Table 2 Summary of some of the key results from interviews and FGDs conducted at Aliero and Jega LGAs

Environmental factor as a driver or risk factor for CSM transmission

a) Crowded sleeping space

“Most of our households have large family size and about 4–7 persons sleep in a room, making the living environment dirty”-IDI from Aliero LGA

b) Timing of onset of epidemics

“The disease usually starts when the weather is very hot and dry, and ends when rains start, usually in June or around this time” - FGD from Jega LGA

(c) Built environment

“Poor ventilation, congestion of structures such as kitchen and toilet facing each other or close to each other, some do not even use the kitchen but cook their food very close to sleeping rooms making it very hot. Lack of community hygiene is also important”-FGD Aliero LGA

Economic factors

(a) Household income

“Poor environmental sanitation, lack of vaccination to prevent the menace, poor government law to control waste, hunger (malnutrition) and poverty are some of the factors that encourage the seasonal occurrence of CSM”- FGD from Jega LGA

(b).Neighbourhood

“Many of the households here are poor and the neighbourhood receives little government attention”- FGD

Socio-cultural factors

(a).Health seeking practices

“Most of the households seek treatment for many ailments through alternative health care providers (traditional and spiritual healers) and patent medicine vendors or graduate of the school of health technology who are not employed. We do not have a long waiting period, and we spend less money compared to a government hospital. Some ‘local doctors’ also come home to provide treatment. It is when this fails that we patronize the general hospital. Parental care is also poor in the community- children are mostly not given proper attention and mothers are not in a position to take decision about where to treat and many of them are not employed”- FGD (Traditional Leaders)

(b). Social mixing patterns

“As you know, women in our environment usually marry early, so I attend wedding ceremony most weekends, and this also provides the opportunity to meet family and friends from villages and other towns”- IDI

“I am an onion farmer, and we receive buyers from within Nigeria and the neighbouring Niger Republic, it is a big market, and we mix freely with them even during the outbreak period”- IDI

(c). Vaccination

“We usually refuse vaccination here in this place but this is changing because we now understand the importance of vaccination, especially to children. Though, truly, there are still parents who do not believe in vaccination”- FGD from Jega LGA

“There is a poor attitude to medical check-up and no routine vaccination against cerebrospinal meningitis…”- FGD from Aliero LGA