Environmental Persistence of Typhoid and Barriers to Treatment-Seeking: An Eco-Health Study in Pankshin Local Government Area of Plateau state, Nigeria

Typhoid fever remains a persistent public health challenge in low-income and middle-income countries, driven by unsafe water, poor sanitation, weak health systems, and socio-cultural factors. In Nigeria, limited surveillance, inadequate diagnostic capacity, and growing antimicrobial resistance further complicate disease control, particularly in rural settings. This study examined the environmental, socio-cultural, and healthcare-related factors influencing the persistence of typhoid fever and treatment-seeking behaviour in rural communities of Pankshin Local Government Area (LGA), Plateau State, Nigeria. A community-based cross-sectional study was conducted in eight rural and peri-urban communities of Pankshin LGA. Eighty adult residents (≥18 years), selected purposively, were interviewed using a structured questionnaire assessing knowledge and perceptions of typhoid, perceived frequency and severity, treatment-seeking behaviour, and barriers to care. Data were analysed using descriptive statistics and inferential tests in R software, while Geographic Information System (GIS) techniques were used to map study locations and spatial patterns. The results showed that most respondents (60.5%) correctly identified contaminated food and water as the main causes of typhoid, although misconceptions such as witchcraft (26.7%) and mosquito transmission (11.6%) persisted. Typhoid was perceived as frequent by 68.6% of respondents, and 75.6% reported knowing someone who had undergone surgery due to typhoid-related complications. While hospitals were the preferred first point of care for most respondents (73.3%), a substantial proportion relied on herbal medicine or chemist shops (40.7%). Cost (55.8%), belief in alternative treatment, and distance to health facilities were the main barriers to hospital utilization. Although confidence in local health centres was relatively high, structural and economic constraints continued to drive delayed or inappropriate care. The study concluded that typhoid fever remains endemic in rural Pankshin LGA, sustained by environmental exposure, economic hardship, health system limitations, and persistent socio-cultural beliefs. Addressing typhoid burden requires integrated eco-health-informed interventions that combine improved water and sanitation, strengthened primary healthcare services, affordable diagnostics and treatment, and targeted community health education to reduce misconceptions and improve timely care-seeking.