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Knowledge–Practice Gap, Attitudes, and Determinants of Dengue Management Practices Among Physicians in Sudan: A Cross-Sectional Study, 2026

This 2026 cross-sectional study of 633 Sudanese physicians reveals a significant knowledge–practice gap in dengue management, demonstrating that clinical practice is driven more by familiarity with and belief in WHO guidelines and positive attitudes than by disease knowledge alone, highlighting the urgent need for targeted training and health-system strengthening in conflict-affected settings.

Original authors: Mohannad Abdalfdeel Almahie Shaban, Thoraya Salah Murtada Sidahmed, Mohamed Faroug Ali Yassin, Hamza Essam Mohamed Abbas, Marwa Imad Awad Ali, Omnia Abdelmonim Mohamed Babiker, Fatima Alamin Mohammed

Published 2026-07-28

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Mohannad Abdalfdeel Almahie Shaban, Thoraya Salah Murtada Sidahmed, Mohamed Faroug Ali Yassin, Hamza Essam Mohamed Abbas, Marwa Imad Awad Ali, Omnia Abdelmonim Mohamed Babiker, Fatima Alamin Mohammed AbdAlrhman, Al-Romaysa M.Osman Khalafalla El-Haj, Altayeb Abayazeed Altayeb Yusuf, Osama Shaban, Gotiba Ibrahim Mohamed Elgorashi, Ward Awadelkarim Elsayed Elhag, Watfaa Siddeg Mohamed Ibrahim, Esraa Yasir Mostafa Mohammed

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

The Great Disconnect: Why Knowing Isn't Always Doing

Imagine you are a chef in a busy kitchen. You have memorized every recipe in the book, you know exactly which spices go with which meat, and you can recite the history of the tomato from memory. You are a walking encyclopedia of cooking. But when the dinner rush hits, you forget to turn on the stove, you grab the wrong pan, and you serve the food cold. This is the frustrating gap between knowledge (what you know) and practice (what you actually do). In the world of medicine, this gap is a huge deal, especially when it comes to diseases like Dengue fever. Dengue is a nasty illness spread by mosquitoes that can make people very sick, and it's becoming more common in places like Sudan. Doctors are the heroes supposed to save the day, but they need to know not just what the disease is, but how to treat it, when to use specific guidelines, and why it matters. If they know the facts but don't act on them, patients suffer. This story is about a group of researchers who decided to investigate exactly why this "knowing-but-not-doing" gap exists among doctors in Sudan.

The Investigation: A Digital Detective Story

In 2026, a team of researchers from universities across Sudan decided to play detective. They wanted to see if the doctors treating patients in their country actually knew how to handle Dengue fever, and more importantly, whether knowing the facts helped them treat patients better. They couldn't just walk into every hospital because the country was going through a tough time with conflict, making travel and traditional surveys impossible. So, they went digital. They sent a questionnaire to 633 doctors via social media and professional networks, asking them to spill the beans on what they knew, how they felt about the disease, and what they actually did in their clinics.

The Shocking Discovery: The "Knowledge" Trap

The results were a bit like finding out that the chef who memorized the recipe book was actually the one burning the dinner. The researchers found a massive knowledge–practice gap.

Here is the twist: The doctors' actual knowledge of Dengue was surprisingly low. Only 3.8% of the doctors had "high" knowledge of the disease. Nearly half (48.8%) had low knowledge. They didn't always know that Dengue is a virus, they weren't sure which mosquitoes carried it, and many didn't know the specific tests needed to confirm it. For instance, only 39.8% correctly identified it as a viral disease, and a tiny 13.9% knew that stagnant clean water was a breeding ground for the mosquitoes.

But here is the plot twist that made the researchers scratch their heads: Even though most doctors didn't know the facts, 40.0% of them still reported having "high" practice scores. However, this doesn't mean the majority were getting it right; in fact, 60% of the doctors were still operating with low or moderate practice scores. The real shock was that knowing the facts didn't actually make the doctors better at treating the disease. When the researchers crunched the numbers, they found the link between "knowing the disease" and "doing the right thing" was very weak (a correlation of just 0.077). It was like having a map of the city but driving anyway; the map didn't seem to help the driving much. The study highlighted a clear knowledge–practice gap, suggesting that having knowledge alone does not guarantee good clinical behavior, and that many doctors were struggling to perform well regardless of their knowledge level.

The Real Heroes: Guidelines and Attitudes

So, if knowing the facts wasn't the key, what was? The researchers found the real "secret sauce" that made doctors act correctly.

The Rulebook (WHO Guidelines): The biggest factor was whether the doctor knew the World Health Organization (WHO) guidelines. Doctors who were familiar with these specific rules were 2.66 times more likely to have high-quality practices. Even more powerful was their belief in the rules: doctors who thought the guidelines were useful were 4.06 times more likely to do the right thing. It wasn't about memorizing the disease; it was about having a clear, trusted instruction manual in hand.
The Mindset (Attitudes): How a doctor felt about the disease mattered too. Doctors who had a more positive, serious attitude toward Dengue prevention were more likely to treat patients well. Every little bump in their attitude score increased their odds of good practice by 7%.
The Experience: Interestingly, the doctors who had actually seen a Dengue case before were much more likely to know the guidelines (4.43 times more likely).

What This Means for the Future

The study suggests that in Sudan, and perhaps in other places facing similar challenges, simply handing doctors a textbook and saying "memorize this" isn't enough. The doctors are often flying blind without the specific WHO guidelines and without the right resources.

