Abstract
Background: Community-acquired infections (CAIs) are infections contracted outside healthcare facilities and constitute a significant source of morbidity among university students globally, particularly in environments characterized by overcrowding, shared sanitation facilities, poor ventilation, and inadequate hygiene infrastructure. In Nigeria, university halls of residence are defined by high population density and constrained living conditions, creating environments highly conducive to respiratory, gastrointestinal, skin, and vector-borne infection transmission. Despite this burden, comprehensive data on the knowledge, attitudes, hygiene practices, prevalence, treatment-seeking behaviour, and environmental determinants of community-acquired infections among hostel-resident undergraduate students in SouthSouth Nigeria remain scarce. Objective: This study aimed to assess the knowledge and preventive measures of students regarding community-acquired infections, ascertain their attitudes towards infections and preventive measures, determine the prevalence and types of infections experienced, and identify risk factors influencing recurrence among undergraduate students residing in the halls of residence at the University of Benin, Benin City, Edo State, Nigeria. Methods: A descriptive cross-sectional study was conducted among undergraduate students residing in the official halls of residence and affiliated hostels at the University of Benin, Ugbowo Campus, Benin City, Edo State, Nigeria. A multistage sampling technique was employed. The minimum sample size of 436 was calculated using the Cochran formula with a design effect of 2.0, based on an estimated infection prevalence of 85% and a precision of 0.05. A xvi total of 487 respondents were enrolled, yielding a 100% response rate. Data were collected using a structured, self-administered questionnaire adapted from the WHO KAP Framework (Cronbach’s α = 0.908 and 0.767 for knowledge and attitude respectively), the WHO/UNICEF JMP WASH indicators (α = 0.743 for hygiene practices), and a validated symptom-based infection history checklist for the six-month recall period. Data were entered and analysed using IBM SPSS version 27. Descriptive statistics were summarised as frequencies and percentages, while inferential analysis was conducted using chi-square tests, Fisher’s exact test, and binary logistic regression to identify predictors of infection. Statistical significance was set at p < 0.05. Results: A total of 487 undergraduate students participated, with a mean age of 21.16 ± 2.68 years; 295 (60.6%) were female and 462 (94.9%) were Christian. Almost four in five respondents (378; 77.6%) were aware of community-acquired infections. Among aware respondents, more than four-fifths (326; 86.2%) had good knowledge, with a mean composite score of 33.18 out of 40. Islamic religion (OR = 0.101; 95% CI: 0.025–0.407; p = 0.001), 100 Level (OR = 0.203; p = 0.014), 200 Level (OR = 0.244; p = 0.007), and non-medical faculty membership (OR = 0.405; p = 0.023) were significant independent negative predictors of good knowledge. Nearly nineteen in twenty respondents (461; 94.7%) held positive attitudes; Islamic religion was the only significant independent predictor (OR = 0.098; 95% CI: 0.034– 0.286; p < 0.001). About two-thirds (329; 67.6%) had good hygiene practices; Islamic religion (OR = 0.101; p < 0.001), 600 Level seniority (OR = 16.43; p = 0.009), and higher monthly allowance (OR = 1.554; p = 0.035) were significant independent predictors. The overall six-month infection prevalence was very high, with 418 (85.8%) reporting at least one infection. Respiratory tract infections were the most prevalent (87.1% of infected xvii respondents), followed by malaria (56.2%), gastrointestinal infections (48.6%), skin and soft tissue infections (32.5%), urinary tract infections (12.7%), and eye infections (6.9%). Male sex was the strongest independent predictor of lower infection odds (OR = 0.376; 95% CI: 0.207–0.681; p = 0.001), while frequent common area cleaning was the strongest independent environmental predictor (OR = 0.195; 95% CI: 0.057–0.666; p = 0.009). Among infected respondents, 368 (88.0%) sought treatment; purchasing drugs from a pharmacy was the most common action (53.3%). Good hygiene practices was the strongest independent predictor of early treatment-seeking (OR = 3.052; p = 0.009). Critical environmental deficits were documented: 80.1% reported no soap in hostel toilets, 90.1% had no access to hand sanitizer, and 72.5% described room ventilation as poor or very poor. Conclusion: The burden of community-acquired infections among undergraduate students in the University of Benin halls of residence is very high, with respiratory tract infections, malaria, and gastrointestinal infections predominating. Although awareness and positive attitudes toward prevention were near-universal, knowledge deficits among junior and non-medical students and structural deficiencies including absent soap, poor ventilation, and infrequent common area cleaning remained the dominant determinants of infection risk. Consistent with the Health Belief Model, high perceived barriers in the form of structurally deficient hostel infrastructure negated the protective potential of adequate knowledge and positive attitudes. Frequent common area cleaning was the strongest modifiable predictor of freedom from infection. University management, the Estates Department, Student Affairs Directorate, and Health Centre should implement coordinated interventions encompassing urgent hostel infrastructure upgrades, mandatory infection prevention curricula for non-medical faculties, xviii religion-sensitive health communication, and proactive student health outreach to substantially reduce the infection burden in the residential setting.