Skills and knowledge of clinical veterinarians regarding monkeypox in the Democratic Republic of the Congo

 Corresponding author: TSHIKUNG KAMBOL MOSSES Didier Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Skills and knowledge of clinical veterinarians regarding monkeypox in the Democratic Republic of the Congo TSHIKUNG KAMBOL MOSSES Didier 1, *, NDONGO KATENGO Erudit 1, KAYIBA KYEZI Shekinah 2, KANYIMBU MBAL Marco 1, KALAMBA KAMBA Betty 1 and TSHASUMA KEDI Alain 1 1 Department of Biology, Systematics and Wildlife, Faculty of Veterinary Medicine, University of Lubumbashi, P.O. Box 1825, Lubumbashi, Democratic Republic of Congo. 2 DMV, Veterinary Clinician, Lubumbashi, Democratic Republic of Congo World Journal of Advanced Research and Reviews, 2025, 27(02), 667-679 Publication history: Received on 27 June 2025; revised on 05 August 2025; accepted on 07 August 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.27.2.2799 Abstract Introduction: Monkeypox, an Orthopoxvirus zoonosis, is caused by a virus belonging to the Orthopoxvirus genus. This emerging zoonotic disease represents a growing threat to public health in the Democratic Republic of the Congo (DRC) and other regions. Given the zoonotic nature of this disease, veterinarians play a crucial role in its detection, management, prevention, and surveillance. Assessing the skills and knowledge of these professionals is therefore essential to identify gaps and strengthen the response to zoonotic diseases. Objective: The aim of this study was to assess the knowledge and skills of clinical veterinarians in the DRC regarding specific zoonotic diseases such as monkeypox. Methods: A cross-sectional online survey was conducted to evaluate the knowledge and skills of clinical veterinarians in the DRC concerning Mpox. Semi-structured questionnaires were distributed via Google Forms. Data were collected from 79 clinical veterinarians registered with the Veterinary Medical Association of Congo, across 14 provinces of the DRC. The study was conducted between September and October 2024. Results: The majority of respondents were male (85%) and aged between 30 and 50 years. Most of the surveyed veterinarians had at least five years of professional experience. Regarding the knowledge of transmission routes, 93.7% of participants were aware of them, and 93.3% were familiar with the symptoms of the disease. The most frequently cited diagnostic methods included molecular analyses and clinical signs evaluation. Conclusion: Although the overall level of knowledge about monkeypox among clinical veterinarians is high, most of them have never received specific training on the management of this disease. Clinical symptoms, transmission routes, and the most affected species are generally well known. However, very few veterinarians participate in epidemiological surveillance programs for monkeypox in the DRC. Classical preventive measures such as hygiene and disinfection, isolation of suspected cases, and the use of personal protective equipment (PPE) remain effective in combating the spread of Mpox. Keywords: Knowledge; Skills; Practice; Veterinarian; Monkeypox; DR Congo World Journal of Advanced Research and Reviews, 2025, 27(02), 667-679 668 1. Introduction Monkeypox is a zoonotic disease caused by a virus belonging to the Orthopoxvirus genus [1]. It is considered an emerging disease in Central and West Africa. Transmission occurs primarily through direct contact with the bodily fluids or skin lesions of infected animals, as well as via respiratory droplets between humans [2]. These characteristics make monkeypox a potential threat in both public health and veterinary contexts. In the Democratic Republic of the Congo (DRC), monkeypox is endemic, with human cases regularly reported [3]. However, the disease has been drawing increased international attention since cases were reported in several countries outside of Africa, raising concerns about the surveillance and management of this zoonosis. Clinical veterinarians play a key role in the early detection, surveillance, and prevention of zoonotic diseases such as monkeypox, particularly due to their direct interaction with both domestic and wild animals [4]. Veterinarians’ ability to identify, treat, and prevent zoonotic diseases largely depends on their knowledge and skills in specific areas [5]. The level of knowledge among veterinarians regarding monkeypox in the DRC is presumed to be variable. Several studies on zoonoses have shown that veterinarians in sub-Saharan Africa are often well-informed about certain endemic diseases such as rabies, brucellosis, and bovine tuberculosis [6]; [7]; [8]; [9]), but much less so about emerging diseases like monkeypox. Veterinarians