{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:54:21Z","timestamp":1782924861398,"version":"3.54.5"},"reference-count":68,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Middle East respiratory syndrome coronavirus (MERS-CoV) remains a global health threat, with frequent hospital outbreaks in the Middle East and Asia. Transmission occurs through contact with dromedary camels, and spillover risk in Northern Kenya is significant due to high camel exposure and growing human mobility. We assessed knowledge, attitudes, practices, and risk perception (KAP-RP) regarding MERS-CoV and other coronaviruses among health care workers (HCWs) in Isiolo and Marsabit counties. A cross-sectional survey was conducted between December 2023 and January 2024. Using two-stage stratified random sampling, HCWs from public health facilities were recruited, covering clinical and nonclinical cadres. Data were collected using a structured, pretested questionnaire on KAP-RP. Scores were classified as sufficient or insufficient. Analyses included descriptive statistics, logistic regression, and Pearson correlations. Of 847 HCWs enrolled (36.4% Isiolo, 63.6% Marsabit), the majority were age 25\u201334 years, with a male:female ratio of 1.3:1. Clinical cadres made up 56.2%, and 77% worked in rural facilities. Only 28.1% demonstrated sufficient knowledge, 74.7% showed favorable attitudes, 25.1% adhered adequately to preventive practices, and 26.7% had high risk perception. PPE use was reported by 85.5%, but only 49.2% wore it consistently, and 33.3% changed it as required. Knowledge was higher among males, older HCWs, and Isiolo residents. Correlation analysis showed a weak positive association between knowledge and practice, a negative association with attitude, and minimal links with risk perception. Substantial knowledge gaps, inconsistent practices, and low risk perception persist, highlighting the need for context-specific, behavior-focused training to strengthen preparedness in zoonotic hot spots.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0585","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T14:22:53Z","timestamp":1778595773000},"page":"153-161","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, Attitudes, Practices, and Risk Perception of MERS-CoV and Other Coronaviruses Among Health Care Workers in Northern Kenya"],"prefix":"10.4269","volume":"115","author":[{"given":"Cynthia","family":"Ombok","sequence":"first","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Karani","sequence":"additional","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"},{"name":"Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyne","family":"Nasimiyu","sequence":"additional","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"},{"name":"Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moshe","family":"Alando","sequence":"additional","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Badha","sequence":"additional","affiliation":[{"name":"Department of Health, Isiolo County, Isiolo, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boru","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Veterinary Services, Marsabit County, Marsabit, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Millicent","family":"Minayo","sequence":"additional","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"},{"name":"Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boru","family":"Wato","sequence":"additional","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Mungai","sequence":"additional","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Odinoh","sequence":"additional","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boku","family":"Bodha","sequence":"additional","affiliation":[{"name":"Department of Veterinary Services, Marsabit County, Marsabit, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Kariuki","family":"Njenga","sequence":"additional","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"},{"name":"Paul Allen School for Global Health, Washington State University, Pullman, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Ngere","sequence":"additional","affiliation":[{"name":"Centers for Research in Emerging Infectious Diseases\u2013East and Central Africa, Nairobi, Kenya;"},{"name":"Paul Allen School for Global Health, Washington State University, Pullman, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"7","key":"b1","series-title":"Arch Virol","first-page":"1517","article-title":"The emergence of SARS, MERS and novel SARS-2 coronaviruses in the 21st century","volume":"165","author":"da Costa","year":"2020"},{"issue":"1","key":"b2","series-title":"Pastoralism","first-page":"25","article-title":"How many large camelids in the world? A synthetic analysis of the world camel demographic changes","volume":"10","author":"Faye","year":"2020"},{"key":"b3","article-title":"Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Summary of Current Situation, Literature Update and Risk Assessment.","year":"2024"},{"issue":"e292","key":"b4","series-title":"Epidemiol Infect","first-page":"e292","article-title":"High MERS-CoV seropositivity associated with camel herd profile, husbandry practices and household socio-demographic characteristics in Northern Kenya","volume":"148","author":"Ngere","year":"2020"},{"issue":"12","key":"b5","series-title":"Proc Natl Acad Sci USA","first-page":"3144","article-title":"MERS coronaviruses from camels in Africa exhibit region-dependent genetic diversity","volume":"115","author":"Chu","year":"2018"},{"issue":"1","key":"b6","series-title":"Viruses","first-page":"125","article-title":"Low-level zoonotic transmission of clade C MYERS-CoV in Africa: Insights from a scoping review and cohort studies in hospital and community settings","volume":"17","author":"Karani","year":"2025"},{"issue":"4","key":"b7","series-title":"Emerg Infect Dis","first-page":"1201","article-title":"Low-level Middle East respiratory syndrome coronavirus among camel handlers, Kenya, 2019","volume":"27","author":"Munyua","year":"2021"},{"issue":"3","key":"b8","series-title":"Lancet Infect Dis","first-page":"385","article-title":"T-cell responses to MERS coronavirus infection in people with occupational exposure to dromedary camels in Nigeria: An observational cohort study","volume":"21","author":"Mok","year":"2021"},{"issue":"6","key":"b9","series-title":"Am J Trop Med Hyg","first-page":"1318","article-title":"No serologic evidence of Middle East respiratory syndrome coronavirus infection among camel farmers exposed to highly seropositive camel herds: A household linked study, Kenya, 2013","volume":"96","author":"Munyua","year":"2017"},{"issue":"8","key":"b10","series-title":"Viruses","first-page":"1743","article-title":"Outbreak of Middle East respiratory syndrome coronavirus in camels and probable spillover infection to humans in Kenya","volume":"14","author":"Ngere","year":"2022"},{"key":"b11","article-title":"A Qualitative Risk Assessment for the Potential Introduction of Clade B MERS-CoV to Africa through Trade of Infected Camels. Available at","year":"2023"},{"issue":"11","key":"b12","series-title":"Viruses","first-page":"2146","article-title":"Prevalence and molecular epidemiology of human coronaviruses in Africa prior to the SARS-CoV-2 outbreak: A systematic review","volume":"15","author":"Tambe","year":"2023"},{"issue":"4","key":"b13","series-title":"East Mediterr Health J","first-page":"435","article-title":"Knowledge and attitudes towards Middle East respiratory syndrome-coronavirus (MERS-CoV) among health care workers in south-western Saudi Arabia","volume":"26","author":"Asaad","year":"2020"},{"issue":"4","key":"b14","series-title":"Viruses","first-page":"396","article-title":"Middle East respiratory syndrome coronavirus (MERS-CoV) seropositive camel handlers in Kenya","volume":"12","author":"Kiyong\u2019a","year":"2020"},{"issue":"6","key":"b15","series-title":"Virol Sin","first-page":"484","article-title":"Genetic evidence of Middle east respiratory syndrome coronavirus (MERS-Cov) and widespread seroprevalence among camels in Kenya","volume":"33","author":"Ommeh","year":"2018"},{"key":"b16","article-title":"MERS-Coronavirus across