Zika virus infection has recently emerged as a major global public health concern due to sporadic outbreaks from one region to another. Zika virus was first isolated in 1947 from a rhesus monkey in the Zika forest in Uganda [1][2]. The first human infection cases were reported in Nigeria in 1954 [3][4]. Later, Zika virus was discovered in human populations in many countries in Africa, Asia and South America, including Sierra Leone, Nigeria, Senegal [5], Ivory Coast, Egypt, India, Malaysia, Philippines and Indonesia [6][7]. However, it was not a public health concern at the time [5]. It was following the epidemic in Latin America in 2015 that vigilance against ZIKV took on a global dimension [8]. Consequently, on February 1, 2016, the World Health Organization declared Zika infection a Public Health Emergency of International Concern. By May 2016, the presence of Zika virus had been reported in 58 countries and territories worldwide, particularly in South America [9][10].

Zika virus is a Flavivirus transmitted mainly by the bite of infected mosquitoes of the genus Aedes, particular Aedes aegypti [8][11]-[13]. Additionally, ZIKV can be sexually transmitted, as documented cases in Argentina, France, Chile, Italy, and New Zealand demonstrate. It can also spread by vertical transmission from mother to child during pregnancy [7], which can lead to microcephaly, a severe congenital brain malformation. While ZIKV infection is frequently asymptomatic, clinical manifestations may include headache, mild fever, arthralgia, conjunctivitis, myalgia, and maculopapular rash [7][14]-[16].

Virus infection has been associated with microcephaly and Guillain-Barré Syndrome (GBS) in newborns [17][18]. Microcephaly is a condition characterized by abnormal head development in newborns, making them much smaller than those of babies of the same age. Head size is often used as an important parameter for monitoring brain growth in children. Clinical manifestations of microcephaly can range from mild to severe and may include intellectual disability, speech impairment, seizures, as well as auditory and visual abnormalities [19][20]. Moreover, its treatment is only symptomatic, as there is no proven cure at present. Conversely, GBS represents a serious autoimmune disorder in which the immune system attacks and destroys healthy nerve cells in the peripheral nervous system. Its clinical manifestations include muscle weakness, numbness and tingling of the extremities, loss of bladder control, difficulty breathing, back pain and paralysis [21].

ZIKV has the potential for rapid spread in countries where its primary vector, Aedes aegypti, is present. To date, active Zika virus circulation has not been conclusively documented in Burkina Faso, despite arboviral surveillance systems implemented since 2016 [22]. A serological survey of the general population carried out between 1963 and 1964 showed serological evidence of Zika virus circulation in the Republic of Upper Volta, now Burkina Faso [23]. Burkina must be particulary vigilant about the spread of the Zika virus, because the presence of competent vectors in the country, combined with silent circulation of the virus, exposes the population to a real risk. The potential consequences particularly neurological complications (Guillain-Barré syndrome) and congenital malformations (microcephaly) in fetuses of infected pregnant women, constitute a critical challenge for healthcare systems. In this context, health workers play a central role in early detection, case management and raising community awareness. However, the effectiveness of their interventions depends on their Knowledge, Attitudes and Practices (KAP) regarding Zika virus. In Burkina Faso, where dengue fever is already endemic, lack of familiarity with Zika could lead to underestimation of the risk, diagnostic confusion or an inappropriate response. Furthermore, logistical (limited access to diagnostic tests) and sociocultural (local perceptions of the disease) challenges could affect the application of recommendations. In a healthcare system with limited resources and weak Zika surveillance, what are the knowledge, attitudes, and practices of Burkinabe health workers regarding this virus? How do practitioners manage suspected cases, particularly in high-risk pregnant women?

This study therefore aims to assess the KAP of health workers in the town of Bobo-Dioulasso and its surrounding area regarding the Zika virus, in order to identify any gaps and strengthen their capabilities for optimal preparation in the event of an epidemic. The results could guide training policies and preventions strategies, thus contributing to the resilience of the health system in the face of emerging arboviruses.

Understanding a community’s knowledge of the Zika virus can be an important tool for developing future interventions and educational materials. To our knowledge, this study is the first systematic investigation of knowledge, attitudes and practice related to the Zika virus among healthcare professionals practising in Bobo-Dioulasso, Burkina Faso. It aimed to assess healthcare professionals’ knowledge of ZIKV infection and its associated factors in several healthcare facilities. The study provided a better understanding of the knowledge, practices and attitudes of healthcare professionals in Bobo-Dioulasso regarding the Zika virus, while also clarifying the relationship between sociodemographic factors and knowledge levels. Our findings revealed that most respondents (67.14%) who had already heard of ZIKV were more or less familiar with the infection.