working in close contact with wildlife particularly in rural areas near tropical forests may have a better understanding of this disease due to their frequent exposure to potential reservoir species [10]. The study by Nka [11] revealed very limited knowledge of the monkeypox virus among healthcare workers, regardless of their sociodemographic or professional characteristics. Consequently, to ensure optimal preparedness and timely responses to Mpox and other similar emerging pathogens, capacity-building programs should be implemented for health professionals. In the DRC, training for veterinarians on the management of suspected monkeypox cases remains limited. There are no formal programs or regular workshops specifically dedicated to the management of this disease in most veterinary schools or professional associations. Furthermore, clinical guidelines for recognizing and managing monkeypox are still largely based on human health protocols, making them difficult to apply in the veterinary field [12]. Clinical veterinarians generally perceive their role in the surveillance and prevention of zoonotic diseases as crucial [13]. However, several obstacles limit their ability to fully carry out this mission. In the DRC, limited resources, the lack of specific guidelines, and the absence of institutional collaboration between animal and human health services often hinder their active participation in zoonosis prevention, including monkeypox [14]. Since its identification in the DRC, monkeypox has represented a growing public health risk, especially considering the key role veterinarians play in zoonotic disease surveillance. Most research on disease surveillance, however, has focused primarily on human health professionals. The overall objective of this study is to assess the knowledge and skills of clinical veterinarians in the DRC regarding specific zoonotic diseases such as monkeypox. 2. Materials and methods 2.1. Study Area Our research was conducted in the Democratic Republic of the Congo (DRC), a country located in the heart of Africa, covering an area of 2,345,410 km², situated at approximately 4°00′00.00″ South latitude and 21°00′00.00″ East longitude. The country is currently divided into 26 provinces and is geographically structured into three main zones: • The central basin, with the lowest elevation, covers about one-third of the national territory. It is characterized by alternating equatorial forests and swampy lands, watered year-round by the Congo River and its tributaries. • The plateaus surrounding the basin, mainly covered by savannas. • The eastern mountain ranges, located in the provinces of North Kivu and South Kivu. The DRC is bordered to the south by Zambia and Angola; to the east by Zambia, Tanzania, Rwanda, Burundi, and Uganda; to the north by the Central African Republic and South Sudan; and to the west by the Republic of the Congo, the Angolan province of Cabinda, and the Atlantic Ocean. World Journal of Advanced Research and Reviews, 2025, 27(02), 667-679 669 Figure 1 Map of the Democratic Republic of the Congo [15]. 3. Methods We conducted a cross-sectional and prospective study with descriptive objective, based on the use of questionnaires, interviews, and analysis of data collected directly in the field. This study was carried out in the DRC between September and October 2024 and focused on the knowledge and skills of clinical veterinarians regarding Mpox. The study population consisted entirely of clinical veterinarians affiliated with the Veterinary Medical Association of Congo. A random sampling method was used, and 79 clinical veterinarians from 14 different provinces of the DRC responded to the survey [16]. 3.1. Study Variables 3.1.1. Independent variables We assessed four main groups of independent variables that could influence knowledge and skills: sociodemographic status (Age, Sex, Province), characteristics of the work area (urban, rural, peri-urban), medical professional development characteristics, professional experience (in years) [16, 17] 3.1.2. Dependent Variables In this study, the dependent variables were the knowledge and skills of clinical veterinarians in the DRC regarding Mpox. Questions were asked to assess their knowledge and competencies, focusing on: the zoonotic nature of Mpox, its modes of transmission, clinical symptoms, available diagnostic methods, risk of transmission, the most affected animal species, treatment of confirmed cases, specific training received, applicable preventive measures, use of personal protective equipment (PPE) and accessibility of vaccines for animals [16, 17] 3.1.3. Survey and Data Collection A link to the survey questionnaire was shared on WhatsApp platforms