The researchers noted that 57.7% of the doctors felt they didn't have enough resources, like medicines or lab tools, to do their jobs properly. They also found that 74.4% of doctors felt they hadn't received enough training.

The bottom line is that the "knowledge gap" isn't the main problem. The problem is that doctors need practical tools (like simplified checklists and mobile apps based on WHO guidelines) and better training that focuses on how to use those tools, rather than just what the disease is. In a place where the health system is under pressure, having a clear, easy-to-follow guide and the right attitude might save more lives than a perfect memory of medical facts ever could.

Technical Summary: Knowledge–Practice Gap, Attitudes, and Determinants of Dengue Management Practices Among Physicians in Sudan

Problem Statement
Dengue fever represents a growing public health threat in Sudan, characterized by recurrent outbreaks within a fragile, conflict-affected healthcare system. While physicians are central to diagnosis, management, and outbreak response, there is limited evidence regarding whether theoretical knowledge of dengue translates into appropriate clinical practice. Previous studies in similar settings have identified gaps in training and resources, but few have examined the specific determinants that drive clinical behavior beyond general knowledge. The core problem addressed is the potential disconnect between what physicians know about dengue (knowledge) and what they actually do in clinical settings (practice), particularly in a resource-constrained environment where laboratory capacity and referral pathways are disrupted.

Methodology
The study employed a nationwide, online cross-sectional survey conducted between February and April 2026.

Population: 633 licensed physicians actively practicing in Sudan, recruited via convenience sampling through professional networks (WhatsApp, Facebook, Telegram) due to the lack of an updated national registry during the conflict.
Instrument: A structured, self-administered questionnaire adapted from validated Dengue Knowledge, Attitude, and Practice (KAP) instruments. It covered sociodemographics, disease knowledge, vector knowledge, attitudes, clinical practices, familiarity with World Health Organization (WHO) guidelines, and health-system readiness.
Analysis:
- Scores were classified using Bloom's cut-off criteria (Low: <60%, Moderate: 60–79%, High: ≥80%).
- Correlation analysis (Pearson) assessed relationships between knowledge/attitude domains and practice scores.
- Multivariable binary logistic regression was used to identify independent predictors of "high dengue management practice" (defined as a practice score ≥80%).
- A supplementary regression model identified predictors of WHO guideline familiarity.
Validity: Psychometric evaluation included Exploratory Factor Analysis (EFA) and Cronbach's alpha, showing acceptable internal consistency for attitude and practice/readiness domains.

Key Results

Knowledge vs. Practice Disparity: A significant knowledge–practice gap was observed. Only 3.8% of physicians demonstrated high disease knowledge, and 28.8% had high vector knowledge. In contrast, 40.0% achieved high practice scores.
Correlation: Correlation analysis revealed a very weak relationship between disease knowledge and practice ( $r = 0.077$ ) and a negligible relationship between vector knowledge and practice ( $r = 0.026$ ). Attitude showed a weak but meaningful positive correlation ( $r = 0.200$ ).
Specific Knowledge Gaps: While general awareness was high, critical gaps existed: only 39.8% correctly identified dengue as viral, 37.4% recognized daytime biting vectors, and 13.9% identified stagnant clean water as a breeding site.
Systemic Barriers: Only 36.2% of physicians were familiar with WHO dengue guidelines, and 57.7% reported inadequate resources (including shortages of medications, laboratory tools, and training).
Determinants of High Practice: Multivariable regression identified that disease knowledge was not a significant predictor of high practice. Instead, high practice was independently associated with:
- Familiarity with WHO guidelines (AOR = 2.66).
- Belief in the usefulness of WHO guidelines (AOR = 4.06).
- Higher attitude scores (AOR = 1.07 per point increase).
- Note: Vector knowledge showed only a borderline association.
Determinants of Guideline Familiarity: Physicians who had previously seen dengue cases (AOR = 4.43) and those with adequate resources (AOR = 2.84) were significantly more likely to be familiar with guidelines. Interestingly, senior physicians had lower odds of guideline familiarity compared to house officers.

Key Contributions

Identification of the Knowledge–Practice Gap: The study provides empirical evidence that in Sudan, high clinical practice scores do not necessarily correlate with high theoretical disease knowledge.
Shift in Determinants: It challenges the assumption that increasing general knowledge is the primary lever for improving clinical management. Instead, it highlights that guideline familiarity, perceived guideline utility, and professional attitudes are the dominant drivers of appropriate clinical behavior.
Contextual Insight: The research documents the specific impact of the ongoing conflict on dengue management, noting that resource shortages and disrupted training pathways are critical barriers that knowledge alone cannot overcome.

Significance and Claims
The paper claims that improving dengue management in conflict-affected settings like Sudan requires a strategic shift from purely knowledge-based education to implementation-focused interventions. The authors argue that because knowledge alone does not predict practice, efforts should prioritize:

Practical Training: Moving beyond theoretical lectures to case-based training and clinical algorithms.
Guideline Implementation: Translating WHO guidelines into simplified, accessible tools (e.g., mobile decision support, checklists) rather than passive dissemination.
System Strengthening: Addressing structural barriers such as resource availability and training access, as even knowledgeable physicians cannot adhere to best practices without necessary tools.

The study concludes that in fragile health systems, physician preparedness is less about individual knowledge accumulation and more about the availability of actionable guidelines, supportive attitudes, and the health system's capacity to enable those practices.