Knowledge, attitudes, and practices of community health workers regarding mpox in Mbarara City, Uganda, February 2025: a cross-sectional study

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During the outbreak, community health workers (CHWs) conducted community surveillance, case detection, and community education. We assessed knowledge, attitudes, and practices (KAP) of CHWs regarding mpox transmission, detection, reporting, and referral in Mbarara City. Methods We conducted a cross-sectional study from February 1–15, 2025 among CHWs selected through simple random sampling from a list of CHWs in all city wards. Data were collected using a questionnaire comprising 26 KAP-related items. Knowledge was assessed using 11 items, attitude with 5 items, and practice with 7 items, each worth 1 point. Scores > 60% were classified as good knowledge, positive attitude, or good practices. Multivariate logistic regression was used to identify KAP-associated factors. Results Among 206 CHWs, 159 (77%) were female, and 127 (62%) had > 10 years of experience. In total, 129 (64%) participants had good knowledge, 181 (90%) had positive attitudes, and seven (3%) demonstrated good practices. Regarding practices, 143 (73%) engaged in health education, 55 (28%) referred suspected cases, and 51 (26%) consistently reported to health authorities when a suspected case was identified. Having attended mpox-specific training (aOR = 5.0; 95%CI: 2.2–11) and having a positive attitude (aOR = 9.0, 95%CI: 2.6–30) were significantly associated with good knowledge. Conclusion Meaningful gaps remained in CHW practices around mpox. particularly case referral and reporting. Targeted CHW training and mentorship could improve outbreak response effectiveness. Mpox Knowledge Attitude Practices Uganda Figures Figure 1 Background Mpox is a zoonotic disease caused by an enveloped double-stranded DNA virus in the genus Orthopoxvirus (family Poxviridae) ( 1 , 2 ). Human-to-human transmission occurs through close contact with infected persons, lesion exudates, body fluids, respiratory droplets, or sexual contact ( 3 ). Clinically, mpox resembles smallpox—fever, headache, myalgia, and rash—but is generally milder and typically features lymphadenopathy, which distinguishes it from smallpox. The incubation period spans 1–21 days, with most patients developing symptoms within seven days of exposure ( 4 , 5 ). Mpox has emerged as a global public health concern, extending beyond its traditional endemic foci in West and Central Africa to affect multiple regions worldwide. In response to increasing case-counts including notable outbreaks in the Democratic Republic of the Congo and other countries, the World Health Organization declared mpox a Public Health Emergency of International Concern (PHEIC) on August 14, 2024 ( 6 ). Uganda confirmed its first human mpox cases on July 24, 2024. By November 30, 2024, a total of 745 PCR-confirmed infections had been reported across 52 districts, including nearly 200 cases among children and adolescents ( 7 ). Urban centers later became epicenters of transmission, with Mbarara City’s caseload rising from 92 in December 2024 to 123 in January 2025. This urban shift underscored critical gaps in prevention, early detection, and timely response. Community health workers (CHWs) are essential for disease surveillance, case identification, and community education; however, their preparedness for mpox control had not been evaluated. Inadequate knowledge, attitudes, and practices (KAP) among CHWs may contribute to delayed reporting and suboptimal outbreak management. This study aimed to assess the knowledge, attitudes and practices of CHWs regarding mpox in Mbarara City, Uganda, February 2025 Methods Study design and setting This cross-sectional study was conducted from February 1–15, 2025, among CHWs from the 23 Wards of Mbarara City, located approximately 270 kilometres (about 168 miles) southwest of Kampala. Mbarara City has a catchment population of approximately 238,500 people. The city is bordered by Isingiro District to the south, Kiruhura District to the north, Rwampara District to the east, and Mbarara District to the west. The public health disease surveillance system in Mbarara City is coordinated by a city surveillance focal person, who oversees surveillance activities citywide. The city is divided into two main divisions: North and South, with the South Division having two designated surveillance officers and the North Division having one. CHWs play an integral role in the disease surveillance structure and are routinely involved in community-level detection and reporting, particularly during public health events. Study population and eligibility criteria This study was conducted among CHWs in Mbarara city southwestern Uganda. Eligible participants had lived in the city, served as CHWs for at least one year, and provided voluntary consent. CHWs who were unavailable during the data collection period were excluded. Sample size and sampling procedure The sample size was determined using a single population proportion formula with the assumption of 50% proportion (since no previous such study was done in Uganda), 95% confidence level, and 5% margin of error. A 15% nonresponse rate was added, making the final sample size of 206. The list of CHWs was obtained from the city health office, which was then used as a sampling frame. A simple random sampling technique was used to select the study participants, and the selection process was carried out using Microsoft Excel to ensure that each CHWs member had an equal chance of being included in the study. Data collection tools and procedures Data were collected using a self-administered, structured questionnaire delivered by three trained field workers (public health officers), following written informed consent. The instrument began with sociodemographic items, including age, sex, education level, and years of service—and proceeded to a 11-item knowledge section covering mpox etiology, transmission, clinical presentation, and management. Each correct knowledge response earned one point, yielding a total maximum score of up to 26. Attitudes were assessed via five statements on perceived severity, confidence in response, and effectiveness of control measures, with positive responses scored as one point (range 0–5). Practices were evaluated through seven yes/no items, such as handwashing, mask use, community education, and referral of suspected cases—each affirmative answer scored one point for a maximum practice score of 17. We applied Bloom’s 60% cut-off to classify scores: those achieving ≥ 60% were deemed to have good knowledge, a positive attitude, or good practice, while scores below 60% indicated poor knowledge, a negative attitude, or poor practice ( 8 ). Data management and analysis Data was collected using Kobo collect and exported to Epi info version 7.2.6.0 for analysis. Categorical variables were summarized using frequencies and percentages. Binary logistic regression was used to assess the association between independent (good KAP) and dependent variables. All variables in the bivariate analysis with a P-value of ≤ 0.2, were entered into a multivariate logistic regression model to determine the independent factors associated with KAP. A p-value of < 0.05 was considered statistically significant. Ethical Considerations This study was in response to a public health emergency and was therefore determined to be non-research. The Ministry of Health (MoH) gave permission to conduct the study. