Nigerians' outlook on pandemic preparedness – gaps and mitigations

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This study assessed the knowledge, attitudes, and perceptions of Nigerians regarding preparedness for the next pandemic. Methods A cross-sectional questionnaire-based national survey was conducted among 1276 respondents in Nigeria to determine public knowledge, attitudes, and perceptions of preparedness for future pandemics. Descriptive and inferential statistics were used for analyses. Results Of the 1276 respondents to this survey, > 50% had not heard of the Spanish flu or Zika disease. Approximately half (594) of the respondents did not consider antimicrobial resistance a possible cause of future pandemics. Over an average proportion of respondents reported unsatisfactory knowledge (655, 51.3%) and poor perception (695, 54.5%) about pandemic preparedness. The respondents' good knowledge and satisfactory attitudes toward pandemic preparedness decreased with increasing age. The respondents' education, age, and state of residence were significantly associated with good knowledge, satisfactory attitudes, and positive perceptions of pandemic preparedness with respondents with tertiary education levels being at least 2× more likely to have these positive outcomes. Conclusion This study revealed serious gaps in Nigerians' knowledge, attitudes, and perceptions of their readiness for upcoming pandemics. To protect Nigerians' health, emphasis should be placed on these issues. Pandemic Preparedness Public perception Knowledge Infectious diseases Nigeria Figures Figure 1 Figure 2 1 Introduction Pandemics are rapidly spreading infectious diseases that affect large numbers of people across countries or continents. Recent (re)emergence of infectious diseases, exemplified by outbreaks such as Ebola, Zika, Monkeypox, and COVID-19, highlights the urgent need for a whole-of-society effective pandemic preparedness and response strategies [ 1 – 4 ]. The disease burdens and consequences of pandemics are huge. For instance, the ongoing COVID-19 pandemic, has afflicted more than 700 million people with approximately 7 million deaths worldwide [ 5 ], and the Spanish Flu of 1918, reportedly infected 500 million people and caused about 50 million deaths globally [ 6 ]. The overuse and misuse of antimicrobial drugs, antimicrobial resistance (AMR) poses a global but inadvertent health crisis akin to a pandemic, and is projected to cause economic losses of approximately $ 100 trillion, and about 10 million annual deaths by 2050 [ 7 ]. Nigeria raised $ 560.52 million for the COVID-19 response and health financing [ 8 ]. Typically, pandemic occurrences are associated with widespread poverty, especially in the low-and-middle-income countries (LMICs) like Nigeria [ 8 – 10 ]. To develop a comprehensive pandemic preparedness plan, the public involvement is paramount. This fosters rapid reporting, community resilience, enhances adherence to preventive measures, and facilitates multichannel information exchange, with ultimately impacts on mitigating the spread of infectious diseases [ 11 , 12 ]. Because risk communication and community engagement (RCCE) are germane in infectious disease control, public knowledge, attitudes, and perceptions (KAP), which significantly influence behavioural change, also influence responses to public health crises such as pandemics [ 13 , 14 ]. KAP offers valuable insights into communities' readiness to adopt preventive measures and compliance with health directives, impacting decisions on vaccination, hygiene, and social distancing that can be used in controlling pandemics [ 15 – 19 ]. Attitudes and perceptions also shape individuals' willingness to accept public health interventions such as quarantine or contact tracing [ 20 – 22 ]. Addressing these factors enables authorities to tailor communication strategies effectively, fostering greater public cooperation and resilience in pandemic responses. Understanding Nigerian perspectives on pandemic preparedness is crucial for developing targeted, culturally sensitive interventions [ 23 , 24 ], and such understanding must be engendered before outbreaks occur for coordination and effective response. Nigeria's diverse cultural landscape requires nuanced communication and community engagement strategies to ensure widespread acceptance and compliance with preventive measures [ 25 ]. Identifying knowledge gaps, attitudes, and perceptions within Nigerian communities, can allow authorities to tailor interventions to address specific concerns, build trust, and optimize resource allocation as evidenced earlier [ 25 ]. This understanding is essential for promoting community resilience and effectively mitigating the impact of the future occurrence of infectious diseases in a country. Previous studies on pandemic preparedness in Nigeria have, for the most part, concentrated on the country's authorities’ responses to specific interventions against infectious diseases such as the COVID-19 pandemic [ 26 – 29 ] rather than on the preparedness of the Nigerian public. Addressing this gap is critical for evaluating Nigeria's readiness for pandemics, pinpointing areas needing enhancement, and minimizing the severity of future epidemic. Therefore, this study assessed the public (Nigerians) KAP regarding preparedness for the future pandemics. 2 Methods 2.1 Study area and Study design The study area for this research is Nigeria, a country located in West Africa. Nigeria is the most populous country in Africa with a population of 229,152,217 as at July 1 2024, based on the United Nations estimates [ 30 ], comprising diverse population groups representing different socio-economic backgrounds, educational levels, and geographical regions. Nigeria has six geo-political zones with 36 states and the Federal Capital Territory. In this study, we randomly selected individuals from six different states (Abia, Borno, Enugu, Kwara, Ogun, and Sokoto) Fig. 1 , which are representative of five of the six geo-political zones of Nigeria. This study employed a cross-sectional design. The data were collected using a structured questionnaire through a face-to-face interview survey and online through a Google form from April to September 2023. The study population included adults aged 18 years and above living in different communities across Nigeria. Individuals who are unable to communicate effectively or who are critically ill will be excluded. 2.2 Sample size and sampling technique The sample size was calculated using the Open-Source Epidemiologic Statistics for Public Health (OpenEpi), v.3.01 (updated June 4, 2013) tool based on the assumption of a confidence level of 95%, the margin of error of 5%, an expected proportion of 50% of the population having satisfactory knowledge of pandemic preparedness, and a precision of 3%. The sample size was calculated to be 1066. At least 1066 participants were recruited for the study. To recruit the respondents, first, six states were randomly selected from the five geo-political zones in Nigeria: Abia, Borno, Enugu, Kwara, Ogun, and Sokoto. From each state, two local government areas (LGAs) were selected using a simple random sampling technique. Households from the following local governments were randomly selected across the selected states; Ilorin South, Moro, Odeda, Nsukka, Wammakko, Maiduguri, Biu, Udi Agwu, Yewa South, Kware, Umuahia South, and Umuahia North. Only one person was sampled from each household. 2.3 Ethical considerations The study protocol was reviewed and approved (FVER/UG/2023-16/32TA029) by the Faculty of Veterinary Medicine Ethical Review Committee, University of Ilorin, Nigeria. The survey participants provided written informed consent before completing the questionnaire. The research objectives were explained to participants before they completed the survey tool. 2.4 Questionnaire design The questionnaire (Supplementary file 1) consisted of four sections: socio-demographic characteristics, respondents’ knowledge, attitudes, and perceptions of preparedness for future pandemics. The questionnaire was designed as closed-ended questions to prevent disparities in the responses received and to improve accuracy and reduce the complexity of data analysis. The first section on the demographic information of the respondents included variables such as gender, level of education, age range, and location (local government area). The second section focused on knowledge of pandemics and included a total of 25 questions. The questions on the attitudes of respondents toward future pandemic preparedness were included in the third section. The last section consisted of 12 questions on a 5-point Likert scale about respondents’ perceptions of future pandemics in Nigeria. 2.5 Questionnaire pre-test and administration Two independent academic reviewers validated the instrument to assess its content and face validity, as well as its ease of administration [ 25 ]. The questionnaire was pre-tested among 20 individuals from Kwara State. Pre-test responses obtained were used to improve the quality of the questionnaire. Trained data enumerators (n = 12) translated the survey instrument into local dialect, where needed, and surveyed the households across six selected states. 2.6 Data management and analysis The data were filtered and entered into a database using Microsoft Excel 2016 (Microsoft Corporation, Redmond, WA, USA) and analyzed using Statistical Package for Social Sciences (SPSS) version 25.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics such as frequencies, percentages, means, and standard deviations were used to summarize the data. We utilized a numeric scoring system [ 31 ] to evaluate the knowledge, attitudes, and perceptions of pandemic preparedness among participants, considering them as outcome variables. The outcome variables were calculated using a predetermined scoring method, as outlined earlier [ 32 , 33 ]. Correct responses to both knowledge and attitude questions received a score of "1," while incorrect responses were assigned a score of "0." The 5-point Likert scale responses for perception were rated on a scale from "4" for "strongly agree" to "0" for "strongly disagree." The total correct scores for each outcome variable were determined as the cumulative scores obtained from the questions answered correctly by the respondents. Respondents scoring greater or lower than the mean scores of all respondents for each outcome variable were considered good/satisfactory or poor/unsatisfactory, respectively [ 14 ]. Significant demographic variables were analyzed as independent factors associated with good knowledge or satisfactory attitudes toward or perceptions of pandemic preparedness using a stepwise backward binary logistic regression model. The goodness of fit of the model was assessed using the Hosmer-Lemeshow test. All the statistical analyses were performed at a 95% confidence level, with p < 0.05 considered significant. 