A periodical of the Faculty of Natural and Applied Sciences, UMYU, Katsina
ISSN: 2955 – 1145 (print); 2955 – 1153 (online)
ORIGINAL RESEARCH ARTICLE
Na’omi Eyimeshi Oyigbenu1, Abba, Ogwuche Joseph1, 2, Pwol Gyang Victor1, Sarah Ofarn Ugolo3
1Department of Community Medicine, College of Community Health, Jos University Teaching Hospital, Plateau State, Nigeria
2Infectious Disease Unit, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
3Chaplaincy College of Health Science and Technology Jos, Plateau State, Nigeria
Corresponding Author: eyimeshi@gmail.com
Background: Emerging and re-emerging infectious diseases continue to pose significant public health threats globally, particularly in low- and middle-income countries. Healthcare workers, as frontline responders, play a critical role in disease detection, containment, and response. Understanding their knowledge, perception, preparedness, and the institutional barriers they face is crucial for informing strategic public health interventions. Objective: This study assessed the knowledge, perception, preparedness, and systemic challenges related to emerging and re-emerging infectious diseases among healthcare workers in Chiroma Ward, Nigeria. Methods: A cross-sectional survey was conducted among 111 healthcare workers selected from various professional cadres using a structured, pretested questionnaire. Descriptive statistics were used to summarise data, while Chi-square tests determined associations between sociodemographic variables and awareness/knowledge levels. Results: The findings showed that 51.4% of respondents were aware of emerging and re-emerging infectious diseases, with Lassa fever being the most frequently recognised (38.7%). A majority (59.5%) reported receiving formal training; however, only 35.1% felt adequately equipped to respond to outbreaks. Facility preparedness was rated as well prepared (32.4%) or moderately prepared (28.8%) by most respondents. Institutional barriers such as inadequate funding (39.6%) and lack of PPE (25.2%) were frequently reported. Statistically significant associations were found between knowledge levels and factors such as age, marital status, cadre, and educational qualification (p < 0.05). Conclusion: Although moderate levels of knowledge and preparedness were observed, there are still gaps in personal readiness, institutional support, and inter-agency collaboration. Addressing these barriers through targeted training, improved funding, and systemic policy reforms is essential for strengthening epidemic preparedness in Chiroma Ward and similar settings.
Keywords: Emerging infectious diseases, healthcare workers, perception, preparedness, institutional barriers
Emerging and re-emerging infectious diseases continue to pose substantial threats to global health, especially in low- and middle-income countries (Kobayashi et al. 2018; Mostafavi et al., 2021; Ramon-Torrell, 2023). Emerging infectious diseases (EIDs) are infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range (Chen, 2022). Re-emerging infectious diseases, on the other hand, are those that were previously controlled, but have again risen to be a significant health threat (Petersen et al., 2018; Mostafavi et al., 2021; Kobayashi et al., 2018). The emergence of high-threat pathogenic diseases has increased globally in recent years (Mostafavi et al., 2021). Almost 75% of recently emerged diseases afflicting humans have a zoonotic origin (Petersen et al., 2018; Munyua et al., 2019). Factors associated with the emergence or re-emergence of high-threat pathogenic diseases include the pathogen’s adaptation or resistance, host behaviour such as migration, international travel, human-animal interaction, poverty, climate change, and industrial and economic development (Morens et al., 2004). EIDs cause a huge economic crisis and public health problems in the world (Morens et al., 2004; McArthur, 2019; Chen, 2022).
The past two decades have witnessed the rise of several EIDs, including SARS, MERS, Ebola virus disease, Zika virus, and, most recently, the COVID-19 pandemic, which has challenged even the most robust healthcare systems globally (WHO, 2020; Omilabu, 2016). In the African context, diseases such as Lassa fever, cholera, yellow fever, and monkey pox have resurfaced, complicating already strained healthcare systems (NCDC, 2023). Nigeria, with its vast population and varying ecological and socioeconomic settings, has experienced recurrent outbreaks of both new and re-emerging infectious diseases (Omitola et al., 2020; Ademulegun et al., 2024). Despite institutional advances such as the establishment of the Nigeria Centre for Disease Control (NCDC), systemic challenges, particularly at the primaary healthcare level still persist. A 2022 WHO Joint External Evaluation report identified gaps in workforce development, real-time surveillance, and risk communication at sub-national levels (WHO JEE, 2022).
