South Ethiopia survey maps knowledge gaps and perception shifts around Marburg virus disease
A community-based mixed-methods study in the South Ethiopia Region found that most adults living in MVD-affected areas had heard enough to answer basic questions about Marburg virus disease, but knowledge and perception were not evenly distributed. Among 611 adults who completed the study, 74.8% had good knowledge and 62.7% held a positive perception of the disease. The gap matters because outbreak control in high-risk settings depends not only on laboratory confirmation and isolation, but on whether households recognize warning signs, trust public messaging, and act before rumors harden into behavior.
The study examined 614 adults between February 16 and March 10, 2026, using an explanatory sequential mixed-methods design. Quantitative data came from interviewer-administered questionnaires entered with Kobo Toolbox, while focus group discussions added a qualitative layer to explain how people interpreted the outbreak and the messages around it. A systematic random sampling strategy identified participants, and binary logistic regression tested factors associated with knowledge and perception. Statistical significance was set at a P value below 0.05.
One result stands out immediately: education shaped knowledge. Participants with higher educational status were far more likely to have good knowledge, with an adjusted odds ratio of 4.40. In practical terms, formal schooling appears to improve the ability to absorb, sort, and retain outbreak information, especially when communities must distinguish Marburg from other febrile illnesses that circulate with overlapping symptoms. For a hemorrhagic fever outbreak, that cognitive advantage can translate into faster care-seeking, more accurate reporting of exposure history, and better acceptance of public health instructions.
Information channels also influenced what people knew. Source of information was associated with knowledge, with an adjusted odds ratio of 0.42, while perception itself was associated with knowledge at an adjusted odds ratio of 2.05. The direction of these relationships points to a familiar outbreak dynamic: when the first messages come through uncertain or poorly trusted channels, people may remember fragments while missing the clinical logic of transmission prevention. Once official information is recognized as credible, misconceptions can be corrected and community confidence can move in the right direction.
Age, social media, and prior knowledge shaped how people judged the outbreak
Perception was not merely a reflection of knowledge. Age, digital exposure, and prior understanding all played separate roles. Adults aged 25 to 59 years were less likely to have a positive perception, with an adjusted odds ratio of 0.40, compared with the reference group used in the analysis. Social media utilization had a strong positive association with perception, with an adjusted odds ratio of 5.13, and good knowledge about MVD doubled the odds of a positive perception at an adjusted odds ratio of 2.00.
Those associations suggest a layered communication challenge. Middle-aged adults often carry the burden of family provision, decision-making, and daily movement through work and market settings, which can expose them to competing explanations and fast-moving rumors. Social media, when used well, can compress the delay between outbreak updates and household awareness. When used badly, it can do the opposite. In this dataset, digital access appears to have functioned as a bridge to more accurate attitudes rather than as a barrier.
The qualitative findings reinforced that pattern. Health education delivered through multiple channels improved knowledge, while official recognition corrected early misconceptions and shifted attitudes. Early in an outbreak, communities may interpret symptoms, deaths, or control measures through the lens of fear, stigma, or prior local experience. Once trusted institutions acknowledge the threat and explain why isolation, contact tracing, and prompt reporting matter, public understanding becomes more grounded. In epidemics caused by high-consequence viruses, perception is not a soft outcome. It shapes whether people comply with risk communication and whether they treat public advice as protection or intrusion.
Risk communication depends on trust as much as it depends on facts
The findings point to a simple operational lesson for outbreak response teams: messages must be repeated, localized, and delivered through trusted platforms. The study’s own recommendations focus on targeted interventions for people with lower educational status and wealth, older adults, and households that rely on weaker information channels. It also calls for stronger risk communication and community engagement, broader use of social media for dissemination, empowerment of housewives, and deliberate efforts to build positive perceptions.
That emphasis on trust is well placed. Marburg virus disease is an outbreak illness where public cooperation determines whether response teams can trace contacts, isolate suspected cases, and interrupt transmission chains before they widen. Knowledge alone does not guarantee the right behavior, but poor knowledge almost guarantees hesitation. The data show that perception and knowledge move together, yet not identically; both need to be addressed if public health messaging is to land with enough force to change household decisions.
The study also has value beyond this single region. Community responses to viral hemorrhagic fevers often differ from responses to more familiar infections because the disease is rare, severe, and easily wrapped in fear. In that setting, the credibility of the messenger can matter as much as the content of the message. Health workers, public health offices, and local leaders therefore need communication strategies that are not only accurate but also repeated through channels people already use and trust.
A final point is easy to miss if the headline numbers are read too quickly: nearly one in four adults still lacked good knowledge, and more than one in three did not hold a positive perception. For an outbreak-prone disease, that leaves a substantial margin for misunderstanding. The study does not show whether improved messaging alone would change clinical outcomes, but it does define where response teams should focus first—on education, message source, and the social routes through which communities make sense of danger.