The Triple Burden of Belief: Socio-Religious and Traditional Barriers to the Clinical Management of Malaria, Typhoid, and Hepatitis in Pankshin LGA of Nigeria

Malaria, typhoid fever, and viral hepatitis constitute a persistent triple infectious burden in rural Nigeria, where socio-religious norms and traditional beliefs intersect with limited healthcare access to influence disease outcomes. This study examined the socio-religious and traditional barriers affecting the clinical management of these infections in eight communities of Pankshin Local Government Area (LGA), Plateau State, north-central Nigeria. A community-based cross-sectional survey was conducted among 80 adult residents, selected purposively to represent diverse socio-demographic and cultural backgrounds. Data were collected using structured, interviewer-administered questionnaires and analysed using descriptive and inferential statistics in R software, with spatial mapping in ArcGIS to visualise patterns of awareness and treatment-seeking behaviour. Results indicate that while general awareness of malaria, typhoid, and hepatitis was moderate to high, in-depth knowledge regarding transmission, prevention, and clinical care was limited. A significant proportion of respondents relied on traditional medicine (47.7%) or spiritual healing, influenced by beliefs in supernatural causation, perceived efficacy of indigenous remedies, and religious doctrines. Hospital care was the first point of contact for 73.3% of participants; however, 25.6% sought chemists, herbalists, or prayer houses first, creating delays in diagnosis and treatment. Physical discomfort, access challenges, and cost further reinforced these barriers. Associations between educational level and health-seeking behaviour were statistically significant (p < 0.05). The study highlights the "Triple Burden of Belief," where socio-religious, cultural, and structural factors jointly impede effective clinical management. To mitigate these barriers, culturally sensitive health education, engagement of traditional and religious leaders as referral partners, and improved access to affordable diagnostics and treatment are recommended. Addressing these intersecting challenges is critical to reducing morbidity and mortality from malaria, typhoid, and hepatitis in rural Nigerian communities.