Trend and Spatial Geographical Distribution of the Reemergence of Diphtheria in Plateau State, North-Central Nigeria

Background: Diphtheria, an infectious disease caused by Corynebacterium diphtheriae, is a major worldwide health problem due to its high incidence and prevalence, especially among children. Nigeria is among the African countries with the highest reported cases in the North-central geopolitical zone, with Plateau State being particularly affected.
Objective: This study aimed to identify Diphtheria trends and spatial geographic distribution in Plateau State, Nigeria.
Methodology: The study used a retrospective cross-sectional and ecological design to understand the temporal trends and spatial distribution of diphtheria cases across Plateau State from January 2015 to December 2024. The sample size was determined by the number of diphtheria cases reported by the WHO from 2015 to 2024. Purposive sampling was used based on the location of suspected, confirmed, and death cases in 17 Local Government Areas (LGAs). Data was extracted from WHO databases and visualised using ArcGIS software. The study adhered to ethical guidelines, ensuring unbiased analysis and open disclosure. Data were analysed using SPSS 25.0 and ArcGIS, and the Chi-square test was used to examine the relationship between LGAs and classification and vaccination at a significance level of 0.05.
Results: The study revealed that Kenam had the highest incidence of suspected, confirmed, and fatal cases among the 441 LGAs, followed by Barkin-Ladi and Jos-North. The lowest incidence was found in Jos-East, Kanke, and Langtang-South. The most confirmed cases were found in Kenam, followed by Jos-East, Kanke, and Langtang-South. The research also found a significant correlation between local government areas and diphtheria incidences, with 59.2% of Kanam's population vaccinated.
Conclusion: There is a significant trend and spread of suspected cases of Diphtheria in Plateau State, with a few confirmed cases. Kanem LGA recorded high suspicion, confirmed, vaccinated, and uncertainty about people's vaccinated status. It is therefore recommended that WHO and PSHMB take prompt action by immunising those who are not afflicted, educating the public about diphtheria symptoms, re-introducing booster shots, identifying symptomatic individuals early, and reducing geographic spread factors.

Diphtheria, confirmed, Plateau State, suspected, trend, vaccinated, LGAs

1. Aborode AT, Ajagbe AO, Adewunmi RO, Fasawe AS. (2023). Resurgence of diphtheria outbreak in Nigeria. New Microbes New Infect 53: 101125. http://dx.doi.org/10.1016/j.nmni.2023.101125 PMID: 37090946 [Google Scholar] [Crossref]

2. Adegboye, O. A., Alele, F. O., Pak, A., Castellanos, M. E., Abdullahi, M. A. S., Okeke, M. I., Emeto, T. I., & McBryde, E. S. (2023). A resurgence and reemergence of Diphtheria in Nigeria, 2023. Therapeutic Advances in Infectious Disease, 10. https://doi.org/10.1177/20499361231161936 [Google Scholar] [Crossref]

3. Ahmed, A., Singh, M., Tank, P., & Yadav, M. (2023). Clinico-epidemiological profile and predictors of poor outcome among children during a diphtheria outbreak in Haryana. Indian Pediatrics, 60(4), 280-284 [Google Scholar] [Crossref]

4. Atere, A. D., Ogaje, M. O., Ahmad, A. F., & Hussain, M. (2024). Risk Assessment and Management of Diphtheria: Strategies for Prevention and Control BJMLS 9(1): 222 – 236 [Google Scholar] [Crossref]

5. Bawa, S. B., Olumuyiwa, A., & Ibrahim, A. (2020). Factors affecting vaccine coverage in Northern Nigeria: A review of trends and challenges. Nigerian Medical Journal, 61(1), 1-5. [Google Scholar] [Crossref]

6. Centres for Disease Control and Prevention (CDCP). (2024). Diphtheria. https://www.cdc.gov/diphtheria/inde x.html. Accessed February 20, 2024 [Google Scholar] [Crossref]

7. Harapan, H., Anwar, S., Dimiati, H. and Sasmono, R.T.A. (2019). Diphtheria outbreak in Indonesia,2017: an ancient and vaccine-preventable disease outbreak in the third millennium. Clin Epidemiol Glob Health; 7: 261–262 [Google Scholar] [Crossref]

8. Ibrahim O, Lawal I, Mohammed B. (2022). Diphtheria outbreak during the COVID-19 pandemic in Katsina, North‐Western Nigeria: epidemiological characteristics and predictors of death. Nigerian J Basic Clin Sci. 19:59. doi:10.4103/NJBCS. NJBCS_35_21 [Google Scholar] [Crossref]

9. Ikejezie, J., Adebusoye, B., Ekezie, W., Langley, T., Lewis, S., & Phalkey, R. (2023). Modifiable risk factors for diphtheria: a systematic review and meta-analysis. Global Epidemiology, 5, 100100 [Google Scholar] [Crossref]

10. Nigeria Centre for Disease Control (NCDC). (2020). Diphtheria Outbreaks in Northern Nigeria: Surveillance and Response Report. NCDC. [Google Scholar] [Crossref]

11. Nigeria Centre for Disease Control and Prevention (NCDC). (2023). Diphtheria situation report. Serial number 02, https://ncdc.gov.ng/diseases/ sitreps/?cat=18&name=An%20Update%20of%20 Diphtheria%20Outbreak%20in%20Nigeria (accessed 3 February 2023) [Google Scholar] [Crossref]

12. Nigeria Centre for Disease Control and Prevention. (2023). Diphtheria https://ncdc.gov.ng/diseases sitreps/?cat=18& NCDC name=An%20Update%20of%20 Diphtheria%20Outbreak%20in%20Nigeria (2023, accessed October 29 2023). [Google Scholar] [Crossref]

13. Olulaja, O. N., Anjorin, E. T., Ekerin, O., Afolabi, O. T., & Inuojo, J. M. (2023). A looming epidemic: combating the recurrent outbreaks of Diphtheria in Nigeria. The Pan African Medical Journal, 45: 186. https://doi.org/10.11604/pamj.2023.45.1 86.41328 [Google Scholar] [Crossref]

14. Rintani A, Mintarsih T, Muliawan YMRB, Siregar JS, Widodo AP. (2018). Risk factors associated with diphtheria outbreaks in developing countries. Jurnal Ilmu Kesehatan Masyarakat. 2018;9:83‐95. doi:10.26553/JIKM.2018.9.2.83‐95 [Google Scholar] [Crossref]

15. Wagner, K. S. (2015). Diphtheria epidemiology in the UK and Europe (Doctoral dissertation, Manchester Metropolitan University). [Google Scholar] [Crossref]

16. World Health Organisation (2017). Diphtheria vaccine: WHO position paper – August 2017. Relevé Épidémiologique Hebdomadaire 2017;92(31):417–35. [9] [Google Scholar] [Crossref]

17. World Health Organisation (2020). Diphtheria reported cases 2020 July 19. Available from http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencediphtheria.html; 2020. [10] [Google Scholar] [Crossref]

18. World Health Organisation. (2023). Diphtheria, tetanus toxoid, and pertussis (DTP) vaccination coverage. Accessed on August 4, 2023. [Google Scholar] [Crossref]

• Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
• Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
• Compliance with JCI Protocols: A Focus on Employee Safety
• Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
• A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar