Knowledge, Attitudes, and Practices Regarding Rubella Infection Among Female Students in Secondary Schools in Aden, Yemen: A Cross-Sectional Study

Abstract Background: Rubella is a highly contagious viral infection that poses a significant public health threat, particularly to pregnant women and their fetuses, potentially leading to congenital rubella syndrome (CRS). Understanding the knowledge, attitudes, and practices (KAP) regarding rubella among adolescent girls is crucial for designing effective prevention strategies. This study aimed to assess the KAP regarding rubella infection among female secondary school students in Aden, Yemen. Methods: A cross-sectional study was conducted among 441 female secondary school students in Aden, Yemen, from May 2026 to October 2026. Data were collected using a structured, interviewer-administered questionnaire covering sociodemographic characteristics, knowledge about rubella, attitudes toward prevention, and vaccination practices. The questionnaire was validated with a content validity index of 0.89 and a Cronbach's alpha of 0.78. Knowledge was assessed using six core items (range 0–6), attitudes using five statements (range 0–5), and practices using three preventive behaviors (range 0–3). Descriptive statistics, chi-square tests, and multivariable logistic regression analysis were performed using R statistical software version 4.3.1. Results: The mean age of participants was 17.5 ± 1.03 years. The majority were single (94.1%), resided in urban areas (99.1%), and attended public schools (69.6%). Overall, 34.7% demonstrated good knowledge, and positive attitudes toward rubella prevention were observed in 44.2% of participants. Regarding practices, 46.9% of female students had good preventive practices regarding rubella infection, and only 28.1% reported having received rubella vaccination. Multivariable logistic regression revealed that students from middle-income families were significantly more likely to have good knowledge compared to low-income families (aOR = 2.83, 95% CI: 1.11–7.36, p = 0.029). In subgroup analysis, maternal education (p = 0.018), paternal education (p = 0.001), and family income (p = 0.002) were significantly associated with good knowledge among private school students. Conclusion: This study revealed moderate knowledge and attitudes toward rubella among female secondary school students in Aden; however, vaccination coverage remains alarmingly low. Targeted health education programs and improved vaccination strategies are urgently needed to prevent potential rubella outbreaks and CRS cases in this vulnerable population.