When a neglected tropical zoonotic disease emerges in non-endemic countries: need to proactively fill the unveiled knowledge gaps towards human monkeypox among the Lebanese population

The ongoing multi-country outbreak of monkeypox (MPX) that emerges in non-endemic areas is a rare and unprecedented event that has sparked a widespread public health concern. Lebanon has reported four confirmed cases of MPX so far. Since good knowledge about the MPX virus and its associated disease is paramount for helping the Lebanese population prepare for a possible outbreak, therefore, it is important to assess their current level of knowledge regarding MPX and to identify its associated factors to highlight any knowledge gaps that need to be filled. An online cross-sectional study was conducted over the first 2 weeks of August 2022 among adults aged 18 years and above recruited from all Lebanese provinces using a convenience sampling technique. An anonymous, Arabic, self-reported questionnaire covering all main aspects of knowledge regarding MPX was developed and adapted based on the available literature. The Chi-square test was used to determine the associations between knowledge levels and independent variables including baseline characteristics. Multivariable logistic regression was also carried out on the significant variables in the bivariate analyses to identify the factors associated with the good knowledge level. A total of 793 Lebanese adults participated in the study. The overall level of knowledge level regarding human MPX was poor among the Lebanese population; with only 33.04% of them having a good knowledge level ≥ 60%. Knowledge gaps and a substantial poor knowledge level were found in the majority of MPX knowledge domains especially those related to the routes of transmission (76.67%), clinical presentation and symptoms (71.63%), treatment (86.25%), and severity of the disease (91.3%). Interestingly, participants have a good knowledge level of the precautionary measures (80.45%), and the response to a suspected infection (65.20%). Female gender [(aOR = 0.870, CI 95% (0.613-0.941)], increased age 49 [aOR = 0.743, CI 95% (0.381-0.908)], and living in rural areas [aOR = 0.412, CI 95% (0.227-0.861)] were found negatively associated with a good level of knowledge. However, participants with higher educational levels [aOR = 1.243, CI 95% (1.032-3.801)], those working in the medical field [aOR = 1.932, CI 95% (1.331-3.419)], those suffering from chronic disease/immunodeficiency [aOR = 1.231, CI 95% (1.128-2.002)], and participants with moderate/high economic situations [aOR = 2.131, CI 95% (1.431-4.221)] were more likely to have a good knowle