3 Results 3.1 Demographic information of the study participants A total of 1276 respondents, from various households in six states across the five sampled geo-political zones of Nigeria, completed the questionnaire. There were more male respondents (700, 54.9%) than female (576, 45.1%) (Table 1 ). The majority of the respondents (695, 54.5%) had a tertiary level of education. The respondents were of a diverse age group, with the distribution of the participants almost even across the surveyed states. Table 1 Demographic structure of the respondents (n = 1276) Characteristic Variables Frequency (n) Percentage (%) Gender Male 700 54.9 Female 576 45.1 Level of education None 225 17.6 Primary 124 9.7 Secondary 232 18.2 Tertiary 695 54.5 Age (years) 18–30 499 39.1 31–40 332 26.0 41–50 314 24.6 51–60 131 10.3 State of residence Abia 221 17.3 Borno 204 16.0 Enugu 210 16.5 Kwara 228 17.9 Ogun 211 16.5 Sokoto 202 15.8 3.2 Knowledge of the respondents on pandemics and pandemic preparedness Overall, an average of 621 (48.7%) of the respondents displayed good knowledge of pandemics and pandemic preparedness. Although a substantial number, 1236 (96.5%), of the respondents are aware of what a pandemic is, the proportion of those acknowledging the Spanish flu (596/1276) and Zika viral disease (541/1276) as causes of previous epidemics and pandemics and a possible future pandemic is low (Table 2 ). It is important to note that less than 55% and 60% of respondents were aware of AMR and highly pathogenic avian influenza as possible causes of future pandemics, respectively. Most participants (> 80.0%) demonstrated high awareness of preparedness strategies against future pandemics, such as social distancing, personal hygiene practices, controlled international travel and trade, lockdown policy, and vaccination. Only 533 (41.8%) of the respondents were aware of the Presidential Task Force put in place in Nigeria during the control of the last major pandemic. Table 2 Knowledge of pandemic preparedness among respondents (n = 1276) s/n Question n (%) 1 A pandemic is a disease outbreak that spreads within Nigeria, throughout Africa, and the rest of the world causing deaths among a high population of people. 1236 (96.5) 2 Which of these are some of the pandemics that you have heard of in the past and could cause future pandemics? Spanish flu 596 (46.7) HIV/AIDS 819 (64.2) Ebola viral disease 1055 (82.7) SARS including COVID-19 1083 (84.9) Monkeypox 933 (73.1) Lassa fever 1004 (78.7) Zika 541 (42.4) Highly pathogenic Avian influenza 732 (57.4) Antimicrobial resistance 682 (53.4) Tuberculosis 760 (59.6) 3 Are you aware of the basic preventive measures to reduce the spread of infectious diseases, such as hand hygiene and wearing masks? 1230 (96.4) 4 Which of these are some of the actions to be taken during pandemics? Social distancing 1177 (92.2) Personal hygiene 1161 (91.0) Risk communication 756 (59.2) Controlled international travel and trade 1057 (82.8) Lockdown policy 1029 (80.6) Use of vaccines and antivirals 1106 (86.7) 5 Are you familiar with the signs and symptoms of common infectious diseases? 1187 (93.0) 6 The following are reliable organizations of information on infectious diseases and pandemics Nigerian Centre for Disease Control and Prevention (NCDC) 1167 (91.5) Federal Ministry of Health 1083 (84.9) African CDC 801 (62.8) World Health Organization (WHO) 1101 (86.3) Centers for Disease Control and Prevention (CDC) 946 (74.1) Presidential Tasks Force Committee on Pandemic Control 533 (41.8) 3.3 Attitudes of respondents toward pandemics and pandemic preparedness Table 3 presents the attitudes of respondents toward preparedness for future pandemics. While most respondents (63.6%) have a satisfactory attitude toward pandemic preparedness, a significant portion have not engaged in related community initiatives (515 out of 1276). Moreover, approximately half of the respondents had not taken proactive steps to educate themselves about pandemic preparedness (704 out of 1276). Additionally, a substantial number do not trust the government's prioritization of pandemic preparedness and response (667 out of 1276), feel that they lack sufficient knowledge to make informed decisions (730 out of 1276), and lack confidence in the health authority's ability to swiftly recover from the economic impact of future pandemics (573 out of 1276). Table 3 Attitudes of respondents on concerns regarding preparedness for future pandemics Variable n (%) Are you personally concerned about the possibility of the occurrence of future pandemics? 1073 (84.1) Have you taken any proactive steps to educate yourself about pandemic preparedness? 704 (55.2) Do you believe that individuals have a responsibility to contribute to pandemic preparedness efforts? 1016 (79.6) Have you participated in any community initiatives related to pandemic preparedness? 515 (40.5) Do you trust that the government will prioritize pandemic preparedness and response? 667 (52.3) Would you be willing to follow public health guidelines and recommendations during the occurrence of a future pandemic, even if they cause inconvenience? 881 (69.0) Have you discussed pandemic preparedness with your friends or family members? 755 (59.2) Do you feel that you have sufficient knowledge to make informed decisions about pandemic preparedness? 730 (57.2) Are you confident in the ability of Nigeria to recover quickly from the economic impact of a future pandemic? 573 (44.9) Would you be willing to volunteer your time or resources to support pandemic response efforts? 939 (73.6) 3.4 Perception of the respondents concerning the control of future pandemics in Nigeria Overall, less than half (581, 45.5%) of the respondents had positive perceptions about controlling future pandemics in Nigeria. In particular, respondents expressed positive opinions regarding the personal responsibility of taking preventive measures during pandemics (860/1276) and the introduction of pandemic control policies such as social distancing (816/1276). However, only a few of the respondents agreed that Nigeria is adequately prepared to handle future pandemics (321/1276). 3.5 Factors associated with good knowledge, satisfactory attitudes, and positive perceptions of pandemic preparedness among respondents Age, educational level, and state of residence were significantly associated with good knowledge, satisfactory attitudes, and positive perceptions of pandemic preparedness (Table 4 ). Respondents with a tertiary education level were twice as likely to have good knowledge (OR: 2.21, 95% CI: 1.62–3.01, p < 0.001), satisfactory attitudes (OR: 1.88, 95% CI: 1.38–2.57, p < 0.001), and positive perceptions (OR: 1.54, 95% CI: 1.14–2.09, p = 0.006) regarding the response to and control of future pandemics. Respondents who were residents of Kwara State were more likely to have a positive perception (OR: 1.96, 95% CI: 1.35–2.86, p = 0.001) of pandemic preparedness. Table 4 Binary logistic regression analysis of factors associated with good knowledge, satisfactory attitudes, and positive perception of pandemic preparedness among respondents Knowledge Factor Poor Good P -value (χ 2 ) OR 95% CI P -value Gender Male 354 (50.6) 346 (49.4) 0.579 - - - Female 301 (52.3) 275 (47.7) - - - Age 18–30 209 (41.9) 290 (58.1) 0.000* REF - - 31–40 174 (52.4) 158 (47.6) 0.65 0.49, 0.87 0.004* 41–50 186 (59.2) 128 (40.8) 0.49 0.37, 0.66 < 0.001* 51–60 86 (65.6) 45 (34.4) 0.38 0.25, 0.56 < 0.001* Education None 141 (62.7) 84 (37.3) 0.000* REF - - Primary 74 (59.7) 50 (40.3) 1.13 0.72, 1.78 0.663 Secondary 140 (60.3) 92 (39.7) 1.10 0.76, 1.61 0.679 Tertiary 300 (43.2) 395 (56.6) 2.21 1.62, 3.01 < 0.001* State of residence Abia 86 (38.9) 135 (61.1) 0.000* REF - - Borno 114 (55.9) 90 (44.1) 0.50 0.34, 0.74 0.001* Enugu 151 (71.9) 59 (28.1) 0.25 0.17, 0.37 < 0.001* Kwara 98 (43.0) 130 (57.0) 0.85 0.58, 1.23 0.435 Ogun 79 (37.4) 132 (62.6) 1.06 0.72, 1.57 0.829 Sokoto 127 (62.9) 75 (37.1) 0.38 0.25, 0.56 < 0.001* Attitudes Factor Poor Satisfactory P -value (χ 2 ) OR 95% CI P -value Gender Male 240 (34.3) 460 (65.7) 0.050 - - - Female 224 (38.9) 352 (61.1) - - - Education None 94 (41.8) 131 (58.2) 0.000* REF - - Primary 62 (50.0) 62 (50.0) 0.72 0.46, 1.12 0.172 Secondary 116 (50.0) 116 (50.0) 0.72 0.49, 1.04 0.095 Tertiary 192 (27.6) 503 (72.4) 1.88 1.38, 2.57 < 0.001* Age 18–30 133 (26.7) 366 (73.3) 0.000* REF - - 31–40 141 (42.5) 191 (57.5) 0.49 0.37, 0.67 < 0.001* 41–50 133 (42.4) 181 (57.6) 0.49 0.37, 0.67 < 0.001* 51–60 57 (43.5) 74 (56.5) 0.47 0.32, 0.70 0.000* State of residence Abia 68 (30.8) 153 (69.2) 0.000* REF - - Borno 72 (35.3) 132 (64.7) 0.81 0.54, 1.22 0.374 Enugu 95 (45.2) 115 (54.8) 0.54 0.36, 0.79 0.003* Kwara 60 (26.3) 168 (73.7) 1.2 0.83, 1.88 0.347 Ogun 96 (45.5) 115 (54.5) 0.53 0.36, 0.79 0.002* Sokoto 73 (36.1) 129 (63.9) 0.79 0.52, 1.18 0.286 Perceptions Factor Low High P -value (χ 2 ) OR 95% CI P -value Gender Male 395 (56.4) 305 (43.6) 0.127 - - - Female 300 (52.1) 276 (47.9) - - - Age 18–30 221 (44.3) 278 (55.7) 0.000* REF - - 31–40 194 (58.4) 138 (41.6) 0.57 0.43, 0.75 < 0.001* 41–50 210 (66.9) 104 (33.1) 0.39 0.29, 0.53 < 0.001* 51–60 70 (53.4) 61 (46.6) 0.69 0.47, 1.02 0.077 Education None 131 (58.2) 94 (41.8) 0.000* REF - - Primary 80 (64.5) 44 (35.5) 0.77 0.49, 1.21 0.299 Secondary 154 (66.4) 78 (33.6) 0.71 0.48, 1.03 0.088 Tertiary 330 (47.5) 365 (52.5) 1.54 1.14, 2.09 0.006* State of residence Abia 122 (55.2) 99 (44.8) 0.000* REF - - Borno 112 (54.9) 92 (45.1) 1.05 0.71, 1.53 0.896 Enugu 154 (73.3) 56 (26.7) 0.45 0.29, 0.67 < 0.001* Kwara 88 (38.6) 140 (61.4) 1.96 1.35, 2.86 0.001* Ogun 126 (59.7) 85 (40.3) 0.83 0.57, 1.22 0.395 Sokoto 93 (46.0) 109 (54.0) 1.44 0.98, 2.12 0.074 4 Discussion We have explored the KAP of Nigerians on pandemic and determined that the current state of pandemic preparedness among Nigerian general public requires urgent attention in terms of focused interventions and bolstering public health resilience. Though respondents demonstrated good knowledge of pandemic preparedness, cause-specific awareness about historical and potential causes of future pandemics, such as the Spanish flu, Zika disease, AMR, and highly pathogenic avian influenza, remains relatively low. While 63.6% of respondents expressed satisfactory attitudes toward pandemic preparedness, a significant portion had not participated in community initiatives, half of them had not educated themselves about pandemic preparedness, and many lacked trust in the government's prioritization, felt insufficiently informed, and lacked confidence in the country's economic recovery from future pandemics. Less than half of the respondents had a positive perception of Nigeria's ability to control future pandemics, although they expressed positive views on personal preventive measures and pandemic control policies, with few believing in Nigeria's preparedness for future pandemics. To the best of our knowledge, this study is the first to survey the knowledge gaps, attitudes, and perceptions of Nigerians regarding preparedness for future pandemics. A noteworthy finding from our study is the prevalence of inadequate knowledge regarding pandemics and preparedness measures among respondents. Despite the high awareness of pandemics in general, particularly in the recognition of recent outbreaks such as COVID-19, the understanding of historical pandemics such as the Spanish flu and emerging threats such as AMR remains alarmingly low. The inadequate knowledge of cause-specific pathogens makes the Nigerian community vulnerable to outbreaks even though awareness and knowledge is there. This deficiency in historical and prospective knowledge underscores the need for targeted educational campaigns