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. §§See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. § 241(d); 5 U.S.C. § 552a; 44 U.S.C. § 3501 et seq. All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda MoH were performed in accordance with the Declaration of Helsinki. Permission to conduct the study was also granted by City Health Office. Prior to data collection, informed consent was obtained from all the participants who were aged 18 years or older (legal age in Uganda). Results All 206 (100%) CHWs members who received questionnaires completed and returned them. The mean age of respondents was 45 years (SD ± 10.5), with ages ranging from 20 to 70 years. The majority were female 159(77%) with males accounting for 47(23%). Most CHWs 127(62%) had over ten years of experience, and while 121(59%) had completed secondary education, only 41(20%) had attained tertiary education. Nearly all respondents (98%) had heard of mpox, and 61(30%) had received specific training on mpox ( Table 1 ). Table 1 Characteristics of community health workers assessed for knowledge, attitudes and practices regarding mpox, Mbarara City, Uganda, February 2025 (N = 206) Variable Frequency (%) Age(years) 18–35 31( 15 ) > 35 175(85) Sex Male 47(23) Female 159(77) Work experience of CHWS’s (years) 10 127(62) Level of education completed Primary 44(21) Secondary 121(59) Tertiary 41( 20 ) Have you heard about mpox Yes 202(98) No 4( 2 ) Have you received any specific training related to mpox Yes 61(30) No 141(70) Among 202 community health workers, 66% had good knowledge, 90% had a positive attitude, and only 3% demonstrated good practices (Fig. 1 ). The majority of the CHWs demonstrated a good understanding of key aspects related to mpox. One hundred and thirty-two (65%) knew how mpox is transmitted, and 70% were aware that specific treatments for mpox exist. Additionally, 81% of CHWs were knowledgeable about how to detect mpox cases in their communities, and 85% understood the procedures for reporting suspected cases. The majority of CHWs (96%) were aware of the health facilities to which they should refer suspected mpox cases, and 87% had access to the contact information for these health facilities ( Table 2 ). Overall, 133 (66%) community health workers had good knowledge about the mpox. Table 2 Community health workers’ knowledge regarding mpox in Mbarara City, Uganda, February 2025 (N = 202) Items* N (%) 1 How is mpox transmitted? 132(65) 2 Are there specific treatments for mpox? 141(70) 3 Do you know how to detect mpox cases in your community? 163(81) 4 Do you know the procedure for reporting a suspected mpox case? 172(85) 5 Are you aware of the specific health facilities to which you should refer suspected mpox cases in your community? 194(96) 6 Do you have access to the contact information of health facilities for mpox referrals in your community? 175(87) * Responses to the items indicate only the “yes” category The majority of the CHWs (n = 158; 78%) considered the threat of mpox to be serious for the community's health and well-being. Additionally, 176 (87%) of CHWs were confident in their ability to identify and manage a suspected mpox case. 180(89%) of CHWs believed in the effectiveness of mpox prevention measures, such as vaccination and handwashing. However, 123(61%) of the CHWs felt that the community was not well-prepared to prevent the spread of mpox, while 138(68%) of CHWs felt supported by local health authorities in their role in preventing mpox (Table 3 ). Overall, 181(90%) community health workers had positive attitude towards mpox (Fig. 1 ). Table 3 Community health workers’ attitudes toward mpox in Mbarara City, Uganda, February 2025 Items N (%) 1 How serious do you think the threat of mpox is for the community’s health and well-being? 158(78) 2 How confident are you in your ability to identify and manage a suspected mpox case ? 176(87) 3 Do you think the community is well-prepared to prevent the spread of mpox ? 123(61) 4 How would you rate your personal belief in the effectiveness of mpox prevention measures (e.g., vaccination, hand washing)? 180(89) 5 Do you feel supported by local health authorities in your role as a CHWs in preventing mpox ? 138(68) Regarding practices for community education and referral activities related to mpox, most of the respondents indicated involvement in community education or awareness activities about mpox 143(73%). However, fewer respondents actively referred suspected mpox cases to higher health facilities 55(28%) or reported suspected cases to health authorities regularly 55(26%). A portion of participants (30%) reported conducting home visits to educate households on mpox prevention ( Table 4 ). Overall, only 7(3%) community health workers demonstrated good practices regarding mpox and the majority 195(97%) exhibited poor practices ( Fig. 1 ). Table 4 Community health workers’ responses to practices regarding mpox in Mbarara City, Uganda, February 2025 Item N (%) 1 Have you been involved in community education or awareness activities about mpox ? 143(73) 2 Do you actively refer suspected mpox cases to higher health facilities? 55(28) 3 How regularly do you report suspected mpox cases to health authorities ? 51(26) 4 Do you conduct home visits to educate households on mpox prevention ? 59(30) Individuals who received specific training related to mpox were 5 times more likely to have good knowledge compared to those who did not receive training (aOR = 5.0, 95%CI:2.2–11) ( Table 5 ). Table 5 Multivariable logistic regression analysis on factors associated with knowledge toward mpox among community health workers in Mbarara City, Uganda, February 2025 Knowledge Variable Good (%) Poor (%) COR (95%CI) AOR (95%CI) Age(years) ≤ 35 22( 17 ) 8( 11 ) Ref > 35 107(83) 65(89) 1.7(0.7–3.9) 0.7(0.2–1.9) Sex Male 28(22) 18(25) Ref Female 101(78) 55(75) 1.9(0.8–4.5) 0.6(0.3–1.6) Work experience of CHW’s(years) 10 54(50) 20(34) 1.1(0.4–2.6) 1.0(0.4–2.3) Level of education completed Secondary 78(79) 43(69) Ref Primary 21(21) 19(31) 1.6(0.8–3.3) 0.8(0.4–1.7) Tertiary 30(28) 11( 20 ) 0.7(0.3–1.5) 1.5(0.6–3.5) Have you received any specific training related to mpox reporting and referral No 77(39) 64(93) Ref Yes 52(61) 9( 7 ) 4.8(2.1.0–10) 5(2.2–11) Ref: reference; cOR: crude odds ratios; aOR: adjusted odds ratios; CI: confidence interval Similarly, individuals who had good knowledge were 9 times more likely to have a positive attitude compared to those who had poor knowledge (aOR = 9.0, 95%CI:2.6–30) (Table.6) Table 6 Factors associated with attitude toward mpox among community health workers in Mbarara City, Uganda, February 2025 Attitude Variable Positive Negative cOR (95%CI) aOR (95%CI) Age(years) ≤ 35 1( 5 ) 29( 16 ) Ref > 35 20(95) 152(84) 3.8(0.5–30) 0.3(0.03–2.9) Sex Male 39(22) 7(33) Ref Female 142(78) 14(67) 0.5(0.2–1.5) 0.4(0.1–1.4) Work experience of CHW’s(years) 10 68(46) 6(35) 0.3(0.1–1.5) 0.9(0.2–3.8) Level of education completed Secondary 109(77) 12(60) Ref Primary 32(23) 8(40) 0.8(0.3–2.9) 0.6(0.2–1.9) Tertiary 40(27) 1( 13 ) 0.6(0.2–1.8) 4.3(0.5–37) Have you received any specific training related to mpox reporting and referral No 124(69) 17(81) Ref Yes 57(31) 4( 19 ) 1.9(0.6–6.1) 0.9(0.9-5.0) Mpox knowledge Poor 56(31) 17(81) Ref Good 125(69) 4( 19 ) 9.9(3.1–29) 9(2.6–30) Ref: reference; cOR: crude odds ratios; aOR: adjusted odds ratios; CI: confidence interval Discussion This study assessed the knowledge, attitudes, and practices (KAP) of Community health workers (CHWs) in Mbarara City, Uganda, regarding mpox. Overall, approximately two-thirds of CHWs demonstrated good knowledge, 90% had a positive attitude, yet only 3% exhibited good practices. No factors were found to be significantly associated with