Knowledge, attitudes, and practices regarding priority zoonotic diseases (Mpox, Ebola, and Rabies) and associated factors among households in Bukavu, Democratic Republic of the Congo, 2025

Abstract Background: Zoonotic diseases are a major public health concern in the Democratic Republic of the Congo (DRC), where diseases such as rabies, Ebola, and Mpox pose ongoing health risks. Household knowledge, attitudes, and practices (KAP) play an important role in preventing zoonotic disease transmission. This study assessed household knowledge, attitudes, and practices regarding priority zoonotic diseases in Bukavu, South Kivu Province, DRC, and identified factors associated with satisfactory overall KAP. Methods: A cross-sectional study was conducted from September 1 to 15, 2025, in the Bagira and Kadutu health zones of Bukavu. A total of 634 households were selected using two-stage cluster sampling. Data were collected using a structured questionnaire administered through KoboCollect and analyzed using Stata version 17. The questionnaire assessed knowledge, attitudes, and practices concerning Ebola, Mpox, and rabies. Knowledge was measured using 17 items, attitudes using five-point Likert-scale items, and practices using five behavioral items. Scores of at least 70% were classified as satisfactory. Descriptive statistics, group comparisons, and bivariate and multivariable logistic regression analyses were used. Nonparametric tests were used when appropriate. Associations were reported as odds ratios (ORs) with 95% confidence intervals (CIs), with p < 0.05 considered statistically significant. Results: Overall, 42.9% of households demonstrated satisfactory knowledge of zoonotic diseases, 63.6% had favorable attitudes, and 11.7% demonstrated adequate preventive practices. Mpox was recognized as a zoonosis by 78.2% of respondents, Ebola by 66.6%, and rabies by 39.1%. Knowledge scores were higher among livestock-farming than non-livestock-farming households (p = 0.002). In the multivariable analysis of overall KAP, university-level education (OR = 12.06; 95% CI: 1.54-94.18; p = 0.018) and access to drinking water (OR = 6.74; 95% CI: 3.91-11.60; p < 0.001) were positively associated with satisfactory overall KAP. Conclusions: Households in Bukavu reported generally favorable attitudes toward zoonotic disease prevention, but satisfactory knowledge was less widespread and adequate preventive practices were uncommon. Interventions should help translate awareness and favorable attitudes into practical preventive behaviors through targeted risk communication and health education, alongside improvements in access to drinking water and sanitation. A coordinated One Health approach involving human, animal, and environmental health stakeholders may strengthen household-level prevention of priority zoonotic diseases. The findings can help inform locally tailored prevention strategies and identify priorities for future community-based research. Keywords: Zoonoses; Knowledge, Attitudes, and Practices; One Health; Bukavu; Democratic Republic of the Congo