International Journal of Recent Innovations in Academic E-ISSN: 2635-3040; P-ISSN: 2659-1561

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This work is licensed under a Creative Commons Attribution 4.0 Volume-8, Issue-8, August-2024: 49-60
International License [CC BY 4.0]

Research Article

Assessment of Perceptions and Preventive Health Behaviours of

Bushmeat Handlers Regarding Mpox Infection in Wildlife Markets of
Northern Nigeria: A One Health Perspective
*aAbdulrahman M. Adeiza, bRamon Yusuf Babatunde and cWesley D. Nafarnda

a&cDepartment of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine,
University of Abuja, Nigeria
bDepartment of Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Abuja, Nigeria

*Corresponding Author Email: [email protected]

Received: August 03, 2024 Accepted: August 22, 2024 Published: August 30, 2024

Abstract
Mpox is a transboundary zoonotic disease of humans and animals. About 88,600 confirmed mpox
cases and 152 deaths were reported globally. We assessed bushmeat handlers’ zoonotic risk perceptions,
preventive measures, and drivers of mpox resurgence in Nigeria. We conducted a cross-sectional study on
purposively selected 438 bushmeat handlers in Nigerian bushmeat (wildlife) markets, from 2022–2023.
Descriptive and analytical statistical analyses were conducted at 95% confidence level. Out of the 450
bushmeat handlers enlisted in this study, 438 (97.3%) participated. Majority (52.7%) were consumers,
20.3% hunters, and 26.9% vendors. Respondents significantly perceived handling bushmeat bodies to be of
high zoonotic risk. Preventive health practices were significantly associated (P<0.05) with mpox outbreak.
Furthermore, socio-cultural and economic drivers of contact with wildlife during hunting, contact with
wildlife at markets, unsanitary market environment and exchange of animals between markets were
significantly (P<0.05) associated with mpox infections. In this study, the drivers of mpox resurgence with
propensity for global spread were identified. We advocate a “One Health” control strategy targeting wild
lives, environment and humans especially, handlers of wild lives and bushmeat to combat the disease.
Keywords: Bushmeat Handlers, Mpox, Preventive Health Behaviors, Wildlife Market, Zoonosis.

Introduction
Monkeypox is an endemic viral zoonotic disease in West and Central Africa. It was first diagnosed in humans
in the Democratic Republic of Congo (DRC) in 1970 (Durski, 2018). Mpox was restricted to Africa until 2022
when few cases were reported from outside the continent in an infection linked to importation from
endemic countries (Islam, 2023; Thornhill et al., 2022). Increasing human-wildlife interactions through
urbanization and declining immunity from discontinued small pox vaccination program was suggested to
have led to sporadic human-mpox outbreaks signaling the disease as a public health threat (Bunge et al.,
2022). Monkeypox has an incubation period of 5–21 days but symptoms usually occur 6–16 days post-
exposure and typically resolve in 2-4 weeks though death in serious complications occur in some patients
(Miura et al., 2022). The disease is usually in two stages as prodromal stage with chills, lymphadenopathy,
myalgia, headache and fatigue lasting 1–5 days while the second stage manifests with ulcers and rashes that
could spread to the face, genitalia, hands and feet (Hatami et al., 2023).

Monkeypox has a mortality rate of between 3–6% (Islam, 2023). Effective vaccinations, treatments and use
of standard protective practices have proven useful in limiting its spread (Miura et al., 2022). Many animal
hosts including rodents and non-human primates have been suggested as the reservoirs of Monkeypox virus
(MPXV). Contact with these hosts have occasionally resulted in sporadic outbreaks of the disease in humans
(Bunge et al., 2022; Heskin et al., 2022). Studies have attributed local chains of transmission from imported
cases and mass gathering events to be the epidemiological source of the current outbreaks (Haider et al.,
2022; Zumla et al., 2022). In Nigeria, annual reports (2017-2022) of sporadic outbreaks of monkeypox
infection were documented (Amao et al., 2022). A dramatic increase of up to 530 suspected cases of the
disease with 220 of them confirmed in 29 of the 37 states of the country (Al Mustapha et al., 2023) was

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recorded in 2022. Despite the availability of treatments and vaccines for the diseases in humans, experts
have suggested early diagnosis and good care as the most effective public health surveillance tools for
controlling human to human transmission of the disease in man (Islam, 2023).

Handlers of various activities involving wildlife have often been hypothesized as facilitators of monkeypox
infections. Adoption of preventive measures, particularly in the context of infectious disease, is largely
determined by the knowledge of the disease, attitudes toward prevention, and intentions to adopt
recommended preventive practices (Bates and Grijalva, 2022; Peng et al., 2023). Managing the disease is
therefore dependent on the level of its perception and knowledge by these handlers. Sufficient knowledge on
the part of the handlers is vital for good preventative practices against the disease in the wild life market.

Our aim in this study therefore is to assess the zoonotic risk perceptions and preventive health behavior of
the bushmeat handlers towards mpox infections in wildlife markets of Northern Nigeria, the drivers of its
risks and its tendency to become a one health conundrum.