good practices. CHWs who received mpox-specific training demonstrated significantly better knowledge, mirroring prior evidence on the value of continuous education for emerging infectious diseases ( 9 , 10 ). This finding underscores that targeted, hands-on training may not only enhance individual preparedness but also strengthen community-level outbreak response capacity ( 11 , 12 ). There is a need for sustained investment in CHWs capacity building, including regular refresher trainings and practical simulations, to bridge gaps in knowledge and practice. Two-thirds of CHWs in our study demonstrated good mpox knowledge, paralleling findings from Nigeria (58.7%), China (56.5%), and Algerian health workers (64.9%) ( 13 – 15 ) .The findings may be attributed to the timing of the study, which was conducted shortly after a notable surge in mpox cases in the city, likely raising public awareness even in the absence of formal training. This exposure may have led to greater informal learning among CHW’s through intensified community sensitization. Similarly, the results of our finding was higher than other previous studies for instance a study in Ethiopia among health workers had 38.5% as good knowledge, in Nigeria 37.8% as good knowledge ( 16 , 17 ). The majority of CHWs (90%) demonstrated a positive attitude toward mpox prevention and control, a proportion comparable to that observed among Indonesian general practitioners (84.3%) and Nigerian health workers (87.8%) ( 17 , 18 ). The study revealed that the odds of having positive attitude were 9 times among those who had good knowledge compared to those who had poor knowledge. This is similar to a study conducted among medical doctors in Bangladesh that found association between good knowledge and positive attitude ( 18 ). In terms of practices, the study findings revealed the good practice in only 3%. This finding is comparable to a study among health workers in Uganda, which reported that 88% exhibited poor practices (21). Other studies, such as one conducted in Vietnam, reported slightly better outcomes, with 51.8% of participants demonstrating good practices ( 10 ) Despite active participation in awareness campaigns, CHWs infrequently referred or reported suspected mpox cases to health authorities. This pattern mirrors observations from other African settings, where CHWs—while essential for community sensitization and preventive outreach—proved most effective only when supported by comprehensive training and adequate resources ( 20 ). A key limitation of this study was its reliance on quantitative survey data alone; the absence of a qualitative component prevented in-depth exploration of CHWs’ experiences, motivations, and the contextual factors influencing their mpox-related KAP. Incorporating qualitative methods—such as in-depth interviews or focus groups—in future research could elucidate the specific barriers and facilitators that shape CHW engagement in outbreak response. Additionally, the reliance on self-reported data may have introduced social desirability bias, where participants tend to over report desirable behaviors, such as participation in community education, and underreport undesirable ones, like failure to refer suspected cases. These biases could have led to an overestimation of knowledge and attitude levels, while underestimating the extent of poor practices among the CHWs Conclusion Although CHWs in Mbarara City demonstrated adequate mpox knowledge and positive attitudes—largely due to targeted training—their actual referral and reporting practices were insufficient. This gap underscores the need for ongoing supportive supervision, practical skills workshops (including case simulations and hands-on use of reporting tools), and timely feedback to help CHWs translate theoretical knowledge into action, to effectively control mpox transmission at community level. Further studies could explore the specific operational barriers CHWs encounter to guide capacity building interventions to strengthen community-level mpox detection and control. Abbreviations aOR: Adjusted Odds Ratio; CDC: Centers for Disease Control and Prevention; CI: Confidence Interval; cOR: Crude Odds Ratio; CHWs: Community Health Workers; CHO: City Health Officer, Mpox: Monkey Pox, PHEIC: Public Health Emergency of International Concern, WHO: World Health Organization; MoH: Ministry of Health, KOFIH: Korea Foundation for International Healthcare Declarations Ethics and consent to participate This study was in response to a public health emergency and was therefore determined to be non-research and clinical trial number not applicable. The Ministry of Health (MoH) gave permission to conduct the study. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. §§See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq. All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda MoH were performed in accordance with the Declaration of Helsinki. Permission to conduct the study was also granted by City Health Office. Prior to data collection, informed consent was obtained from all the participants who were aged 18 years or older (legal age in Uganda). Competing interests The authors declare no competing interests Consent for publication Not applicable Availability of data and materials The datasets upon which our findings are based belong to the Uganda Public Health Fellowship Program. For confidentiality reasons, the datasets are not publicly available. The datasets can be availed upon reasonable request from the corresponding author with permission from the Uganda Public Health Fellowship Program. Request can be directed at: [email protected] Funding and disclaimer This study was supported by Korea Foundation for International Healthcare (KOFIH) under the project titled, “Strengthening Health Systems to Prevent, Detect and Respond to Infectious Diseases in Uganda” implemented in collaboration with the Uganda Public Health Fellowship Program and Ministry of Health. Author contribution PK, conceptualized the study idea, collected data, analyzed it and wrote the manuscript.HK, CM, EM, OJK, LON, EOO, AM,conceptualized the study idea, collected data and reviewed the manuscript. RM, IL, BK, and ARA supported in editing, and reviewing of the manuscript. All authors read and approved the final manuscript. Acknowledgments We extend our appreciation to Mbarara City Health Office team, City Health Educator for their overall coordination and leadership during the study in the city. We also thank Community health workers for the active participation. Lastly, we recognize the Uganda Public Health Fellowship Program for providing technical oversight, coordination, and funding throughout the study. References Dubey AK. Monkeypox-An Overview of Transmission, Clinical Manifestations and Treatment Approaches. IGJPS. 2022;12(12):273–80. Shafaati M, Zandi M. Monkeypox virus neurological manifestations in comparison to other orthopoxviruses. 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Kobusingye JO, Mfitundinda E, Katumba H, Nalwanga J, Wenani D, Eyu P, et al. Knowledge attitude and practices toward mpox among healthcare workers in Kasese and Mayuge districts, Uganda, August-September, 2024. 2025;10(1). Pete PMN, Biguioh RM, Njuwa FKG, Folayan MO, Ngandu C, Ngongo N, et al. Unlocking the potentials of community health workers for effective control of mpox outbreaks in Africa. The Pan African Medical Journal [Internet]. 2025 Mar 2 [cited 2025 May 14];50(3). Available from: https://www.panafrican-med-journal.com//content/article/50/3/full Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Kwizera","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYDACHgaGAyCaH4gPMDaQokWygRQtYGAA0kiUFnOeM4YHf1Tckze+kXvwcOEOBrt+Bh7jF/i0WPb2GByQOFNsuO1GXsLhmWcYkmc28JhZ4NNicJ53wwHDtgTGbTdyDA7ztjEkGxzgMTMgqCXxX4L95hlEaznbu+HAwYaExA0SEC12QC3GD/D6pef8h4MNxxKSZ5x5Y3B4ZptEgmQzWxk+HcAQS0v++KMmwba/Pcf4c2GbjT0/e/PmD3gdhsxhZmCQSGxgZmCTIEULgz2IxmvLKBgFo2AUjDgAAAimT7nW49DnAAAAAElFTkSuQmCC","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":true,"prefix":"","firstName":"Patrick","middleName":"","lastName":"Kwizera","suffix":""},{"id":484458577,"identity":"16b044f6-666d-44e0-85a5-14e7fbe1f6d7","order_by":1,"name":"Richard Migisha","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"","lastName":"Migisha","suffix":""},{"id":484458578,"identity":"0431ba7d-8c2a-4c63-a0fc-45986f0b4343","order_by":2,"name":"Hannington Katumba","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Hannington","middleName":"","lastName":"Katumba","suffix":""},{"id":484458579,"identity":"35e85b14-c430-4076-a0d0-10e2f2d30f7c","order_by":3,"name":"Charity Mutesi","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Charity","middleName":"","lastName":"Mutesi","suffix":""},{"id":484458580,"identity":"9ea3814e-df61-46ee-8d4f-0d09f14dd98e","order_by":4,"name":"Emmanuel Mfitundinda","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"","lastName":"Mfitundinda","suffix":""},{"id":484458581,"identity":"fce8998a-487b-4a61-944d-dd49ec854b8c","order_by":5,"name":"Owens Joyce Kobusingye","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Owens","middleName":"Joyce","lastName":"Kobusingye","suffix":""},{"id":484458582,"identity":"6d15d230-6a49-4568-bdbb-eca7b5fc248e","order_by":6,"name":"Loryndah Olive Namakula","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Loryndah","middleName":"Olive","lastName":"Namakula","suffix":""},{"id":484458583,"identity":"1d1fcac9-dba2-477d-bbe4-82734820ad97","order_by":7,"name":"Emmanuel Okiror Okello","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"Okiror","lastName":"Okello","suffix":""},{"id":484458584,"identity":"210a400b-f5f5-475d-847d-c6e8916182be","order_by":8,"name":"Abraham Muhwezi","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Abraham","middleName":"","lastName":"Muhwezi","suffix":""},{"id":484458585,"identity":"0499e147-6c72-45db-a9a7-52dc6b2eff15","order_by":9,"name":"Dansan Atim","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Dansan","middleName":"","lastName":"Atim","suffix":""},{"id":484458586,"identity":"46e3c7a6-3af9-41b0-bdf4-253760642ef6","order_by":10,"name":"Ivan Lukabwe","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Ivan","middleName":"","lastName":"Lukabwe","suffix":""},{"id":484458587,"identity":"7e215104-dc16-48bc-88c9-3fdc60f7cd9a","order_by":11,"name":"Benon Kwesiga","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Benon","middleName":"","lastName":"Kwesiga","suffix":""},{"id":484458588,"identity":"acf8f29f-6eb5-4bac-8130-590180dd455c","order_by":12,"name":"Alex Riolexus Ario","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program-Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Alex","middleName":"Riolexus","lastName":"Ario","suffix":""}],"badges":[],"createdAt":"2025-05-29 06:08:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6773212/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6773212/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86675018,"identity":"2de08dca-8749-4501-9578-c3e265189670","added_by":"auto","created_at":"2025-07-14 11:54:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":17448,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKnowledge, attitude and practicestowards mpox among community health workers, Mbarara City, Uganda, February 2025 (n=202).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6773212/v1/dd776b75f3a07ede87ed8faf.png"},{"id":87502701,"identity":"dcc9c8ff-c5fb-4ad2-b801-3a2d244a523f","added_by":"auto","created_at":"2025-07-24 14:08:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1491376,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6773212/v1/f477802c-81dd-4e62-b56d-4f42cc2bee03.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, attitudes, and practices of community health workers regarding mpox in Mbarara City, Uganda, February 2025: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eMpox is a zoonotic disease caused by an enveloped double-stranded DNA virus in the genus Orthopoxvirus (family Poxviridae) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Human-to-human transmission occurs through close contact with infected persons, lesion exudates, body fluids, respiratory droplets, or sexual contact (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Clinically, mpox resembles smallpox\u0026mdash;fever, headache, myalgia, and rash\u0026mdash;but is generally milder and typically features lymphadenopathy, which distinguishes it from smallpox. The incubation period spans 1\u0026ndash;21 days, with most patients developing symptoms within seven days of exposure (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMpox has emerged as a global public health concern, extending beyond its traditional endemic foci in West and Central Africa to affect multiple regions worldwide. In response to increasing case-counts including notable outbreaks in the Democratic Republic of the Congo and other countries, the World Health Organization declared mpox a Public Health Emergency of International Concern (PHEIC) on August 14, 2024 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUganda confirmed its first human mpox cases on July 24, 2024. By November 30, 2024, a total of 745 PCR-confirmed infections had been reported across 52 districts, including nearly 200 cases among children and adolescents (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Urban centers later became epicenters of transmission, with Mbarara City\u0026rsquo;s caseload rising from 92 in December 2024 to 123 in January 2025. This urban shift underscored critical gaps in prevention, early detection, and timely response. Community health workers (CHWs) are essential for disease surveillance, case identification, and community education; however, their preparedness for mpox control had not been evaluated. Inadequate knowledge, attitudes, and practices (KAP) among CHWs may contribute to delayed reporting and suboptimal outbreak management. This study aimed to assess the knowledge, attitudes and practices of CHWs regarding mpox in Mbarara City, Uganda, February 2025\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eThis cross-sectional study was conducted from February 1\u0026ndash;15, 2025, among CHWs from the 23 Wards of Mbarara City, located approximately 270 kilometres (about 168 miles) southwest of Kampala. Mbarara City has a catchment population of approximately 238,500 people. The city is bordered by Isingiro District to the south, Kiruhura District to the north, Rwampara District to the east, and Mbarara District to the west.\u003c/p\u003e\u003cp\u003eThe public health disease surveillance system in Mbarara City is coordinated by a city surveillance focal person, who oversees surveillance activities citywide. The city is divided into two main divisions: North and South, with the South Division having two designated surveillance officers and the North Division having one. CHWs play an integral role in the disease surveillance structure and are routinely involved in community-level detection and reporting, particularly during public health events.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population and eligibility criteria\u003c/h3\u003e\n\u003cp\u003eThis study was conducted among CHWs in Mbarara city southwestern Uganda. Eligible participants had lived in the city, served as CHWs for at least one year, and provided voluntary consent. CHWs who were unavailable during the data collection period were excluded.