Mpox outbreak preparedness and response capacity in Nigeria's Federal Capital Territory: a mixed-methods study.

BACKGROUND: Mpox has re-emerged globally as a public health threat, with implications for low-resource settings where surveillance and response systems remain fragile. Nigeria’s Federal Capital Territory (FCT) hosts large mobile populations and international institutions, heightening outbreak vulnerability. Evidence on sub-national preparedness capacity is limited. This study assessed Mpox awareness, preparedness, and institutional response capabilities across the FCT using a mixed-methods approach. METHODS: A convergent parallel mixed-methods study was conducted in four Area Councils representing urban, peri-urban, and rural settings. A multi-stage probability sample yielded 408 adults who completed a structured questionnaire. Preparedness scores were computed using a 20-item, WHO-adapted scale (score range 0–60). Variables associated with adequate awareness and preparedness were examined using multivariable logistic regression, reporting adjusted odds ratios (aOR) and 95% confidence intervals (CI). Retrospective confirmed case surveillance data (2017–2024) were analysed. Qualitative stakeholder data (n = 15) were analysed using thematic content analysis, with triangulation through joint display matrices. RESULTS: From 2017–2024, 37 confirmed Mpox cases were recorded, with a case fatality rate (CFR) of 29.7% based on confirmed-case denominators. The highest incidence occurred in 2022 (n = 25). Among respondents, 52.0% (95% CI: 47.1–56.9) had prior awareness of Mpox; however, only 36.3% demonstrated adequate knowledge. Awareness was significantly predicted by tertiary education (aOR = 2.87; 95% CI: 1.63–5.04; p < 0.001), urban residence (aOR = 1.94; 95% CI: 1.18–3.19; p = 0.009), and formal employment (aOR = 1.72; 95% CI: 1.04–2.85; p = 0.035). Overall, 41.7% of facilities demonstrated “moderate” preparedness, while rural facilities scored significantly lower than urban centres (p < 0.001). Qualitative analysis revealed gaps in rapid reporting, laboratory turnaround time, PPE distribution, and sustained risk communication. Mixed-methods triangulation showed convergence of quantitative and qualitative evidence. CONCLUSION: Mpox preparedness in the FCT is characterised by fragmented but evolving institutional capacity, marked awareness gaps, and significant urban–rural inequities. Strengthening laboratory systems, decentralising logistics, establishing pre-emptive risk communication frameworks, and operationalising One Health collaboration are critical for improved zoonotic outbreak resilience.