Unveiling the nexus! Understanding knowledge issues, animal contact patterns and interaction of health care providers in the context of monkeypox and COVID-19 during monkeypox outbreak 2022

Figures & data

Table 1. Demographic characteristics of the studied HCPs.

	F (%)
Age groups
18 to <35 years	460 (56.37)
35 to <50 years	254 (31.13)
50 to <65 years	61 (7.48)
65 years or more	41 (5.02)
Sex
Female	422 (51.72)
Male	394 (48.28)
Marital status
Single	390 (47.79)
Divorced/widow	73 (8.95)
Married	353 (43.26)
Nationality
Cameroonian	157 (19.24)
Egyptian	183 (22.4)
Saudi	177 (21.69)
Syrian	234 (29.7)
Others^a	65 (7.97)
Place of residency
Rural	144 (17.65)
Urban	672 (82.35)
Specialty
Administrative role at health care services	30 (3.68)
Dentist	34 (4.17)
Nurse	92 (11.27)
Other health care professions	102 (12.50)
Non-health care profession	193 (23.67)
Pharmacist	48 (5.88)
Physical therapist	17 (2.08)
Physician	281 (34.44)
Student	17 (2.08)
Veterinarian	2 (0.25)
Works include interaction with patients (frontline)	304 (37.25)
Had comorbidities
No	667 (81.74)
Only organic illness	136 (16.67)
Only psychiatric (mental) illness	6 (0.74)
Yes, both	7 (0.86)
Chickenpox vaccination status
No, I hesitate	79 (9.68)
No, but I intend to get the vaccine	85 (10.42)
No, I don't intend to	342 (41.91)
Yes	310 (37.99)

^a Others include Iraq and Libyan.

Table 2. The HCPs' knowledge and experience.

Participants' percentages of correct answers regarding	COVID-19 F (%)	Monkeypox F (%)
You got infected with	510 (62.50)	26 (3.19)
You dealt with cases or suspected cases	590 (62.50)	34 (4.17)
You received a program or training course	452 (55.39)	72 (8.82)
Have you been vaccinated
No, I hesitate	20 (2.45)	187 (22.92)
No, but I intend to get the vaccine	44 (5.39)	158 (19.36)
No, I don't intend to	103 (12.62)	423 (51.84)
Yes	649 (79.53)	48 (5.88)
You ever sexually contacted homosexual people(MSM)		72 (8.82)
Which of the following is true regarding
Fever	668 (81.86)	393 (48.16)
Headache	665 (81.50)	350 (42.89)
Cough	657 (80.51)	293 (35.91)
Sore throat	647 (79.29)	338 (41.42)
Skin lesion	278 (34.07)	431 (52.82)
Back pain	250 (30.64)	239 (29.29)
Muscle pain	168 (20.59)	275 (33.70)
Lymph node swelling	464 (56.86)	260 (31.86)
Has a post-COVID-19 symptoms (multi-system affection)	504 (61.76)	289 (35.42)
The incubation period is less than a week	366 (44.85)	313 (38.36)
The incubation period is between a week and two weeks	332 (40.69)	220 (26.96)
Is a zoonotic disease	345 (42.28)	353 (43.26)
Can be transmitted by droplets	650 (79.66)	218 (26.72)
Can be a sexually transmitted disease	489 (59.93)	299 (36.64)
Can be transmitted by contact with contaminated surfaces	210 (25.74)	252 (30.88)
Can lead to death	673 (82.48)	365 (44.73)
Is a viral infection	192 (23.53)	528 (64.71)
Is a bacterial infection	158 (19.36)	232 (28.43)
Has a known treatment	130 (15.93)	264 (32.35)
Has a known vaccine	658 (80.64)	532 (65.20)
Is an emerging disease	407 (49.88)	321 (39.34)
Is a re-emerging disease	128 (15.69)	528 (64.71)
The level of knowledge
High	46 (5.64)	37 (4.53)
Moderate	464 (56.86)	309 (37.87)
Poor	306 (37.50)	470 (57.60)
Total knowledge score, median (IQR)	11.00(9.00–13.00)	9.00 (5.00–13.00)

Table 3. Multivariate linear regression analysis of COVID-19 knowledge score.