Materials and Methods

Geographical Areas of Study: A cross-sectional study conducted amongst eligible bushmeat handlers in the
wildlife markets in northern Nigeria, an area occupying 692,826 km2 (70% of the land mass) of Nigeria with
a population of 75,392,622 persons based on the 2006 Housing and Population census (Almu et al., 2019). It
is located on latitude 110 19’ 48” (11.330) north, longitude of center 60 53’ 24” (6-890) between January,
2021 and December, 2022. It is bordered to the south by the Gulf of Guinea (Atlantic Ocean), west by the
Benin Republic; Cameroon to the east, Chad and the Niger Republic to the north. The northern Nigeria is a
typical tropical savannah vegetation region with relatively high temperature of up to 40 0C recorded at a
mean of 270C in the year. Tropical savanna ecozone is a humid tropical forest with an annual rainfall of
1600– 300mm. The choice of the study area was due to the favorable climate of warm forest and woodland
of the cold south and the hot north that favors bushmeat natural breeding.

Figure 1. The map of northern Nigeria.

Health Belief Model Concept: Health Belief Model (HBM) is built on health beliefs of positive threats and
attractive negatives regarding behavioural responses to disease (Abraham and Sheeran, 1996). Perceived
susceptibility is the risk perception of contracting a disease while perceived severity is the perception of the
seriousness associated with contracting the disease. These variables according to Janz and Becker (1994)
relate to the probability of a subject getting involved in some health-related actions modified by
demographic characteristics of personality and social pressure.

Sample Size Determination and Procedure: Open-Source Epidemiologic Statistics for Public Health tools
(OpenEpi) 3.1 software for percentage frequency in a finite population (9) were employed in determining
the sample size in this study. The expected proportion was assumed to be 50% at a 95% confidence interval
with a 4% margin of error resulting in 500 as the sample size used in this study. An encouraging pilot study
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was conducted using 10% (50) of the sample size in the study to test the reliability of our method leaving a
balance of 450 used in the final study. The 450 participants were selected from the study area in a multi-
staged sampling approach based on existing federal structure and contiguity. Equal number of participants
were selected from each of the 19 states that constitute the northern Nigeria, the study area. A total of 23
bushmeat handlers were randomly selected from 3 most prominent markets in each of the states (sampling
sites). The selected markets were those that had government registered market union and a minimum of
200 or more bush meat handlers (hunters, vendors and consumers). Vehicle drivers who assisted only in
transportations in the market and labourers who do not engage in bushmeat transactions were excluded
from this study.

Questionnaire: We designed and utilized a well structured, closed-ended questionnaire and literature
guides for this study. The questionnaire design was aimed at precision and data enhancement according to
Thrusfield (2018). The questionnaire, in three parts, was written in English language and translated into
Hausa, a major language spoken in the area for ease of communication. In the design, part A was made of 5
questions directed at the socio-demographic characteristics of bushmeat handlers, part B had 8 questions on
“Awareness of information on risks of mpox transmission associated with bushmeat handling activities”,
part C had 7 questions on “Socio-cultural and economic factors influencing emergence and spread of mpox at
the wildlife markets”, part D had 5 questions on “Perceptions of risk pathway of mpox associated with
bushmeat handling activities” had 5 questions while part E had 12 questions on “Practices of preventive
health behaviours against mpox disease at the wildlife markets in northern Nigeria. The questionnaire was
reviewed by subject experts for its design, content, relevance, understanding and simplicity. A total of 38
trained enumerators (2 from each state) were engaged to administer the questionnaire to the participants
under supervision. While some of the participants appended their signatures on the data collected from
them, data from others was based on verbal consent as they showed unwillingness to append their
signatures even after being assured of the confidentiality of their participation.

Data Entering and Analysis: Microsoft Excel 2016 spreadsheet (Microsoft Corporation, Redmond, WA,
USA) was used in cleaning and processing the data obtained to generate descriptive statistics and frequency
tables. Descriptive statistics of frequencies and proportions were used to express categorical variables while
Pearson chi-square test or Fisher’s exact tests were used to express associations amongst the handlers. A
numeric scoring system was used to assess the perception, and preventive health behaviour levels of the
handlers. Variables from respondents based on their socio-demographic and socio-cultural and economic
predictive themes were grouped as ‘inadequate’ versus ‘full adequate’, and ‘poor impact’ versus ‘positive
impact’, respectively. Binary responses of No and Yes were scored with ‘1’ for ‘Yes’ considered a correct
response and ‘0’ for ‘No’ considered incorrect on a grading system ranging from 1 to 20. The total scores for
each response were collated and graded with cut-off points set at “1 to 10” for “below average” or “≤50%”
and these were regarded as ‘inadequate’ responses while those of “11 to 20” were considered “above
average” or “≥50%” and considered ‘adequate’. This same line was applied to ‘poor impact’ and ‘positive
impact’ responses for socio-cultural and economic predictive determinants (Alhaji et al., 2018). Higher
scores indicate higher knowledge-perception of preventive health behaviour and socio-cultural and
economic determinants levels for monkeypox. Variables associated with the probability of ‘inadequate’ and
‘adequate’ or ‘poor’ and ‘positive impact’ responses were identified using univariate analysis performed with
Chi-square test. Unconditional associations with p<0.05 were further subjected to a multivariate logistic
regression model to control for confounders and effect modifiers. The predictive ability of this model was
tested using Hosmer–Lemeshow goodness-of-fit test and was confirmed fit (Hosmer, et al., 2013). Statistical
analyses were conducted using confidence intervals of logistic regression software Stata 17 (Stata Corp,
College Station, TX, USA) setting the test at 5% significance level.