Kenya: A spatial examination of social and environmental drivers","author":"Lawrence","year":"2023"},{"issue":"9","key":"b17","series-title":"Indian J Anaesth","first-page":"652","article-title":"Sample size calculation: Basic principles","volume":"60","author":"Das","year":"2016"},{"issue":"48","key":"b18","series-title":"Euro Surveill","first-page":"1900244","article-title":"Middle East respiratory syndrome coronavirus (MERS-CoV) neutralising antibodies in a high-risk human population, Morocco, November 2017 to January 2018","volume":"24","author":"Abbad","year":"2019"},{"issue":"5","key":"b19","series-title":"Int J Med Sci Public Health","first-page":"952","article-title":"Knowledge, attitude, and practice toward MERS-CoV among primary health-care workers in Makkah Al-Mukarramah: An intervention 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and Control of Infectious Diseases in the EU\/EEA.","year":"2025"},{"issue":"2","key":"b24","series-title":"J Public Health Afr","first-page":"570","article-title":"Healthcare professionals\u2019 awareness, knowledge, attitudes, perceptions and beliefs about Ebola at Gondar University Hospital, Northwest Ethiopia: A cross-sectional study","volume":"7","author":"Abebe","year":"2016"},{"key":"b25","series-title":"J Trop Med","first-page":"431317","article-title":"Knowledge, attitude, and practice of health workers in a tertiary hospital in Ile-Ife, Nigeria, towards Ebola Viral Disease","volume":"2015","author":"Olowookere","year":"2015"},{"issue":"6","key":"b26","series-title":"PLoS One","first-page":"e0252852","article-title":"Knowledge, awareness and preventive practices of dengue outbreak in Bangladesh: A countrywide study","volume":"16","author":"Hossain","year":"2021"},{"issue":"1","key":"b27","series-title":"BMC Health Serv Res","first-page":"465","article-title":"Knowledge, practice and associated factors of infection prevention among healthcare workers in Debre Markos Referral Hospital, Northwest Ethiopia","volume":"18","author":"Desta","year":"2018"},{"issue":"9","key":"b28","series-title":"PLoS One","first-page":"e0308348","article-title":"Knowledge, attitude and practice of healthcare workers on infection prevention and control in Ethiopia: A systematic review and meta-analysis","volume":"19","author":"Wubneh","year":"2024"},{"issue":"1","key":"b29","series-title":"BMC Infect Dis","first-page":"273","article-title":"The perceived effectiveness of MERS-CoV educational programs and knowledge transfer among primary healthcare workers: A cross-sectional survey","volume":"19","author":"Aldohyan","year":"2019"},{"key":"b30","series-title":"BMC Public Health","first-page":"1281","article-title":"Knowledge and attitude of healthcare workers about Middle East respiratory syndrome in multispecialty hospitals of Qassim, Saudi Arabia","volume":"14","author":"Khan","year":"2014"},{"issue":"2","key":"b31","series-title":"JMIR Public Health Surveill","first-page":"e19160","article-title":"Knowledge and perceptions of COVID-19 among health care workers: Cross-sectional study","volume":"6","author":"Bhagavathula","year":"2020"},{"key":"b32","article-title":"Assessment of Iranian Nurses\u2019 Knowledge and Anxiety Toward COVID-19 During the Current Outbreak in Iran; Research Article 15; Archives of Clinical Infectious Diseases.","author":"Nemati","year":"2020"},{"issue":"2","key":"b33","series-title":"TIJPH","first-page":"67","article-title":"The Nigerian health workers\u2019 attitude and knowledge of the Middle East Respiratory Syndrome","volume":"4","author":"Famuyiwa","year":"2016"},{"issue":"1","key":"b34","series-title":"BMC Infect Dis","first-page":"4","article-title":"An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia","volume":"17","author":"Abolfotouh","year":"2017"},{"issue":"7","key":"b1","series-title":"Arch Virol","first-page":"1517","article-title":"The emergence of SARS, MERS and novel SARS-2 coronaviruses in the 21st century","volume":"165","author":"da Costa","year":"2020"},{"issue":"1","key":"b2","series-title":"Pastoralism","first-page":"25","article-title":"How many large