The study was conducted in Ebonyi, a state in southeast geopolitical zones of Nigeria. It shares boundary in the North with Enugu and Benue States and in the Southern part with Cross River as well as Abia States. It involved health care professionals working in various hospitals in Ebonyi State. These hospitals included Alex-Ekwueme Federal University Hospital Abakaliki (AEFUTHA), National Obstetric Fistula Centre (NOFIC), and Mile 4 Maternity Hospital (MMH).

The study was a cross-sectional descriptive study on knowledge of health workers towards monkeypox and its infection prevention and control measures. It involved the use of self-administered pretested questionnaire to collect data with a target population of health worker in Ebonyi State. The questionnaire required approximately 10 - 15 minutes to be completed. Personal identities of the participants were guarantee confidentiality and anonymity. The data was analyzed using Statistical Package of Social Sciences (SPSS) version 25.

The target population included different cadre of healthcare professionals working in Ebonyi State.

All consenting healthcare professional working in Ebonyi State that completed the questionnaire before close of work on the day of survey were recruited for the study.

Any healthcare worker who was not working in Ebonyi State or those who were not ready to submit the filled questionnaire before the close of work were exempted from the study.

About 70% of the healthcare professionals work in Alex-Ekwueme Federal University Teaching Hospital, followed by 20% HCW in National Obstetrics Fistula Centre (NOFIC) and 10% from Mile 4 Maternity Hospital (MMH). Systematic random sampling technique was used to select one in every four-healthcare worker with specific consideration on the population size of the hospitals. Two hundred, one hundred and fifty-one HCWs were recruited from AEFUTHA, NOFIC, and MMH, respectively. However, the enrolled participants were not up to the calculated sample size of 356 because some HCW either did not return the forms, refused to participate or did not complete the questionnaire properly.

The sample size was determined using the Cochran formula for cross-sectional studies, where minimum sample size (N) was equivalent to the following:

$N=Z^2\frac{pq}{d^2}$

N = the desired sample size.

Z = the standard normal deviation, usually set at 1.96, corresponding to 95%

confidence interval.

P = the prevalence.

q = 1 − p.

d = the standard error (margin of error) set at 0.05.

Where prevalence (p) is 36.5%, the prevalence of good knowledge of Monkeypox in a similar study [12] .

The sample size was calculated using the formula above where: z = 1.96; p = 0.365; q = 1 − p = 0.635; and d = 0.05.

$\begin{array}{c}N={\left(1.96\right)}^2\times 0.365\times 0.635/{\left(0.05\right)}^2\\ =3.8416\times \frac{0.231775}{0.0025}\\ =>356.1549\\ =356\end{array}$

The data was collected using a semi-structured questionnaire and consisted of two sections (A and B). Section A comprised questions on socio-demographic characteristics of the healthcare professionals, level of health institution, health professional cadre, and years of experience in healthcare profession. The second section (section B) consisted of 20 multiple-choice questions related to knowledge of MPX symptoms, transmission, infection prevention and control measures. The questionnaire was developed based on existing facts from the World Health Organization (WHO) factsheet on MPX [2] and modifying previously used questionnaire on available literature in similar study [12] . The validity and reliability of the questions were tested among 20 healthcare workers in a pilot study.

Participants were recruited based on systematic consecutive sampling techniques. The pretested questionnaire was administered to the participants after obtaining an informed consent. Data generated were entered on excel sheet version 2010 and analyzed using SPSS version 25.

A correct response to an item was assigned one point, while an incorrect or not sure was assigned zero point. The level of knowledge was assessed and grouped into: high level of knowledge (80% - 100%), moderate level of knowledge (60% - 79%) and low level of knowledge (˂60%). Based on Modified Bloom’s cutoff point (80% of the total score) [12] [13] . A correct response to an item was assigned one point, while an incorrect or not sure response was assigned zero point.

Ethical clearance was obtained from Alex-Ekwueme Ethical Committee and informed consent was obtained from the participants before data collection. Ethical approval number: NHREC/16/05/413. Informed consent was obtained from all participants before specimen collection.

A total of 251 healthcare workers (HCWs) participated in the study and response rate was (70.5%, 251/356). More males (56.6%, 142/251) participated in the study than females (43.4%, 109/251). Majority of the respondents (46.2%, 116/251) were between the age group of 30 to 39 years and the least (6%, 15/251) was between age range of 50 and above. A higher proportion of the respondents (70%, 176/251) were HCWs working in Alex-Ekwueme Federal University Teaching Hospital Abakaliki while a proportion (20%, 50/251) and (10%, 25/251) were working in National Obstetric Fistula Centre (NOFIC) and Mile 4 Maternity Hospital (CMH) respectively. Most HCWs (86.5%, 217/251) were working in tertiary hospitals and doctors accounted for higher proportion of participants (70.9%, 178/251). Ward assistants and pharmacists were the least respondents with percentages of (3.6%, 9/251) and (1.2%, 3/251) respectively. There were most participants (46.2%, 116/251) that had at least 10 years of working experience that were enrolled in the study ( Table 1 ).

Overall mean knowledge score of MPXV infection, management and its prevention and control measures was (58.7%). Over 90% of the respondents had good knowledge of the causative agent while about 50% was aware of the mode of transmission. Only a few of the health workers (30.7%) were aware that MPXV can be transmitted through sexual intercourse. The mean score of the knowledge of aetiologic agent and mode of transmission (63.4%) was marginally below 80% Modified Bloom’s cut off point ( Table 2 ). Most HCWs (91.2%) had high level of knowledge of the symptoms of MPX infection but very level of knowledge (33.9%) of drug used in treating MPOX. The average score of knowledge of clinical features of MPOX was 74.1% which is moderate level of knowledge ( Table 3 ).

Majority of the HCWs (38.5%) do not know proper infection prevention and measures of MPOX infection. In fact, high proportion (40.2%) still did not know the proper PPE to use when managing MPOX patients. There was also poor knowledge (11.2%) among the participants on appropriate way of wearing PPE in MPX case management. There was generally poor knowledge of infection prevention and control measures of MPX infection among HCWs ranging from minimal knowledge of proper hand hygiene on contact with MPX patients (27.5%) to low knowledge of proper waste management (44.2%) ( Table 4 ).

The mean score knowledge of aetiology and mode of transmission; symptoms ant treatment; and prevention and control measures were 63.4%, 74.1% and 38.5% respectively ( Table 5 ). All components of the knowledge assessment scored below the 80% Bloom’s cut-off point, with the lowest performance observed in the area of infection prevention and control measures among healthcare workers.