Assessment of healthcare workers' knowledge and attitude on Ebola virus disease in Somalia: a multicenter nationwide survey

Abstract
Background In September 2022, a new Ebola outbreak was reported in Uganda, East Africa, and 142 confrmed
cases, including 19 Healthcare workers (HCWs) reported. Ebola is not endemic in Somalia, but the country is at a
reasonable risk of the virus being introduced due to the direct connection with daily fights from Uganda without border health control and prevention activities. Therefore, evaluating HCWs’ Knowledge and attitude is crucial since this
is the frst time being evaluated in Somalia. The study’s objective is to evaluate the HCWs’ Knowledge and attitude
toward the Ebola virus disease in Somalia.
Method An online self-administrated cross-sectional survey was conducted among HCWs (n=1103) in all six federal
member states of Somalia using a validated, reliable, well-structured questionnaire. Data we analyzed using descriptive statistics and Logistic regression were used to determine sociodemographic characteristics associated with poor
Knowledge and negative attitude.
Result Over one-third (37.3%) of HCWs had poor Knowledge; the mean knowledge score was 7.97 SD±2.15. Almost
40.1% of the HCWs had a negative attitude; the mean attitude was 27.81 SD±8.06. Low-income HCWs (AOR=2.06,
95%CI:1.01–4.19), Married HCWs (AOR=1.39, 95%CI: 1.110–1.963), Midwives (AOR=2.76, 95%CI: 1.74–4.39), Lab technicians (AOR=2.43, 95%CI: 1.43–4.14), HCWs work in Jubaland state of Somalia (AOR=3.69, 95%CI: 2.39–5.70), Galmudug state (AOR=8.50, 95%CI: 4.59–15.77), Hirshabelle state (AOR=3.18, 95%CI: 2.15–4.71) were more likely to have
poor Knowledge compared to their counterparts. HCWs who work in Hirshabelle state (AOR=5.44,95%CI: 3.58–8.27),
Jubaland state (AOR=8.47, 95%CI: 4.69–15.29), and Galmudug state (AOR=4.43, 95%CI: 3.03–6.48) was more likely
to have a negative attitude than those working in the Banadir region administration.
Conclusion Most Somali healthcare workers showed good Knowledge and a positive attitude toward the Ebola
virus. The implementation to enhance Knowledge and attitude must specifcally focus on low-income HCWs, Midwives, Lab technicalities, and those who work in Hirshabelle, Jubaland, and Galmudug states of Somalia.
Keywords Ebola virus disease, Knowledge, Attitude, Practice, KAP survey, Healthcare workers, Infection prevention
and control, East Africa, Somalia