Results
Characteristics of the Respondents
The characteristics of the participants in this study are as presented in table 1. Out of the 450 bushmeat
handlers in the wildlife hotspots targeted in this study, 97.3% (n = 438) participated. The participants were
consumers (52.7%), vendors (26.9%) and hunters (20.3%). Majority of the participants (24.7%) were
between the age of 27–33 years (n = 108) while male handlers (80.1%) were higher than the females
(19.9%). In terms of education, primary school certificate holders (32.9%) predominated others while those
married (80.8%, n = 354) were more than the singles (19.2%; n = 84). Awareness of information on risks of
mpox transmission associated with bushmeat handling activities was captured in table 2. While more than
three-quarter of the bushmeat handlers claimed not to be aware of monkeypox outbreak in Nigeria in the
order of hunters (77.5%), consumers (72.2%) and vendors (76.2%), all the bushmeat handlers (31.6%

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consumers; 14.45% vendors; 11.2%) had a significantly (p = 0.05) low claim to “ever heard of monkeypox”.
A paltry proportion of the handlers (12.4% hunters; 0.9% vendors; 3% consumers) significantly indicated
having “ever seen monkeypox patients”. Close to 100% of the bushmeat handlers (97% hunters; 93.5%
consumers; 92.4% vendors) did not perceive mpox virus as “having the ability to infect wildlife”. More than
50% of bushmeat handlers perceived mpox as zoonotic. They were the hunters (64.0%), vendors (61.9%)
and consumers (50%). Conversely, only vendors majorly (66.1%) perceived mpox to be anthroponotic
(transmissible from humans to humans) while less than one-fifth of the other handlers consisting of
consumers (19.5%) and hunters (1.1%) shared such perception. Furthermore, majority of the consumers
(60.2%) significantly (p < 0.05) perceived mpox virus as transmissible from the environment to humans
while hunters (48.3%) and vendors (33.1%) believed likewise.

All factors of socio-cultural and economic activities influencing re-emergence and spread of mpox at the
wildlife markets showed significant (p < 0.05) positive impact and shown in table 3. Aggregation of different
wildlife before transport to the markets (67.7%) showed 4 times (OR = 4.20) likelihood of influencing the
emergence and spread of monkeypox. Others were unsanitary market environment (87.8%) with 3 times
(OR = 3.32) likelihood of positive impact (87.8%), exchange of wild lives within market shops (87.4%; OR =
2.76), poor butchering practices (88.2%) and yet others, aggregation of different wildlife during
transportation to the markets (48.6%) and aggregation of different wildlife at hunting or capturing (86.5%)
were perceived to have less impact.

The bushmeat handlers in this study were associated with all the risk pathways tested (p > 0.05), but
showed a low risk of monkeypox infection. Consumption of raw or uncooked bushmeat and its products
(92.1%; n = 82) by the hunters, 56.8% of vendors and 66.2% of consumers. More than 90% of the hunters
(94.4%) considered contact with wildlife and fomites as low risk to monkeypox infection compared to the
81.8% of the consumers and 66.9% of the vendors. A moderate number of handlers in this study (hunters
=52.8%; vendors = 52.5%; consumers = 67.5%) considered environmental contamination through exposure
to surfaces and aerosol as low-risk pathway to monkeypox infection (Table 4).

All the suspected and established risks factors of mpox transmission (Table 5) were significantly (p = 0.05)
perceived by the bushmeat handers as low risk to mpox infection. They were consumers (70.1%; n = 162),
vendors (82.2%; n = 97) and hunters (41.6%; n = 37). Consumption of raw or uncooked bushmeat and its
products was perceived as a significant low risk to monkeypox infection (92.1%; n = 82) in the same way as
56.8% of vendors and 66.2% of consumers. More than 90% of the hunters (94.4%) considered contact with
wildlife and fomites as a low risk to monkeypox infection while 81.8% of the consumers and 66.9% of the
vendors hold the same view. A moderate number of handlers in this study (hunters =52.8%; vendors =
52.5%; consumers = 67.5%) considered environmental contamination through exposure to surfaces and
aerosol as a low-risk pathway to monkeypox infection.

Majority of preventive health care practices to mpox infection tested were significantly (p < 0.05) associated
with monkeypox infection by the handlers. Hand washing after touching wildlife (hunters = 24.7%; vendors
= 1.7%; consumers = 2.6%). Hunters (79.8%), vendors (83.9%) and consumers (99.6%) significantly
practiced washing hands with soap after eating bush meat as preventive measure against monkeypox
infection. All the bushmeat handlers (consumers (90%), vendors (4.2%) and hunters (11.2%) significantly
(p < 0.05) practiced “sterilization of tools after use” as a preventive measure against monkeypox infections.