The frontline role of healthcare workers (HCWs) in infectious disease detection, containment, and management is widely acknowledged. Their awareness, attitudes, and preparedness are pivotal to the success of public health responses (Sultan et al., 2020; Tang et al., 2022). However, studies have shown that many HCWs in developing countries lack adequate training, resources, and institutional support to effectively respond to emerging infections (Abalkhail and Alslamah, 2022; Iheanacho et al., 2021). Understanding their perspectives, particularly in rural or semi-urban wards like Chiroma, is essential for informing policy and improving response mechanisms at the local level.
Chiroma Ward, located in a semi-urban area with limited health infrastructure, represents one such underserved locality. The locality is characterised by limited access to diagnostic infrastructure, irregular training, and overstretched health personnel. The ward remains vulnerable to infectious disease threats. Yet, to date, no published study has systematically examined the perceptions, awareness levels, or institutional preparedness of HCWs within this locality. This research, therefore, seeks to fill a critical gap by examining healthcare worker perspectives on emerging and re-emerging infectious diseases in Chiroma Ward. The study aims to provide evidence that will inform locally responsive policies, capacity-building interventions, and community-level preparedness strategies that align with Nigeria’s broader public health security goals.
The study adopted a cross-sectional descriptive design aimed at assessing the perspectives of healthcare workers on emerging and re-emerging infectious diseases. The cross-sectional approach was appropriate for capturing data at a specific point in time, allowing for an analysis of knowledge, attitudes, and perceived preparedness among health personnel (Levin, 2006; Maier et al., 2023).
The study was conducted in Chiroma Ward, located within Lafia LGA, in Nasarawa State, Nigeria. The ward is part of Nigeria’s decentralised healthcare delivery system, where primary health care (PHC) facilities form the foundational tier. The ward is representative of many semi-urban communities across northern and middle-belt Nigeria, characterised by moderate population density, limited health infrastructure, and high vulnerability to infectious disease outbreaks due to environmental, socioeconomic, and systemic health factors. Health services in the ward are delivered through a combination of Primary Health Centres (PHCs), Health Posts, and dispensaries, staffed predominantly by Community Health Extension Workers (CHEWs), nurses, midwives, and occasionally medical officers. The ward’s vulnerability is heightened by its ecological profile, which may include stagnant water bodies, poor waste management systems, and seasonal climate variability. Chiroma is also situated within a region classified by the Nigeria Centre for Disease Control (NCDC) as moderately endemic for Lassa fever and prone to annual outbreaks of cholera and measles (NCDC, 2022).
The target population comprised healthcare workers (HCWs) currently practising in Chiroma Ward. These included community health extension workers (CHEWs), nurses and midwives, medical Officers, laboratory scientists/technicians, and environmental health officers.
Inclusion criteria required that respondents be actively engaged in healthcare delivery and present in the ward during the period of data collection. Volunteers, corps members, student trainees, interns, HCWs on leave and administrative staff were excluded.
The sample size for this study was determined using the Taro Yamane formula (Yamane, 1967), which is commonly applied in social science and public health research to determine sample size from a finite population. The formula is given as:
\[\frac{\mathbf{N}}{\mathbf{1 + N\ (e}\mathbf{)}^{\mathbf{2}}}\]
Where:
n = sample size
N = total population of healthcare workers in Chiroma Ward (135)
e = margin of error (commonly set at 0.05 for 95% confidence level)
Substituting the values into the formula:
n = 135 / (1 + 135 * 0.05²) = 135 / (1 + 135 * 0.0025) = 135 / (1 + 0.3375) = 135 / 1.3375 = 100.9
Rounded up, the minimum required sample size is 101 healthcare workers.
To account for non-response or incomplete questionnaires, a 10% buffer was added:
101 + 10% of 101 = 101 + 10.1 = 111
A stratified random sampling method was employed to ensure proportional representation across different cadres of healthcare workers. The strata included CHEWs, nurses/midwives, medical officers, and laboratory personnel. From each stratum, participants were randomly selected using facility rosters and random number generation.
A structured self-administered questionnaire was used to collect data. The researcher designed the instrument after conducting a literature review. The questionnaire consisted of five sections. Section A elicited sociodemographic characteristics of participants, section B was concerned with knowledge of emerging and re-emerging infectious diseases, section C was concerned with perception of risk and preparedness while section D was concerned with attitudes and beliefs about response efforts while section E was concerned with systematic and institutional challenges in the management of emerging and re-emerging infectious diseases.