camelids in the world? A synthetic analysis of the world camel demographic changes","volume":"10","author":"Faye","year":"2020"},{"key":"b3","article-title":"Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Summary of Current Situation, Literature Update and Risk Assessment.","year":"2024"},{"issue":"e292","key":"b4","series-title":"Epidemiol Infect","first-page":"e292","article-title":"High MERS-CoV seropositivity associated with camel herd profile, husbandry practices and household socio-demographic characteristics in Northern Kenya","volume":"148","author":"Ngere","year":"2020"},{"issue":"12","key":"b5","series-title":"Proc Natl Acad Sci USA","first-page":"3144","article-title":"MERS coronaviruses from camels in Africa exhibit region-dependent genetic diversity","volume":"115","author":"Chu","year":"2018"},{"issue":"1","key":"b6","series-title":"Viruses","first-page":"125","article-title":"Low-level zoonotic transmission of clade C MYERS-CoV in Africa: Insights from a scoping review and cohort studies in hospital and community settings","volume":"17","author":"Karani","year":"2025"},{"issue":"4","key":"b7","series-title":"Emerg Infect Dis","first-page":"1201","article-title":"Low-level Middle East respiratory syndrome coronavirus among camel handlers, Kenya, 2019","volume":"27","author":"Munyua","year":"2021"},{"issue":"3","key":"b8","series-title":"Lancet Infect Dis","first-page":"385","article-title":"T-cell responses to MERS coronavirus infection in people with occupational exposure to dromedary camels in Nigeria: An observational cohort study","volume":"21","author":"Mok","year":"2021"},{"issue":"6","key":"b9","series-title":"Am J Trop Med Hyg","first-page":"1318","article-title":"No serologic evidence of Middle East respiratory syndrome coronavirus infection among camel farmers exposed to highly seropositive camel herds: A household linked study, Kenya, 2013","volume":"96","author":"Munyua","year":"2017"},{"issue":"8","key":"b10","series-title":"Viruses","first-page":"1743","article-title":"Outbreak of Middle East respiratory syndrome coronavirus in camels and probable spillover infection to humans in Kenya","volume":"14","author":"Ngere","year":"2022"},{"key":"b11","article-title":"A Qualitative Risk Assessment for the Potential Introduction of Clade B MERS-CoV to Africa through Trade of Infected Camels. Available at","year":"2023"},{"issue":"11","key":"b12","series-title":"Viruses","first-page":"2146","article-title":"Prevalence and molecular epidemiology of human coronaviruses in Africa prior to the SARS-CoV-2 outbreak: A systematic review","volume":"15","author":"Tambe","year":"2023"},{"issue":"4","key":"b13","series-title":"East Mediterr Health J","first-page":"435","article-title":"Knowledge and attitudes towards Middle East respiratory syndrome-coronavirus (MERS-CoV) among health care workers in south-western Saudi Arabia","volume":"26","author":"Asaad","year":"2020"},{"issue":"4","key":"b14","series-title":"Viruses","first-page":"396","article-title":"Middle East respiratory syndrome coronavirus (MERS-CoV) seropositive camel handlers in Kenya","volume":"12","author":"Kiyong\u2019a","year":"2020"},{"issue":"6","key":"b15","series-title":"Virol Sin","first-page":"484","article-title":"Genetic evidence of Middle east respiratory syndrome coronavirus (MERS-Cov) and widespread seroprevalence among camels in Kenya","volume":"33","author":"Ommeh","year":"2018"},{"key":"b16","article-title":"MERS-Coronavirus across Kenya: A spatial examination of social and environmental drivers","author":"Lawrence","year":"2023"},{"issue":"9","key":"b17","series-title":"Indian J Anaesth","first-page":"652","article-title":"Sample size calculation: Basic principles","volume":"60","author":"Das","year":"2016"},{"issue":"48","key":"b18","series-title":"Euro Surveill","first-page":"1900244","article-title":"Middle East respiratory syndrome coronavirus (MERS-CoV) neutralising antibodies in a high-risk human population, Morocco, November 2017 to January 2018","volume":"24","author":"Abbad","year":"2019"},{"issue":"5","key":"b19","series-title":"Int J