Knowledge, Attitudes and Practices of Physicians Regarding Brucellosis in Sana'a City, Yemen: Diagnostic Shortcomings Despite High Awareness

الملخص

Background: Brucellosis is a widespread zoonotic infection that poses significant diagnostic and therapeutic challenges. However, it remains underdiagnosed due to nonspecific symptoms. Therefore, this study aimed to assess the knowledge, attitudes and practices (KAPs) of physicians regarding brucellosis in Sana'a City, Yemen.

Methods: A descriptive, cross-sectional study was conducted among 264 physicians of various specialties in Sana’a City, Yemen, from March to May 2025. Data on physician characteristics and brucellosis-related KAPs were collected using a structured electronic questionnaire. Responses were scored and categorized into good/poor knowledge, positive/negative attitudes, and acceptable/unacceptable practices, based on predefined thresholds. Data were summarized and presented using descriptive statistics.

Results: Among 264 surveyed physicians, 94% demonstrated good knowledge of brucellosis. Most identified animals (87.9%) as reservoirs and farmers (89%) as a high-risk group, though fewer recognized laboratory personnel (42.4%) as being at risk. Commonly known transmission routes included raw milk (89%), raw meat (69.3%), and direct contact with animals (66.3%), while awareness of occupational exposures—placentas (44.7%), aborted materials (42.4%), and aerosols (24.6%)—was limited. Clinical signs like fever (91.3%), gastrointestinal symptoms (85.2%), and neurological involvement (78.2%) were well recognized. Anemia (72.7%) was the most known hematological finding. While 72% correctly identified the doxycycline-rifampin regimen, only 51.1% knew the six-week treatment duration. A positive attitude prevailed among 92% of physicians, with strong support for increasing medical awareness (80.7%), recognizing frequent misdiagnosis (78.1%), and promoting continuing education (78%). About 71.3% trusted serological tests, and 69.7% supported referring cases to specialists, yet only 51.1% viewed brucellosis as a major public health issue in Yemen. Diagnostic practices were acceptable among 68% of physicians, though few routinely asked about raw milk (40.2%), raw meat (23.1%), or animal contact (42.8%). Only 32.6% consistently tested chronic fever cases for brucellosis, and testing was rarely ordered for lab workers (8.7%) or animal-exposed individuals (25%).

Conclusion: Physicians in Sana'a City show good knowledge and attitudes toward brucellosis, but gaps remain in recognizing atypical exposures and applying consistent diagnostic practices. Limited perception of brucellosis as a major health issue hinders effective management, highlighting the need for standardized protocols and targeted continuing education to improve diagnosis and care.