Public perception and health behaviours related to diphtheria risk in Northern Nigeria

Journal article

Background: Diphtheria, a vaccine-preventable disease, has re-emerged in Northern Nigeria with serious public health consequences. Understanding how awareness and risk perception shape health behaviours is critical for controlling outbreaks. This study assessed public awareness, risk perception, and associated socio-demographic factors among residents in selected high-burden states in northern Nigeria. Methods: A cross-sectional survey was conducted from December 2022 to December 2023 in ten northern states (Katsina, Kano, Jigawa, Zamfara, Kaduna, Bauchi, Borno, Yobe, Nasarawa, and the Federal Capital Territory). A multistage sampling technique selected respondents aged 18 years and above. Data were collected using a structured, interviewer-administered questionnaire adapted from the WHO Diphtheria Rapid Perception Survey Tool, translated into Hausa and back-translated. Descriptive and inferential statistics, including binary logistic regression, identified predictors of awareness and risk perception. Results: A total of 2,924 respondents participated (mean age: 34.6 ± 11.2 years; 58.2% female). Awareness of diphtheria was 63.4%, and 48.1% perceived the disease as highly dangerous. Radio was the predominant information source (62.9%). Higher education (aOR = 2.14, 95% CI: 1.56–2.92), prior knowledge of vaccination (aOR = 1.87, 95% CI: 1.29–2.70), and residence in urban areas (aOR = 1.66, 95% CI: 1.21–2.32) were significant predictors of awareness. Risk perception was higher among females (aOR = 1.42, 95% CI: 1.13–1.78), participants with formal education (aOR = 1.51, 95% CI: 1.20–1.92), and those citing radio as a major information source (aOR = 1.36, 95% CI: 1.03–1.80). Conclusion: Socio-demographic factors and information exposure significantly influence awareness and perception of diphtheria. Strengthened community engagement, social listening, behavioural intelligence, radio-based campaigns, and integration of diphtheria information into primary health education can enhance outbreak preparedness and vaccine uptake.

Authors: Erim, AA; Okafor, UG; Pam, MZ; Nzedibe, O; Eze, OP

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: Discover Public Health
• Volume: 23
• Issue: 1
• Article number: 543
• Publication date: 2026-04-17
• Acceptance date: 2026-03-13
• DOI: 10.1186/s12982-026-01759-8
• EISSN: 3005-0774
• ISSN: 3005-0774
• Language: English
• Keywords: Health belief model; Awareness; Diphtheria; Vaccine-preventable diseases; Risk perception; Northern Nigeria