Adequate sanitation and hygiene practices against mpox infection were upheld by a significantly low
proportion of hunters (2.3%), vendors (5.1%), and consumers (0.9%).A minimum of 2m physical and social
distancing in wet markets sites were significantly (p < 0.05) practiced by a little under half of the consumers
(49.4%), (12.7%), hunters (0). More than half of the consumers (58.0%), vendors (53.4) and hunters
(46.1%) avoided hugging and handshakes while 58.4% of hunters, 61.0% of vendors and 90.0% of the
consumers significantly (p < 0.05) made use of face masks as preventive measures against mpox.

A little fraction of vendors (6.8%), consumers (22.5%) and hunters (22.5%) significantly (p < 0.05) use
personal protective equipment. Majority of the consumers (90.5%), vendors (2.5%) and hunters (16.9%)
were significantly aware of the places designated as bushmeat markets. There was a significantly (p < 0.05)
low awareness of the presence of veterinary posts in the markets for inspection of meat before offering it for
consumption comprising of hunters (21.3%), vendors (5.1%) and consumers (5.6%). Similarly, significantly
(p < 0.05) low percentage of hunters (34.8%), vendors (21.2%), and consumers (12.6%) affirmed routine
fumigation of wildlife markets and their spots as a preventive health measure against mpox infection. A high

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proportion of hunters (96.6%) compared to a low proportion of vendors (26.3%) and consumers (4.3%)
were aware of vaccination against mpox disease (Table 6).

Table 1. Socio-demographic characteristics of bushmeat handlers associated with knowledge, risk

perceptions and preventive health behaviors of mpox disease in wildlife markets in northern Nigeria: 2021-
2022.
Factors Inadequate response Full response Odds ratio 95% CI P-value
n (%) n (%)
Age
13-19 9 (29.0) 22 (71.0) 10.84 2.17, 54.28 0.001
20-26 2 (3.6) 53 (96.4) 10.84 2.17, 54.27 0.001
27-33 12 (11.1) 96 (88.9) 3.27 1.23, 8.73 0.020
34-40 7 (12.5) 49 (87.5) 2.86 0.95, 8.68 0.070
41-47 2 (2.7) 71 (97.3) 14.52 2.92, 72.29 0.001
48-54 8 (17.4) 38 (82.6) 1.94 0.66, 5.77 0.245
55-61 7 (10.1) 62 (89.9) 3.62 1.21, 10.90 0.020
Gender
Male 15 (4.3) 336 (95.7) 0.07 0.05, 0.22 < 0.001
Female 33 (37.9) 54 (62.1) 0.07 0.04, 0.14 <0.001
Marital status
Single 38 (45.2) 46 (54.8) 0.035 0.72, 6.22 <0.001
Married 10 (2.8) 344 (97.2) 28.42 13.27, 60.85 <0.001
Economic activities
Hunters 3 (3.4) 86 (96.6) 0.07 0.01, 0.14 <0.001
Vendors 39 (33.1) 79 (66.9) 0.07 0.02, 0.24 <0.001
Consumers 6 (2.6) 225 (97.4) 1.31 0.32, 5.35 0.698
Formal education
None 32 (35.2) 59 (64.8) 0.05 0.01, 0.12 <0.001
Primary 3 (2.1) 141 (97.9) 25.49 7.51, 86.50 <0.001
Secondary 7 (6.0) 109 (94.0) 8.45 3.51, 20.30 <0.001
Tertiary 6 (6.9) 81 (93.1) 7.32 2.88, 18.64 0.001
Note: n = number; % = percent; p-value = 0.05

Table 2. Awareness of information on risks of mpox transmission associated with bushmeat handling
activities in wildlife markets in northern Nigeria: 2021–2022.
Variables Bushmeat No Yes Chi- P-value
handlers n (%) n (%) square
Ever heard of monkeypox Hunters 79 (88.8) 10 (11.2) 15.16 0.001
Vendors 101 (85.6) 17 (14.4)
Consumers 188 (81.4) 73 (31.6)
Aware of monkeypox disease outbreak in Hunters 69 (77.5) 20 (22.5) 1.39 0.498
Nigeria Vendors 84 (72.2) 34 (28.8)
Consumers 176 (76.2) 55 (23.8)
Ever seen monkeypox disease patients? Hunters 78 (87.6) 11 (12.4) 18.22 0.001
Vendors 117 (99.2) 1 (0.9)
Consumers 224 (96.9) 7 (3.0)
Monkeypox virus can infect wildlife Hunters 87 (97.8) 2 (2.3) 2.90 0.234
Vendors 109 (92.4) 9 (7.6)
Consumers 216 (93.5) 15 (6.5)
Monkeypox can be transmitted from Hunters 32 (35.9) 57 (64.0) 5.77 0.060
wildlife to humans (zoonosis) Vendors 45 (38.1) 73 (61.9)
Consumers 112 (48.5) 119 (51.5)
Monkeypox can be transmitted from Hunters 88 (98.9) 1 (1.1) 101.7 <0.001
humans to wildlife (reverse zoonosis) Vendors 40 (33.9) 78 (66.1)
Consumers 186 (80.5) 45 (19.5)
Monkeypox can be transmitted from Hunters 46 (51.7) 43 (48.3) 23.01 0.001
environment to humans Vendors 79 (66.9) 39 (33.1)
Consumers 92 (39.8) 139 (60.2)
Note: n = number; % = percent; p-value = 0.05