Content validity was ensured through expert review by two epidemiologists and one public health researcher. Face validity was established via a pilot test involving 20 healthcare workers in a neighbouring ward, not part of the study area.
For reliability, Cronbach’s alpha was computed for internal
consistency. A coefficient of 0.84 was obtained, indicating an
acceptable level of reliability (Kılıç,
2016).
Data were collected over a three-week period by trained research assistants under the supervision of the principal investigator. Respondents were briefed on the purpose of the study and assured of confidentiality. Informed consent was obtained prior to questionnaire administration.
Collected data were coded and entered into Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Descriptive statistics such as frequencies, means, and standard deviations were used to summarise the data. Inferential statistics including the chi-square test was employed to examine associations between sociodemographic characteristics and perspectives on infectious disease threats. Significance was set at p < 0.05.
Ethical approval for the study was obtained from the Nasarawa State Ministry of Health (NIREC Protocol No: 18/06/2017). Permission to conduct the study was obtained from the management of the facilities to be used as study centres. Informed consent was obtained from each participant. Confidentiality, anonymity, and voluntary participation were ensured throughout the data collection process, in accordance with the Declaration of Helsinki.
Table 1: Sociodemographic Information of Respondents
| Variables | Frequency | Percentages |
|---|---|---|
| Gender | ||
| Male | 57 | 51.4 |
| Female | 46 | 41.4 |
| Prefer not to say | 8 | 7.2 |
| Age (Years) | ||
| 18-25 | 22 | 19.8 |
| 26-35 | 25 | 22.5 |
| 36-45 | 20 | 18.0 |
| 46-55 | 20 | 18.0 |
| 56 and above | 24 | 21.6 |
| Marital status | ||
| Single | 30 | 27.0 |
| Married | 27 | 24.3 |
| Divorced | 24 | 21.6 |
| Separated | 22 | 19.8 |
| Widowed | 8 | 7.2 |
| Cadre/Designation | ||
| Medical Director | 23 | 20.7 |
| Nurse/Midwife | 27 | 24.3 |
| Lab Scientist/Technician | 36 | 32.4 |
| Community Health Officer | 25 | 22.5 |
| Educational level | ||
| Diploma | 27 | 24.3 |
| B. Sc. | 35 | 31.5 |
| M. Sc. | 28 | 25.2 |
| Fellowship/Doctorate | 21 | 18.9 |
| Total | 111 | 100 |
Source: Field Survey, 2025
Table 1 shows the demographic information of the respondents. Findings of the study reveal that the majority of the participants were males (51.4%), who were within the age range of 26–35 years (22.5%). Most respondents were single (27.0%), and the predominant professional group was laboratory scientists/technicians (32.4%). The highest level of education among participants was a Bachelor of Science degree (31.5%), and most of them worked in public health facilities (51.4%). In terms of years of professional experience, the majority had between 1–5 years (34.2%).
Table 2: Knowledge of Emerging and Re-Emerging Infectious Diseases
| Variables | Frequency | Percentages (%) |
|---|---|---|
| Awareness of emerging and re-emerging infections | ||
| Yes | 57 | 51.4 |
| No | 36 | 32.4 |
| Not sure | 18 | 16.2 |
| Emerging Infectious Disease | ||
| Covid-19 | 27 | 24.3 |
| Lassa fever | 43 | 38.7 |
| Ebola Virus Disease | 30 | 27.0 |
| Zika virus | 11 | 9.9 |
| Re-emerging Infectious Disease | ||
| Measles | 36 | 32.4 |
| Tuberculosis | 33 | 29.7 |
| HIV/AIDS | 6 | 5.4 |
| Smallpox | 13 | 11.7 |
| Cholera | 23 | 20.7 |
| Factors contributing to EID/RID | ||
| Climate change | 24 | 21.6 |
| Urbanisation | 20 | 18.0 |
| Antimicrobial Resistance | 7 | 6.3 |
| Global travel | 22 | 19.8 |
| All of the above | 38 | 34.2 |
| Formal Training on emerging and re-emerging infectious diseases | ||
| Yes | 66 | 59.5 |
| No | 45 | 40.5 |
| Level of Knowledge | ||
| Poor | 20 | 18.0 |
| Fair | 36 | 32.4 |
| Good | 21 | 18.9 |
| Very Good | 7 | 6.3 |
| Excellent | 27 | 24.3 |
Source: Field Survey, 2025
Table 2 shows the respondents’ knowledge of emerging and re-emerging infectious diseases. The majority of the respondents (51.4%) were aware of such diseases, with Lassa fever (38.7%) being the most frequently identified emerging infection. In the category of re-emerging diseases, measles was most commonly cited (32.4%). The majority of participants (34.2%) acknowledged all listed factors (climate change, urbanisation, antimicrobial resistance, and global travel) as contributing to the emergence and re-emergence of infectious diseases. Additionally, 59.5% of respondents indicated they had received formal training on the topic. In terms of self-assessed knowledge levels, the most frequently reported category was “fair” (32.4%), suggesting moderate awareness among healthcare professionals in the study area.
Table 3: Perception and Preparedness of Healthcare Workers
| Variables | Frequency | Percentages (%) |
|---|---|---|
| Emerging/re-emerging infectious diseases are a serious threat to public health? | ||
| Strongly disagree | 21 | 18.9 |
| Disagree | 21 | 18.9 |
| Neutral | 27 | 24.3 |
| Agree | 24 | 21.6 |
| Strongly agree | 18 | 16,2 |
| Facility Preparedness | ||
| Not prepare | 9 | 8.1 |
| Slightly prepared | 13 | 11.7 |
| Moderately prepare | 32 | 28.8 |
| Well prepared | 36 | 32.4 |
| Fully prepared | 21 | 18.9 |
| Adequately equipped WITH the skills to manage such diseases | ||
| Yes | 39 | 35.1 |
| No | 46 | 41.4 |
| Not sure | 26 | 23.4 |
| Facility have an infection prevention and control (IPC) protocol for outbreaks | ||
| Yes | 45 | 40.5 |
| No | 38 | 34.2 |
| Not sure | 28 | 25.2 |
| Outbreak drills or simulation exercises | ||
| Never | 60 | 54.1 |
| Occasionally | 21 | 18.9 |
| Often | 13 | 11.7 |
| Very frequently | 17 | 15.3 |
Source: Field Survey, 2025
Presented in Table 3 is the perception and preparedness of healthcare workers toward emerging and re-emerging infectious diseases. Findings show that respondents were fairly divided in their perception of threat, with 24.3% maintaining a neutral stance, while 21.6% agreed and 18.9% strongly disagreed that such diseases pose a serious public health threat. In terms of facility preparedness, most respondents indicated their facilities were either well prepared (32.4%) or moderately prepared (28.8%). However, only 35.1% believed they were adequately equipped with the skills to manage such diseases, while 41.4% disagreed, indicating a notable skills gap among healthcare workers. Furthermore, only 40.5% confirmed that their facilities had an infection prevention and control (IPC) protocol in place, and a majority (54.1%) reported that their facilities never conducted outbreak drills or simulations.
Table 4: Attitudes and Perceptions of Healthcare Workers towards these Diseases
| Items | Attitudes and Perceptions | \[\overline{\mathbf{x}}\] | Sd | Decision |
|---|---|---|---|---|
| 1 | Emerging infectious diseases are inevitable in the 21st century | 3.9 | 0.7 | Accepted |
| 2 | I am willing to volunteer during an outbreak in my facility | 3.1 | 1.4 | Accepted |
| 3 | Personal protective equipment (PPE) should be mandatory during suspected outbreaks | 3.1 | 1.3 | Accepted |
| 4 | Healthcare workers should receive periodic training on infectious disease preparedness | 3.0 | 1.5 | Accepted |
| 5 | I feel confident in my ability to respond effectively during an infectious disease | 3.0 | 1.3 | Accepted |
| Cluster Mean | 3.2 | 1.7 | Accepted |
Source: Field Survey, 2025
Presented in Table 4 are the attitudes and perceptions of healthcare workers towards emerging and re-emerging infectious diseases. Results obtained from the table indicate that the perception that emerging infectious diseases are inevitable in the 21st century, willingness to volunteer during an outbreak, the belief that PPE should be mandatory during suspected outbreaks, the notion that healthcare workers should receive periodic training on infectious disease preparedness, and confidence in their ability to respond effectively during an infectious disease outbreak had mean scores of 3.9, 3.1, 3.1, 3.0, and 3.0 respectively. With all items having mean values equal to or greater than the decision benchmark of 3.0, it can be inferred that the attitudes and perceptions of healthcare workers towards emerging and re-emerging infectious diseases are generally positive.
