Assessing the Knowledge, Attitudes, and Practices (KAP) of Sudanese citizens regarding dengue fever prevention and control during the 2025 outbreak in Sudan: a multi-center cross-sectional study

BACKGROUND: Dengue fever remains a major and expanding public health threat in tropical regions, with outbreaks increasingly affecting fragile and conflict-affected settings. In Sudan, the ongoing armed conflict has compounded vulnerabilities, limited healthcare access, and amplified the importance of community-level prevention and awareness. METHODS: We conducted a community-based, multi-center cross-sectional study to assess knowledge, attitudes, and practices (KAP) related to dengue fever prevention and control during the 2025 outbreak in Sudan. A total of 459 adult participants from seven outbreak-affected states were recruited using an online, convenience-based sampling approach. Due to reliance on online platforms, the sample is predominantly composed of young, educated individuals; this limitation is acknowledged explicitly. Data were collected using a validated KAP questionnaire. Participants were classified as having 'Good Knowledge' if they scored ≥ 60% (12/20) on the knowledge section, and 'Positive Attitude' if they scored ≥ 60% on the attitude section. Good Practice was defined as a score ≥ 5 out of 9. Data were analyzed using descriptive statistics, chi-square tests, independent t-tests, and binary logistic regression for multivariate analysis. Statistical significance was set at p ≤ 0.05. RESULTS: Overall awareness of the dengue outbreak was high (96.5%). The majority of participants demonstrated good knowledge (96.5%), positive attitudes (99.8%), and good preventive practices (91.3%). However, substantial misconceptions persisted, particularly regarding transmission: 77.3% of respondents incorrectly believed dengue could be spread through contaminated food or water. Knowledge and practice scores were significantly associated with age, gender, and educational level, with older adults, males, and individuals with lower formal education exhibiting poorer outcomes. Attitudes toward dengue prevention were uniformly positive across all demographic groups (p > 0.05). CONCLUSION: Despite high overall KAP levels, critical knowledge gaps and demographic disparities threaten effective dengue prevention during outbreaks. Targeted, demographic-specific educational interventions addressing misconceptions about transmission and vector behavior are urgently needed to strengthen community-based control efforts, particularly in conflict-affected settings such as Sudan. Future research should prioritize in-person sampling strategies to ensure adequate representation of older adults and individuals with lower levels of formal education.