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Background <p>Neglected Tropical Diseases (NTDs) disproportionately affect impoverished communities, contributing to significant morbidity and economic hardship. Despite global efforts, certain areas remain persistent NTD hotspots. Building on a previous study that identified NTD hotspots using a crowdsourced image-based surveillance approach, this study examines environmental, socioeconomic, and health system-related factors associated with NTD hotspots in southern Nigeria.</p> Methods <p>A sequential explanatory mixed-methods design was employed, integrating a cross-sectional survey, environmental situational assessments using observational checklist, and key informant interviews (KIIs). The study covered 15 communities across Ondo State, Nigeria, categorized as either hotspots or moderate-prevalence locations based on prevalence data from a previous study. Quantitative data were analyzed using chi-square, while qualitative data underwent thematic analysis.</p> Results <p>A total of 550 residents participated, with 52.2% (<i>n</i> = 287) from hotspot communities and 47.8% (<i>n</i> = 263) from moderate-prevalence areas. Women comprised 54.2% of respondents. The mean age was 32.6 ± 13.7 years, similar between hotspot (32.9 ± 13.9) and moderate-prevalence (32.4 ± 13.5) communities. Regarding education, 36.4% had secondary education, 23.5% had tertiary education, and 19.3% had only primary education. Monthly household income ranged from &lt; $33.33 to &gt; $666.67; over one-third (34.7%) reported earnings below $133.33 per month. Hotspot residents were significantly more likely to have only primary or secondary education (χ² = 14.8, <i>p</i> &lt; 0.001) and to report lower income (χ² = 12.8, <i>p</i> = 0.096). About 41.5% of hotspot respondents reported having an NTD compared with 34.6% in moderate-prevalence communities. Only 30% of affected individuals sought treatment, and use of modern care was lower in hotspot areas (χ² = 15.2, <i>p</i> = 0.02). Trust in local healthcare providers was also markedly lower in hotspots (66.2% vs. 37.6% reporting no trust; χ² = 34.9, <i>p</i> &lt; 0.001).</p> Conclusion <p>This study attempts to highlights the environmental and systemic challenges that are likely to be sustaining NTD hotspots. Strengthening community-based surveillance (diseases reporting and follow-up), improving access to NTD-specific treatment, and addressing healthcare trust deficits stood out and look critical for effective disease control. Findings from this study are applicable to other NTD-endemic regions, providing a framework for targeted interventions aligned with the WHO 2030 NTD elimination goals.</p>

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Environmental, socioeconomic, and health-system factors associated with NTD hotspots in southern Nigeria: a mixed-methods study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月12日

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  • Ayoola Oluwaseun Bosede,
  • Christopher Sule Oyamienlen,
  • Adanna Nneoma Chukwuocha,
  • Uzochukwu Godswill Ekeleme,
  • Justina Ugochi Udensi,
  • Obinna Godwin Udujih,
  • Uchechukwu Madukaku Chukwuocha

摘要

Background

Neglected Tropical Diseases (NTDs) disproportionately affect impoverished communities, contributing to significant morbidity and economic hardship. Despite global efforts, certain areas remain persistent NTD hotspots. Building on a previous study that identified NTD hotspots using a crowdsourced image-based surveillance approach, this study examines environmental, socioeconomic, and health system-related factors associated with NTD hotspots in southern Nigeria.

Methods

A sequential explanatory mixed-methods design was employed, integrating a cross-sectional survey, environmental situational assessments using observational checklist, and key informant interviews (KIIs). The study covered 15 communities across Ondo State, Nigeria, categorized as either hotspots or moderate-prevalence locations based on prevalence data from a previous study. Quantitative data were analyzed using chi-square, while qualitative data underwent thematic analysis.

Results

A total of 550 residents participated, with 52.2% (n = 287) from hotspot communities and 47.8% (n = 263) from moderate-prevalence areas. Women comprised 54.2% of respondents. The mean age was 32.6 ± 13.7 years, similar between hotspot (32.9 ± 13.9) and moderate-prevalence (32.4 ± 13.5) communities. Regarding education, 36.4% had secondary education, 23.5% had tertiary education, and 19.3% had only primary education. Monthly household income ranged from < $33.33 to > $666.67; over one-third (34.7%) reported earnings below $133.33 per month. Hotspot residents were significantly more likely to have only primary or secondary education (χ² = 14.8, p < 0.001) and to report lower income (χ² = 12.8, p = 0.096). About 41.5% of hotspot respondents reported having an NTD compared with 34.6% in moderate-prevalence communities. Only 30% of affected individuals sought treatment, and use of modern care was lower in hotspot areas (χ² = 15.2, p = 0.02). Trust in local healthcare providers was also markedly lower in hotspots (66.2% vs. 37.6% reporting no trust; χ² = 34.9, p < 0.001).

Conclusion

This study attempts to highlights the environmental and systemic challenges that are likely to be sustaining NTD hotspots. Strengthening community-based surveillance (diseases reporting and follow-up), improving access to NTD-specific treatment, and addressing healthcare trust deficits stood out and look critical for effective disease control. Findings from this study are applicable to other NTD-endemic regions, providing a framework for targeted interventions aligned with the WHO 2030 NTD elimination goals.