza vaccine should be administered which is inconsistent with a result of a similar study authored by Alshammari et al. [21]. With such knowledge deficit and low awareness, education interventions such training of HCPs through continuous professional development with help reduce the gap in knowledge and increase influenza vaccine acceptance and uptake.

Inferential statistics indicate that only years of experience was significantly associated with knowledge about influenza and vaccine when knowledge items were summed. HCPs with 6–10 years of experience were more knowledgeable than those with 1–2 years experience based on the scored eleven knowledge questions items. This result contrasts with the study conducted by Kahn et al. in which HCP with 1-2 years experience were more knowledgeable compared to those with more than two years experience. The same study also reported that nurses and physiotherapist were more knowledgeable than the other cadres of health professionals [16]. The fact that HCPs with less working experience in our study exhibited a deficiency in knowledge might be due to the possibility that modules on influenza were not properly taught in college or this cohort of HCPs have had less encounter with patients with or exposure to influenza and influenza-related symptoms. Also, it might be linked to the perception that the disease is self-limiting, and being young offers immunity. Less awareness of the influenza vaccine might affect HCPs’ uptake even if the vaccine is made available. Previous research has reported a positive link between increased knowledge of influenza and its vaccine and higher vaccine uptake among HCPs [17]. It is imperative that the need for increased education about influenza and its vaccine through training be intensified during pre- graduation and immediately after post-graduation. Our study also reported no significant difference in knowledge among the different groups of health care workers – a result that is not consistent with a similar study conducted in Pakistan in which nurses were more knowledgeable than physicians [16]. The difference observed may be linked to variations in study methodology and sample size. Ours was a multi-site study with a larger sample size as compared to that in Pakistan which was quite the opposite. With regards to gender, our study resonates with what was observed in Pakistan [16]. Also, HCPs further demonstrated a lack of knowledge and awareness of influenza vaccination in that more than half of the HCPs surveyed were not aware or were not too sure of CDC’s recommendation for mandatory influenza vaccination among all healthcare providers. We observed similar response with regards to their awareness of the joint CDC and ACIP guidelines on influenza vaccination. Previous research has reported similar observation [21]. It is essential that appropriate education strategies are developed to increase knowledge and awareness among HCPs in Freetown Sierra Leone.

Limitations and strength

A key limitation of this study is that our findings cannot be generalised for the whole country as we surveyed only healthcare professionals in Freetown. Future studies should incorporate a nationwide sample to get a representative view of HCP country wide regarding influenza vaccination. Also, the sampling method used reduces the possibility every HCP to have an equal chance of being selected. However, this sampling method was chosen to target key respondents that can provide meaningful information required to sufficiently test the study hypothesis. Notwithstanding these limitations, a key strength of our study was that we used a large sample size and HCPs were targeted both from both public and private health facilities.


Influenza vaccine uptake among HCPs in Freetown Sierra Leone is very low. High cost, inadequate knowledge about influenza and its vaccine as well as the lack of awareness of vaccine availability were key reasons for the low coverage. Increasing access to influenza vaccine and the use appropriate educational interventions to increase knowledge and awareness are required to improve influenza vaccination coverage among HCP.



Healthcare professionals


Integrated Disease Surveillance and Response


Sentinel Surveillance in Africa


  1. WHO. WHO Public Health Research Agenda for Influenza Biannual Progress Review and Report 2010–2011 Geneva. 2013. Available at Accessed 15 Mar 2017.

  2. Fiore AE, Uyeki TM, Broder K, Finelli L, Euler GL, Singleton JA, Iskander JK, Wortley PM, Shay DK, Bresee JS: Prevention and control of influenza with vaccines: recommendations of the advisory committee on immunization practices (ACIP), 2010: Department of Health and Human Services, Centers for Disease Control and Prevention; 2010.

    Google Scholar 

  3. Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(1):36–44.

    Article  PubMed  Google Scholar 

  4. Salgado CD, Farr BM, Hall KK, Hayden FG. Influenza in the acute hospital setting. Lancet Infect Dis. 2002;2(3):145–55.

    Article  PubMed  Google Scholar 

  5. Stott DJ, Kerr G, Carman WF. Nosocomial transmission of influenza. Occup Med. 2002;52(5):249–53.

    Article  CAS  Google Scholar 

  6. Van Buynder PG, Konrad S, Kersteins F, Preston E, Brown PD, Keen D, Murray NJ. Healthcare worker influenza immunization vaccinate or mask policy: strategies for cost effective implementation and subsequent reductions in staff absenteeism due to illness. Vaccine. 2015;33(13):1625–8.