aimed at enhancing public awareness and understanding of pandemic dynamics. Though, recent studies have indicated that citizens of various countries have good knowledge of recent pandemics such as COVID-19 [ 14 , 18 , 34 ], emphasis should be placed on the need for Nigerian citizens to be enlightened about past pandemics to create a sense of adequate preparation for future pandemics. A sufficient understanding of pandemics and general health information serves to dispel misconceptions surrounding pandemic situations, heighten awareness of susceptibility to infection risk and bolster self-efficacy in self-protection measures [ 35 – 37 ]. In particular, awareness about AMR and the highly pathogenic avian influenza pandemics is increasing as they present constant re-emergence threats to the world, including Nigeria. Our observation that most participants exhibited strong awareness of preparedness strategies for future pandemics, including social distancing, personal hygiene, regulated international travel and trade, lockdown policies, and vaccination is expected. This finding is similar to earlier reports in which citizens demonstrated the required level of awareness and preparedness for pandemics [ 38 ]. However, more efforts should be made to educate Nigerian citizens on national bodies such as the Presidential Task Force entrusted with the duties to curtail pandemics. Although most of the respondents (63.6%) in our survey displayed satisfactory attitudes toward pandemic preparedness, a significant portion did not engage in related community initiatives. Not participating in community initiative makes the society leaves the responsibility of pandemic control to health authorities alone, but whole-of-society approach at disease management will engender One Health disease intelligence better. Community initiatives are crucial for pandemic control, fostering collective responses to curb the spread of infectious diseases as they empower communities to promote public health guidelines, provide essential resources, organize vaccination drives, and support vulnerable populations. Strong community infrastructure is a necessary element that has been insufficiently addressed in effective pandemic prevention, preparedness, and response frameworks [ 39 ]. Poor community engagement initiatives have led to disastrous events during the Ebola virus disease epidemic in West Africa from 2014–2016 [ 40 ]. However, with the COVID-19 pandemic, community engagement was well-utilized during the pandemic resulting in positive outcomes in some LMICs [ 40 , 41 ]. Through grassroots efforts, communities can disseminate accurate information, combat misinformation, and encourage adherence to preventive measures such as social distancing and hygiene practices. These initiatives promote solidarity, mutual aid, and resilience, ensuring that no one is left behind. Moreover, our findings revealed a pervasive sense of skepticism and apprehension among respondents regarding the adequacy of preparedness efforts, with a substantial proportion (667/1276) expressing doubts about the government's commitment to prioritizing pandemic preparedness and response. This finding is similar to an earlier report from South American countries [ 42 ]. This reflects broader concerns about institutional capacity and efficacy. The lack of confidence in the country's ability to swiftly recover from the economic fallout of future pandemics underscores the interconnectedness of public health and socio-economic resilience. Lack of confidence in the government’s ability to contain disease outbreaks create trust gap, hence self-help and hiding information from government about early outbreaks will become rampant. Addressing these perception challenges demands proactive engagement and advocacy with stakeholders to foster trust, transparency, and accountability in pandemic response strategies [ 43 , 44 ]. Tertiary education has emerged as a key predictor of better knowledge, attitudes, and perceptions, emphasizing the pivotal role of education in shaping public health literacy and awareness. Similarly, younger respondents exhibit greater levels of knowledge and more positive perceptions than older respondents, suggesting the need for targeted interventions tailored to different demographic segments. Furthermore, variations in perception across different states highlight the importance of contextualizing interventions to address regional disparities and sociocultural nuances in Nigeria. Efforts to strengthen pandemic preparedness should prioritize comprehensive education initiatives targeting diverse demographic groups. However, higher tertiary level education dominating the study may not truly reflect the whole population structure of the country, hence, may not give overall comprehensive outlook of how the whole of society may behave. Possibly a similar study in the more rural areas may have different outcomes, as general health perception may vary by residence [ 45 ]. The study is subject to certain limitations, including the cross-sectional design and the reliance on self-reported data, which may be subject to recall bias and social desirability effects. However, we ensured that our methodology was well-structured and included a validated instrument ensuring reliability and depth in understanding Nigerians' knowledge, attitudes, and perceptions regarding pandemic preparedness. The main strength of the research lies in its comprehensive assessment, facilitated by a large and diverse sample size of 1276 respondents across Nigeria. Additionally, adherence to ethical guidelines, contextual relevance, and the identification of significant knowledge gaps further enhance the study's robustness and its potential to inform targeted interventions and policy recommendations for enhancing public health resilience in Nigeria. Future research should adopt longitudinal approaches and incorporate qualitative methods to gain deeper insights into the socio-cultural factors shaping public perceptions of pandemic preparedness. Exploring the role of social media and traditional communication channels in influencing public attitudes can offer valuable insights into effective risk communication strategies. 5 Conclusion Addressing the knowledge gaps and perception challenges identified in this study is imperative for strengthening Nigeria's resilience against future pandemics. By fostering a culture of proactive engagement, informed decision-making, and collaborative action, policymakers and public health practitioners can mitigate the impact of future infectious disease outbreaks and safeguard the well-being of the Nigerian population. Declarations Acknowledgment s We acknowledge all the respondents for their time spent completing and survey questions and the researchers who helped to revise the questionnaire. A uthor contributions Ismail Ayoade Odetokun was involved in the study conceptualization, investigation, analysis, writing of the manuscript, review, and editing. Oluwatobi Oniyanda participated in the investigation, analysis, writing, and editing. Ali Raza was involved in the methodology, writing, and editing. Uduak Akpabio, Aliyu Ibrahim Musawa, Idris Umar Hambali, and Shuaibu Gidado Adamu were involved in the methodology, investigation, data collection, review, and editing. Lateefah Oyafajo partook in the investigation, methodology, and project administration. Nma Bida Alhaji and Folorunso Oludayo Fasina were involved in methodology, project administration, supervision, review, and editing. All authors reviewed and approved the final version for publication. Funding This research received no specific funding. Data availability Data is available upon reasonable request. Ethical approval The study protocol was reviewed and approved (FVER/UG/2023-16/32TA029) by the Faculty of Veterinary Medicine Ethical Review Committee, University of Ilorin, Nigeria. Consent to participate The survey participants provided written informed consent before completing the questionnaire. The research objectives were explained to participants before they completed the survey tool. Conflict of interests The authors of this manuscript declare no potential conflicts of interest. References Petersen E, Abubakar I, Ihekweazu C, Heymann D, Ntoumi F, Blumberg L, et al. 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Lancet. 2020;395(10238):1676–1678. https://doi.org/10.1016/S0140-6736(20)31054-0 Razak G, Fischer HT, Appiah-Brimpong E, Opoku D, Hanefeld J. Community engagement for pandemic preparedness and response in Sub-Saharan Africa: A Scoping Review. Eur J Public Health. 2023;33(Suppl 2):ckad160.019. https://doi.org/10.1093/eurpub/ckad160.019 Bavel JJV, Baicker K, Boggio PS, Capraro V, Cichocka A, Cikara M, et al. Using social and behavioural science to support COVID-19 pandemic response. Nat Hum Behav. 2020;4(5):460–471. https://doi.org/10.1038/s41562-020-0884-z Hager E, Odetokun IA, Bolarinwa O, Zainab A, Okechukwu O. Al-Mustapha AI. Knowledge, attitude, and perceptions towards the 2019 Coronavirus Pandemic: A bi-national survey in Africa. PloS One. 2020;15(7):e0236918. https://doi.org/10.1371/journal.pone.0236918 Anjorin AA, Odetokun IA, Abioye AI, Elnadi H, Umoren MV, Damaris BF, et al. Will Africans take COVID-19 vaccination? PloS One. 2021;16(12):e0260575. https://doi.org/10.1371/journal.pone.0260575 Alhaji NB, Odetokun IA, Lawan MK, Adeiza AM, Nafarnda WD, Salihu MJ. Risk assessment and preventive health behaviours toward COVID-19 amongst bushmeat handlers in Nigerian wildlife markets: Drivers and One Health challenge. Acta Trop. 2022;235:106621. https://doi.org/10.1016/j.actatropica.2022.106621 Odetokun IA, Alhaji NB, Akpabio U, Abdulkareem MA, Bilat GT, Subedi D, et al. Knowledge, risk perception, and prevention preparedness towards COVID-19 among a cross-section of animal health professionals in Nigeria. Pan Afr Med J. 2022;41:20. https://doi.org/10.11604/pamj.2022.41.20.28315 Odetokun IA, Al-Mustapha AI, Elnadi H, Subedi D, Ogundijo OA, Oyewo M. The COVID-19 pandemic: A multi-regional cross-sectional survey of public knowledge, attitudes, and perceptions. PLOS Glob Public Health. 2022;2(7):e0000737. https://doi.org/10.1371/journal.pgph.0000737 Alhaji NB, Aliyu MB, Adamu AM, Adeiza AM, Nafarnda WD, Usman A, et al. Assessment of Abattoir Workers’ Knowledge, Perceptions and Preventive ‎Preparedness during COVID-19 Pandemic in North-central Nigeria: The ‎Health Belief Model. Sahel J Vet Sci. 2023;20(1):13-21. https://doi.org/10.54058/saheljvs.v20i1.308 Kozyreva A, Lorenz-Spreen P, Lewandowsky S, Garrett PM, Herzog SM, Pachur T, et al. Psychological factors shaping public responses to COVID-19 digital contact tracing technologies in Germany. Sci Rep. 2021;11(1):18716. https://doi.org/10.1038/s41598-021-98249-5 Lang R, Benham JL, Atabati O, Hollis A, Tombe T, Shaffer B, et al. Attitudes, behaviours and barriers to public health measures for COVID-19: a survey to inform public health messaging. BMC Public Health. 2021;21(1):765. https://doi.org/10.1186/s12889-021-10790-0 Amara PS, Platt JE, Raj M, Nong P. Learning about COVID-19: sources of information, public trust, and contact tracing during the pandemic. BMC Public Health. 2022;22(1):1348. https://doi.org/10.1186/s12889-022-13731-7 Anyanwu MU, Festus IJ, Nwobi OC, Jaja C-JI, Oguttu JW. A Perspective on Nigeria’s preparedness, response and challenges to mitigating the spread of COVID-19. Challenges. 2020;11:22. https://doi.org/10.3390/challe11020022 Olumade TJ, Adesanya OA, Fred-Akintunwa IJ, Babalola DO, Oguzie JU, Ogunsanya OA, et al. Infectious disease outbreak preparedness and response in Nigeria: history, limitations and recommendations for global health policy and practice. AIMS Public Health. 2020;7(4):736–757. https://doi.org/10.3934/publichealth.2020057 Elelu N, Bilewu O, Sanusi F, Al-Mustapha AI. Community-level survey of coronavirus disease 2019 (COVID-19) preventive measures in Kwara State, Nigeria: good knowledge vs poor attitude. Glob Health J. 2022;6(3):168–173. https://doi.org/10.1016/j.glohj.2022.07.002 Amzat J, Aminu K, Kolo VI, Akinyele AA, Ogundairo JA, Danjibo MC. Coronavirus outbreak in Nigeria: Burden and socio-medical response during the first 100 days. Int J Infect Dis. 2020;98:218-224. https://doi.org/10.1016/j.ijid.2020.06.067 Dan-Nwafor C, Ochu CL, Elimian K, Oladejo J, Ilori E, Umeokonkwo C, et al. Nigeria’s public health response to the COVID-19 pandemic: January to May 2020. J Glob Health. 2020;10(2):020399. https://doi.org/10.7189/jogh.10.020399 Akinyemi OO, Popoola OA, Fowotade A, Adekanmbi O, Cadmus EO, Adebayo A. Qualitative exploration of health system response to COVID-19 pandemic applying the WHO health systems framework: Case study of a Nigerian state. Sci Afr. 2021;13:e00945. https://doi.org/10.1016/j.sciaf.2021.e00945 Jacobs ED, Okeke MI. A critical evaluation of Nigeria’s response to the first wave of COVID-19. Bull Natl Res Cent. 2022;46(1):44. https://doi.org/10.1186/s42269-022-00729-9 World Population Review 2024. Nigeria Population 2024 (Live). https://worldpopulationreview.com/countries/nigeria-population Odetokun IA, Ghali-Mohammed I, Alhaji NB, Nuhu AA, Oyedele HA, Ameen SA, et al. Occupational health and food safety risks in Ilorin, Northcentral Nigeria: a cross-sectional survey of slaughterhouse workers. Food Prot Trends. 2020;40:241–250. Odetokun IA, Borokinni BO, Bakare SD, Ghali-Mohammed I, Alhaji NB. A cross-sectional survey of consumers’ risk perception and hygiene of retail meat: a Nigerian study. Food Prot Trends. 2021;41:274–283. Odetokun IA, Afolaranmi ZM, Nuhu AA, Borokinni BO, Ghali-Mohammed I, Cisse H, et al. Knowledge and self-reported food safety practices among meat consumers in Ilorin, Nigeria. Dialogues Health. 2022;1:100039. https://doi.org/10.1016/j.dialog.2022.100039 Alrajhi AM, Hussain WA, Rafie BA, Taj M, Elgarf AM. Knowledge and awareness of COVID-19 epidemic preparedness and response among health care workers in Makkah city. Ther Adv Infect Dis. 2022;9:20499361221079452. https://doi.org/10.1177/20499361221079452 Lau JT, Griffiths S, Choi KC, Tsui HY. Widespread public misconception in the early phase of the H1N1 influenza epidemic. J Infect. 2009;59(2):122–127. https://doi.org/10.1016/j.jinf.2009.06.004 Wong LP, Sam IC. Knowledge and attitudes in regard to pandemic influenza A(H1N1) in a multiethnic community of Malaysia. Int J Behav Med. 2011;18(2):112–121. https://doi.org/10.1007/s12529-010-9114-9 Rincón Uribe FA, Godinho RCS, Machado MAS, Oliveira KRDSG, Neira Espejo CA, de Sousa NCV, et al. Health knowledge, health behaviors and attitudes during pandemic emergencies: A systematic review. PloS One. 2021;16(9):e0256731. https://doi.org/10.1371/journal.pone.0256731 Tripathi R, Alqahtani SS, Albarraq AA, Meraya AM, Tripathi P, Banji D, et al. Awareness and Preparedness of COVID-19 Outbreak Among Healthcare Workers and Other Residents of South-West Saudi Arabia: A Cross-Sectional Survey. Front Public Health. 2020;8:482. https://doi.org/10.3389/fpubh.2020.00482 Byanyima W, Lauterbach K, Kavanagh MM. Community pandemic response: the importance of action led by communities and the public sector. Lancet. 2023;401(10373):253–255. https://doi.org/10.1016/S0140-6736(22)02575-2 Kutalek R, Ahmed SM, Kaawa-Mafigiri D, Giles-Vernick T. Community engagement: learning from low-income countries. Lancet. 2023;401(10390):1767–1768. https://doi.org/10.1016/S0140-6736(23)00568-8 Hyland-Wood B, Gardner J, Leask J, Ecker UKH. Toward effective government communication strategies in the era of COVID-19. Humanit Soc Sci Commun. 2021;8:30. https://doi.org/10.1057/s41599-020-00701-w Ramírez Varela A, Touchton M, Miranda JJ, Grueso JM, Laajaj R, Carrasquilla G, et al. Assessing pandemic preparedness, response, and lessons learned from the COVID-19 pandemic in four south American countries: agenda for the future. Front Public Health. 2023;11:1274737. https://doi.org/10.3389/fpubh.2023.1274737 Huang L, Cleveland T, Clift K, Egginton JS, Pacheco-Spann L, Johnson MG, et al. Key Stakeholder Perspectives of Community Engagement Efforts and the Impact of the Covid-19 Pandemic. J Prim Care Community Health. 2022;13:21501319221133076. https://doi.org/10.1177/21501319221133076 Ingram M, Sabo S, Rothers J, Wennerstrom A, de Zapien JG. Community Health Workers and community advocacy: addressing health disparities. J Community Health. 2008;33(6):417–424. https://doi.org/10.1007/s10900-008-9111-y Mainous AG 3rd, Kohrs FP. A comparison of health status between rural and urban adults. J Community Health. 1995;20(5):423–431. https://doi.org/10.1007/BF02260438 Additional Declarations No competing interests reported. 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14:53:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4554233/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4554233/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-024-00195-w","type":"published","date":"2024-09-02T16:05:47+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":59551807,"identity":"7388d47d-9207-4b9a-bd10-43b1fdb77cfe","added_by":"auto","created_at":"2024-07-03 06:30:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97208,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Nigeria showing the study area\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4554233/v1/f5bc800180a4e436ea88a54c.png"},{"id":59552740,"identity":"34c9921e-0c35-4084-a0e2-f0bd53afbd46","added_by":"auto","created_at":"2024-07-03 06:38:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55667,"visible":true,"origin":"","legend":"\u003cp\u003ePerception of respondents on the control of future pandemics in Nigeria\u003c/p\u003e\n\u003cp\u003eIs the total 1,276.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4554233/v1/b7b66f465b3eab26c331dfb8.png"},{"id":64186019,"identity":"6ba9f4cb-114e-4808-92ff-584c0aef4864","added_by":"auto","created_at":"2024-09-09 16:23:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1063656,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4554233/v1/74947126-6f92-4db7-8768-0ae7da882e43.pdf"},{"id":59551804,"identity":"45ae2405-d1e7-4131-b784-648c50836b93","added_by":"auto","created_at":"2024-07-03 06:30:25","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26037,"visible":true,"origin":"","legend":"","description":"","filename":"QUESTIONNAIRE.suppfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4554233/v1/979e4a6a637dcd6f8d76d268.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nigerians' outlook on pandemic preparedness – gaps and mitigations","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003ePandemics are rapidly spreading infectious diseases that affect large numbers of people across countries or continents. Recent (re)emergence of infectious diseases, exemplified by outbreaks such as Ebola, Zika, Monkeypox, and COVID-19, highlights the urgent need for a whole-of-society effective pandemic preparedness and response strategies [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The disease burdens and consequences of pandemics are huge. For instance, the ongoing COVID-19 pandemic, has afflicted more than 700\u0026nbsp;million people with approximately 7\u0026nbsp;million deaths worldwide [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and the Spanish Flu of 1918, reportedly infected 500\u0026nbsp;million people and caused about 50\u0026nbsp;million deaths globally [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The overuse and misuse of antimicrobial drugs, antimicrobial resistance (AMR) poses a global but inadvertent health crisis akin to a pandemic, and is projected to cause economic losses of approximately \u003cspan\u003e$\u003c/span\u003e100 trillion, and about 10\u0026nbsp;million annual deaths by 2050 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nigeria raised \u003cspan\u003e$\u003c/span\u003e560.52\u0026nbsp;million for the COVID-19 response and health financing [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Typically, pandemic occurrences are associated with widespread poverty, especially in the low-and-middle-income countries (LMICs) like Nigeria [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo develop a comprehensive pandemic preparedness plan, the public involvement is paramount. This fosters rapid reporting, community resilience, enhances adherence to preventive measures, and facilitates multichannel information exchange, with ultimately impacts on mitigating the spread of infectious diseases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Because risk communication and community engagement (RCCE) are germane in infectious disease control, public knowledge, attitudes, and perceptions (KAP), which significantly influence behavioural change, also influence responses to public health crises such as pandemics [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. KAP offers valuable insights into communities' readiness to adopt preventive measures and compliance with health directives, impacting decisions on vaccination, hygiene, and social distancing that can be used in controlling pandemics [\u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Attitudes and perceptions also shape individuals' willingness to accept public health interventions such as quarantine or contact tracing [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Addressing these factors enables authorities to tailor communication strategies effectively, fostering greater public cooperation and resilience in pandemic responses.\u003c/p\u003e \u003cp\u003eUnderstanding Nigerian perspectives on pandemic preparedness is crucial for developing targeted, culturally sensitive interventions [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and such understanding must be engendered before outbreaks occur for coordination and effective response. Nigeria's diverse cultural landscape requires nuanced communication and community engagement strategies to ensure widespread acceptance and compliance with preventive measures [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Identifying knowledge gaps, attitudes, and perceptions within Nigerian communities, can allow authorities to tailor interventions to address specific concerns, build trust, and optimize resource allocation as evidenced earlier [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This understanding is essential for promoting community resilience and effectively mitigating the impact of the future occurrence of infectious diseases in a country.\u003c/p\u003e \u003cp\u003ePrevious studies on pandemic preparedness in Nigeria have, for the most part, concentrated on the country's authorities\u0026rsquo; responses to specific interventions against infectious diseases such as the COVID-19 pandemic [\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] rather than on the preparedness of the Nigerian public. Addressing this gap is critical for evaluating Nigeria's readiness for pandemics, pinpointing areas needing enhancement, and minimizing the severity of future epidemic. Therefore, this study assessed the public (Nigerians) KAP regarding preparedness for the future pandemics.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study area and Study design\u003c/h2\u003e \u003cp\u003eThe study area for this research is Nigeria, a country located in West Africa. Nigeria is the most populous country in Africa with a population of 229,152,217 as at July 1 2024, based on the United Nations estimates [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], comprising diverse population groups representing different socio-economic backgrounds, educational levels, and geographical regions. Nigeria has six geo-political zones with 36 states and the Federal Capital Territory. In this study, we randomly selected individuals from six different states (Abia, Borno, Enugu, Kwara, Ogun, and Sokoto) Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which are representative of five of the six geo-political zones of Nigeria.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis study employed a cross-sectional design. The data were collected using a structured questionnaire through a face-to-face interview survey and online through a Google form from April to September 2023. The study population included adults aged 18 years and above living in different communities across Nigeria. Individuals who are unable to communicate effectively or who are critically ill will be excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Sample size and sampling technique\u003c/h2\u003e \u003cp\u003eThe sample size was calculated using the Open-Source Epidemiologic Statistics for Public Health (OpenEpi), v.3.01 (updated June 4, 2013) tool based on the assumption of a confidence level of 95%, the margin of error of 5%, an expected proportion of 50% of the population having satisfactory knowledge of pandemic preparedness, and a precision of 3%. The sample size was calculated to be 1066. At least 1066 participants were recruited for the study.\u003c/p\u003e \u003cp\u003eTo recruit the respondents, first, six states were randomly selected from the five geo-political zones in Nigeria: Abia, Borno, Enugu, Kwara, Ogun, and Sokoto. From each state, two local government areas (LGAs) were selected using a simple random sampling technique. Households from the following local governments were randomly selected across the selected states; Ilorin South, Moro, Odeda, Nsukka, Wammakko, Maiduguri, Biu, Udi Agwu, Yewa South, Kware, Umuahia South, and Umuahia North. Only one person was sampled from each household.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Ethical considerations\u003c/h2\u003e \u003cp\u003e The study protocol was reviewed and approved (FVER/UG/2023-16/32TA029) by the Faculty of Veterinary Medicine Ethical Review Committee, University of Ilorin, Nigeria. The survey participants provided written informed consent before completing the questionnaire. The research objectives were explained to participants before they completed the survey tool.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Questionnaire design\u003c/h2\u003e \u003cp\u003eThe questionnaire (Supplementary file 1) consisted of four sections: socio-demographic characteristics, respondents\u0026rsquo; knowledge, attitudes, and perceptions of preparedness for future pandemics. The questionnaire was designed as closed-ended questions to prevent disparities in the responses received and to improve accuracy and reduce the complexity of data analysis. The first section on the demographic information of the respondents included variables such as gender, level of education, age range, and location (local government area). The second section focused on knowledge of pandemics and included a total of 25 questions. The questions on the attitudes of respondents toward future pandemic preparedness were included in the third section. The last section consisted of 12 questions on a 5-point Likert scale about respondents\u0026rsquo; perceptions of future pandemics in Nigeria.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Questionnaire pre-test and administration\u003c/h2\u003e \u003cp\u003eTwo independent academic reviewers validated the instrument to assess its content and face validity, as well as its ease of administration [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The questionnaire was pre-tested among 20 individuals from Kwara State. Pre-test responses obtained were used to improve the quality of the questionnaire. Trained data enumerators (n\u0026thinsp;=\u0026thinsp;12) translated the survey instrument into local dialect, where needed, and surveyed the households across six selected states.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Data management and analysis\u003c/h2\u003e \u003cp\u003eThe data were filtered and entered into a database using Microsoft Excel 2016 (Microsoft Corporation, Redmond, WA, USA) and analyzed using Statistical Package for Social Sciences (SPSS) version 25.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics such as frequencies, percentages, means, and standard deviations were used to summarize the data. We utilized a numeric scoring system [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] to evaluate the knowledge, attitudes, and perceptions of pandemic preparedness among participants, considering them as outcome variables. The outcome variables were calculated using a predetermined scoring method, as outlined earlier [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Correct responses to both knowledge and attitude questions received a score of \"1,\" while incorrect responses were assigned a score of \"0.\" The 5-point Likert scale responses for perception were rated on a scale from \"4\" for \"strongly agree\" to \"0\" for \"strongly disagree.\" The total correct scores for each outcome variable were determined as the cumulative scores obtained from the questions answered correctly by the respondents. Respondents scoring greater or lower than the mean scores of all respondents for each outcome variable were considered good/satisfactory or poor/unsatisfactory, respectively [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Significant demographic variables were analyzed as independent factors associated with good knowledge or satisfactory attitudes toward or perceptions of pandemic preparedness using a stepwise backward binary logistic regression model. The goodness of fit of the model was assessed using the Hosmer-Lemeshow test. All the statistical analyses were performed at a 95% confidence level, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Demographic information of the study participants\u003c/h2\u003e \u003cp\u003eA total of 1276 respondents, from various households in six states across the five sampled geo-political zones of Nigeria, completed the questionnaire. There were more male respondents (700, 54.9%) than female (576, 45.1%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of the respondents (695, 54.5%) had a tertiary level of education. The respondents were of a diverse age group, with the distribution of the participants almost even across the surveyed states.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic structure of the respondents (n\u0026thinsp;=\u0026thinsp;1276)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBorno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnugu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKwara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOgun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSokoto\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Knowledge of the respondents on pandemics and pandemic preparedness\u003c/h2\u003e \u003cp\u003eOverall, an average of 621 (48.7%) of the respondents displayed good knowledge of pandemics and pandemic preparedness. Although a substantial number, 1236 (96.5%), of the respondents are aware of what a pandemic is, the proportion of those acknowledging the Spanish flu (596/1276) and Zika viral disease (541/1276) as causes of previous epidemics and pandemics and a possible future pandemic is low (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). It is important to note that less than 55% and 60% of respondents were aware of AMR and highly pathogenic avian influenza as possible causes of future pandemics, respectively. Most participants (\u0026gt;\u0026thinsp;80.0%) demonstrated high awareness of preparedness strategies against future pandemics, such as social distancing, personal hygiene practices, controlled international travel and trade, lockdown policy, and vaccination. Only 533 (41.8%) of the respondents were aware of the Presidential Task Force put in place in Nigeria during the control of the last major pandemic.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge of pandemic preparedness among respondents (n\u0026thinsp;=\u0026thinsp;1276)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003es/n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA pandemic is a disease outbreak that spreads within Nigeria, throughout Africa, and the rest of the world causing deaths among a high population of people.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1236 (96.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhich of these are some of the pandemics that you have heard of in the past and could cause future pandemics?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpanish flu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e596 (46.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHIV/AIDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e819 (64.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEbola viral disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1055 (82.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSARS including COVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1083 (84.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonkeypox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e933 (73.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLassa fever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1004 (78.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZika\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e541 (42.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly pathogenic Avian influenza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e732 (57.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAntimicrobial resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e682 (53.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTuberculosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e760 (59.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAre you aware of the basic preventive measures to reduce the spread of infectious diseases, such as hand hygiene and wearing masks?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1230 (96.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhich of these are some of the actions to be taken during pandemics?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial distancing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1177 (92.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal hygiene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1161 (91.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRisk communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e756 (59.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControlled international travel and trade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1057 (82.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLockdown policy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1029 (80.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of vaccines and antivirals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1106 (86.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAre you familiar with the signs and symptoms of common infectious diseases?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1187 (93.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe following are reliable organizations of information on infectious diseases and pandemics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNigerian Centre for Disease Control and Prevention (NCDC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1167 (91.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFederal Ministry of Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1083 (84.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfrican CDC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e801 (62.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorld Health Organization (WHO)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1101 (86.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCenters for Disease Control and Prevention (CDC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e946 (74.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresidential Tasks Force Committee on Pandemic Control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e533 (41.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Attitudes of respondents toward pandemics and pandemic preparedness\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the attitudes of respondents toward preparedness for future pandemics. While most respondents (63.6%) have a satisfactory attitude toward pandemic preparedness, a significant portion have not engaged in related community initiatives (515 out of 1276). Moreover, approximately half of the respondents had not taken proactive steps to educate themselves about pandemic preparedness (704 out of 1276). Additionally, a substantial number do not trust the government's prioritization of pandemic preparedness and response (667 out of 1276), feel that they lack sufficient knowledge to make informed decisions (730 out of 1276), and lack confidence in the health authority's ability to swiftly recover from the economic impact of future pandemics (573 out of 1276).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitudes of respondents on concerns regarding preparedness for future pandemics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre you personally concerned about the possibility of the occurrence of future pandemics?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1073 (84.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you taken any proactive steps to educate yourself about pandemic preparedness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e704 (55.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you believe that individuals have a responsibility to contribute to pandemic preparedness efforts?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1016 (79.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you participated in any community initiatives related to pandemic preparedness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e515 (40.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you trust that the government will prioritize pandemic preparedness and response?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e667 (52.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWould you be willing to follow public health guidelines and recommendations during the occurrence of a future pandemic, even if they cause inconvenience?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e881 (69.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you discussed pandemic preparedness with your friends or family members?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e755 (59.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you feel that you have sufficient knowledge to make informed decisions about pandemic preparedness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e730 (57.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre you confident in the ability of Nigeria to recover quickly from the economic impact of a future pandemic?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e573 (44.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWould you be willing to volunteer your time or resources to support pandemic response efforts?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e939 (73.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Perception of the respondents concerning the control of future pandemics in Nigeria\u003c/h2\u003e \u003cp\u003eOverall, less than half (581, 45.5%) of the respondents had positive perceptions about controlling future pandemics in Nigeria. In particular, respondents expressed positive opinions regarding the personal responsibility of taking preventive measures during pandemics (860/1276) and the introduction of pandemic control policies such as social distancing (816/1276). However, only a few of the respondents agreed that Nigeria is adequately prepared to handle future pandemics (321/1276).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Factors associated with good knowledge, satisfactory attitudes, and positive perceptions of pandemic preparedness among respondents\u003c/h2\u003e \u003cp\u003eAge, educational level, and state of residence were significantly associated with good knowledge, satisfactory attitudes, and positive perceptions of pandemic preparedness (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Respondents with a tertiary education level were twice as likely to have good knowledge (OR: 2.21, 95% CI: 1.62\u0026ndash;3.01, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), satisfactory attitudes (OR: 1.88, 95% CI: 1.38\u0026ndash;2.57, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and positive perceptions (OR: 1.54, 95% CI: 1.14\u0026ndash;2.09, p\u0026thinsp;=\u0026thinsp;0.006) regarding the response to and control of future pandemics. Respondents who were residents of Kwara State were more likely to have a positive perception (OR: 1.96, 95% CI: 1.35\u0026ndash;2.86, p\u0026thinsp;=\u0026thinsp;0.001) of pandemic preparedness.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinary logistic regression analysis of factors associated with good knowledge, satisfactory attitudes, and positive perception of pandemic preparedness among respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value (χ\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e354 (50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e346 (49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e301 (52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e275 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209 (41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e290 (58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.49, 0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.004*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e186 (59.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128 (40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.37, 0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.25, 0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141 (62.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.72, 1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (60.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.76, 1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e300 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e395 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.62, 3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (44.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.34, 0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnugu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151 (71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.17, 0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKwara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (57.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.58, 1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOgun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132 (62.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.72, 1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSokoto\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127 (62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.25, 0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eAttitudes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSatisfactory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value (χ\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e240 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e460 (65.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e224 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e352 (61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.46, 1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.49, 1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e192 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e503 (72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.38, 2.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e366 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.37, 0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181 (57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.37, 0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.32, 0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132 (64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.54, 1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnugu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.36, 0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKwara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e168 (73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.83, 1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOgun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115 (54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.36, 0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSokoto\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (63.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.52, 1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003ePerceptions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value (χ\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e395 (56.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e305 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e300 (52.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e276 (47.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e221 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e278 (55.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194 (58.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138 (41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.43, 0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210 (66.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29, 0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (53.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (46.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.47, 1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (64.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.49, 1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (66.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.48, 1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e330 (47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e365 (52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.14, 2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.006*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.71, 1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.896\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnugu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29, 0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKwara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (61.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.35, 2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOgun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.57, 1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.395\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSokoto\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (46.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (54.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.98, 2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eWe have explored the KAP of Nigerians on pandemic and determined that the current state of pandemic preparedness among Nigerian general public requires urgent attention in terms of focused interventions and bolstering public health resilience. Though respondents demonstrated good knowledge of pandemic preparedness, cause-specific awareness about historical and potential causes of future pandemics, such as the Spanish flu, Zika disease, AMR, and highly pathogenic avian influenza, remains relatively low. While 63.6% of respondents expressed satisfactory attitudes toward pandemic preparedness, a significant portion had not participated in community initiatives, half of them had not educated themselves about pandemic preparedness, and many lacked trust in the government's prioritization, felt insufficiently informed, and lacked confidence in the country's economic recovery from future pandemics. Less than half of the respondents had a positive perception of Nigeria's ability to control future pandemics, although they expressed positive views on personal preventive measures and pandemic control policies, with few believing in Nigeria's preparedness for future pandemics. To the best of our knowledge, this study is the first to survey the knowledge gaps, attitudes, and perceptions of Nigerians regarding preparedness for future pandemics.\u003c/p\u003e \u003cp\u003eA noteworthy finding from our study is the prevalence of inadequate knowledge regarding pandemics and preparedness measures among respondents. Despite the high awareness of pandemics in general, particularly in the recognition of recent outbreaks such as COVID-19, the understanding of historical pandemics such as the Spanish flu and emerging threats such as AMR remains alarmingly low. The inadequate knowledge of cause-specific pathogens makes the Nigerian community vulnerable to outbreaks even though awareness and knowledge is there. This deficiency in historical and prospective knowledge underscores the need for targeted educational campaigns aimed at enhancing public awareness and understanding of pandemic dynamics. Though, recent studies have indicated that citizens of various countries have good knowledge of recent pandemics such as COVID-19 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], emphasis should be placed on the need for Nigerian citizens to be enlightened about past pandemics to create a sense of adequate preparation for future pandemics. A sufficient understanding of pandemics and general health information serves to dispel misconceptions surrounding pandemic situations, heighten awareness of susceptibility to infection risk and bolster self-efficacy in self-protection measures [\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In particular, awareness about AMR and the highly pathogenic avian influenza pandemics is increasing as they present constant re-emergence threats to the world, including Nigeria.\u003c/p\u003e \u003cp\u003eOur observation that most participants exhibited strong awareness of preparedness strategies for future pandemics, including social distancing, personal hygiene, regulated international travel and trade, lockdown policies, and vaccination is expected. This finding is similar to earlier reports in which citizens demonstrated the required level of awareness and preparedness for pandemics [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. However, more efforts should be made to educate Nigerian citizens on national bodies such as the Presidential Task Force entrusted with the duties to curtail pandemics.\u003c/p\u003e \u003cp\u003eAlthough most of the respondents (63.6%) in our survey displayed satisfactory attitudes toward pandemic preparedness, a significant portion did not engage in related community initiatives. Not participating in community initiative makes the society leaves the responsibility of pandemic control to health authorities alone, but whole-of-society approach at disease management will engender One Health disease intelligence better. Community initiatives are crucial for pandemic control, fostering collective responses to curb the spread of infectious diseases as they empower communities to promote public health guidelines, provide essential resources, organize vaccination drives, and support vulnerable populations. Strong community infrastructure is a necessary element that has been insufficiently addressed in effective pandemic prevention, preparedness, and response frameworks [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Poor community engagement initiatives have led to disastrous events during the Ebola virus disease epidemic in West Africa from 2014\u0026ndash;2016 [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, with the COVID-19 pandemic, community engagement was well-utilized during the pandemic resulting in positive outcomes in some LMICs [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Through grassroots efforts, communities can disseminate accurate information, combat misinformation, and encourage adherence to preventive measures such as social distancing and hygiene practices. These initiatives promote solidarity, mutual aid, and resilience, ensuring that no one is left behind.\u003c/p\u003e \u003cp\u003eMoreover, our findings revealed a pervasive sense of skepticism and apprehension among respondents regarding the adequacy of preparedness efforts, with a substantial proportion (667/1276) expressing doubts about the government's commitment to prioritizing pandemic preparedness and response. This finding is similar to an earlier report from South American countries [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This reflects broader concerns about institutional capacity and efficacy. The lack of confidence in the country's ability to swiftly recover from the economic fallout of future pandemics underscores the interconnectedness of public health and socio-economic resilience. Lack of confidence in the government\u0026rsquo;s ability to contain disease outbreaks create trust gap, hence self-help and hiding information from government about early outbreaks will become rampant. Addressing these perception challenges demands proactive engagement and advocacy with stakeholders to foster trust, transparency, and accountability in pandemic response strategies [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTertiary education has emerged as a key predictor of better knowledge, attitudes, and perceptions, emphasizing the pivotal role of education in shaping public health literacy and awareness. Similarly, younger respondents exhibit greater levels of knowledge and more positive perceptions than older respondents, suggesting the need for targeted interventions tailored to different demographic segments. Furthermore, variations in perception across different states highlight the importance of contextualizing interventions to address regional disparities and sociocultural nuances in Nigeria. Efforts to strengthen pandemic preparedness should prioritize comprehensive education initiatives targeting diverse demographic groups. However, higher tertiary level education dominating the study may not truly reflect the whole population structure of the country, hence, may not give overall comprehensive outlook of how the whole of society may behave. Possibly a similar study in the more rural areas may have different outcomes, as general health perception may vary by residence [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study is subject to certain limitations, including the cross-sectional design and the reliance on self-reported data, which may be subject to recall bias and social desirability effects. However, we ensured that our methodology was well-structured and included a validated instrument ensuring reliability and depth in understanding Nigerians' knowledge, attitudes, and perceptions regarding pandemic preparedness. The main strength of the research lies in its comprehensive assessment, facilitated by a large and diverse sample size of 1276 respondents across Nigeria. Additionally, adherence to ethical guidelines, contextual relevance, and the identification of significant knowledge gaps further enhance the study's robustness and its potential to inform targeted interventions and policy recommendations for enhancing public health resilience in Nigeria. Future research should adopt longitudinal approaches and incorporate qualitative methods to gain deeper insights into the socio-cultural factors shaping public perceptions of pandemic preparedness. Exploring the role of social media and traditional communication channels in influencing public attitudes can offer valuable insights into effective risk communication strategies.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eAddressing the knowledge gaps and perception challenges identified in this study is imperative for strengthening Nigeria's resilience against future pandemics. By fostering a culture of proactive engagement, informed decision-making, and collaborative action, policymakers and public health practitioners can mitigate the impact of future infectious disease outbreaks and safeguard the well-being of the Nigerian population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003cstrong\u003es\u0026nbsp;\u003c/strong\u003eWe acknowledge all the respondents for their time spent completing and survey questions and the researchers who helped to revise the questionnaire.