Clinical, Operational, and Economic Evaluation of Point-of-Care X-ray Use in Outbreak Response in Nigeria: A Cross-Sectional Mixed-Methods Study

Background: Rapid and accurate diagnosis is essential for outbreak control, particularly in resource-limited settings where centralized imaging is often unavailable. Point-of-care (POC) X-ray systems offer portable and cost effective radiography that may support outbreak detection and faster clinical decision-making. Methods: We conducted a cross-sectional mixed-methods survey of 327 healthcare professionals and outbreak responders across urban, rural/remote, and outbreak-field settings in Nigeria. Quantitative data were summarized using descriptive statistics. Associations were explored using chi-square tests, independent t-tests, and logistic regression. Primary outcome: High perceived clinical utility of POC X-ray for rapid screening/triage (Likert rating ≥4). Results: Respondents were predominantly male (64.2%) and aged 20–40 years (66.4%); 85.6% reported outbreak response experience, mainly involving respiratory outbreaks (85.7% of those with outbreak experience). POC X-ray was rated highly for rapid screening/triage (mean 4.6/5), differential diagnosis (4.3/5), and disease severity assessment (4.2/5). In multivariable analysis, physician cadre (aOR=1.85, p=0.02), outbreak-field workers (aOR=2.10, p=0.008), years of experience (aOR 1.03 per year; 95% CI 1.01–1.06), and high familiarity with POC X-ray ((aOR=3.50, p<0.001) were significantly more likely to rate POC X-ray as extremely valuable. Key implementation barriers reported included limited availability of skilled operators (75%), high operational costs (70%), and limited technical support (60%). Conclusion: POC X-ray significantly enhances outbreak diagnostic capacity but requires investment in workforce training and maintenance systems maximize its clinical and economic impact.