Item	Estimate	Std. error	t value	p value
(Intercept)	2.967	0.627	4.730	<0.001*
Age group: (18 to <35 years)
35 to <50 years	−0.097	0.266	−0.363	0.716
50 to <65 years	0.252	0.452	0.557	0.578
65 years or more	1.282	0.574	2.234	0.026*
Sex (female)
Male	−0.280	0.202	−1.389	0.165
Marital status (single)
Divorced/widow	−0.057	0.435	−0.131	0.896
Married	0.536	0.263	2.033	0.042*
Place of residence (rural)
Urban	−0.200	0.264	−0.760	0.447
Does your work include interaction with patients? (frontline)
Yes	0.176	0.229	0.769	0.442
Do you suffer from any organic or psychiatric (mental) illnesses?(No)
Only organic illness	0.018	0.319	0.058	0.954
Only psychiatric (mental) illness	1.879	1.118	1.681	0.093
Yes, both	0.005	1.063	0.004	0.997
Have you been vaccinated with COVID-19 vaccine?(No)
Yes	−0.103	0.263	−0.394	0.694
Have you got infected with SARS-CoV-2 virus? (No)
Yes	1.537	0.238	6.462	<0.001*
Have you received any program or training course on COVID-19? (No)
Yes	1.388	0.236	5.875	<0.001*
Knowledge-seeking behaviour (information on COVID-19) (passive attention)
Active search	0.224	0.263	0.850	0.396
Ongoing search	−0.490	0.340	−1.439	0.150
Passive search	−0.055	0.280	−0.196	0.845
Animal exposure pattern score	−0.042	0.022	−1.942	0.053
Adherence to health precautions	0.058	0.017	3.366	0.001*

*Significance level is p value <0.05.

Table 4. Multivariate linear regression analysis of monkeypox knowledge score.

Item	Estimate	Std. error	t value	P value
(Intercept)	5.271	0.801	6.579	<0.001*
Age group (18 to <35 years)
35 to <50 years	0.391	0.438	0.892	0.373
50 to <65 years	0.125	0.735	0.170	0.865
65 years or more	−3.574	0.932	−3.835	<0.001*
Sex (female)
Male	−0.460	0.321	−1.433	0.152
Marital status (single)
Divorced/widow	0.760	0.714	1.064	0.288
Married	1.132	0.431	2.627	0.009*
Place of residence (rural)
Urban	−0.693	0.430	−1.610	0.108
Does your work include interaction with patients ?(frontline)
Yes	1.211	0.365	3.316	0.001*
Do you suffer from any organic or psychiatric (mental) illnesses? (No)
Only organic illness	−1.840	0.520	−3.536	<0.001*
Only psychiatric (mental) illness	2.093	1.838	1.138	0.255
Yes, both	−0.124	1.744	−0.071	0.943
Have you been vaccinated with the chickenpox vaccine? (No)
Yes	−0.609	0.360	−1.689	0.092
Have you been vaccinated with the monkeypox vaccine? (No)
Yes	−1.119	0.720	−1.555	0.120
Have you got infected with monkeypox virus?(No)
Yes	0.085	1.022	0.083	0.934
Have you dealt with cases or suspected cases of monkeypox? (No)
Yes	0.944	0.886	1.064	0.287
Have you received any program or training course on monkeypox? (No)
Yes	3.178	0.582	5.457	<0.001*
Have you ever sexually contacted homosexual people? (No)
Yes	2.489	0.654	3.806	<0.001*
Knowledge-seeking behaviour (information on Monkeypox) (passive attention)
Active search	1.265	0.454	2.787	0.005*
Ongoing search	1.576	0.616	2.557	0.011*
Passive search	0.411	0.403	1.019	0.308
Animal exposure pattern score	−0.119	0.034	−3.530	<0.001*
Adherence to health precautions	0.029	0.028	1.019	0.308

*Significance level is p value <0.05.

Figure 1. Sources of information about monkeypox.

Figure 2. The levels of knowledge among HCPs regarding COVID-19 and MPOX.

Table 5. The HCPs' knowledge-seeking behaviour regarding COVID-19 and monkeypox.

