We conducted a descriptive, analytical cross-sectional study between July 1 and July 31, 2025, in Mbujimayi, the capital of Kasai-Oriental Province in the Democratic Republic of the Congo (DRC). The study was carried out in two general referral hospitals located in distinct health zones: Saint Jean Baptiste General Referral Hospital in the Diulu Health Zone and Muya General Referral Hospital in the Muya Health Zone.

The target population included healthcare professionals working in the selected hospitals. Participants were categorized into two main groups: medical professionals (general practitioners and specialists) and paramedical professionals (nurses, laboratory and imaging technicians, nutritionists, physiotherapists, anesthesiologists, and midwives). Inclusion criteria were being employed at one of the two hospitals and providing informed consent to participate in the study.

We calculated the sample size using the formula for cross-sectional studies:

The minimum required sample size was estimated at 151 participants, assuming an expected proportion of 50% for adequate knowledge, a precision of 8%, and a 95% confidence level. Our final sample (n = 191) exceeded this threshold.

A non-probabilistic, voluntary sampling approach was used. All eligible healthcare workers who agreed to participate during the study period were included. The final sample comprised 191 respondents.

Data were collected using a structured electronic questionnaire developed in KoboCollect and administered via Android smartphones. A pilot study was conducted from June 15 to 30, 2025, among 30 healthcare professionals from two hospitals in the city of Mbujimayi not included in the study, with the aim of pretesting the questionnaire to ensure the clarity and consistency of the items. The pre-tested questionnaire was administered by four trained third-year undergraduate students in Biomedical Sciences, under the supervision of a physician-academic assistant. Prior to fieldwork, all enumerators received one day of training covering: 1) research ethics and informed consent procedures; 2) administration of standardized questionnaires (avoiding leading questions); 3) neutral interview techniques; and 4) operation of the KoboCollect system. The survey covered all hospital departments, including Internal Medicine, Pediatrics, Gynecology-Obstetrics, Surgery, Laboratory, Imaging, Dentistry, Physiotherapy, and Pharmacy.

The questionnaire captured sociodemographic characteristics (age, gender, marital status, education level, profession, residence, and religion), as well as knowledge, attitudes, and practices (KAP) related to viral hepatitis B and C.

Knowledge was assessed using 11 items covering general awareness, transmission routes, symptoms, complications, prevention, and vaccination. Scores ranged from 0 to 28. A score ≥ 14 was considered adequate, aligned with WHO standardized KAP surveys. This threshold reflects competence in identifying key hepatitis facts and transmission prevention strategies.Attitudes were measured using 4 items (maximum score: 6), including perceived risk, emotional response to diagnosis, and perceived cost of care. A score ≥3 was considered favorable.Practices were evaluated using 5 items (maximum score: 5), including screening history, vaccination status, and behavior toward infected individuals. A score ≥3 was considered good.

The cut-off points used to classify KAP scores (knowledge ≥ 14, attitudes ≥ 3, practices ≥ 3) were based on similar studies conducted in sub-Saharan Africa, ensuring comparability of findings across contexts.

Data were exported to Stata version 16 for analysis. Descriptive statistics summarized participant characteristics and KAP levels. Bivariate analyses (Chi-square or Fisher’s exact test, as appropriate) were used to identify associations between sociodemographic variables and KAP outcomes. Variables with p ≤ 0.20 in bivariate analysis were included in multivariate logistic regression models to adjust for potential confounders. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported. Statistical significance was set at p < 0.05.

Ethical approval was obtained from the Institutional Ethics Committee of the University of Mbujimayi (Approval No. 002/CEI/UM/2023). Written authorization was also secured from the Faculty of Medicine, Pharmacy and Public Health, and from the administrative authorities of both hospitals. All participants provided informed consent, and confidentiality and anonymity were strictly maintained throughout the study. All data collected via KoboCollect were anonymized and securely stored on password-protected servers, in compliance with ethical standards for electronic data management.

A total of 191 healthcare professionals participated in the study.

Table 1. Distribution of the study population by sociodemographic characteristics.

*Except for variables whose parameters are specified next to the variable name.

