Abebayehu N. Yilma

Introduction: Evidence remains limited on how urbanicity modifies the relationship between household cooking fuel type and respiratory symptoms in young children in low- and middle-income countries (LMICs). This study examined the prevalence of cough and dyspnea across ten East African countries and the associations of these symptoms with fuel type and residence among children aged under two years. Methods: Pooled Demographic and Health Survey data (2015–2023) from mother–child pairs across ten East African countries were analyzed. Outcomes were maternal reports of cough and dyspnea in the past two weeks as a proxy to ARI. The exposure was a four-category of cooking fuel type and residence (urban-clean vs. rural-clean, urban-unclean, rural-unclean). Multivariable logistic regression was adjusted for child, maternal, and household characteristics. Results: There were 38,849 mother-child pairs. Cough prevalence ranged from 13 (Mozambique) to 44% (Uganda), and dyspnea from 3% (Tanzania) to 21% (Uganda). Most households used unclean fuels (96%), and 79% were rural. Compared with children in urban–clean households, the adjusted odds of cough were higher in urban–unclean (aOR = 1.36; 95% CI:1.06–1.74) and rural–unclean households (aOR = 1.40; 95% CI:1.09–1.81). Dyspnea was more likely in urban–unclean (aOR = 2.21; 95% CI:1.46–3.74) and in rural–unclean households (aOR = 3.08; 95% CI:1.89–5.01). Children aged 12–23 months had higher odds of cough (aOR = 1.16; 95% CI: 1.09–1.22) than those 0–11 months. Conclusions: Children under two years living in households using unclean fuels had a higher likelihood of respiratory symptoms, regardless of urban or rural residence. These findings suggest that both fuel use and living context may shape exposure patterns in early childhood.

Zoonotic diseases disproportionately burden settings where humans and livestock coexist, yet community-level knowledge, attitudes, and practices (KAP) remain poorly characterized in West Africa. This study aimed to assess KAP regarding zoonotic diseases and document household biosecurity gaps among livestock-keeping community members in Ada East Distrct in Ghana. A concurrent mixed-methods design was employed, integrating a quantitative cross-sectional survey with a qualitative focus group discussion. Livestock-keeping adults were recruited from five health facilities in Ada East District. A structured survey measured knowledge, attitudes, and livestock-handling practices. Composite KAP scores were dichotomized using a modified Bloom’s cutoff (≥60%). Multivariable logistic regression analyses were conducted to identify factors associated with good knowledge, positive attitudes, and good practices. A focus group discussion (FGD) explored perceptions of transmission, livestock management, and outbreak preparedness. Among 252 survey participants, 66.3% demonstrated good overall knowledge of zoonotic diseases; however, only 10.6% had good knowledge of Ebola virus disease symptoms. Positive attitudes were observed in 44.0% of respondents, while 86.9% reported good livestock-handling practices. Education beyond primary school was independently associated with higher odds of good knowledge (adjusted odds ratio (aOR) 1.97, 95% confidence intervals (CI) 1.05–3.69). Animal-related occupations were associated with lower odds of positive attitudes (aOR 0.46, 95% CI 0.25–0.85) but higher odds of good practices (aOR 3.58, 95% CI 1.26–11.8). FGD ( n = 8) identified bats and sick animals as transmission sources, described economic barriers, and expressed variable beliefs regarding prevention and stigma. These findings highlight the need for locally tailored, One Health–oriented risk communication and biosecurity interventions targeting groups with lower educational attainment and limited access to animal health services.

Zoonotic diseases pose a growing global health threat, particularly in low-resource settings where human-animal-environmental interfaces are common. Although Ghana has adopted One Health policies, limited evidence exists on frontline healthcare workers’ (FHWs) zoonosis preparedness. Thus, this study assessed FHWs’ knowledge, attitudes, and practices related to zoonoses and One Health in Ghana’s Ada East district. We conducted a cross-sectional survey of 250 FHWs across 18 selected health facilities. A 54-item questionnaire measured knowledge, attitudes, and practices regarding priority zoonoses, Ebola virus disease, and the One Health approach. Scores were scaled to 100% and dichotomized using Bloom’s cut-off, with >60% representing “good knowledge,” “positive attitudes,” or “good practices.” Multivariable logistic regression identified predictors of good knowledge and practices. According to this study, while 79.2% of FHWs scored ≥60% on the total knowledge scale, classified as “good knowledge” of zoonoses, Ebola virus disease, and One Health, only 22.4% correctly identified >60% of listed zoonoses. Ebola-specific knowledge was high, though misconceptions about transmission and treatment persisted. Only 6.8% scored ≥60% on the attitude scale, reflecting limited confidence and widespread concern about personal safety, institutional readiness, and community stigma. While 47.2% demonstrated “good” prevention and control practices, institutional protocol use and intersectoral collaboration were limited. Rabies-focused training increased odds of good knowledge (AOR = 3.25, 95% CI: 1.04–11.1) and practices (AOR = 2.46, 95% CI: 1.07–5.87). In-facility training improved practices (AOR = 2.77, 95% CI: 1.34–5.92), whereas government-delivered training and infrequent climate-health engagement were linked to poor knowledge and practices. Gaps in zoonoses literacy and institutional preparedness were evident among FHWs. Targeted staff retraining, peer-led mentorship, and expanded rabies training may offer practical entry points for One Health capacity building. Addressing stigma and embedding climate-health content into community-based risk communication may improve frontline readiness.