Among the 141 respondents assessed, 56.74% demonstrated good knowledge of ZIKV infection. A similar study conducted among healthcare professionals in Indonesia showed comparable results (50%) to ours [24]; this concordance of data indicates a need for continuing education programmes. Compared to previous studies [24][25], healthcare workers in our study exhibited relatively higher knowledge (60.2%). Another recent study conducted among general practitioners in Indonesia showed that 64% of them had good knowledge of ZIKV [26]. In contrast, other similar studies reported insufficient knowledge levels. One of them was conducted among dentists in India [25]. This study surveyed 412 participants and found that the majority (61.8%) had inadequate knowledge of ZIKV [25]. In addition, another study conducted among Middle Eastern practitioners in Qatar revealed that among 446 participants, 66% reported having poor knowledge about ZIKV [27]. Also, a study surveyed practitioners from different countries revealed that the majority of participants have insufficient knowledge about ZIKV [28]. This difference in results could be due to exposure to epidemics and the quality of local training. This indicates that in nations such as ours, following the dengue epidemic, emphasis has been placed on continuous education and training of healthcare professionals regarding emerging diseases, resulting in a moderately high knowledge score. In our study, nearly one-third (28.37%) of respondents demonstrated poor knowledge, which could compromise early detection and case management. This cohort was primarily composed of medical assistants and midwives. The study revealed that professional status was significantly associated with ZIKV infection knowledge levels. Our results showed that respondents who were doctors or laboratory technicians had better knowledge than others. This makes sense, as education has long been associated with good health practices, particularly the assimilation of medical information [29]. A study conducted in the Middle East [27] revealed a significant association between levels of education and knowledge of the Zika virus. These findings align with our observations, as nearly all laboratory technicians held either a Master’s degree or were completing their graduate studies (Master’s level), while all physicians possessed a State Medical Doctorate. Notably, nurses, who are also clinicians, had a good knowledge of the infection.

Senior practitioners (with over 15 years of experience) demonstrated extensive knowledge of the disease (69.49%), potentially attributable to their likely exposure to recent epidemics. During global disease outbreaks, medical staff receive brief training on the disease. Consequently, our research confirmed that professional experience is significantly associated with knowledge levels. Regarding practice setting, no notable differences were observed. A similar study was conducted in Indonesia, where the authors noted that doctors working in private hospitals had a higher probability of having good knowledge of ZIKV infection than those working in public hospitals [24]. These results differ from ours because all health workers of the same status generally receive the same basic training, and also, most in public hospitals are the same ones who work in private hospitals.

Nearly half of the healthcare professionals involved in this study were aware that mosquito bites represent the primary mode of Zika virus transmission. It is therefore understandable that this group, and potentially more, are in favour of the importance of personal protection as a means of preventing infection. Thus, 56.74% of respondents supported the introduction of vaccines against these arboviruses, which are clearly re-emerging. These results suggest that most of the health professionals surveyed are familiar with preventive measures against the Zika virus. Furthermore, studies demonstrate that avoiding areas where Zika virus is actively transmitted is one of the most effective strategies to prevent Zika virus infection. Although almost all of the healthcare professionals involved in this study were able to recognize the pathogen and the signs and symptoms of Zika virus infection, it would be wise to step up ongoing training. However, a number of respondents were unaware that Zika, dengue and chikungunya virus diseases have similar symptoms [30]. These findings suggest that even some physicians among them might be unable to make the differential diagnosis of a Zika virus infection. Given the broad differential diagnosis associated with Zika virus, the Centers for Disease Control and Prevention (CDC) recommends that patients with suspected Zika infection should also be evaluated and managed for potential dengue and chikungunya co-infections [7]. There is proven evidence that there is no cure for Zika virus infection [7]. Symptoms are generally mild and self-limiting. To practice effectively, healthcare professionals need this data and knowledge.

This study has some limitations that should be considered, as they will contribute to a better understanding and interpretation of the implications of its results. The small sample size and its unique location in a specific region limit the generalization of the results across the entire countries. Another limitation lies in the lack of practical skill assessments (such as simulated clinical cases). Furthermore, the cross-sectional aspect of the study prevents observation of knowledge progression over time. These limitations do not invalidate the conclusions but call for further research. Nevertheless, this study, although pioneering, has identified critical areas (paramedical training, differential diagnosis) requiring targeted interventions.

This study is the first to assess the knowledge, attitudes, and practices (KAP) of healthcare professionals in Bobo-Dioulasso regarding the Zika virus. The results reveal that most (67.14%) of respondents have already heard of the virus, and more than half (56.74%) demonstrated good clinical and preventive knowledge of it. The figures, although higher than those observed in some regions, such as India and Qatar, remain below those observed in countries heavily affected by epidemics (Brazil). Nevertheless, it provides a solid basis for strengthening the fight against Zika in Burkina Faso, but highlights the need for interventions adapted to local realities and different professional profiles. An integrated approach, combining capacity building and continuous training, will be essential to prevent future outbreaks. Finally, these results could guide similar policies in other sub-Saharan African countries facing the challenges of re-emerging diseases.

The authors would like to thank all participants and the heads of each healthcare facility for their collaboration.