The mean age was 36 ± 7 years, with 63.35% aged 35 years or older. The majority were male (61.26%) and married (70.68%). Regarding education, 43.98% were medical doctors, 19.37% held a bachelor’s degree, 17.80% had an associate degree, and 17.28% had a secondary school certificate. Most participants resided in the communes of Kanshi (28.27%), Muya (25.65%), and Dibindi (20.94%). Professionally, doctors represented 45.55% of the sample, followed by nurses (36.13%), laboratory technicians (9.95%), and midwives/nutritionists (4.19% each). Nearly all participants identified as Christian (97.38%) (Table 1).

Figure 1 shows the frequency of adequate knowledge, favorable attitudes, and good practices among participants.

Figure 1. Assessment of healthcare providers’ knowledge, attitudes, and practices regarding HBV and HCV in the two hospitals in Mbujimayi.

3.2.1. Knowledge of Healthcare Workers on Viral Hepatitis

Overall, 90.05% of participants demonstrated adequate knowledge of hepatitis B and C (Figure 1). Table 2 presents participants’ knowledge of viral hepatitis.

Table 2.Distribution of the study population according to knowledge about HBV or C.

Most had heard of viral hepatitis (97.38%) and knew it affects the liver (95.28%). Commonly recognized types included HBV (24.60%), HCV (24.08%), and HAV (22.51%). Knowledge of transmission routes was high: contaminated blood (93.71%), unprotected sex (91.62%), sharp objects (89%), mother-to-child transmission (81.67%), and tattoos (60.73%). While 94.24% acknowledged the potential for complications, only 9.42% believed hepatitis B or C could be cured. Prevention methods were well known, with 94.24% citing vaccination and 78.53% mentioning pre-transfusion screening. However, only 89.53% knew that HBV vaccination is available for children (Table 2).

3.2.2. Attitudes toward Viral Hepatitis

A favorable attitude was observed in 93.72% of participants (Figure 1). Table 3 presents participants’ attitudes toward Viral Hepatitis.

Table 3. Distribution of the study population according to attitudes and perceptions toward viral hepatitis B and C.

Most believed they could contract hepatitis (81.67%) and would seek hospital care if diagnosed (31.93%). Fear was the most common emotional response (32.11%), followed by concern about death (51.83%) and transmission to family members (16.23%). The cost of diagnosis and treatment was perceived as high by 81.68% of respondents (Table 3).

3.2.3. Prevention and Care Practices

Good practices were reported by 86.91% of participants (Figure 1). Table 4 presents participants’ practices regarding prevention and care of viral hepatitis.

Table 4.Distribution of the study population according to practices regarding hepatitis B and C.

A large majority had undergone screening for hepatitis B or C (93.68%), primarily during blood donation (72.47%) or voluntary testing (67.41%). However, only 24.08% had been vaccinated against hepatitis B, and 3.14% had received treatment for hepatitis. Most participants (94.21%) expressed willingness to interact with infected individuals, and 81.68% considered the vaccine safe (Table 4).

Table 5. Factors associated with adequate knowledge of viral hepatitis B and C.

Among the 87 doctors, 3 were specialists (CS) and 84 were general practitioners.

In the analysis of factors associated with knowledge (Table 5), education level and professional category emerged as the strongest predictors. Physicians demonstrated the highest levels of knowledge, while midwives and laboratory technicians showed markedly lower scores. Although younger age (<35 years) was associated with poorer knowledge in unadjusted analysis, this effect was not sustained after adjustment.

Table 6.Factors associated with adequate attitude towards viral hepatitis B and C.

Among the 87 doctors, 3 were specialists (CS) and 84 were general practitioners.

Regarding attitudes (Table 6), most healthcare professionals exhibited favorable perceptions toward hepatitis B and C. However, professional category remained a significant determinant, with midwives showing notably less favorable attitudes. No other sociodemographic variable was significantly associated with attitude levels.

Table 7. Factors associated with adequate practice of viral hepatitis B and C.

Among the 87 doctors, 3 were specialists (CS) and 84 were general practitioners.

As for practices (Table 7), younger age, lower education, and non-physician roles were independently associated with suboptimal preventive behaviors. Midwives and nurses were less likely to report good practices, particularly in vaccination and care-seeking. These findings underscore the need for targeted interventions among younger and non-medical staff to improve hepatitis-related practices.