\u003c/p\u003e\n\u003ch3\u003eSample size and sampling procedure\u003c/h3\u003e\n\u003cp\u003eThe sample size was determined using a single population proportion formula with the assumption of 50% proportion (since no previous such study was done in Uganda), 95% confidence level, and 5% margin of error. A 15% nonresponse rate was added, making the final sample size of 206. The list of CHWs was obtained from the city health office, which was then used as a sampling frame. A simple random sampling technique was used to select the study participants, and the selection process was carried out using Microsoft Excel to ensure that each CHWs member had an equal chance of being included in the study.\u003c/p\u003e\n\u003ch3\u003eData collection tools and procedures\u003c/h3\u003e\n\u003cp\u003eData were collected using a self-administered, structured questionnaire delivered by three trained field workers (public health officers), following written informed consent. The instrument began with sociodemographic items, including age, sex, education level, and years of service\u0026mdash;and proceeded to a 11-item knowledge section covering mpox etiology, transmission, clinical presentation, and management. Each correct knowledge response earned one point, yielding a total maximum score of up to 26.\u003c/p\u003e\u003cp\u003eAttitudes were assessed via five statements on perceived severity, confidence in response, and effectiveness of control measures, with positive responses scored as one point (range 0\u0026ndash;5). Practices were evaluated through seven yes/no items, such as handwashing, mask use, community education, and referral of suspected cases\u0026mdash;each affirmative answer scored one point for a maximum practice score of 17. We applied Bloom\u0026rsquo;s 60% cut-off to classify scores: those achieving\u0026thinsp;\u0026ge;\u0026thinsp;60% were deemed to have good knowledge, a positive attitude, or good practice, while scores below 60% indicated poor knowledge, a negative attitude, or poor practice (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eData was collected using Kobo collect and exported to Epi info version 7.2.6.0 for analysis. Categorical variables were summarized using frequencies and percentages. Binary logistic regression was used to assess the association between independent (good KAP) and dependent variables. All variables in the bivariate analysis with a P-value of \u0026le;\u0026thinsp;0.2, were entered into a multivariate logistic regression model to determine the independent factors associated with KAP. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003eThis study was in response to a public health emergency and was therefore determined to be non-research. The Ministry of Health (MoH) gave permission to conduct the study. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. \u0026sect;\u0026sect;See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. \u0026sect;\u0026nbsp;241(d); 5 U.S.C. \u0026sect;\u0026nbsp;552a; 44 U.S.C. \u0026sect;\u0026nbsp;3501 et seq.\u0026nbsp; All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda MoH were performed in accordance with the Declaration of Helsinki. Permission to conduct the study was also granted by City Health Office. Prior to data collection, informed consent was obtained from all the participants who were aged 18 years or older (legal age in Uganda).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAll 206 (100%) CHWs members who received questionnaires completed and returned them. The mean age of respondents was 45 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5), with ages ranging from 20 to 70 years. The majority were female 159(77%) with males accounting for 47(23%). Most CHWs 127(62%) had over ten years of experience, and while 121(59%) had completed secondary education, only 41(20%) had attained tertiary education. Nearly all respondents (98%) had heard of mpox, and 61(30%) had received specific training on mpox \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eCharacteristics of community health workers assessed for knowledge, attitudes and practices regarding mpox, Mbarara City, Uganda, February 2025 (N\u0026thinsp;=\u0026thinsp;206)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e175(85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47(23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e159(77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork experience of CHWS\u0026rsquo;s (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43(21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127(62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of education completed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44(21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e121(59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you heard about mpox\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e202(98)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you received any specific training related to mpox\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61(30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e141(70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong 202 community health workers, 66% had good knowledge, 90% had a positive attitude, and only 3% demonstrated good practices (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe majority of the CHWs demonstrated a good understanding of key aspects related to mpox. One hundred and thirty-two (65%) knew how mpox is transmitted, and 70% were aware that specific treatments for mpox exist. Additionally, 81% of CHWs were knowledgeable about how to detect mpox cases in their communities, and 85% understood the procedures for reporting suspected cases. The majority of CHWs (96%) were aware of the health facilities to which they should refer suspected mpox cases, and 87% had access to the contact information for these health facilities \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Overall, 133 (66%) community health workers had good knowledge about the mpox.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eCommunity health workers\u0026rsquo; knowledge regarding mpox in Mbarara City, Uganda, February 2025 (N\u0026thinsp;=\u0026thinsp;202)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItems*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow is mpox transmitted?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132(65)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAre there specific treatments for mpox?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e141(70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo you know how to detect mpox cases in your community?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e163(81)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo you know the procedure for reporting a suspected mpox case?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e172(85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAre you aware of the specific health facilities to which you should refer suspected mpox cases in your community?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e194(96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo you have access to the contact information of health facilities for mpox referrals in your community?