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Table 3. Socio-cultural and economic factors influencing emergence and spread of mpox at the wildlife
markets in northern Nigeria: 2021–2022.
Factors Poor Positive Odds 95% CI P-value
impact impact ratio
Aggregation of different wild life at hunting or capturing
No 57(21.9) 203(78.1) 0.02 0.01, 0.055 <0.001
Yes 154(86.5) 24 (13.5) 0.04 0.03, 0.074 <0.001
Aggregation of different wildlife during transportation to the markets
No 63 (24.7) 192 (75.3) 0.21 0.11, 0.32 <0.001
Yes 94 (51.4) 89 (48.6) 0.31 0.21, 0.46 <0.001
Aggregation of different wild life in the markets
No 49 (33.8) 96 (66.2) 0.21 0.21, 0.57 <0.001
Yes 183 (62.5) 110 (32.8) 0.30 0.20, 0.46 <0.001
Aggregation of different wild life before transport to the markets
No 102 (66.7) 51 (33.3) 1.10 0.72, 1.21 <0.001
Yes 92 (32.2) 193 (67.7) 4.20 2.76, 6.37 <0.001
Unsanitary market environment
No 41 (24.4) 127 (75.6) 4.12 1.52, 4.72 0.001
Yes 33 (12.2) 237 (87.8) 3.32 1.40, 3.85 0.001
Poor butchering practices
No 169 (96.6) 16 (9.1) 1.31 0.61, 1.89 0.211
Yes 172 (88.2) 23 (11.8) 1.41 0.72, 2.77 0.319
Exchange of wild lives within market shops
No 84 (80.0) 21 (20.0) 4.21 32.1, 7.22 0.004
Yes 42 (12.6) 291 (87.4) 2.76 1.41, 5.41 0.003
Note: n = number; % = percent; p-value = 0.05

Table 4. Risk pathways for the emergence and spread of mpox at the wildlife markets during the monkeypox
infection in northern Nigeria: 2021–2022.
Variables Bushmeat Low risk High risk Chi- P-value
handlers n (%) n (%) square
Consumption of raw or uncooked Hunters 82 (92.1) 7 (7.9) 31.31 0.001
bushmeat and its products Vendors 67 (56.8) 51 (43.2)
Consumers 153 (66.2) 78 (33.8)
Contact with wildlife and fomites Hunters 84 (94.4) 5 (5.6) 22.34 0.001
Vendors 79 (66.9) 39 (33.1)
Consumers 189 (81.8) 42 (18.2)
Environmental contamination (exposures Hunters 47 (52.8) 42 (47.2) 10.11 0.006
through surfaces and aerosols) Vendors 62 (52.5) 56 (47.5)
Consumers 156 (67.5) 75 (32.5)
Note: n = number; % = percent; p-value = 0.05

Table 5. Perceptions of risks of monkeypox transmission associated with bushmeat handling activities in
wildlife markets in northern Nigeria: 2021–2022.
Variables Bushmeat Low risk High risk Chi- P-value
handlers n (%) n (%) square
Handling body of live wildlife Hunters 37 (41.6) 52 (58.4) 39.68 <0.001
Vendors 97 (82.2) 21 (23.6)
Consumers 162 (70.1) 69 (29.9)
Handling body of dead wildlife Hunters 53 (59.6) 46 (51.7) 56.44 <0.001
Vendors 113 (95.8) 5 (4.2)
Consumers 142(61.5) 89 (38.5)
Co-habitation with wildlife Hunters 73 (82.0) 16 (18.0) 8.91 0.010
Vendors 89 (75.4) 29 (24.6)
Consumers 153 (66.2) 78 (33.8)
Wildlife farming in urban and peri-urban Hunters 43 (48.3) 47 (52.8) 12.36 0.002
areas Vendors 81 (68.6) 37 (31.4)
Consumers 156 (67.5) 76 (32.9)
Note: n = number; % = percent; p-value = 0.05

