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

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. 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. 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. 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.