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e175(87)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e*\u003cb\u003eResponses to the items indicate only the \u0026ldquo;yes\u0026rdquo; category\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe majority of the CHWs (n\u0026thinsp;=\u0026thinsp;158; 78%) considered the threat of mpox to be serious for the community's health and well-being. Additionally, 176 (87%) of CHWs were confident in their ability to identify and manage a suspected mpox case. 180(89%) of CHWs believed in the effectiveness of mpox prevention measures, such as vaccination and handwashing. However, 123(61%) of the CHWs felt that the community was not well-prepared to prevent the spread of mpox, while 138(68%) of CHWs felt supported by local health authorities in their role in preventing mpox (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Overall, 181(90%) community health workers had positive attitude towards mpox (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eCommunity health workers\u0026rsquo; attitudes toward mpox in Mbarara City, Uganda, February 2025\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow serious do you think the threat of mpox is for the community\u0026rsquo;s health and well-being?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e158(78)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow confident are you in your ability to identify and manage a suspected mpox case ?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e176(87)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo you think the community is well-prepared to prevent the spread of mpox ?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e123(61)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow would you rate your personal belief in the effectiveness of mpox prevention measures (e.g., vaccination, hand washing)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e180(89)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo you feel supported by local health authorities in your role as a CHWs in preventing mpox ?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e138(68)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding practices for community education and referral activities related to mpox, most of the respondents indicated involvement in community education or awareness activities about mpox 143(73%). However, fewer respondents actively referred suspected mpox cases to higher health facilities 55(28%) or reported suspected cases to health authorities regularly 55(26%). A portion of participants (30%) reported conducting home visits to educate households on mpox prevention \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Overall, only 7(3%) community health workers demonstrated good practices regarding mpox and the majority 195(97%) exhibited poor practices \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCommunity health workers\u0026rsquo; responses to practices regarding mpox in Mbarara City, Uganda, February 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHave you been involved in community education or awareness activities about mpox ?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143(73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo you actively refer suspected mpox cases to higher health facilities?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow regularly do you report suspected mpox cases to health authorities ?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51(26)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo you conduct home visits to educate households on mpox prevention ?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59(30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIndividuals who received specific training related to mpox were 5 times more likely to have good knowledge compared to those who did not receive training (aOR\u0026thinsp;=\u0026thinsp;5.0, 95%CI:2.2\u0026ndash;11) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eMultivariable logistic regression analysis on factors associated with knowledge toward mpox among community health workers in Mbarara City, Uganda, February 2025\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePoor (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107(83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65(89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.7(0.7\u0026ndash;3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.7(0.2\u0026ndash;1.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e101(78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.9(0.8\u0026ndash;4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.6(0.3\u0026ndash;1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork experience of CHW\u0026rsquo;s(years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53(71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38(72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9(0.4\u0026ndash;2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.1(0.5\u0026ndash;2.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1(0.4\u0026ndash;2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0(0.4\u0026ndash;2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of education completed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78(79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43(69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21(21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.6(0.8\u0026ndash;3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.8(0.4\u0026ndash;1.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30(28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7(0.3\u0026ndash;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.5(0.6\u0026ndash;3.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you received any specific training related to mpox reporting and referral\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77(39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52(61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.8(2.1.0\u0026ndash;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e5(2.2\u0026ndash;11)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eRef: reference; cOR: crude odds ratios; aOR: adjusted odds ratios; CI: confidence interval\u003c/h3\u003e\n\u003cp\u003eSimilarly, individuals who had good knowledge were 9 times more likely to have a positive attitude compared to those who had poor knowledge (aOR\u0026thinsp;=\u0026thinsp;9.0, 95%CI:2.6\u0026ndash;30) \u003cb\u003e(Table.6)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eFactors associated with attitude toward mpox among community health workers in Mbarara City, Uganda, February 2025\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ecOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eaOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20(95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e152(84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.8(0.5\u0026ndash;30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.3(0.03\u0026ndash;2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39(22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142(78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5(0.2\u0026ndash;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.4(0.1\u0026ndash;1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork experience of CHW\u0026rsquo;s(years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80(71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5(0.1\u0026ndash;3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.1(0.3\u0026ndash;4.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68(46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3(0.1\u0026ndash;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.9(0.2\u0026ndash;3.