    Article  PubMed  Google Scholar 

  7. Bénet T, Régis C, Voirin N, Robert O, Lina B, Cronenberger S, Comte B, Coppéré B, Vanhems P. Influenza vaccination of healthcare workers in acute-care hospitals: a case-control study of its effect on hospital-acquired influenza among patients. BMC Infect Dis. 2012;12(1):30.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Poland GA, Tosh P, Jacobson RM. Requiring influenza vaccination for health care workers: seven truths we must accept. Vaccine. 2005;23(17):2251–5.

    Article  PubMed  Google Scholar 

  9. Backer H. Counterpoint: in favor of mandatory influenza vaccine for all health care workers. Clin Infect Dis. 2006;42(8):1144–7.

    Article  PubMed  Google Scholar 

  10. WHO. Global Influenza Programme Pandemic influenza preparedness and response: a WHO guidance document: Geneva World Health Organization. 2009. Available at Accessed 18 Mar 2017.

  11. Pearson ML, Bridges CB, Harper SA. Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control. 2006;55(RR-2):1–16.

  12. Song JY, Park CW, Jeong HW, Cheong HJ, Kim WJ, Kim SR. Effect of a hospital campaign for influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol. 2006;27(6):612–7.

    Article  PubMed  Google Scholar 

  13. Lam P-P, Chambers LW, MacDougall DMP, McCarthy AE. Seasonal influenza vaccination campaigns for health care personnel: systematic review. Can Med Assoc J. 2010;182(12):E542–8.

    Article  Google Scholar 

  14. Maltezou HC. Nosocomial influenza: new concepts and practice. Curr Opin Infect Dis. 2008;21(4):337–43.

    Article  PubMed  Google Scholar 

  15. Alhammadi A, Khalifa M, Abdulrahman H, Almuslemani E, Alhothi A, Janahi M. Attitudes and perceptions among the pediatric health care providers toward influenza vaccination in Qatar: a cross-sectional study. Vaccine. 2015;33(32):3821–8.

    Article  PubMed  Google Scholar 

  16. Khan TM, Khan AU, Ali I, Wu DB-C. Knowledge, attitude and awareness among healthcare professionals about influenza vaccination in Peshawar, Pakistan. Vaccine. 2016;34(11):1393–8.

    Article  PubMed  Google Scholar 

  17. Rehmani R, Memon JI. Knowledge, attitudes and beliefs regarding influenza vaccination among healthcare workers in a Saudi hospital. Vaccine. 2010;28(26):4283–7.

    Article  PubMed  Google Scholar 

  18. Alicino C, Iudici R, Barberis I, Paganino C, Cacciani R, Zacconi M, Battistini A, Bellina D, Di Bella AM, Talamini A, et al. Influenza vaccination among healthcare workers in Italy: the experience of a large tertiary acute-care teaching hospital. Hum Vaccin Immunother. 2015;11(1):95–100.

    Article  PubMed  Google Scholar 

  19. Durando P, Alicino C, Dini G, Barberis I, Bagnasco AM, Iudici R, Zanini M, Martini M, Toletone A, Paganino C, et al. Determinants of adherence to seasonal influenza vaccination among healthcare workers from an Italian region: results from a cross-sectional study. BMJ Open. 2016;6(5):e010779.

  20. Abu-Gharbieh E, Fahmy S, Rasool BA, Khan S. Influenza vaccination: healthcare workers attitude in three Middle East countries. Int J Med Sci. 2010;7(5):319–25.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Alshammari TM, AlFehaid LS, AlFraih JK, Aljadhey HS. Health care professionals’ awareness of, knowledge about and attitude to influenza vaccination. Vaccine. 2014;32(45):5957–61.

    Article  PubMed  Google Scholar 

  22. Bali NK, Ashraf M, Ahmad F, Khan UH, Widdowson MA, Lal RB, Koul PA. Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India. Influenza Other Respir Viruses. 2013;7(4):540–5.

    Article  PubMed  Google Scholar 

  23. Kadi Z, Atif M-L, Brenet A, Izoard S, Astagneau P. Barriers of influenza vaccination in health care personnel in France. Am J Infect Control. 2016;44(3):361–2.

    Article  PubMed  Google Scholar 

  24. WHO-AFRO. Sierra Leone Health Analytical Summary Status and Trends. 2014. Available at: Accessed 9 Jan 2017.

  25. Kebede S, Conteh IN, Steffen CA, Vandemaele K, Wurie I, Alemu W, Kuti-George F, Dafae F, Jambai A, Yahaya AA, et al. Establishing a national influenza sentinel surveillance system in a limited resource setting, experience of Sierra Leone. Health Res Policy Syst. 2013;11(1):22.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ministry of Health and Sanitation. Basic Package of Essential Health Services for Sierra Leone. In., 20 May 2017 edn; 2010.

