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.

Nigeria.

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.

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.

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

Harapan et al., 2019; CDCP, 2024). Despite vaccine efforts, the disease remains a concern in areas with

limited healthcare facilities and low vaccination coverage (WHO, 2017). Diphtheria creates a potent exotoxin

that causes a thick, greyish film in the throat and upper respiratory tract, causing both local tissue destruction

and systemic consequences such as myocarditis, neuropathy, and respiratory failure. The disease is highly

contagious but preventable. It typically affects the pharynx, tonsils, and nose, but it can also injure essential

organs such as the heart, kidneys, and nervous system (Adegboye et al., 2023; Bawa, Olumuyiwa & Ibrahim,

2020; Atere et al., 2024).

Diphtheria was a significant cause of infant mortality in the early 20th century, particularly in temperate

regions (Ahmed et al., 2023). The diphtheria incidence rate in Canada was 98 per 100,000 in 1924 and

decreased to approximately 0 per 100,000 by 1969 following the vaccine's introduction in 1926. In 1940, the

causes of morbidity and mortality in developing nations (Rintani et al., 2018). As of October 9, 2023, 14,587

instances were documented in four African Union Member States, with Nigeria accounting for more than 90%

(CDCP, 2024). The outbreaks have affected people from other countries without prior vaccines, with more

than 65% of cases having no vaccination record. Women account for 62% of cases, and socioeconomic

differences add to the burden of diphtheria. Outbreaks are frequently related to overcrowded living

circumstances, poor hygiene standards, and impediments to healthcare access. Nigeria reported 493 cases of

diphtheria in Lagos and Kano due to inadequate pentavalent vaccine coverage, poor sanitation, and

surveillance systems (NCDC, 2023). There were 31,129 documented suspected cases of diphtheria in 36 states,

encompassing 318 local government areas (LGAs). Out of them, 18,250 (59%) were verified, resulting in 863

fatalities. Of the verified instances, 369 (2%) were identified by laboratory testing, 515 (3%) through

(Harapan et al., 2019; CDCP, 2024; Aborode et al., 2023). The global average of yearly cases during the last

5-year interval was 6,582, reflecting a 37% rise from the preceding 5-year average of 4,809 cases between

2008 and 2012 (WHO, 2020). The Southeast Asia region consistently reports the majority of worldwide

diphtheria cases annually. In the European Region, the incidence dropped by 95%, from 1.82 cases per million

people in 2000 to 0.07 cases per million population in 2009. 85% of cases originated from Russia and Ukraine.

However, Latvia, with a population of under two million, recorded the highest yearly incidence from 2000 to

2009 (Wagner, 2015). Diphtheria has been recorded at 29.9% of cases in the African region from 2013 to 2022

(WHO, 2024). The majority of African nations have inadequate DTP3 vaccination coverage. Starting in July

2023, at least five African countries (Guinea, Mauritania, Niger, Nigeria, and South Africa) have reported an

atypical surge in diphtheria cases and are now facing active epidemics. Nigeria experienced a diphtheria

suspected cases (396), followed by Yobe with 78 and Katsina with 34 (Ikejezie et al., 2023). The World Health

Organisation rated Nigeria's 2020-2024 data as the fourth highest, indicating a diphtheria reemergence in the

country (WHO, 2024).

Source: extracted from the WHO report 2024

understand the trend of diphtheria.

Plateau State, located in north-central Nigeria, has a history of vaccine-preventable diseases due to socio-

political difficulties, inadequate healthcare infrastructure, and restricted vaccination coverage. The World

Health Organisation attributes diphtheria epidemics in Nigeria and Plateau to inadequate vaccination rates,

especially in northern and rural areas. In these areas, diphtheria cases are frequently underreported due to

insufficient monitoring and diagnostic facilities, complicating the determination of correct prevalence

estimates. Research by Ibrahim et al. (2022) revealed that diphtheria incidence in Plateau State predominantly

affects children under 15 years old, who are particularly susceptible to inadequate vaccination regimens. The

research identified a link between outbreaks and population migrations, especially among internally displaced

persons (IDPs) escaping conflict, which has hindered vaccination initiatives (Ibrahim et al., 2022). The Case

Fatality Rate (CFR) of diphtheria in Plateau State is increasing due to treatment delays, inadequate healthcare

infrastructure, and the absence of diphtheria antitoxin (DAT), which is essential for efficient disease

Plateau State is situated in the North Central Region of Nigeria, positioned between latitudes 8.371° N and

10.301° N and longitudes 7.401° E and 8.371° E. Plateau State was delineated from Benue-Plateau State in

1979. A subsequent division occurred in 1996 when Nassarawa State was established, after forming other

states in Nigeria. The state borders Bauchi State to the north, Taraba State to the east, Nassarawa State to the

south, and Kaduna State to the west. The state encompasses an area of 26,901 square kilometres (Timothy,

2006). Plateau State has 17 Local Government Areas: Barkin Ladi, Bassa, Bokkos, Jos East, Jos North, Jos

South, Kanam, Kanke, Langtang North, Langtang South, Mangu, Mikang, Pankshin, Qu'an-Pan, Riyom,

Shendam, and Wase (see Figure 1).

Figure 1: Nigeria showing Plateau State

ii. Suspected and confirmed diphtheria cases from WHO (clinical and laboratory confirmed)

Table 3: Distribution of Suspected, Confirmed and Death Cases of Diphtheria in Plateau State LGAs 2023-

2024

Diphtheria classification cases based on LGAs in Table 4 reveal the following: 14.1% of suspected cases in

Barkin-Ladi, 1.6% not yet classified, 14.3% not a case, and 1.6% suspected cases in Bassa. Additionally, there

0

0

9

Source: WHO (2024) X2= 0.000; (645.388)

Table 5 presents the diphtheria cases against vaccination in LGAs of Plateau State. The vaccination rates were

59.2% in Kanam, 9.6% in Shendam, and 8.8% in Barkin-Ladi, out of a total of 260 individuals in the study. In

contrast, Kanam had 45% for the unvaccinated, followed by Wase with 30% and Langtang-North with 11.7%.