Brain health, a fundamental component of overall well-being, reflects a complex, dynamic state of mental, motor, cognitive and functional abilities sustained by neurophysiological processes.¹ Globally, brain disorders are now the leading cause of disability and the second leading cause of death, with disability-adjusted life years (DALY) attributable to neurological conditions rising by 18% from 1990 to 2021.² This burden falls disproportionately on low- and middle-income countries, including Nigeria, where projections estimate a staggering 500% increase in neurological conditions by 2050, translating to 50.8 million DALYs and an economic impact of $51.4 billion.³

Demographic transitions, population growth, lifestyle behaviours, socio-economic factors and low education attainment are among the primary contributors to the increasing burden of brain disorders.⁴ A lack of awareness, limited knowledge and stigma associated with neurological conditions serve as significant barriers to diagnosis and treatment.^5,6 In many low- and middle-income countries, particularly in sub-Saharan Africa, a common misconception is that brain disorders such as dementia are a natural part of ageing, associated with witchcraft and other negative spiritual connotations.^7,8 However, accurate perceptions can promote healthier lifestyles,⁹ reducing the associated burden and stigma associated with these neurological conditions.

The significance of lifestyle factors demonstrated to impact brain health is poorly understood.¹⁰ Furthermore, little is known about public perceptions of brain health in Nigeria and the factors that influence it. Understanding these perceptions is essential for shaping public health strategies to mitigate modifiable risk factors, improve early detection and intervention, and guide educational and policy initiatives addressing Nigeria’s escalating neurological burden. It is vital to understand how people perceive brain health and the steps they are willing to take to preserve their brain functioning.¹¹ Having this understanding would assist in determining the appropriate interventions to promote the right perceptions. Of note, the lack of policy, belief systems, and cultural values of individuals and communities contributes to the exacerbation of brain health issues.¹² Given the high prevalence of brain disorders^13,14 and lack of information on the Nigerian perception of brain health, it is imperative to investigate the public perception to identify knowledge gaps among our population.

The research question posed was: ‘How do socio-demographic factors shape public perception of brain health?’ This study aimed to capture a comprehensive view of perceptions regarding brain health in Nigeria. This study’s finding has the potential to inform the development of policies aimed at addressing brain health challenges in Nigeria. By understanding these influences, such policies could foster positive social and community impacts, ultimately enhancing overall well-being and contributing to societal progress.

Table 1 shows the socio-demographic characteristics of the 570 respondents who participated in the survey. Majority of the respondents were between the age range of 26–40 years (45.4%), female (61.4%), Yoruba (79.3%), had at least a University/college degree (89.9%), and single (72.1%).

This study provides unique insight into the public perception of brain health in Nigeria, serving as a baseline study for future research. In descending order, respondents rated the importance of factors influencing brain health as follows: physical health, social environment, diet, education, genetics, life goals, profession, physical environment, sleeping habits, family income and substance use. Surprisingly, quite a significant proportion of our respondents rated substance use as a weak factor influencing brain health. Men were less likely to view substance use as a factor that has an impact on brain health. We observed that all life periods, with more emphasis on childhood and young adulthood, were rated as important for taking care of the brain. The diseases and disorders highly rated as having an association with brain health include migraine, bipolar disorder, Alzheimer’s disease, anxiety, stroke, addiction and depression in an ascending order. Remarkably, a large percentage disagreed on the association of hypertension, diabetes and arthritis with brain health.

Substance use disorders are identified as important global contributors to disability and mortality.¹⁵ A sizable portion of our respondents did not perceive that substance use could impact brain health. This result indicated a contrast with studies conducted in Western countries, which reported a high ranking of substance use as an influencing factor for brain health.^11,16 Substance use at high doses leads to consequences such as embarrassment, automobilist accidents, sexual abuse, child abuse, suicide attempts and fatalities, cardiovascular accidents, or overdose death.¹⁷ In developing countries such as Nigeria, the necessity of raising awareness and sensitisation on substance use, which has been demonstrated to hurt brain health,¹⁸ cannot be over-emphasised.

The majority of our respondents believed that sleep is an important factor for brain health. This finding corroborates with previous research that identified poor sleep quality impacts different domains including physical, psychological and cognitive health.^19,20 Similar to the findings from Watson et al.’s²¹ study, our study showed a significant association between gender and perception of sleep.²¹ Specifically, men were less likely to perceive that sleep is associated with brain health. This may be because of societal norms that make men place more importance on work than on getting enough sleep. For instance, gender inequity in Nigeria consequently allows more men than women to participate in jobs such as jobs in the manufacturing sector.²² Combating gender inequity and creating targeted awareness could indirectly address this uninformed perception.

Our findings indicated that ethnicity significantly influenced the perception of our respondents on the link between diet and brain health. Disparities in diverse cultures and dietary preferences may influence the perception of different ethnic groups. Further analysis showed that older adults were less likely than younger ones to perceive diet as an influencing factor for brain health. Similarly, older adults of different ethnic groups in other parts of the world, including Hispanics, whites and African Americans, have previously expressed doubt on the relationship between brain health and diet.²³ Our respondents rated physical health as the highest influencing factor of brain health. This high rating is consistent with a report from Budin-Ljøsne and colleagues,¹¹ which implies that physical health seems to be held with high importance across diverse geographical contexts.