Med Sci Public Health","first-page":"952","article-title":"Knowledge, attitude, and practice toward MERS-CoV among primary health-care workers in Makkah Al-Mukarramah: An intervention study","volume":"5","author":"Alkot","year":"2016"},{"issue":"6","key":"b20","series-title":"Zoonoses Public Health","first-page":"635","article-title":"Middle East respiratory syndrome coronavirus (MERS-CoV) infection: Analyses of risk factors and literature review of knowledge, attitude and practices","volume":"69","author":"Rahman","year":"2022"},{"key":"b21","series-title":"Int Res J Med Med Sci","first-page":"102","article-title":"Knowledge, attitude and practices of healthcare providers towards MERS-CoV infection at Makkah hospitals, KSA","volume":"3","author":"Nour","year":"2015"},{"issue":"12","key":"b22","series-title":"Int J Environ Res Public Health","first-page":"1214","article-title":"Knowledge, attitudes and behaviours of healthcare workers in the Kingdom of Saudi Arabia to MERS coronavirus and other emerging infectious diseases","volume":"13","author":"Alsahafi","year":"2016"},{"key":"b23","article-title":"ECDC Assessment of Public Health Workforce Capacity in Prevention and Control of Infectious Diseases in the EU\/EEA.","year":"2025"},{"issue":"2","key":"b24","series-title":"J Public Health Afr","first-page":"570","article-title":"Healthcare professionals\u2019 awareness, knowledge, attitudes, perceptions and beliefs about Ebola at Gondar University Hospital, Northwest Ethiopia: A cross-sectional study","volume":"7","author":"Abebe","year":"2016"},{"key":"b25","series-title":"J Trop Med","first-page":"431317","article-title":"Knowledge, attitude, and practice of health workers in a tertiary hospital in Ile-Ife, Nigeria, towards Ebola Viral Disease","volume":"2015","author":"Olowookere","year":"2015"},{"issue":"6","key":"b26","series-title":"PLoS One","first-page":"e0252852","article-title":"Knowledge, awareness and preventive practices of dengue outbreak in Bangladesh: A countrywide study","volume":"16","author":"Hossain","year":"2021"},{"issue":"1","key":"b27","series-title":"BMC Health Serv Res","first-page":"465","article-title":"Knowledge, practice and associated factors of infection prevention among healthcare workers in Debre Markos Referral Hospital, Northwest Ethiopia","volume":"18","author":"Desta","year":"2018"},{"issue":"9","key":"b28","series-title":"PLoS One","first-page":"e0308348","article-title":"Knowledge, attitude and practice of healthcare workers on infection prevention and control in Ethiopia: A systematic review and meta-analysis","volume":"19","author":"Wubneh","year":"2024"},{"issue":"1","key":"b29","series-title":"BMC Infect Dis","first-page":"273","article-title":"The perceived effectiveness of MERS-CoV educational programs and knowledge transfer among primary healthcare workers: A cross-sectional survey","volume":"19","author":"Aldohyan","year":"2019"},{"key":"b30","series-title":"BMC Public Health","first-page":"1281","article-title":"Knowledge and attitude of healthcare workers about Middle East respiratory syndrome in multispecialty hospitals of Qassim, Saudi Arabia","volume":"14","author":"Khan","year":"2014"},{"issue":"2","key":"b31","series-title":"JMIR Public Health Surveill","first-page":"e19160","article-title":"Knowledge and perceptions of COVID-19 among health care workers: Cross-sectional study","volume":"6","author":"Bhagavathula","year":"2020"},{"key":"b32","article-title":"Assessment of Iranian Nurses\u2019 Knowledge and Anxiety Toward COVID-19 During the Current Outbreak in Iran; Research Article 15; Archives of Clinical Infectious Diseases.","author":"Nemati","year":"2020"},{"issue":"2","key":"b33","series-title":"TIJPH","first-page":"67","article-title":"The Nigerian health workers\u2019 attitude and knowledge of the Middle East Respiratory Syndrome","volume":"4","author":"Famuyiwa","year":"2016"},{"issue":"1","key":"b34","series-title":"BMC Infect Dis","first-page":"4","article-title":"An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi 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