Table 5: Systemic and Institutional Challenges in the Management of Emerging and Re-emerging Infectious Diseases
| Variables | Frequency | Percentages (%) |
|---|---|---|
| Institutional Challenges | ||
| Inadequate funding | 44 | 39.6 |
| Lack of PPE | 28 | 25.2 |
| Poor communication | 16 | 14.4 |
| Insufficient Staff | 11 | 9.9 |
| Poor surveillance infrastructure | 12 | 10.8 |
| Partners with Authorities | ||
| Yes | 34 | 30.6 |
| No | 40 | 36.0 |
| Not sure | 37 | 33.3 |
| Feedback Mechanism | ||
| Yes | 31 | 27.9 |
| No | 52 | 46.8 |
| Don’t know | 28 | 25.2 |
Source: Field Survey, 2025
Presented in Table 5 are the systemic and institutional challenges encountered by healthcare workers in responding to emerging and re-emerging infectious diseases in Chiroma Ward. The results indicate that the most frequently reported institutional challenge was inadequate funding, cited by 39.6% of respondents. This is followed by a lack of personal protective equipment (PPE) (25.2%), poor communication systems (14.4%), poor surveillance infrastructure (10.8%), and insufficient staffing (9.9%). In terms of institutional collaboration, only 30.6% of respondents affirmed that their facilities partnered with local or state public health authorities during outbreaks. A slightly higher proportion (36.0%) indicated the absence of such partnerships, while 33.3% were uncertain. With regard to internal review systems, only 27.9% of healthcare workers reported the presence of a feedback mechanism in their facility following outbreak responses. In contrast, 46.8% stated that no such mechanism existed, and 25.2% were unaware.
Table 6: Sociodemographic Characteristics and Awareness of Emerging and Re-emerging Infectious Diseases
| Variables | Awareness | χ2 | P-Value | ||
|---|---|---|---|---|---|
| Yes (%) | No (%) | Not sure (%) | |||
| Gender | |||||
| Male | 26 (45.5) | 18 (31.6) | 13(22.8) | 10.9 | 0.027 |
| Female | 23 (50.0) | 18 (39.1) | 5 (10.9) | ||
| Prefer not to say | 8 (100.0) | 0 (0.0) | 0 (0.0) | ||
| Age (Years) | |||||
| 18-25 | 20 (90.9) | 2 (9.1) | 0 (0.0) | 58.3 | 0.000 |
| 26-35 | 7 (28.0) | 11 (44.0) | 7 (28.0) | ||
| 36-45 | 20 (100.0) | 0 (0.0) | 0 (0.0) | ||
| 46-55 | 1 (5.0) | 12 (60.0) | 7 (35.0) | ||
| 56 and above | 9 (37.5) | 11 (45.8) | 4 (16.7) | ||
| Marital status | |||||
| Single | 13 (43.3) | 8 (26.7) | 9 (30.0) | 10.12 | 0.256 |
| Married | 11 (40.7) | 13 (48.1) | 3 (11.1) | ||
| Divorced | 15 (62.5) | 6 (25.0) | 3 (12.5) | ||
| Separated | 14 (63.6) | 6 (27.3) | 2 (9.1) | ||
| Widowed | 4 (50.0) | 3 (37.5) | 1 (12.5) | ||
| Cadre/Designation | |||||
| Medical Director | 20 (87.0) | 3 (13.0) | 0 (0.0) | 60.7 | 0.000 |
| Nurse/Midwife | 25 (92.6) | 2 (7.4) | 0 (0.0) | ||
| Lab Scientist/Technician | 3 (8.3) | 20 (55.6) | 13 (36.1) | ||
| Community Health Officer | 9 (36.0) | 11 (44.0) | 5 (20.0) | ||
| Educational level | |||||
| Diploma | 23 (85.2) | 4 (14.8) | 0 (0.0) | 37.23 | 0.000 |
| B. Sc. | 7 (20.0) | 15 (42.9) | 13 (37.1) | ||
| M. Sc. | 19 (67.9) | 6 (21.4) | 3 (10.7) | ||
| Fellowship/Doctorate | 8 (38.1) | 11 (52.4) | 2 (9.5) | ||
Source: Field Survey, 2025
Table 6 presents the association between selected sociodemographic variables and healthcare workers’ awareness of emerging and re-emerging infectious diseases. Findings of the study showed that awareness was highest among those who preferred not to state their gender (100%), followed by females (50.0%) and males (45.5%). Respondents aged 36–45 years (100%) and 18–25 years (90.9%) were more aware compared to those aged 46–55 years, of whom only 5.0% were aware. By professional designation, awareness was most prevalent among nurses/midwives (92.6%) and medical directors (87.0%), whereas laboratory scientists/technicians (8.3%) exhibited the least awareness. Educationally, those with Diplomas (85.2%) and Master’s degrees (67.9%) reported higher awareness than respondents with Bachelor’s degrees (20.0%) and Doctorates/Fellowships (38.1%).