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Table 6. Practices of preventive health behaviors adopted by bushmeat handlers against mpox disease
northern Nigeria: 2021–2022.
Variables Bushmeat No Yes Chi- P-value
handlers square
Hand wash after touching wild life Hunters 67 (75.3) 22 (24.7) 56.00 <0.001
Vendors 116 (98.3) 2 (1.7)
Consumers 225 (97.4) 6 (2.6)
Washing hands with soap after eating bush Hunters 18 (20.2) 71 (79.8) 44.57 <0.001
meat Vendors 21 (17.8) 99 (83.9)
Consumers 1 (0.4) 230 (99.6)
Sterilization of tools after use Hunters 79 (88.8) 10 (11.2) 300.1 <0.001
Vendors 113 (95.8) 5 (4.2)
Consumers 23 (10.0) 208 (90.0)
Adequate sanitation and hygiene of wet Hunters 86 (96.6) 2 (2.3) 6.22 0.040
market Vendors 112 (94.9) 6 (5.1)
Consumers 229 (99.1) 2 (0.9)
Minimum 2m physical and social Hunters 89 (100.0) 0 (0.00) 7.09 <0.001
distancing in wet markets sites Vendors 103 (87.2) 15 (12.7)
Consumers 117 (50.7) 114 (49.4)
Avoidance of hugging and handshakes Hunters 48 (53.9) 41 (46.1) 4.28 0.117
Vendors 55 (46.6) 63 (53.4)
Consumers 94 (40.7) 134 (58.0)
Use of face masks Hunters 37 (41.6) 52 (58.4) 54.25 <0.001
Vendors 46 (39.0) 72 (61.0)
Consumers 23 (10.0) 208 (90.0)
Use of personal protective equipment Hunters 69 (77.5) 20 (22.5) 14.27 0.001
when touching wildlife Vendors 110 (93.2) 8 (6.8)
Consumers 179 (77.5) 52 (22.5)
Awareness of designated places as markets Hunters 74 (83.1) 15 (16.9) 296.6 <0.001
Vendors 115 (97.5) 3 (2.5)
Consumers 22 (9.5) 209 (90.5)
Presence of veterinary posts in the Hunters 67 (75.3) 19 (21.3) 24.02 0.001
markets for veterinary inspection of meat Vendors 112 (94.9) 6 (5.1)
before offering it for consumers markets Consumers 218 (94.4) 13 (5.6)
Routine fumigation of wild life markets Hunters 58 (65.2) 31 (34.8) 20.71 0.001
and their spots environment Vendors 93 (78.8) 25 (21.2)
Consumers 202 (87.5) 29 (12.6)
Belief that vaccination against mpox is Hunters 3 (3.4) 86 (96.6) 266.1 <0.001
preventative Vendors 87 (73.7) 31 (26.3)
Consumers 221 (95.7) 10 (4.3)
Note: n = number; % = percent; p-value = 0.05

Discussion
The re-emergence of mpox in Nigeria in 2019, with reported cases in northern Nigeria (Ekpunobi et al.,
2023) where they impacted heavily on the public health, economy, tourism leading to the World Health
Organization (WHO) describing the outbreak as “Public Health Emergency of International Concern” (PHEIC)
(Nuzzo et al., 2022; Wenham and Eccleston-Turner, 2022). Bushmeat is defined as meat derived from wild
birds, reptiles, terrestrial and amphibian mammals usually harvested for consumption or trade (Cawthorn
and Hoffman, 2015; Islam, 2023). Often presented live, slaughtered or dead in interspecies mix in wildlife
markets by vendors and hunters, trade in bushmeat is a major enterprise and delicacy of the people of the
study area. Markets for wild lives and their related handling activities have been identified by Islam, (2023)
as focal centers of spread of zoonotic and anthroponotic infections. Majority of bushmeat handlers in this
study were married male holders of primary education certificate between the ages of 27–33 years. The
awareness raised on zoonotic diseases as an aftermath of campaign against Covid-19 pandemic in 2019 and
Ebola disease in 2014, access to social media may have contributed to the interest of this young age on the
topic of study. The married male handlers were in the majority probably due to the traditional perception of
hunting as male age-group hobby/enterprise of men undertaken to cater for their families. This constantly
exposes males to the wild lives and their infections. The dominance of these youthful handlers signals an
availability of mobilizable populace deployable in campaigns against mpox disease in the area. The drawback

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however is their low level of education which may pose a hinderance to a successful sensitization campaign
against the disease due to their poor conceptualization of the dynamics of the disease that may constrain a
campaign of conviction to the general populace. On being aware of information on risks of mpox
transmission associated with bushmeat handling activities, most handlers of bushmeat denied “ever heard of
a disease called mpox” much less aware of its outbreak in Nigeria just as the majority in this study denied
“ever seen an mpox patient”. This may be due to the self-resolving nature of the infection and the low-level
campaign against the disease which makes it go unnoticed in some patients. Many of the respondents do not
believe that mpox virus could infect wildlife. This belief differs from reports from multiple studies indicating
mpox could infect wildlife (Seang et al., 2022).

A high number of bushmeat handlers, insignificantly (p > 0.05) however claimed to have heard and believed
monkeypox is zoonotic and transmissible from wildlife to humans. This perception is supported by the
previous works of Kaler et al., (2022) and Kumar et al., (2022) who reported a transmission of mpox virus
from animals to human through direct contact with infected animals or with contaminated objects. It is
noteworthy that majority of the vendors (66.1%) believed in the transmissibility of mpox virus from humans
to wildlife. This perception is in tandem with the reported human-to-dog transmission (reverse zoonosis) of
mpox virus (Seang et al., 2022). This form of transmission has raised concerns about the likelihood of
creation of new reservoirs especially in pets in furtherance of further public health problems in the
traditionally non-endemic areas (Ogunleye et al., 2024). We advocate wider surveillance in both humans and
animals and the adoption of a one-health approach in assessing the risks associated with animal to human
and human to animal interface in areas of potential outbreaks. A moderate proportion of bushmeat handlers
associated transmission of mpox virus from the environment to humans. This result agrees with the report
of Lai et al., (2022) and Zhum et al., (2022) that contact with contaminated objects in the environment,
respiratory aerosols and fomites were ways of transmission of the mpox virus.