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of education completed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e109(77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32(23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.8(0.3\u0026ndash;2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.6(0.2\u0026ndash;1.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40(27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6(0.2\u0026ndash;1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.3(0.5\u0026ndash;37)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you received any specific training related to mpox reporting and referral\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124(69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57(31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.9(0.6\u0026ndash;6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.9(0.9-5.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMpox knowledge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56(31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125(69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.9(3.1\u0026ndash;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e9(2.6\u0026ndash;30)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eRef: reference; cOR: crude odds ratios; aOR: adjusted odds ratios; CI: confidence interval\u003c/h2\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the knowledge, attitudes, and practices (KAP) of Community health workers (CHWs) in Mbarara City, Uganda, regarding mpox. Overall, approximately two-thirds of CHWs demonstrated good knowledge, 90% had a positive attitude, yet only 3% exhibited good practices. No factors were found to be significantly associated with good practices.\u003c/p\u003e\u003cp\u003eCHWs who received mpox-specific training demonstrated significantly better knowledge, mirroring prior evidence on the value of continuous education for emerging infectious diseases (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This finding underscores that targeted, hands-on training may not only enhance individual preparedness but also strengthen community-level outbreak response capacity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). There is a need for sustained investment in CHWs capacity building, including regular refresher trainings and practical simulations, to bridge gaps in knowledge and practice.\u003c/p\u003e\u003cp\u003eTwo-thirds of CHWs in our study demonstrated good mpox knowledge, paralleling findings from Nigeria (58.7%), China (56.5%), and Algerian health workers (64.9%) (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) .The findings may be attributed to the timing of the study, which was conducted shortly after a notable surge in mpox cases in the city, likely raising public awareness even in the absence of formal training. This exposure may have led to greater informal learning among CHW\u0026rsquo;s through intensified community sensitization. Similarly, the results of our finding was higher than other previous studies for instance a study in Ethiopia among health workers had 38.5% as good knowledge, in Nigeria 37.8% as good knowledge (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe majority of CHWs (90%) demonstrated a positive attitude toward mpox prevention and control, a proportion comparable to that observed among Indonesian general practitioners (84.3%) and Nigerian health workers (87.8%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe study revealed that the odds of having positive attitude were 9 times among those who had good knowledge compared to those who had poor knowledge. This is similar to a study conducted among medical doctors in Bangladesh that found association between good knowledge and positive attitude (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn terms of practices, the study findings revealed the good practice in only 3%. This finding is comparable to a study among health workers in Uganda, which reported that 88% exhibited poor practices (21). Other studies, such as one conducted in Vietnam, reported slightly better outcomes, with 51.8% of participants demonstrating good practices (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDespite active participation in awareness campaigns, CHWs infrequently referred or reported suspected mpox cases to health authorities. This pattern mirrors observations from other African settings, where CHWs\u0026mdash;while essential for community sensitization and preventive outreach\u0026mdash;proved most effective only when supported by comprehensive training and adequate resources (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA key limitation of this study was its reliance on quantitative survey data alone; the absence of a qualitative component prevented in-depth exploration of CHWs\u0026rsquo; experiences, motivations, and the contextual factors influencing their mpox-related KAP. Incorporating qualitative methods\u0026mdash;such as in-depth interviews or focus groups\u0026mdash;in future research could elucidate the specific barriers and facilitators that shape CHW engagement in outbreak response. Additionally, the reliance on self-reported data may have introduced social desirability bias, where participants tend to over report desirable behaviors, such as participation in community education, and underreport undesirable ones, like failure to refer suspected cases. These biases could have led to an overestimation of knowledge and attitude levels, while underestimating the extent of poor practices among the CHWs\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAlthough CHWs in Mbarara City demonstrated adequate mpox knowledge and positive attitudes\u0026mdash;largely due to targeted training\u0026mdash;their actual referral and reporting practices were insufficient. This gap underscores the need for ongoing supportive supervision, practical skills workshops (including case simulations and hands-on use of reporting tools), and timely feedback to help CHWs translate theoretical knowledge into action, to effectively control mpox transmission at community level. Further studies could explore the specific operational barriers CHWs encounter to guide capacity building interventions to strengthen community-level mpox detection and control.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eaOR: Adjusted Odds Ratio; CDC: Centers for Disease Control and Prevention; CI: Confidence Interval; cOR: Crude Odds Ratio; CHWs: Community Health Workers; CHO: City Health Officer, Mpox: Monkey Pox, PHEIC: Public Health Emergency of International Concern, WHO: World Health Organization; MoH: Ministry of Health, KOFIH: Korea Foundation for International Healthcare\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was in response to a public health emergency and was therefore determined to be non-research and\u0026nbsp;clinical trial number not applicable. The Ministry of Health (MoH) gave permission to conduct the study. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. \u0026sect;\u0026sect;See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. \u0026sect;241(d); 5 U.S.C. \u0026sect;552a; 44 U.S.C. \u0026sect;3501 et seq. All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda MoH were performed in accordance with the Declaration of Helsinki. Permission to conduct the study was also granted by City Health Office. Prior to data collection, informed consent was obtained from all the participants who were aged 18 years or older (legal age in Uganda).