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

In many parts of the world, the line between human health and animal health is thinner than a thin wall. Diseases do not respect the boundary between a barnyard and a living room; they move freely between species, jumping from animals to people and back again. These illnesses, known as zoonotic diseases, are a major global concern because they can spread quickly and cause severe harm. Some are famous for their sudden, terrifying outbreaks, while others are quiet, constant threats that linger in communities year after year. Understanding how people in these communities think about these diseases, what they believe about them, and what they actually do to stay safe is crucial. If a person knows a disease is dangerous but lacks the water to wash their hands or the money to buy medicine, knowledge alone cannot stop the spread. This gap between what people know and what they can do is the central puzzle researchers try to solve when they study how communities manage health risks.

In the city of Bukavu, located in the eastern part of the Democratic Republic of the Congo, a team of researchers set out to understand this exact gap. They focused on three specific diseases that pose a high risk to the region: Mpox, Ebola, and rabies. These are not just abstract medical terms; they are real threats that have caused suffering and death in the area. The researchers wanted to see if the families living there knew enough about these diseases, if they believed prevention was possible, and most importantly, if they were actually taking steps to protect themselves. To find the answers, the team visited 634 households across two distinct neighborhoods in Bukavu. One neighborhood was a dense, busy urban area with many markets and animals moving through the streets, while the other was a quieter, semi-rural zone where families kept pigs and chickens in their yards. Over a two-week period in September 2025, trained interviewers spoke with the heads of these households, asking them a series of questions about their daily lives, their education, their access to clean water, and their understanding of these three diseases.

The results revealed a story of mixed feelings and difficult realities. Most people in the study had heard of zoonotic diseases, but their knowledge was often shallow and focused only on the most famous outbreaks. When asked to identify specific diseases, nearly 80 percent of the respondents correctly named Mpox, and about two-thirds recognized Ebola. However, when it came to rabies, a disease that kills almost everyone it infects if not treated immediately, fewer than 40 percent could identify it as a threat. Even more concerning was that very few people could name other common animal-borne illnesses like anthrax or brucellosis. The researchers found that people who had attended university were much more likely to have a solid understanding of these diseases, as were families who raised livestock, likely because they dealt with animals every day. Yet, despite this knowledge, the attitude toward prevention was complicated. While most people agreed that hygiene and animal vaccines were important, a large majority believed that prayers or traditional rituals were more effective at stopping disease than modern medicine.

The most striking finding, however, was the wide chasm between what people believed and what they actually did. Even though many households felt that prevention was important, very few were practicing the necessary safety measures. Only about 12 percent of the families demonstrated good preventive habits overall. For instance, while two-thirds of people said they avoided eating undercooked meat, only about one-quarter washed their hands with soap after touching animals. Even fewer knew how to properly dispose of a dead animal, and less than half knew the correct steps to take after being bitten by a dog or another animal. The researchers discovered that this lack of action was not because people did not care or did not understand the risks. Instead, it was driven by the physical environment in which they lived. Families who had reliable access to clean drinking water were far more likely to practice good hygiene, simply because they had the means to do so. Similarly, those with better sanitation facilities were more likely to keep their homes and surroundings clean.

The study concluded that in Bukavu, the ability to stay safe from these diseases depends less on how much a person knows and more on whether they have the basic tools to act on that knowledge. The researchers found that having a university education and access to clean water were the strongest factors linked to better overall knowledge and behavior. This suggests that simply telling people to be careful is not enough if they are struggling to find clean water or lack proper toilets. The team argued that to truly protect these communities, health efforts must go beyond emergency campaigns for outbreaks like Ebola or Mpox. Instead, a coordinated approach is needed that treats human health, animal health, and the environment as one connected system. This means investing in clean water infrastructure, making veterinary care affordable for local farmers, and teaching people about the diseases that are always present, not just the ones making headlines. Without these structural changes, the gap between knowing the danger and staying safe will remain wide, leaving families vulnerable to the next outbreak.