Knowledge and perceptions on dengue among internship medical students and rural physicians in Ecuador: a cross-sectional study, 2025

Dengue is a public health concern in Ecuador, with sustained transmission in the Pacific Coast, Amazon, Galapagos Islands, and emerging in the Andean region. Adequate knowledge and perceptions among medical students and physicians are essential for diagnosis, appropriate management, patient education, and control. This study evaluated dengue-related knowledge and perceptions among Ecuadorian students in the internship program (interns) and physicians in the rural medical service program, and to identify factors associated with higher knowledge scores. A nationwide cross-sectional study was conducted between January and July 2025 using a self-administered online questionnaire. The 44-item survey covered knowledge of dengue (0–27 points) across four domains—aetiology/pathophysiology (6 questions), clinical features (6), diagnosis (5), and management/treatment (10)—as well as training experiences and perceptions (14 questions). Descriptive statistics and inferential analyses were performed using χ² tests, Student’s t-test, one-way ANOVA, and Pearson’s correlation, with significance set at p < 0.05. A total of 811 responses were analysed (455 interns and 356 rural GPs; mean age 25.8 ± 3.4 years; 61.3% female). The overall mean knowledge score was 14.0 ± 3.4/27 points, slightly above the midpoint. Scores were highest for aetiology/pathophysiology (4.3 ± 1.0/6) and diagnosis (2.7 ± 0.9/5), but lowest for clinical features (2.4 ± 1.2/6) and management/treatment (4.5 ± 1.7/10). Higher scores were significantly associated with prior lectures in tropical medicine and previous experience diagnosing or treating dengue cases. No statistically significant differences were observed in overall knowledge between the two groups. However, physicians were more likely than interns to report dengue-specific training in the past year (64.8%; p = 0.001), familiarity with the dengue official guidelines (64.3%; p = 0.001), and prior clinical experience managing dengue cases (62.4%; p = 0.001). Over half of participants perceived insufficient dengue training during medical education and believed that health authorities do not adequately train physicians. This first nationwide study reveals critical gaps in dengue knowledge, particularly in clinical recognition and management, among Ecuadorian medical interns and rural physicians. Strengthening tropical medicine curricula and continuing professional education is needed to improve clinical preparedness and enhance the healthcare system’s capacity to respond to ongoing dengue transmission and outbreaks.