Knowledge, attitudes and practices of the general population towards Marburg virus disease in sub-Saharan African countries: a cross-sectional study.

Background: Marburg virus disease (MVD) is categorized among viral hemorrhagic fevers. MVD is associated with high rates of morbidity and mortality. This study aimed to identify factors affecting MVD knowledge, attitudes and practices in sub-Saharan African countries.

Methods: Using a validated questionnaire, a cross-sectional survey was conducted from 21 April to 23 May 2023 in eight English-speaking sub-Saharan African countries (Ethiopia, Ghana, Kenya, Lesotho, Nigeria, Senegal, South Africa and Tanzania).

Results: Of 3142 participants, 51% were males, 66.0% were aged 18-29 y, 74.4% were living in urban areas, 47.9% completed their university education and 21.7% were healthcare workers (HCWs). Tanzanians had the highest good knowledge (89%), while Kenyans had the lowest (26%). Tanzanians had the highest positive attitude (82%), while Nigerians had the highest negative attitude (95%). The best practices exhibited were by Ethiopians (70%), and the poorest practices exhibited were by Ghanaians (94%). The predictors of good knowledge were marital status (adjusted OR [aOR]=0.75; 95% CI 0.59 to 0.94; p=0.013), knowing the correct mode of transmission (aOR=18.31; 95% CI 13.31 to 25.66; p<0.001), whether the participant has heard before about MVD (aOR=2.24; 95% CI 1.82 to 2.75; p<0.001), whether they modified their working habits (aOR=2.79; 95% CI 2.12 to 3.67; p<0.001), nationality (p<0.001) and being a HCW (aOR=2.71; 95% CI 2.01 to 3.67; p<0.001). The predictors of good attitude were being female (aOR=0.71; 95% CI 0.60 to 0.85; p<0.001), age (aOR=0.99; 95% CI 0.98 to 0.99; p=0.01), place of residence (aOR=3.13; 95% CI 2.46 to 3.99; p<0.001), level of education (aOR=1.67; 95% CI 1.37 to 2.04; p<0.001), knowing the correct mode of transmission (aOR=1.59; 95% CI 1.28 to 1.98; p<0.001), modification of working habits (aOR=1.30; 95% CI 1.01 to 1.68; p=0.039) and nationality (p<0.001). The predictors of practice were being female (aOR=1.17; 95% CI 1.01 to 1.37; p=0.042), place of residence (aOR=1.23; 95% CI 1.02 to 1.48; p=0.033), marital status (aOR=0.65; 95% CI 0.55 to 0.78; p<0.001), knowing the correct mode of transmission (aOR=0.46; 95% CI 0.38 to 0.56; p<0.001), modification of working habits (aOR=0.40; 95% CI 0.32 to 0.49; p<0.001) and occupation (aOR=0.37; 95% CI 0.30 to 0.46; p<0.001).

Conclusions: Different modifiable and non-modifiable risk factors can be targeted to improve population perspectives towards MVD.