Knowledge-seeking behaviour	COVID-19		Monkeypox
	F (%)	Median (IQR)	F (%)	Median (IQR)
Passive attention	316 (38.73)	11.00(9.00–13.00)	415 (50.86)	8.00(3.00–13.00)
Active search	235 (28.80)	11.00(10.00–15.00)	147 (18.01)	10.00(8.00–14.00)
Ongoing search	103 (12.62)	12.00(10.00–14.00)	66 (8.09)	12.00(8.00–15.00)
Passive search	162 (19.85)	11.00(9.00–13.00)	188 (23.04)	9.00(7.00–13.00)
P value of Kruskal–Wallis test	0.001*		<0.001*

^* Significant p value <0.05.

Table 6. The HCPs' belief about MPOX and their adherence to health precautions (MPOX health belief model).

	Strongly agree F (%)	Agree F (%)	Neutral F (%)	Disagree F (%)	Strongly disagree F (%)
(A) Perceived susceptibility and severity
Do you consider yourself liable to infection with monkeypox? (perceived susceptibility) Mean (SD) 2.91 (1.00)	40 (4.90)	185 (22.55)	330 (40.44)	190 (23.28)	72 (8.82)
Do you consider yourself liable to severe infection with monkeypox? (perceived severity) Mean (SD) 2.56 (0.99)	29 (3.55)	85 (10.42)	324 (39.71)	2 53 (31.00)	125 (15.32)
(B) Cues to action (what is your expectation regarding the spread of monkeypox in comparison to COVID-19?
As COVID-19 Less than COVID-19 More than COVID-19	81 (9.93) 715 (87.62) 20 (2.45)
(C) Action (adherence to health precautions)
	Always F (%)	Often F (%)	Sometimes F (%)	No or rarely F (%)	Total practice
Wearing masks	106 (12.99)	171 (20.96)	340 (41.67)	199 (24.39)	Median= 18.00 (IQR) = (15.00–23.00)
Keeping safe spaces or distances	99 (12.13)	139 (17.03)	334 (40.93)	244 (29.90)
Regular disinfection of surfaces	113 (13.85)	163 (19.98	360 (44.12)	180 (22.06)
Hygienic hand wash	300 (36.76)	263 (32.23)	162 (19.85)	91 (11.15)
Sticking to cough etiquette	243 (29.78)	177 (21.69)	218 (26.72)	178 (21.81)
Drinking more than two liter of water daily	204 (25.00)	203 (24.88)	279 (34.19)	130 (15.93)
Supplements intake	85 (10.42)	137 (16.79)	293 (35.91)	301 (36.89)
Regular exercise one hour and a half per week	90 (11.03)	152 (18.63)	312 (38.24)	262 (32.11)

Always (seven days per week), often (5–6 days per week), sometimes (2–4 days per week) and no or rarely (less than once per week).

Table 7. Animal contact patterns among the HCPs.

	Not at all F (%)	Yearly or monthly F (%)	Weekly F (%)	Daily F (%)
Rodents, mice,and hamsters	550 (67.40)	41 (5.02)	144 (17.65)	81 (9.93)
Bats	647 (79.29)	32 (3.92)	71 (8.70)	66 (8.09)
Monkeys	689 (84.44)	17 (2.08)	57 (6.99)	53 (6.50)
Camels	677 (82.97)	16 (1.96)	63 (7.72)	60 (7.35)
Reptile pets such as turtles, alligators, crocodiles, lizards and snakes	645 (79.04)	27 (3.31)	94 (11.52)	50 (6.13)
Aquatic pets such as fish	603 (73.90)	27 (3.31)	118 (14.46)	68 (8.33)
Avian pets such as parrots, and passerines	390 (47.79)	73 (8.95)	300 (36.76)	53 (6.50)
Total animal contact patterns score	Median (IQR) = 2 (0–6)

Table 8. Spearman's correlation analysis

Variable 1 (total score of)	Variable 2 (total score of)	r	p Value
Monkeypox knowledge	COVID-19 knowledge	0.48	<0.001*
Monkeypox knowledge	Animal contact patterns	−0.20	<0.001*
COVID-19 knowledge	Animal contact patterns	−0.33	<0.001*
Monkeypox knowledge	Adherence to health precautions	0.1	0.005*
COVID-19 knowledge	Adherence to health precautions	0.16	<0.001*
Animal contact patterns	Adherence to health precautions	−0.03	0.374

^* The significance level is p value <0.05/r (correlation coefficient).

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request ([email protected]).