Chi-square analysis revealed that marital status did not show a significant association (p = 0.256). However, there was a statistically significant associations between awareness and gender (χ² = 10.9, p = 0.027), age (χ² = 58.3, p < 0.001), cadre/designation (χ² = 60.7, p < 0.001), and educational qualification (χ² = 37.23, p < 0.001).
Table 7: Sociodemographic Characteristics and Level of Knowledge on Emerging and Re-emerging Infectious Diseases
| Variables | Level of Knowledge | χ2 | P-Value | ||||
|---|---|---|---|---|---|---|---|
| Poor (%) | Fair (%) | Good (%) | Very Good (%) | Excellent (%) | |||
| Gender | |||||||
| Male | 8 (14.0) | 21 (36.8) | 9 (15.8) | 5 (8.8) | 14 (24.6) | 11.6 | 0.170 |
| Female | 8 (17.4) | 15 (32.6) | 9 (19.6) | 2 (4.3) | 12 (26.1) | ||
| Prefer not to say | 4 (50.0) | 0 (0.0) | 3 (37.5) | 0 (0.0) | 1 (12.5) | ||
| Age (Years) | |||||||
| 18-25 | 0 (0.0) | 8 (36.4) | 3 (13.6) | 0 (0.0) | 11 (50.0) | 126.0 | 0.000 |
| 26-35 | 0 (0.0) | 12 (48.0) | 13 (52.0) | 0 (0.0) | 0 (0.0) | ||
| 36-45 | 14 (70.0) | 3 (15.0) | 0 (0.0) | 0 (0.0) | 3 (15.0) | ||
| 46-55 | 4 (20.0) | 3 (15.0) | 0 (0.0) | 0 (0.0) | 13 (65.0) | ||
| 56 and above | 2 (8.3) | 10 (41.7) | 5 (20.8) | 7 (29.2) | 0 (0.0) | ||
| Marital status | |||||||
| Single | 3 (10.0) | 7 (23.3) | 6 (20.0) | 2 (6.7) | 12 (40.0) | 42.8 | 0.000 |
| Married | 6 (22.2) | 11 (40.7) | 1 (3.7) | 0 (0.0) | 9 (33.3) | ||
| Divorced | 8 (33.3) | 3 (12.5) | 8 (33.3) | 5 (20.8) | 0 (0.0) | ||
| Separated | 3 (13.6) | 11 (50.0) | 3 (13.6) | 0 (0.0) | 5 (22.7) | ||
| Widowed | 0 (0.0) | 4 (50.0) | 3 (37.5) | 0 (0.0) | 1 (12.5) | ||
| Cadre/Designation | |||||||
| Medical Director | 0 (0.0) | 8 (34.8) | 4 (17.4) | 0 (0.0) | 11 (47.8) | 70.1 | 0.000 |
| Nurse/Midwife | 15 (55.6) | 8 (29.6) | 0 (0.0) | 0 (0.0) | 4 (14.8) | ||
| Lab Scientist/Technician | 2 (5.6) | 14 (38.9) | 12 (33.3) | 0 (0.0) | 8 (22.2) | ||
| Community Health Officer | 3 (12.0) | 6 (24.0) | 5 (20.0) | 7 (28.0) | 4 (16.0) | ||
| Educational level | |||||||
| Diploma | 0 (0.0) | 8 (29.6) | 8 (29.6) | 0 (0.0) | 11 (40.7) | 59.9 | 0.000 |
| B. Sc. | 3 (8.6) | 15 (42.9) | 11 (31.4) | 0 (0.0) | 6 (17.1) | ||
| M. Sc. | 12 (42.9) | 5 (17.9) | 2 (7.1) | 7 (25.0) | 2 (7.1) | ||
| Fellowship/Doctorate | 5 (23.8) | 8 (38.1) | 0 (0.0) | 0 (0.0) | 8 (38.1) | ||
Source: Field Survey, 2025
Table 7 presents the association between selected sociodemographic variables and healthcare workers’ level of knowledge of emerging and re-emerging infectious diseases. Findings of the study showed that knowledge was highest among respondents aged 46–55 years, where 65.0% demonstrated excellent knowledge, followed by the 18–25 years group, of whom 50.0% had excellent knowledge and none reported poor knowledge. In contrast, a majority of respondents aged 36–45 years (70.0%) reported poor knowledge. Regarding gender, respondents who preferred not to disclose their gender had the highest proportion of poor knowledge (50.0%), followed by females (17.4%) and males (14.0%), though gender was not statistically significant. Among marital groups, excellent knowledge was most observed among single respondents (40.0%) and married respondents (33.3%), while divorced respondents had the highest poor knowledge at 33.3%.
