Public perception and health behaviours related to diphtheria risk in Northern Nigeria

Background: Diphtheria, a vaccine-preventable disease, has re-emerged in Northern Nigeria with serious public health consequences. Understanding how awareness and risk perception shape health behaviours is critical for controlling outbreaks. This study assessed public awareness, risk perception, and associated socio-demographic factors among residents in selected high-burden states in northern Nigeria. Methods: A cross-sectional survey was conducted from December 2022 to December 2023 across ten northern Nigerian states. A structured, interviewer-administered questionnaire was utilized to obtain data from 2,924 arbitrarily designated adult participants through multistage sampling. Descriptive statistics were used to summarize findings. Logistic regressions (univariate and multivariate) identified associations and real predictors of Diphtheria awareness and risk perception. Results: Out of 3,050 individuals approached, 2,924 completed the survey (95.9% response rate). Overall, 87.1% were aware of diphtheria. Radio (51.9%) and healthcare workers (28.7%) were the dominant sources of information. Tertiary education was the strongest predictor of awareness (COR 3.302; 95% CI:2.204–4.947; aOR 2.337; 95% CI:1.418–3.853; p < 0.001), while individuals with no formal education had significantly lower awareness (COR 0.486; p = 0.003). Islamic affiliation became significant after adjustment (aOR 1.527; p = 0.021), suggesting confounding or effect modifications. Marital status remained a key factor, with Single and Separated individuals being less aware of Diphtheria compared to married (aOR 0.776; 95% CI: 0.672–0.896; p = 0.001). Risk perception was also positively associated with tertiary education (aOR 1.262; p < 0.001), while males had significantly lower perception than females (aOR 0.790; p = 0.005). State of residence significantly influenced both awareness and risk perception (aOR 1.031; 95% CI: 1.000–1.063; p = 0.049). Despite high awareness, misconceptions persisted. Most participants (78.0%) were willing to vaccinate their under-five children, though 2.4% exhibited vaccine-hesitance. Conclusions: High awareness of diphtheria coexists with disparities in risk perception across marital status, state of residence, and gender. While education and trusted communication channels play a critical role in shaping public understanding, significant knowledge gaps remain. Addressing misconceptions, promoting vaccine acceptance, and implementing targeted awareness initiatives are essential. To improve Diphtheria outbreak response and preventive practices in Nigeria, it is vital to increase education, reduce gender disparities and enhance risk communication through culturally sensitive, multilingual strategies.