All the socio-cultural and economic indices of the bushmeat handlers comprising aggregation of different
wildlife during transportation to the markets, aggregation of different wildlife before transport to the
markets, aggregation of different wildlife at hunting or capturing, exchange of wildlife within market shops
and unsanitary market environment except poor butchering practices tested in this study were significantly
(p < 0.05) associated with mpox as drivers of the infection. This result is in line with the previous findings of
Santiago-Alarcon and MacGregor-Fors (2020) who reported an interface between different wildlife species
and humans as an avenue for exposure of humans to pathogens that are zoonotic in the environment.
Furthermore, contamination of wildlife in trade, stress from the aggregations of live wildlife during hunting,
transport and storage, breeding farms, shops and markets where they are sold were reported as driving
forces to zoonotic infections (Pruvot et al., 2019; Huong et al., 2020). Poor butchering practices was
perceived as not being able to facilitate the spread of monkeypox in this study. This perception may be due
to the poor knowledge of the disease by the participants because spread of mpox virus has been associated
with fluid from broken blisters and scabs on the palms during butchering (Amer et al., 2023).

A significantly high number of vendors abstained from consumption of raw or uncooked bushmeat because
of the fear of being infected with the monkeypox virus. Consumption of raw and undercooked bushmeat is
widely reported to be a veritable means of transmission of the mpox virus (Milband and Vira, 2022). Alhaji et
al., (2007) had previously advocated avoidance of the consumption of uncooked bushmeat or non-biltong
meat (a dried-meat delicacy) as a means of preventing zoonosis from wildlife. While it is noteworthy that
complete abstinence is not prescribed as a preventive measure against mpox, centre for disease control
(CDC), advised the consumption of only thoroughly cooked meat (Amer et al., 2023). Relative availability,
cheapness of bushmeat for protein needs, and the general assumption that cooked bushmeat cannot
transmit the virus may be responsible for the low abstinence from bushmeat consumption by a significant
proportion of the handlers. We observed that only a small proportion of handlers were significantly
associated with a high risk of Mpox virus transmission through contact with live wildlife, fomites, handling
dead wildlife, co-habitation with wildlife, and wildlife farming in urban and peri-urban areas (p < 0.05). This
position may be informed by the absence of medical screening and substantially non clinical nature of the
disease. Only very low proportion of vendors (4.2%) who regularly hawk dead and live animals however
perceived their vocation as high risk. This low perception poses enormous danger to the populace as the
handlers may constitute a pool of spreaders of the virus in the area (Hasan and Saeed, 2022). We advise that
wildlife vendors be targeted as a critical group to be educated in a campaign against mpox.

Handling of the body of live wildlife was perceived by a significant 58.4% of hunters as a high-risk exposure
to monkeypox infections compared to 23.6% of vendors and 29.9% of consumers. This position of the

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hunters is supported by Milband and Vira (2022) who suggested humans in contact with live animals get
infected through bites or body fluids. In the same vein, a moderate number of hunters associated a
significantly high risk of monkeypox infection with handling of bodies of dead wildlife compared with the
high proportion of vendors and consumers who believed otherwise. This result generally highlighted a poor
high-level risk perception of the handlers in handling both dead and live wild animals. This may be
attributable probably to their experience in the course of their vocation.

Co-habitation with wildlife is perceived by a high proportion of bushmeat handlers as a significantly (p <
0.05) low risk to spread of monkeypox virus. Physical contact with an infected animal according to Rabaan et
al., (2023) puts a human at an increased risk of infection as infected animals have been reported capable of
transmitting the virus through respiratory droplets and discharges. This perception testifies to the grave
danger posed to those who domesticate wildlife for prestige, games and shows. There is a need to educate
handlers who raise wild lives for bushmeat markets on the dangers of human cohabiting with wild lives
especially regarding transmission of monkeypox. A high risk of infection with monkeypox virus was
perceived by moderate number of bushmeat handlers to be associated with wildlife farming in urban and
peri-urban especially those raising wild lives for bushmeat markets. This contrasts the work of Al-Mustapha
et al., (2023) that reported increasing contact with wildlife as a way of transmitting the mpox virus. The
lowly perception of participants is dangerous considering the current interest at wildlife farming. There is
therefore an urgent need to re-strategize on focusing on this group of handlers in the sensitization drive
against mpox.

Results from investigation on preventive health adopted by bushmeat handlers against mpox disease in
northern Nigeria showed that the practices of handshake, hugging and kissing were perceived by the
handlers as having no association with mpox infections in contrast to the reports of Brown and Leggat,
(2016) that such practices are capable of facilitating human-to-human transmission by way of respiratory
droplets and secretions. Similarly, only a few handlers believed hand washing after touching wildlife in the
market was capable of transmitting mpox virus. This contrasts sharply with the reports of Brown and
Leggat, (2016) who reported hand washing as a potent way to avoid mpox infection. Interestingly, 99.6% of
the consumers, 83.9% of vendors and 79.8% of the hunters practiced washing hands with soap after eating
bushmeat during the mpox outbreak. We could not find a reason as to why the same handlers who barely
believed in washing hands after touching live animals would readily embrace same practice upon eating
bushmeat. We believe the culture of washing hands after meals by the people of the study area as the likely
reason. While 90% of consumers claimed to have significantly (p < 0.05) sterilized their tools after use on
bushmeat, very few vendors and hunters indulge in the same habit. On the other hand, adequate sanitation
and hygiene of wet markets was marginally adopted by the handlers against mpox in the wet market. This
low preventive health attitude of the handlers demonstrated the low level of enlightenment, awareness and
comprehension of preventive health practices against mpox. Contact with contaminated objects have been
reported to be sources of infection (Ghazy et al., 2023). We advise therefore, the cleaning and disinfection of
all contaminated surfaces and proper disposal of contaminated wastes and objects or washed with warm
water and detergent. Lack of awareness of the dangers of mpox and absence of regulation of hunting
profession may account for the reasons why the hunters and some other handlers never considered a
minimum of 2m physical and social distancing in wet markets as protective against mpox. Social distancing
from those infected or in the post-exposure state could help minimize possible respiratory transmission
according to Rabaan et al., (2023).

