Mpox in Nigeria: Perceptions and knowledge of the disease among critical stakeholders—Global public health consequences

Abstract

Background The mpox (monkeypox) disease is a re-emerging viral zoonosis of international concern that is endemic in parts of Africa. The mpox virus (MPXV), which was hitherto largely limited to some Central and West African countries, was declared a public health emergency of international concern by the WHO on July 23, 2022 following the rapid spread of the virus to non-endemic countries. Globally, as of March 16, 2023, the WHO had reported 86,496 laboratory-confirmed cases of mpox and 111 deaths in 110 countries. Of the 1,420 cases of mpox reported in Africa as of March 16, 2023, Nigeria alone recorded 57.1% (812) of the confirmed cases and eight fatalities recorded in the continent. To help improve on the understanding of the current situation in Nigeria, the present study assessed the perception and knowledge of mpox among Nigerian healthcare workers, academics and tertiary students. The study also sought to highlight the global public health significance of the MPXV, and recommend a One Health approach to limit exporting of the virus beyond the borders of Nigeria. Methods A web-based cross-sectional survey was conducted between 24 July 2022 and 12 August 2022 to evaluate the perception and knowledge of mpox among 1544 Nigerians, consisted of healthcare workers (n = 832), academics (n = 306) and tertiary students (n = 462). Data on the respondents’ socio demographics and their information sources on mpox were also collected. Each correct response was allotted one point while an incorrect response was scored zero. The scores for perception and knowledge were dichotomized into positive (>5.5) and negative (≤5.5) and adequate (>5.8) and inadequate (≤5.8), respectively; using the average scores for perception and knowledge. The average score for perception and knowledge were summarised and presented as the mean and standard deviation (SD). Chi-square tests of association and binary logistic regression were carried out to determine factors associated with the outcome variables. Results Of the 1452 respondents that had heard of mpox, 878 (60.5%) and 419 (28.9%) had adequate knowledge and positive perception concerning MPXV infection respectively. Average perception score was 5.5. Mean perception and knowledge scores were 4.5(SD: 2.0) and 5.8 (SD: 1.9), respectively. Factors that were significantly associated with knowledge level were age (p = 0.020) educational qualification attained (p = 0.004), occupation (p<0.001), and geopolitical zone of residency (p = 0.001). There was a positive correlation between perception and knowledge scores (r = 0.4, p<0.001). Positive perceptions were likely among respondents who had tertiary education, and residing in North-west Nigeria. Likewise, adequate knowledge scores were likely among respondents under 30 years of age, with tertiary education or reside in North-west Nigeria. Sources of information were significantly associated with perception (p = 0.004) and knowledge (p<0.001) of the respondents. Conclusion The findings of this study show that there is disparity in the knowledge and perception of mpox in the study population, and as a result, there is a need to intensify awareness about MPXV infection to enhance positive perception among the respondents. This has potential to safeguard public health and contain the disease thus preventing it from spreading to the global community. A One Health approach involving animal and human health workers is imperative for improved knowledge and a good perception towards the disease among respondents, and enhanced active surveillance and early detection of MPXV in reservoir hosts (rodents and non-human primates); to prevent reverse zoonotic transmission of the virus at the human-animal interface.

Sources of information on monkeypox virus infection. A systematic review with meta-analysis

“…Similar results have been found in several studies on the use of radio and television as sources of information about the Mpox virus in different regions of the world. For example, Awoyomi OJ et al in Nigeria reported a prevalence of 12% in the use of radio as a source of information about the Mpox virus (20). In Brazil, Torres TS and his team reported that 13.7% of the population used radio for information about the virus, while 72.5% preferred television as a source of information (26).…”

“…On the other hand, access via the internet accounted for 61% (95% CI: 44-77%; 14002 participants; 5 studies; I 2 = 100%) (Figure S2) (26,28,30,31,33). As for radio, a level of 10% (95% CI: 07-13%; 8917 participants; 4 studies; I 2 = 93%) was observed (Figure S3) (20,(26)(27)(28), while television accounted for 24% (95% CI: 09-43%; 14896 participants; 8 studies; I 2 = 100%) (Figure S4) (26-28, 31,33,38,40,41). The combination of radio and television accounted for 45% (95% CI: 31-60%; 4207 participants; 7 studies; I 2 = 99%) (Figure S5) (21)(22)(23)29,34,36,37).…”

“…The combined prevalence of information sources about the monkeypox virus on social networks reached 58% (95% CI 46-70%; 17227 participants; 21 studies; I 2 = 100%) (Figure S1) (19)(20)(21)(22)(23)(24)(25)(27)(28)(29)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). On the other hand, access via the internet accounted for 61% (95% CI: 44-77%; 14002 participants; 5 studies; I 2 = 100%) (Figure S2) (26,28,30,31,33).…”

“…Friends and relatives accounted for 18% (95% CI 10-28%; 16551 participants; 18 studies; I 2 = 100%) (Figure S7) (19)(20)(21)(22)(23)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)40,41). World Health Organization (WHO) websites accounted for 17% (95% CI 07-29%; 1656 participants; 3 studies; I 2 = 97%) (Figure S8) (28,31,39), whereas Centers for Disease Control and Prevention (CDC) websites contributed 10% (95% CI 03-21%; 2378 participants; 3 studies; I 2 = 98%) (Figure S9) (20,31,39). The combination of WHO and CDC websites comprised 60% (95% CI 48-72%; 1828 participants; 4 studies; I 2 = 96%) (Figure S10) (21,23,25,35).…”

“…The prevalence of information sources from social networks regarding monkeypox virus among study participants stood at 61% (95% CI: 45-77%; n=6865 participants; 9 studies; I 2 = 99%) (19,20,22,28,31,32,34,35,37) in the general population, and 55% (95% CI: 37-72%; n=9989 participants; 11 studies; I 2 = 100%) (21,24,25,27,29,33,36,(38)(39)(40)(41) in the health care worker group (Figure S12).…”