This study conducted in Mbujimayi, Democratic Republic of the Congo, revealed that most healthcare professionals demonstrated satisfactory levels of knowledge, attitudes, and practices (KAP) regarding hepatitis B and C. However, significant disparities persist across age groups, education levels, and professional categories. These findings are consistent with those reported in other African settings and underscore the need for targeted interventions to address persistent gaps in hepatitis-related competencies among healthcare workers.

Knowledge levels were highest among physicians and those with advanced education, while midwives and laboratory technicians exhibited significantly lower scores. Similar trends have been documented in Ethiopia, where Hebo et al. found that although 73.9% of healthcare workers had good knowledge of HBV, only 42.6% demonstrated good preventive practices, and vaccination coverage remained low (25%) [11]. In Liberia, Freeman et al. reported that only 35.9% of healthcare workers had completed the HBV vaccination schedule, despite high awareness of transmission risks [12]. In South Africa, Mashilo et al. observed that while 83% of primary healthcare staff had good knowledge of HBV epidemiology, only 40% demonstrated adequate understanding of prevention and management strategies [13].

Attitudes toward hepatitis were generally favorable in our study, with most participants recognizing their vulnerability and expressing willingness to seek care if diagnosed. Nonetheless, midwives were significantly less likely to report favorable attitudes, even after adjustment. This finding aligns with studies from Ghana and Sudan, which highlighted similar attitudinal gaps among paramedical staff [14]. Fear of death and concerns about treatment costs were prevalent, echoing findings from Burkina Faso and Sierra Leone, where stigma and limited access to care were identified as major barriers to effective hepatitis management [14][15].

Preventive and care practices were widely adopted, particularly screening, which was reported by over 93% of participants. However, vaccination coverage remained low (24.08%), and only a small fraction had ever received treatment. These findings mirror those from Ghana, where Kumah et al. found that although 100% of public health students were aware of HBV vaccination, only 58.8% had been vaccinated, and cost was a major barrier [16]. In a pan-African study involving 12 countries, Shah et al. reported that only 61% of healthcare workers were vaccinated against HBV, with significant disparities between East and West Africa, and cost cited as the most frequent reason for non-vaccination [14].

The finding that only 9.42% of participants believe hepatitis B or C can be cured may negatively affect patient counseling and adherence to treatment. Targeted educational interventions are needed to correct this misconception among healthcare workers.

The most commonly identified transmission routes—contaminated blood, unprotected sex, and sharp objects—are consistent with findings from studies in Dakar [17]. However, awareness of hepatitis virus types beyond B and C remains limited, as also reported in Morocco [18] and Ghana [16].

Our findings indicate descriptive associations between sociodemographic characteristics and KAP scores. Given the cross-sectional design, these results should not be interpreted as causal relationships.

Taken together, these findings highlight the need for structured continuing education programs, improved access to hepatitis vaccines, and enhanced communication strategies to address misconceptions and promote evidence-based practices. Aligning these efforts with the WHO Strategic Framework for Viral Hepatitis 2021-2030 will be essential to achieving national and regional elimination goals.

Future educational programs should emphasize the distinction between hepatitis B, which is preventable through vaccination, and hepatitis C, which is highly curable with modern antiviral therapies. This differentiation is critical for effective prevention and treatment strategies.

This study has several limitations. First, its cross-sectional design precludes any inference of causality between sociodemographic factors and KAP outcomes. Second, data were collected through self-reported questionnaires, which may be subject to social desirability bias, particularly regarding attitudes and practices. Third, the study was conducted in only two hospitals in Mbujimayi, limiting the generalizability of findings to other regions of the Democratic Republic of the Congo or sub-Saharan Africa. Moreover, the use of non-probabilistic, voluntary sampling may introduce selection bias, limiting the representativeness of our findings. Therefore, results should be interpreted as specific to the two hospitals included in this study. Fourth, the absence of serological testing prevented correlation between reported practices and actual hepatitis B or C infection status. Finally, the low vaccination rate reported may reflect both limited access and recall bias, as many participants were unsure of their vaccination history.

Despite these limitations, the study provides valuable insights into hepatitis-related KAP among healthcare professionals in a resource-limited setting and highlights key areas for intervention aligned with WHO elimination targets.