  27. Saxen H, Virtanen M. Randomized, placebo-controlled double blind study on the efficacy of influenza immunization on absenteeism of health care workers. Pediatr Infect Dis J. 1999;18(9):779–83.

    Article  CAS  PubMed  Google Scholar 

  28. Benowitz I, Esposito DB, Gracey KD, Shapiro ED, Vázquez M. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clin Infect Dis. 2010;51(12):1355–61.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Abramson ZH, Levi O. Influenza vaccination among primary healthcare workers. Vaccine. 2008;26(20):2482–9.

    Article  PubMed  Google Scholar 

  30. Loulergue P, Moulin F, Vidal-Trecan G, Absi Z, Demontpion C, Menager C, Gorodetsky M, Gendrel D, Guillevin L, Launay O. Knowledge, attitudes and vaccination coverage of healthcare workers regarding occupational vaccinations. Vaccine. 2009;27(31):4240–3.

    Article  CAS  PubMed  Google Scholar 

  31. Torun SD, Torun F. Vaccination against pandemic influenza a/H1N1 among healthcare workers and reasons for refusing vaccination in Istanbul in last pandemic alert phase. Vaccine. 2010;28(35):5703–10.

    Article  PubMed  Google Scholar 

  32. Khazaeipour Z, Ranjbarnovin N, Hoseini N. Influenza immunization rates, knowledge, attitudes and practices of health care workers in Iran. J Infect Dev Ctries. 2010;4(10):636–44.

    Article  PubMed  Google Scholar 

  33. Oria PA, Matini W, Nelligan I, Emukule G, Scherzer M, Oyier B, Ochieng HN, Hooper L, Kanyuga A, Muthoka P, et al. Are Kenyan healthcare workers willing to receive the pandemic influenza vaccine? Results from a cross-sectional survey of healthcare workers in Kenya about knowledge, attitudes and practices concerning infection with and vaccination against 2009 pandemic influenza a (H1N1), 2010. Vaccine. 2011;29(19):3617–22.

    Article  PubMed  Google Scholar 

  34. Government of Sierra Leone. Human resources for health policy in Sierra Leone. 2006. Avaliable at: Accessed 16 Mar 2017.

  35. Wicker S, Rabenau HF. Vaccination rates of healthcare workers vary according to their occupational group. Procedia in Vaccinology. 2011;4:14–8.

    Article  Google Scholar 

  36. CDC. Influenza (Flu) Clinical Signs and Symptoms of Influenza. Avaliable at Accessed 3 Mar 2017. In.; 2016.

Download references


Authors would like to thank the management and staff of the hospitals involved in providing the enabling environment for data collection. We also want to extend our thanks and appreciation to all the trained data collectors.


This work was self-funded by the authors.

Availability of data and materials

The dataset supporting the conclusions of this article is included within the article and the Additional file 2: SPSS dataset.

Author information

Authors and Affiliations



PBJ was involved in study conceptualization and designing, data interpretation, wrote the draft manuscript and critically reviewed the manuscript. IUR contributed to the design and analysed the data and contributed in data interpretation as well as reviewed the manuscript. AJB, ML and CPC participated in designing the study, supervised data collection and critically reviewed the manuscript. TMK contributed to study conceptualization and designing and critically reviewed the manuscript. All authors read and approved the final version manuscript.

Corresponding author

Correspondence to Peter Bai James.

Ethics declarations

Ethics approval and consent to participate

Ethical approval was sort from the research and ethics committee of the College of Medicine and Allied Health Sciences, University of Sierra Leone. Participation in the study was voluntary. We solicited verbal consent because the study did not pose any risk to participants. The research and ethics committee of the College of Medicine and Allied Health Sciences, University of Sierra Leone approved such method of seeking consent to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional files

Additional file 1:

A cross sectional survey on health care professional’s awareness of knowledge about and attitude towards influenza vaccination in Freetown Sierra Leone. (DOCX 115 kb)

Additional file 2:

SPSS dataset. (SAV 851 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

James, P.B., Rehman, I.U., Bah, A.J. et al. An assessment of healthcare professionals’ knowledge about and attitude towards influenza vaccination in Freetown Sierra Leone: a cross-sectional study. BMC Public Health 17, 692 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: