Community Perceptions of Yellow Fever in Nigeria’s North East: Environmental, Socioeconomic, and Behavioral Determinants of Transmission Risk

Abstract

Background: Yellow fever virus (YFV) remains a recurrent public health concern in Nigeria, particularly in the North East geopolitical region. Although an effective vaccine is available, continued outbreaks are shaped by ecological suitability for mosquito vectors, socioeconomic vulnerability, and health system limitations. Evidence on community perceptions of epidemiological patterns and transmission determinants is essential to inform context-specific prevention and control strategies. Objective: To assess community perceptions of the current yellow fever situation in Nigeria’s North East and to examine environmental, socioeconomic, and behavioral factors perceived to influence YFV transmission. Methods: A community-based cross-sectional study was conducted among 563 adult respondents across six states (Adamawa, Bauchi, Borno, Gombe, Taraba, and Yobe). A multistage sampling technique was used. Data were collected through a structured questionnaire capturing socio-demographic characteristics and perception-based items on epidemiological patterns and determinants of transmission. Perception statements were rated on a 5-point Likert scale. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize responses. Findings reflect community-reported perceptions rather than confirmed surveillance data. Results: Females constituted 60% of respondents, and 57% were aged 20–39 years. Nearly half reported no formal or only Qur’anic education, while farming (35%) and unemployment (32%) were the predominant occupations. Most participants agreed that yellow fever remains a major public health concern in the region (mean = 2.97 ± 0.92), that cases have increased in recent years (2.85 ± 0.83), and that outbreaks follow seasonal patterns (2.75 ± 0.74). Climate variability (2.95 ± 0.92), poor waste management (2.82 ± 0.87), limited healthcare infrastructure (2.80 ± 0.86), and low vaccination uptake and inadequate personal protection (2.73 ± 0.76) were widely perceived as key contributors to transmission. Conclusion: Yellow fever is widely perceived as an ongoing public health threat in Nigeria’s North East, driven by interconnected environmental, socioeconomic, and behavioral factors. Strengthening vaccination coverage, improving surveillance and healthcare access, promoting environmental management, and implementing culturally tailored risk communication strategies are essential. These interventions should be integrated within climate-informed and cross-border coordination frameworks to enhance sustainable yellow fever control in the region.