In terms of professional designation, medical directors recorded the highest excellent knowledge level (47.8%) and none reported poor knowledge. In contrast, nurses/midwives showed the highest percentage of poor knowledge (55.6%), while laboratory scientists/technicians showed relatively balanced responses with 22.2% scoring excellent and 33.3% good knowledge. Community health officers had a mixed distribution, with the highest percentage (28.0%) in the very good knowledge category. Educationally, respondents with Diplomas had the highest proportion of excellent knowledge (40.7%), followed by Fellowship/Doctorate holders (38.1%), while Master’s degree holders recorded the highest poor knowledge (42.9%).
Chi-square analysis revealed no significant association between knowledge and gender (p = 0.170). However, there were statistically significant associations between knowledge and age (χ² = 126.0, p < 0.001), marital status (χ² = 42.8, p < 0.001), cadre/designation (χ² = 70.1, p < 0.001), and educational qualification (χ² = 59.9, p < 0.001).
This study was conducted to assess the knowledge, perception, preparedness, and institutional challenges related to emerging and re-emerging infectious diseases among healthcare workers in Chiroma Ward, Nigeria. The findings revealed that 51.4% of the respondents were aware of emerging and re-emerging infectious diseases. This finding aligns with the study by Rugarabamu et al. (2020) in Tanzania, which reported that 84% of healthcare workers were aware of infectious disease outbreaks. It is also similar to the report of Zhong et al. (2020) in China, where awareness among healthcare workers during the COVID-19 outbreak was over 90%. These findings corroborate the report of Patel et al. (2017), who reported a high level of awareness and knowledge among medical students. It is also in line with findings from an Ethiopian study (Abebe et al., 2016) where around 80% HCWs were aware of EVD. Alsahafi and Cheng (2019) also reported a higher level of awareness among healthcare workers in Hajj 2015. The finding of this study however, differs from the report of Alsahafi and Cheng (2016) in Mecca, Medina and Jeddah, where the knowledge about MERS-CoV, Ebola and other emerging infectious diseases was low. The disparity may be attributed to differences in outbreak exposure, availability of surveillance infrastructure, and training across regions.
Lassa fever was the most frequently recognised emerging disease, which is consistent with the findings by Olowookere et al. (2015), who reported that Lassa fever was one of the most commonly identified infectious threats among Nigerian health personnel. Awareness of contributing factors such as climate change, urbanisation, antimicrobial resistance, and global travel was reported by 34.2% of participants, similar to findings by Jones et al. (2008), Allen et al. (2017) and Liao et al. (2024), who identified these factors as key drivers of global disease emergence. Formal training on infectious diseases was reported by 59.5% of participants. This is comparable to a study by Temsah et al. (2020), where 61.7% of healthcare workers in Saudi Arabia received formal outbreak training. Regarding the level of knowledge, the majority of respondents rated themselves as having fair knowledge. This corroborates the report by Ndu et al. (2019), who reported fair knowledge levels among healthcare workers in Enugu. It also echoes the findings of Bhagavathula et al. (2020), who reported moderate knowledge levels among health workers in the UAE during the early pandemic stages. This finding also corroborates the report of Sampa (2025), who reported low knowledge in Chililabombwe and Lusaka Districts of Zambia, and Ndu et al. (2019), who reported fair knowledge among HCWs in Enugu
On perception, 24.3% of respondents were neutral about the threat of emerging diseases, while 21.6% agreed and 18.9% strongly disagreed. These divergent views reflect a possible gap between knowledge and perceived risk. This observation is consistent with findings by Olapegba et al. (2020), who reported similar inconsistencies in knowledge and perception among Nigerian respondents during the early phase of the COVID-19 pandemic. This finding is also similar to the report of Isah et al. (2020), who reported misconceptions in the general population of Katsina State, Nigeria. A possible reason for the mixed perceptions could be attributed to variations to exposure to accurate health information. Primary healthcare workers in many parts of Nigeria often rely on fragmented or outdated training modules and may lack regular access to continuing medical education or standardised outbreak communication materials.
