ASSESSMENT OF THE LEVEL OF AWARENESS, KNOWLEDGE, AND RISK PERCEPTION OF COMMUNITY MEMBERS ABOUT MPOX INFECTION IN NIGERIA

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D. Bakare¹, J. Salako¹, A. Sogbesan¹, O.E Olojede¹,A.A Bakare²,

1. Department of Paediatrics, University of Ibadan, Ibadan, Nigeria.
2. Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
3. Department of Community Medicine, University College Hospital, Ibadan, Nigeria.

Abstract

Background: Since the resurgence of mpox disease in 2017, Nigeria alone has accounted for about 60% of confirmed cases reported in the African region. This study therefore aimed to understand the knowledge and perception of the general public towards the mpox infection.

Methods: We conducted a cross-sectional study among 958 community members across three states (Oyo, Lagos and Jigawa) in Nigeria. Knowledge of mpox infection was assessed across four domains: (1) general knowledge, (2) transmission, (3) signs and symptoms, and (4) prevention and treatment where we assigned a score of 1 for each correct response. Binary logistic regression was conducted to explore factors associated with knowledge of mpox infection at 5% level of significance. We assessed perception of mpox infection across 5 constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy) from the health belief model, using 3-point Likert scales. We used Kruskal-Wallis and Mann-WhitneyU tests to assess factors associated with each construct.

Results: Overall, only about one-third (38.3%) of community members were aware of mpox infection. There were variations in perceptions and knowledge across the three states. Knowledge of mpox infection transmission, prevention, and treatment was low across the states. Only 28.9% of respondents knew that sharing utensils with an infected person is a means of contracting the disease, and just 15.9% were aware that mpox infection may resolve spontaneously. The mean of general knowledge scores was higher in Jigawa 14.8 (±3.2) compared to Lagos 12.1 (±4.1) and Oyo states 12.5 (±5.6) (p<0.001). Respondents with tertiary-level education (p=0.001) were significantly more likely to perceive themselves as susceptible to mpox while males (p<0.001) and respondents who live in Jigawa state (p=0.002) were significantly more likely to perceive mpox as severe with 90.5% believing that being infected will stop their daily activity (p<0.001). Perceived barriers to adherence to mpox preventive strategies were higher in Jigawa state (p<0.001), with 68.3%reporting that use of hand sanitizers might be expensive for them.

Conclusion: The analysis of our findings revealed significant knowledge gaps and a very low level of public awareness about mpox. Key areas of limited knowledge included the disease’s route of transmission, as well as its prevention and treatment. To control the spread of mpox infection, there is need to strengthen public health risk communication focusing on the transmission and preventive actions.

Keywords: Knowledge, Severity, Risk perception, Disease, Outbreak, MPOX, Sub-Saharan Africa

Introduction

Mpox is a re-emerging zoonosis disease that was first identified in humans in 1970.¹ While initially originating and prevalent in central and western Africa, mpox spread beyond the continent in 2003 when the United States reported its first case² , thereafter, sporadic cases of mpox have been reported across Africa. On July 23, 2022, mpox was officially declared a public health emergency of international concern (PHEIC) by the World Health Organisation (WHO) due to the discovery of multiple cases of human-to-human transmission in previously non-endemic, high-income including the United States and the United Kingdom.³ Between January 1, 2022, and January 30, 2023, WHO reported 85,449 confirmed global cases of mpox, with 89 resulting in death.⁴ The majority of these cases occurred in region of the Americas (57,989; 68%), followed by Europe (25,804; 30%), and the African region (1,302;1.5%).⁵ However, underreporting of mpox infection and other related diseases is a significant concern in Africa, particularly in rural areas, due to limited medical facilities, self-medication, and a poor illness reporting culture.⁶ To facilitate an effective public health response and community engagement, it is essential to understand the knowledge and perception of the general public towards the mpox infection.

Between 2017-2022, Nigeria reported sporadic cases of mpox infection, with only 512 suspected cases and 226 confirmed cases between 2017 and 2021. However, the number of reported cases surged significantly in 2022, with the country documenting 2,123 suspected cases and 762 confirmed cases across 34 states and the Federal Capital Territory (FCT) in that year alone. This figure accounts for approximately 60% of confirmed cases in the African region.⁷

Since the resurgence of the disease in 2017⁸, the Nigerian government has implemented specific response activities to protect the health of Nigerians. These measures include providing technical assistance to high burden states, establishing immediate and realtime reporting, provision of specific guidelines for the disease, and training of personnel on early case detection and reporting of mpox infection and other high priority diseases using an integrated disease approach among other initiatives.⁹ Despite these efforts, the National Centre for Disease Control and Prevention (NCDC) reported 71 newly confirmed cases of mpox infection between January 1, 2023 and April 16, 2023.⁷ This indicates a continuing challenge, especially considering that most control plans are aimed at healthcare workers. While this increase in number of cases may be due to the effects of climate change and increased interaction between man and animal, the awareness and knowledge of community members about mpox infection are important for community actions that can prevent outbreaks and limit contagion if an outbreak occurs.

Previous studies on mpox infection knowledge and perception have primarily focused on healthcare workers (HCW) and critical stakeholders. Some of these studies were conducted through online surveys on social media platforms, limiting reach to rural populations where technology use is lowest and disease underreporting is highest.^10–12 To the best of our knowledge, there is limited evidence of in-person survey on mpox infection among community members in many Nigerian states including Jigawa. There are also no studies comparing mpox knowledge and risk perception across geo-political zones.