We observed that men were less likely to perceive the ‘before birth’ period as a phase that needs proper care for the brain. This could be linked to less male involvement and awareness of preconception and conception care practices in developing nations.^24,25 Adverse effects, which include learning disabilities, developmental delays, cognitive impairments, and sensory deficiencies, could result from nutritional shortages that manifest during critical phases of brain development.²⁶ Asymptomatic injuries that develop during the early stages of brain development appear to have long-lasting consequences for health in adulthood.²⁷ Moreover, it is thought that the observed cognitive alterations interact with the divergence that occurs in the developmental pathway of some brain regions during childhood.²⁸ To better prevent late-life morbidities, Lazar and colleagues proposed that intervention approaches that focus on modifiable risk and protective factors may be put into practice as early as childhood or young adulthood.^29,30

Our findings highlight a significant association between the perception of different brain diseases/disorders and variables of age, gender and educational level. Despite the negative effect of migraine on brain performance and quality of life, study respondents (aged 41 years and older) were less likely to perceive that migraine is associated with brain health. Respondents’ perception may arise from the thought that migraine is just a minor inconvenience, and this could result in delayed treatment seeking. Multiple investigations have shown how vascular variables affect cognitive health in later life, particularly diabetes mellitus³¹ and hypertension.³² Iadecola et al.³³ suggest that treating hypertension and other vascular risk factors early in life may both reduce the need for and increase the safety of antihypertensive medication. However, having an uninformed perception of the impact of hypertension on brain wellness may result in poor management of blood pressure, thereby increasing the risk of adverse outcomes for brain health. There is compelling evidence that brain disorders such as dementia, including Alzheimer’s, mixed-type dementia, and multi-infarct dementia, are more prevalent among individuals with type 2 diabetes.³⁴ For a healthy brain, it is therefore imperative, to prioritise blood sugar, blood pressure, and cholesterol management, social and physical exercise, and moderation in alcohol consumption, weight control, and having enough sleep.³⁵

Overall, numerous barriers could hinder effective communication about brain health in Nigeria. These may include language barriers and varying levels of health literacy among the population. To promote awareness and correct the wrong perceptions about brain health, a collaborative effort from governmental and non-governmental institutions is required. Nigeria can make substantial advances in enhancing public awareness of brain health by addressing educational, cultural, and socio-economic barriers and improving access to healthcare. Additionally, maximising the use of digital technologies in advancing public awareness of brain health could provide opportunities to promote the knowledge of potentially remediable risk factors of brain health.

This study presents some limitations that could be linked to the selected methodology. An online survey approach used for data collection may restrict the involvement of rural, non-literate and impoverished residents, who might have limited or no access to technology and the Internet. This also might have a skewed effect on our data, as most respondents were highly educated and from the Yoruba tribe. Additionally, response bias could be unavoidable as respondents may tend not to provide honest answers. Sampling issues because of the online research method applied limit the generalisability of this study. Future studies should focus on the inclusion of a more robust methodology aimed at achieving more reliable data. Despite these limitations, this study retains its validity as it directly captured first-hand information on perceptions of brain health in Nigeria. Its relevance lies in serving as a preliminary baseline for a more robust research.

Our study highlighted knowledge gaps on issues related to brain health. This suggests the need for formulation and implementation of health policies that prioritises brain health awareness from the community level to the national level. This could inform the design of interventional strategies, including educational campaigns that are tailored to different demographics such as age, gender and educational level groups. It is imperative that a multisectoral pathway involving the clinicians, public health professionals and community stakeholders engage in community sensitisation and awareness campaigns on risk factors, early signs and symptoms, preventive measures and management of brain diseases and disorders for early detection and better treatment. In addition, to promote a healthy brain throughout the life span, the inclusion of brain health-related knowledge in primary and secondary education curricula is suggested to keep the younger population well-informed on risk and protective factors for brain health. Allocation of funds for brain health research should be prioritised to facilitate the gathering of data on the nation’s current state of awareness and knowledge. Urgent implementation of these interventions is needed to change uninformed brain health-related perceptions of individuals and communities, improve knowledge, and ultimately improve brain health across the nation.

The study’s findings revealed a poor understanding among the study population regarding key contributors to brain disorders, such as substance use, hypertension and diabetes. This highlights the urgent need for action by the government, policymakers and relevant stakeholders. Given the critical impact of brain health on national development, prioritising health promotion programmes aimed at changing uninformed perceptions and behaviours towards fostering brain health is paramount. Future research should explore both positive and negative perceptions of specific brain diseases/disorders which may pinpoint attitudes towards discrimination and stigmatisation. This study additionally recommends extending brain health perception studies to other countries in Africa to identify gaps peculiar to each regional setting.