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets upon which our findings are based belong to the Uganda Public Health Fellowship Program. For confidentiality reasons, the datasets are not publicly available. The datasets can be availed upon reasonable request from the corresponding author with permission from the Uganda Public Health Fellowship Program. Request can be directed at: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding and disclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Korea Foundation for International Healthcare (KOFIH) under the project titled, \u0026ldquo;Strengthening Health Systems to Prevent, Detect and Respond to Infectious Diseases in Uganda\u0026rdquo; implemented in collaboration with the Uganda Public Health Fellowship Program and Ministry of Health.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePK, conceptualized the study idea, collected data, analyzed it and wrote the manuscript.HK, CM, EM, OJK, LON, EOO, AM,conceptualized the study idea, collected data and reviewed the manuscript. RM, IL, BK, and ARA\u0026nbsp;supported in editing, and reviewing of the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our appreciation to Mbarara City Health Office team, City Health Educator for their overall coordination and leadership during the study in the city. We also thank Community health workers for the active participation. Lastly, we recognize the Uganda Public Health Fellowship Program for providing technical oversight, coordination, and funding throughout the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDubey AK. Monkeypox-An Overview of Transmission, Clinical Manifestations and Treatment Approaches. IGJPS. 2022;12(12):273\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eShafaati M, Zandi M. Monkeypox virus neurological manifestations in comparison to other orthopoxviruses. 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Sage Open. 2024 Oct;14(4):21582440241306827. \u003c/li\u003e\n\u003cli\u003eMasiira B, Nakiire L, Kihembo C, Katushabe E, Natseri N, Nabukenya I, et al. Evaluation of integrated disease surveillance and response (IDSR) core and support functions after the revitalisation of IDSR in Uganda from 2012 to 2016. BMC Public Health. 2019 Dec;19(1):46. \u003c/li\u003e\n\u003cli\u003eMusoke D, Lubega GB, Twesigye B, Nakachwa B, Brown MO, Gibson L. Enhancing the capacity of community health workers in prevention and control of epidemics and pandemics in Wakiso district, Uganda: evaluation of a pilot project. BMC Primary Care. 2024 Jul 17;25(1):260. \u003c/li\u003e\n\u003cli\u003eAl-Mustapha AI, Ogundijo OA, Sikiru NA, Kolawole B, Oyewo M, El-Nadi H, et al. A cross-sectional survey of public knowledge of the monkeypox disease in Nigeria. BMC Public Health. 2023 Mar 29;23(1):591. \u003c/li\u003e\n\u003cli\u003eRen F, Liu J, Miao J, Xu Y, Zhang R, Fan J, et al. Public awareness, specific knowledge, and worry about mpox (monkeypox): A preliminary community-based study in Shenzhen, China. Front Public Health. 2023 Feb 14;11:1077564. \u003c/li\u003e\n\u003cli\u003eLounis M, Bencherit D, Abdelhadi S. Knowledge and awareness of Algerian healthcare workers about human monkeypox and their attitude toward its vaccination: An online cross-sectional survey. Vacunas. 2023;24(2):122\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eAynalem Z, Abate M, Meseret F, Muhamed A, Abebe G, Adal A, et al. Knowledge, Attitude and Associated Factors of Monkeypox Infection Among Healthcare Workers in Injibara General Hospital, Northwest Ethiopia. JMDH. 2024 Mar;Volume 17:1159\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eOyebade AO, Oshineye AO, Olarinmoye AT, Kayode OO, Akinpelu AA, Oladosu M. Monkeypox related knowledge, attitudes and practices among students in a tertiary institution in southwest, Nigeria: A cross-sectional study. Research Journal of Health Sciences. 2023 Sep 30;11(3):205\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eHasan M, Hossain MA, Chowdhury S, Das P, Jahan I, Rahman MF, et al. Human monkeypox and preparedness of Bangladesh: A knowledge and attitude assessment study among medical doctors. J Infect Public Health. 2023 Jan;16(1):90\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eKobusingye JO, Mfitundinda E, Katumba H, Nalwanga J, Wenani D, Eyu P, et al. Knowledge attitude and practices toward mpox among healthcare workers in Kasese and Mayuge districts, Uganda, August-September, 2024. 2025;10(1). \u003c/li\u003e\n\u003cli\u003ePete PMN, Biguioh RM, Njuwa FKG, Folayan MO, Ngandu C, Ngongo N, et al. Unlocking the potentials of community health workers for effective control of mpox outbreaks in Africa. The Pan African Medical Journal [Internet]. 2025 Mar 2 [cited 2025 May 14];50(3). Available from: https://www.panafrican-med-journal.com//content/article/50/3/full\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mpox, Knowledge, Attitude, Practices, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-6773212/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6773212/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eDuring December 2024 and January 2025, Mbarara City in central Uganda recorded a steep increase in new mpox cases amid an ongoing outbreak. During the outbreak, community health workers (CHWs) conducted community surveillance, case detection, and community education. We assessed knowledge, attitudes, and practices (KAP) of CHWs regarding mpox transmission, detection, reporting, and referral in Mbarara City.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a cross-sectional study from February 1\u0026ndash;15, 2025 among CHWs selected through simple random sampling from a list of CHWs in all city wards. Data were collected using a questionnaire comprising 26 KAP-related items. Knowledge was assessed using 11 items, attitude with 5 items, and practice with 7 items, each worth 1 point. Scores\u0026thinsp;\u0026gt;\u0026thinsp;60% were classified as good knowledge, positive attitude, or good practices. Multivariate logistic regression was used to identify KAP-associated factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong 206 CHWs, 159 (77%) were female, and 127 (62%) had\u0026thinsp;\u0026gt;\u0026thinsp;10 years of experience. In total, 129 (64%) participants had good knowledge, 181 (90%) had positive attitudes, and seven (3%) demonstrated good practices. Regarding practices, 143 (73%) engaged in health education, 55 (28%) referred suspected cases, and 51 (26%) consistently reported to health authorities when a suspected case was identified. Having attended mpox-specific training (aOR\u0026thinsp;=\u0026thinsp;5.0; 95%CI: 2.2\u0026ndash;11) and having a positive attitude (aOR\u0026thinsp;=\u0026thinsp;9.0, 95%CI: 2.6\u0026ndash;30) were significantly associated with good knowledge.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eMeaningful gaps remained in CHW practices around mpox. particularly case referral and reporting. Targeted CHW training and mentorship could improve outbreak response effectiveness.\u003c/p\u003e","manuscriptTitle":"Knowledge, attitudes, and practices of community health workers regarding mpox in Mbarara City, Uganda, February 2025: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 11:53:22","doi":"10.21203/rs.3.rs-6773212/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"09ae24ce-8fcf-4724-9c11-d3e0ec54060d","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-24T14:08:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-14 11:53:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6773212","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6773212","identity":"rs-6773212","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}