Zoonotic disease knowledge, attitudes, and livestock biosecurity practices among community members in Ada East District, Ghana: a concurrent mixed-methods study

Zoonotic diseases disproportionately burden settings where humans and livestock coexist, yet community-level knowledge, attitudes, and practices (KAP) remain poorly characterized in West Africa. This study aimed to assess KAP regarding zoonotic diseases and document household biosecurity gaps among livestock-keeping community members in Ada East Distrct in Ghana. A concurrent mixed-methods design was employed, integrating a quantitative cross-sectional survey with a qualitative focus group discussion. Livestock-keeping adults were recruited from five health facilities in Ada East District. A structured survey measured knowledge, attitudes, and livestock-handling practices. Composite KAP scores were dichotomized using a modified Bloom's cutoff (≥60%). Multivariable logistic regression analyses were conducted to identify factors associated with good knowledge, positive attitudes, and good practices. A focus group discussion (FGD) explored perceptions of transmission, livestock management, and outbreak preparedness. Among 252 survey participants, 66.3% demonstrated good overall knowledge of zoonotic diseases; however, only 10.6% had good knowledge of Ebola virus disease symptoms. Positive attitudes were observed in 44.0% of respondents, while 86.9% reported good livestock-handling practices. Education beyond primary school was independently associated with higher odds of good knowledge (adjusted odds ratio (aOR) 1.97, 95% confidence intervals (CI) 1.05-3.69). Animal-related occupations were associated with lower odds of positive attitudes (aOR 0.46, 95% CI 0.25-0.85) but higher odds of good practices (aOR 3.58, 95% CI 1.26-11.8). FGD (n = 8) identified bats and sick animals as transmission sources, described economic barriers, and expressed variable beliefs regarding prevention and stigma. These findings highlight the need for locally tailored, One Health-oriented risk communication and biosecurity interventions targeting groups with lower educational attainment and limited access to animal health services.