In terms of preparedness, most respondents reported their facilities as well prepared or moderately prepared, which is similar to findings by Ilesanmi and Afolabi (2021), who noted a comparable trend among healthcare facilities in Ibadan. Ndu et al. (2019) also reported a poor level of preparedness for Lassa fever in Engu, Nigeria. The findings, however, disagree with the report of Ughasoro et al. (2019) in Nigeria, where 98.4% of HCWs reported that their HCFs were insufficiently equipped to respond to disease outbreaks. A poor level of preparedness was also observed in the study conducted by Ndu et al. (2019) and Olowookere et al. (2015). However, only 35.1% felt personally equipped to manage emerging infections, indicating a notable skills gap. This aligns with the study by Al Meslamani et al. (2025), which showed insufficient readiness among healthcare providers to manage Mpox. A study conducted by Sadek et al. (2024) in Egypt also found that nurses’ readiness for Mpox was inadequate. Attitudinally, a majority agreed that emerging infectious diseases are inevitable and that periodic training is necessary, suggesting proactive orientation. This supports findings from studies by Al Meslamani et al. (2025), Sadek et al. (2024), Hasan et al. (2023), AlBalas et al. (2024) and Malaeb et al. (2023), which reported positive attitudes among health workers towards outbreak preparedness. The difference in attitudes may be attributed to variations in organisational support, training opportunities, and exposure to infectious disease management in healthcare settings.
Systemic barriers such as inadequate funding (39.6%), lack of PPE (25.2%), and poor communication infrastructure (14.4%) were most reported. These findings are consistent with those of Olumade et al. (2020) and Dairo et al. (2010), who identified funding and logistic limitations as major constraints that continue to limit the ability of the Nigerian public healthcare system to effectively prepare and respond to infectious disease outbreaks. This finding is also in line with the findings of Ughasoro et al. (2019), who reported that lack of funds, amongst many other barriers, mitigate against having an optimal level of preparedness. Chi-square analysis revealed significant associations between awareness and demographic variables such as gender, age, cadre, and education. This aligns with the findings of Ilesanmi and Alele (2016), who also found significant demographic predictors of outbreak awareness. Similarly, knowledge levels were significantly associated with age, marital status, cadre, and education. This is consistent with reports by Olowookere et al. (2015), who highlighted occupation as a determinants of good/appropriate knowledge of EVD.
Emerging and re-emerging infectious diseases remain a major public health concern, particularly in resource-constrained settings such as Chiroma Ward, Nigeria. This study has shown that while healthcare workers demonstrate moderate levels of awareness and fair knowledge, their individual preparedness to respond to disease outbreaks is limited. Although many facilities were perceived as moderately or well prepared, a significant proportion of healthcare workers did not feel personally equipped to manage emerging health threats, pointing to critical gaps in skills and practical training. This disjunction between perceived preparedness and actual institutional capacity is not merely academic; it carries life-and-death consequences in a region vulnerable to epidemics such as Lassa fever and COVID-19. The study’s nuanced insights into how sociodemographic variables influence knowledge and preparedness further provide a roadmap for designing targeted interventions that are equitable and evidence-based. From a public health perspective, this study highlights the urgent need to integrate epidemic preparedness into routine health service delivery. It highlights the necessity of embedding simulation drills, continuous professional training, and inter-agency partnerships into health facility protocols, not as reactive measures, but as institutional standards. Policymakers must prioritise sustained investment in workforce development, the establishment of real-time surveillance mechanisms, and equitable access to personal protective resources across all levels of care. The study calls for a paradigm shift from episodic response to permanent preparedness. If translated into actionable policy, its findings can help catalyse a more resilient, responsive, and risk-informed healthcare system, not only in Chiroma Ward but across similar resource-constrained settings in Nigeria and sub-Saharan Africa.
Based on the findings, it is recommended that:
The government and health authorities at local and state levels should ensure continuous, evidence-based training for healthcare workers. Training should be inclusive of all healthcare cadres and should address the specific knowledge gaps revealed in this study.
Inadequate funding was identified as the most significant institutional barrier. Local governments and health ministries should increase budgetary allocation to primary health facilities, with specific provisions for personal protective equipment, emergency stockpiles, and capacity-building initiatives.
Awareness efforts should be demographically tailored, addressing sociodemographic groups identified in the study as having low awareness or knowledge. Community-based strategies, including outreach by trained health educators, should complement facility-based programs.
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