Rabaan et al., (2023) generally considered a distance within six meters of an infected person as a high risk to
mpox infection. Wet markets in the study area generally do not have defined designations, borders,
personnel, shops or regulations. The unregulated mode of operation in the market may be a challenge to
some advocated preventive practices. Bushmeat handlers in the area generally perceived the use of personal
protective equipment, creation of designated places as markets, presence of veterinary posts in the markets
for veterinary inspection of meat before offering it to consumers and routine fumigation of wildlife markets
and their spots as preventive. It is surprising that only a very small fraction of the handlers practiced use of
personal protective equipment (PPE) during mpox infections while others did not. This is quite disturbing as
refusal to use personal protection equipment facilitates the spread of the viruses (Rallapalli et al., 2022). We
advocate stricter enforcement of the use of PPE by all handlers of bushmeat to forestall the spread of the
virus. Lack of awareness of the existence of designated markets for wildlife as claimed by the handlers
underscores the reason behind the reckless display of dead carcasses and live wild-lives along the major
highways in the study area with an attendant spread of the viruses. We advise therefore that the appropriate
authorities should properly designate the area of wet markets with defining rules and regulations. There is a

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high proportion of hunters in this study who significantly (p < 0.05) believed that vaccination against mpox
is preventive. This is predictive of this high-risk group, whose vocation makes them interface directly with
wild lives. Vaccination is recommended to people deemed at high risk for severe monkeypox disease
exposure (Petersen et al., 2022). The belief of the hunters in the preventive measure of the mpox vaccines
suggest a willingness to submit to immunization in the event of the vaccine availability. Although only about
a quarter of the vendors and very few consumers concurred with the preventive nature of vaccination
against mpox, acceptance of vaccines by the hunters who are the first contact with wild lives in the bushmeat
business chain, will significantly break the chain of infections.

Conclusion
This study generally showed that bushmeat handlers in the study area have low to moderate awareness
about the nature, risk pathway and drivers of mpox disease. This reflects in their dismal to moderate
perception and preventive health attitudes towards mpox infection in the wet markets leading to gaps in the
control and prevention efforts of the health authorities in the area. These gaps are likely to engender
multiplication of reservoirs in the area. We therefore advocate the control of this disease through a
multisectoral collaborative one-health approach in the area of surveillance, health education, increased
bushmeat handler’s sensitization tools.

Declarations
Acknowledgments: We are grateful to the officials of the market unions of the wet markets, veterinary
assistants that assisted in this survey.
Author Contributions: AMA: Writing, conceptualization, original draft, methodology, formal analysis, data
collection, writing-review and editing; RYB: Conceptualization, editing, methodology, formal analysis, data
collection, writing-review; WDN: Writing–review and editing, writing–original draft, supervision,
methodology, formal analysis, data collection and conceptualization.
Conflict of Interest: The authors declare no conflict of interest.
Consent to Publish: The authors agree to publish the paper in International Journal of Recent Innovations
in Academic Research.
Data Availability Statement: The data obtained are available and shall be released by the corresponding
author on behalf of other authors upon reasonable request.
Funding: We declare that we did not take any grant for this study from any organization, funding agencies
or individuals.
Institutional Review Board Statement: The protocols for this study were reviewed and approved by the
Health Research Ethics Committee of the Federal Capital Territory with Ethics number:
FHREC/2022/01/210/04-11 and the Institutional Review Board Administration of the University of Abuja,
Davis (Research Committee No 0202).
Informed Consent Statement: All participants provided informed consent prior to their inclusion in the
study. The study adhered to the principles of the Declaration of Helsinki, ensuring that participation was
entirely voluntary, with participants free to withdraw from the study at any time without any consequences.
For infants and children, consent was obtained from their parents or legal guardians following a detailed
explanation of the study's objectives, the participants' roles, potential risks and benefits, and the voluntary
nature of participation.
Research Content: The research content of manuscript is original and has not been published elsewhere.

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Citation: Abdulrahman M. Adeiza, Ramon Yusuf Babatunde and Wesley D. Nafarnda. 2024. Assessment of
Perceptions and Preventive Health Behaviours of Bushmeat Handlers Regarding Mpox Infection in Wildlife
Markets of Northern Nigeria: A One Health Perspective. International Journal of Recent Innovations in
Academic Research, 8(8): 49-60.
Copyright: ©2024 Abdulrahman M. Adeiza, et al. This is an open-access article distributed under the terms
of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and
source are credited.
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