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003cstrong\u003euthor\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eIsmail Ayoade Odetokun was involved in the study conceptualization, investigation, analysis, writing of the manuscript, review, and editing. Oluwatobi Oniyanda participated in the investigation, analysis, writing, and editing. Ali Raza was involved in the methodology, writing, and editing. Uduak Akpabio, Aliyu Ibrahim Musawa, Idris Umar Hambali, and Shuaibu Gidado Adamu were involved in the methodology, investigation, data collection, review, and editing. Lateefah Oyafajo partook in the investigation, methodology, and project administration. Nma Bida Alhaji and Folorunso Oludayo Fasina were involved in methodology, project administration, supervision, review, and editing. All authors reviewed and approved the final version for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThis research received no specific funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003eData is available upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003eThe study protocol was reviewed and approved (FVER/UG/2023-16/32TA029) by the Faculty of Veterinary Medicine Ethical Review Committee, University of Ilorin, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003eThe survey participants provided written informed consent before completing the questionnaire. The research objectives were explained to participants before they completed the survey tool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einterests\u0026nbsp;\u003c/strong\u003eThe authors of this manuscript declare no potential conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePetersen E, Abubakar I, Ihekweazu C, Heymann D, Ntoumi F, Blumberg L, et al. Monkeypox - Enhancing public health preparedness for an emerging lethal human zoonotic epidemic threat in the wake of the smallpox post-eradication era. IJID. 2019;78\u0026ndash;84. https://doi.org/10.1016/j.ijid.2018.11.008\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMorens DM, Fauci AS. Emerging Pandemic Diseases: How We Got to COVID-19. Cell. 2020;182(5):1077\u0026ndash;1092. https://doi.org/10.1016/j.cell.2020.08.021\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSharan M, Vijay D, Yadav JP, Bedi JS, Dhaka P. 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Nigeria\u0026rsquo;s public health response to the COVID-19 pandemic: January to May 2020. J Glob Health. 2020;10(2):020399. https://doi.org/10.7189/jogh.10.020399\u003c/li\u003e\n \u003cli\u003eAkinyemi OO, Popoola OA, Fowotade A, Adekanmbi O, Cadmus EO, Adebayo A. Qualitative exploration of health system response to COVID-19 pandemic applying the WHO health systems framework: Case study of a Nigerian state. Sci Afr. 2021;13:e00945. https://doi.org/10.1016/j.sciaf.2021.e00945\u003c/li\u003e\n \u003cli\u003eJacobs ED, Okeke MI. A critical evaluation of Nigeria\u0026rsquo;s response to the first wave of COVID-19. Bull Natl Res Cent. 2022;46(1):44. https://doi.org/10.1186/s42269-022-00729-9\u003c/li\u003e\n \u003cli\u003eWorld Population Review 2024. Nigeria Population 2024 (Live). https://worldpopulationreview.com/countries/nigeria-population\u003c/li\u003e\n \u003cli\u003eOdetokun IA, Ghali-Mohammed I, Alhaji NB, Nuhu AA, Oyedele HA, Ameen SA, et al. Occupational health and food safety risks in Ilorin, Northcentral Nigeria: a cross-sectional survey of slaughterhouse workers. Food Prot Trends. 2020;40:241\u0026ndash;250.\u003c/li\u003e\n \u003cli\u003eOdetokun IA, Borokinni BO, Bakare SD, Ghali-Mohammed I, Alhaji NB. A cross-sectional survey of consumers\u0026rsquo; risk perception and hygiene of retail meat: a Nigerian study. Food Prot Trends. 2021;41:274\u0026ndash;283.\u003c/li\u003e\n \u003cli\u003eOdetokun IA, Afolaranmi ZM, Nuhu AA, Borokinni BO, Ghali-Mohammed I, Cisse H, et al. Knowledge and self-reported food safety practices among meat consumers in Ilorin, Nigeria. Dialogues Health. 2022;1:100039. https://doi.org/10.1016/j.dialog.2022.100039\u003c/li\u003e\n \u003cli\u003eAlrajhi AM, Hussain WA, Rafie BA, Taj M, Elgarf AM. Knowledge and awareness of COVID-19 epidemic preparedness and response among health care workers in Makkah city. Ther Adv Infect Dis. 2022;9:20499361221079452. https://doi.org/10.1177/20499361221079452\u003c/li\u003e\n \u003cli\u003eLau JT, Griffiths S, Choi KC, Tsui HY. Widespread public misconception in the early phase of the H1N1 influenza epidemic. J Infect. 2009;59(2):122\u0026ndash;127. https://doi.org/10.1016/j.jinf.2009.06.004\u003c/li\u003e\n \u003cli\u003eWong LP, Sam IC. Knowledge and attitudes in regard to pandemic influenza A(H1N1) in a multiethnic community of Malaysia. Int J Behav Med. 2011;18(2):112\u0026ndash;121. https://doi.org/10.1007/s12529-010-9114-9\u003c/li\u003e\n \u003cli\u003eRinc\u0026oacute;n Uribe FA, Godinho RCS, Machado MAS, Oliveira KRDSG, Neira Espejo CA, de Sousa NCV, et al. Health knowledge, health behaviors and attitudes during pandemic emergencies: A systematic review. PloS One. 2021;16(9):e0256731. https://doi.org/10.1371/journal.pone.0256731\u003c/li\u003e\n \u003cli\u003eTripathi R, Alqahtani SS, Albarraq AA, Meraya AM, Tripathi P, Banji D, et al. Awareness and Preparedness of COVID-19 Outbreak Among Healthcare Workers and Other Residents of South-West Saudi Arabia: A Cross-Sectional Survey. Front Public Health. 2020;8:482. https://doi.org/10.3389/fpubh.2020.00482\u003c/li\u003e\n \u003cli\u003eByanyima W, Lauterbach K, Kavanagh MM. Community pandemic response: the importance of action led by communities and the public sector. Lancet. 2023;401(10373):253\u0026ndash;255. https://doi.org/10.1016/S0140-6736(22)02575-2\u003c/li\u003e\n \u003cli\u003eKutalek R, Ahmed SM, Kaawa-Mafigiri D, Giles-Vernick T. Community engagement: learning from low-income countries. Lancet. 2023;401(10390):1767\u0026ndash;1768. https://doi.org/10.1016/S0140-6736(23)00568-8\u003c/li\u003e\n \u003cli\u003eHyland-Wood B, Gardner J, Leask J, Ecker UKH. Toward effective government communication strategies in the era of COVID-19. Humanit Soc Sci Commun. 2021;8:30. https://doi.org/10.1057/s41599-020-00701-w\u003c/li\u003e\n \u003cli\u003eRam\u0026iacute;rez Varela A, Touchton M, Miranda JJ, Grueso JM, Laajaj R, Carrasquilla G, et al. Assessing pandemic preparedness, response, and lessons learned from the COVID-19 pandemic in four south American countries: agenda for the future. Front Public Health. 2023;11:1274737. https://doi.org/10.3389/fpubh.2023.1274737\u003c/li\u003e\n \u003cli\u003eHuang L, Cleveland T, Clift K, Egginton JS, Pacheco-Spann L, Johnson MG, et al. Key Stakeholder Perspectives of Community Engagement Efforts and the Impact of the Covid-19 Pandemic. J Prim Care Community Health. 2022;13:21501319221133076. https://doi.org/10.1177/21501319221133076\u003c/li\u003e\n \u003cli\u003eIngram M, Sabo S, Rothers J, Wennerstrom A, de Zapien JG. Community Health Workers and community advocacy: addressing health disparities. J Community Health. 2008;33(6):417\u0026ndash;424. https://doi.org/10.1007/s10900-008-9111-y\u003c/li\u003e\n \u003cli\u003eMainous AG 3rd, Kohrs FP. A comparison of health status between rural and urban adults. J Community Health. 1995;20(5):423\u0026ndash;431. https://doi.org/10.1007/BF02260438\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pandemic, Preparedness, Public perception, Knowledge, Infectious diseases, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-4554233/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4554233/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003ePandemics are global health crises that have caused millions of deaths, enormous socio-economic disruptions, and considerable public and global health security consequences. This study assessed the knowledge, attitudes, and perceptions of Nigerians regarding preparedness for the next pandemic.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional questionnaire-based national survey was conducted among 1276 respondents in Nigeria to determine public knowledge, attitudes, and perceptions of preparedness for future pandemics. Descriptive and inferential statistics were used for analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 1276 respondents to this survey, \u0026gt;\u0026thinsp;50% had not heard of the Spanish flu or Zika disease. Approximately half (594) of the respondents did not consider antimicrobial resistance a possible cause of future pandemics. Over an average proportion of respondents reported unsatisfactory knowledge (655, 51.3%) and poor perception (695, 54.5%) about pandemic preparedness. The respondents' good knowledge and satisfactory attitudes toward pandemic preparedness decreased with increasing age. The respondents' education, age, and state of residence were significantly associated with good knowledge, satisfactory attitudes, and positive perceptions of pandemic preparedness with respondents with tertiary education levels being at least 2\u0026times; more likely to have these positive outcomes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study revealed serious gaps in Nigerians' knowledge, attitudes, and perceptions of their readiness for upcoming pandemics. To protect Nigerians' health, emphasis should be placed on these issues.\u003c/p\u003e","manuscriptTitle":"Nigerians' outlook on pandemic preparedness – gaps and mitigations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-03 06:30:21","doi":"10.21203/rs.3.rs-4554233/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-04T13:55:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-04T13:55:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-01T02:16:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-30T21:05:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291289827637164170132912895140731879666","date":"2024-06-28T13:42:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303322765009922644671312711127030551302","date":"2024-06-26T16:51:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182878189814828208881619840563070097527","date":"2024-06-26T16:48:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133719880335404764625910456051054839475","date":"2024-06-25T15:03:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-25T11:01:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209373866982467273670769372586114616817","date":"2024-06-25T08:33:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-24T16:46:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-17T06:41:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-17T06:35:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2024-06-09T14:47:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c33bfe1a-cbba-45ab-9c5d-fe5611589174","owner":[],"postedDate":"July 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-09T16:14:29+00:00","versionOfRecord":{"articleIdentity":"rs-4554233","link":"https://doi.org/10.1186/s12982-024-00195-w","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2024-09-02 16:05:47","publishedOnDateReadable":"September 2nd, 2024"},"versionCreatedAt":"2024-07-03 06:30:21","video":"","vorDoi":"10.1186/s12982-024-00195-w","vorDoiUrl":"https://doi.org/10.1186/s12982-024-00195-w","workflowStages":[]},"version":"v1","identity":"rs-4554233","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4554233","identity":"rs-4554233","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}