Socio-demographic determinants of Monkeypox virus preventive behavior: A cross-sectional study in Pakistan

PLOS ONE RESEARCH ARTICLE Socio-demographic determinants of Monkeypox virus preventive behavior: A cross-sectional study in Pakistan Hashaam Jamil ID1, Muhammad Idrees ID2, Kashmala Idrees1, Waleed Tariq ID1, Qudsia Sayyeda3, Muhammad Sohaib Asghar ID4, Muhammad Junaid Tahir5, Samra Akram1, Kaleem Ullah ID6, Ali Ahmed ID7, Aroop Mohanty8, Bijaya Kumar Padhi9, Ranjit Sah ID10,11,12* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Lahore General Hospital, Lahore, Pakistan, 2 Multan Institute of Kidney Diseases, Multan, Pakistan, 3 Red Crescent of Tampa Bay, Tampa, FL, United States of America, 4 Mayo Clinic, Rochester, MN, United States of America, 5 Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan, 6 Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Pakistan, 7 School of Pharmacy, Monash University, Subang Jaya, Selangor, Malaysia, 8 Department of Microbiology, All India Institute of Medical Sciences, Gorakhpur, India, 9 Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 10 Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal, 11 Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India, 12 Harvard Medical School, Boston, MA, United States of America * OPEN ACCESS Citation: Jamil H, Idrees M, Idrees K, Tariq W, Sayyeda Q, Asghar MS, et al. (2023) Sociodemographic determinants of Monkeypox virus preventive behavior: A cross-sectional study in Pakistan. PLoS ONE 18(8): e0279952. https://doi. org/10.1371/journal.pone.0279952 Editor: Jan Rychtář, Virginia Commonwealth University, UNITED STATES Received: December 18, 2022 Accepted: March 29, 2023 Abstract Background Monkeypox (mpox), re-emerging zoonotic infectious disease, is striking the world with serious public health concerns, especially in non-endemic countries. The public’s knowledge and attitude towards the monkeypox virus (MPXV) influence their adherence to preventive strategies. Therefore, we aimed to assess the public’s knowledge, attitudes, and perceptions (KAP) of MPXV in Pakistan. Published: August 10, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0279952 Copyright: © 2023 Jamil et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Methods We collected data for this cross-sectional study from 1040 participants via online selfreported questionnaire from July 5th, 2022, to August 1st, 2022. The questionnaire consisted of a total of 29 items in four sections, assessing socio-demographics, knowledge, attitudes, and practices regarding MPXV. The data were analyzed using IBM SPSS V.25, and factors associated with MPXV knowledge, attitude, and practices were identified by using logistic regression analyses. Results A total of 1040 participants were included. 61.4% were male, and 57.2% had graduation level education. Only 34.4% had good knowledge about MPXV, and 30% knew the effectiveness of the smallpox vaccine against MPXV. 41.7% had a positive attitude, 48.6% agreed that it is a fatal disease, and 44.6% were in favour of banning travel from endemic to PLOS ONE | https://doi.org/10.1371/journal.pone.0279952 August 10, 2023 1 / 16 PLOS ONE Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Monkeypox (mpox) virus knowledge among the Pakistani population non-endemic regions. 57.7% had good practices, and 69.9% would use protective measures if MPXV became an epidemic. Binary logistic regression analysis revealed that gender and education significantly impacted knowledge (p<0.05). While monthly income status had a significant impact on attitudes (p<0.05). The practices were positively correlated with gender and education (p<0.05). Conclusion The majority of study participants had inadequate levels of knowledge, and attitudes regarding MPXV. To prevent the emergence and spread of MPXV in Pakistan, a comprehensive strategic framework for public health education must be established and implemented. Introduction The monkeypox virus (MPXV), a member of the POXVIRIDAE family of the genus Orthopoxvirus, is the pathogen responsible for monkeypox (mpox) fever, a zoonotic infectious disease [1]. The first known outbreak of the virus in monkeys was discovered in 1958 at an animal research centre in Copenhagen, Denmark, giving rise to the term "monkeypox" [2]. MPXV was not recognized as a human virus until 1970 when the virus was isolated from a child in the Democratic Republic of the Congo (DRC) who had symptoms of suspected smallpox infection [3]. The potential modes of MPXV transmission are either animal-human or human-human. Animal-human transmission is associated with direct contact with the blood, body fluids, and cutaneous or mucosal wounds of infected animal hosts [4]. Close contact with respiratory secretions, infected patient objects or surroundings, an infected person’s skin lesions, and sexual contact with an infected person who has genital and groin lesions can cause human-tohuman transmission [5]. However, in the recent multi-country MPXV outbreak, the majority of MPXV cases have primarily been reported among men who have had sex with men (MSM) [6–8]. Human mpox has clinical features that are strikingly similar to those of smallpox, but less severe [9, 10]. After an incubation period of 10 to 14 days, the majority of patients experience prodromic symptoms, including fever, malaise, and enlarged lymph nodes. About 90% of patients infected with MPXV develop lymphadenopathy [11, 12]. After an initial prodromal period, a centrifugally distributed maculopapular rash developed. Lesions develop from macules to papules, vesicles, pustules, and eventually crust over in two to four weeks [13]. Treatment of MPXV is mainly symptomatic. The smallpox vaccination is 85% effective in protecting against mpox [14]. However, Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN), an authorized vaccine, and the antiviral medications tecovirimat and brincidofovir are not easily available [15, 16]. In 2003, the United States reported the first MPXV outbreak in humans outside of Africa, with 70 cases, which was associated with the importation of exotic pets from Ghana [17]. Since then, the incidence in endemic (...truncated)