used by veterinary doctors. Responses were collected anonymously, and to ensure data confidentiality, access to participants’ responses was managed solely by the principal investigator. The survey questions focused on sociodemographic information, and the knowledge and skills of clinical veterinarians regarding monkeypox. Respondents provided free and informed consent on the first page of the questionnaire. World Journal of Advanced Research and Reviews, 2025, 27(02), 667-679 670 • The questionnaire was designed to assess veterinarians' knowledge of monkeypox, including questions on symptoms, modes of transmission, preventive measures, and the management of suspected cases. • Semi-structured interviews were also conducted to explore veterinarians' perceptions of zoonotic risks and to identify gaps in training. • Field observations were carried out through visits to veterinary clinics and offices, where we observed biosafety practices and the availability of diagnostic tools. 3.2. Data Analysis The data collected were analyzed using an Excel spreadsheet (EpiCollect5), frequencies were calculated. Key themes, opinions, and experiences recorded in the dataset were explored using basic statistical calculations to determine the proportions reflecting veterinarians’ knowledge and skills regarding monkeypox in the DRC. 3.3. Ethical Considerations and Data Confidentiality Respondents were interviewed based on informed consent and their voluntary decision to answer the survey questions. Data confidentiality for each participant was strictly maintained throughout the data collection and analysis phases. 4. Results We present the results obtained from our investigation. 4.1. Sociodemographic Characteristics of Respondents The sociodemographic characteristics of the surveyed veterinarians are presented in Table 1 below: Table 1 Sociodemographic Characteristics of Surveyed Veterinarians Variables Number (n=79) Frequencies (%) Gender Male Female 67 12 85 15 Age group (year) Under 30 ] 30 - 40] ] 40 - 50] Over 50 18 30 20 10 23 38 25 14 Province of residence Haut-Katanga Haut-Uélé Ituri Kasaï-Oriental Kinshasa Kongo-Central Kwango Kwilu Lualaba Nord-Kivu Sud-Kivu Sankuru Tanganyika Tshopo 37 1 2 1 19 4 1 1 1 4 4 1 1 2 48 1 2.5 1 25 5 1 1 1 5 5 1 1 2.5 World Journal of Advanced Research and Reviews, 2025, 27(02), 667-679 671 Years of experience as a clinical veterinarian Less than 5 year ] 5 – 10 ans] ] 10 – 15 ans] More than 15 year 18 26 16 19 23 33 20 24 Work area Urban Rural Urban-rural (peri-urban) 51 11 17 64.5 14 21.5 From this table, it appears that the majority of the clinical veterinarians interviewed were male. Most were over 30 years old. They came from 14 different provinces of the Democratic Republic of the Congo, with a predominance of clinical veterinarians from Haut-Katanga Province (48%). The majority had at least 5 years of professional experience and worked either in urban areas (64.5%), rural areas (14%), or peri-urban zones (21.5%). 4.2. Knowledge About Monkeypox Table 2a Proportion of Respondents Who Reported Knowledge of Monkeypox Symptoms and Modes of Transmission Variables Number (n=79) Frequencies % Knowledge of monkeypox symptoms Yes No 74 5 93.7 6.3 Symptoms listed Number of times mentioned % Fever Skin lesions Fatigue Loss of appetite others No reponse 74 73 38 37 7 5 93.6 92.4 48.1 58.2 8.8 6.3 Knowledge of monkeypox transmission modes Number (n=79) % Yes No 77 2 97.5 2.5 Modes of transmission listed Number of times mentioned % Direct contact with infected secretions Bites/scratches Consumption of infected meat Contact with contaminated surfaces Aerosol transmission Others No reponse 77 30 53 55 19 4 2 97.5 50.6 68.8 71.4 24.6 5.2 2.6 It appears from Table 2a that 93.7% of respondents reported being aware of the symptoms of monkeypox. The most frequently listed symptoms were fever, skin lesions, fatigue, and loss of appetite. Among those respondents, 97.5% indicated that they were aware of the modes of transmission of the disease. World Journal of Advanced Research and Reviews, 2025, 27(02), 667-679 672 Table 2b Disease Definition, Affected Animal Species, and Diagnostic Procedures Monkeypox known as a zoonotic disease Number (n=79) % Yes No 78 1 98.7 1.3 Animal species affected by monkeypox Number of times mentioned % Primates Rodents Domestics animals Others (prairie dog) 77 52 15 3 97.4 65.8 18.9 3.8 Aware of monkeypox diagnostic methods Number (n=79) % Yes No No response 59 19 1 75 24 1 Known diagnostic methods Number of times mentioned % Clinical signs evaluation Paraclinical analyses Serology (ELISA) Molecular analysis (PCR) GeneXpert Monkeypox Antigen test cassette 28 19 9 32 1 1 47.4 32.2 6.7 54.2 1.6 1.6 Ont déjà traité les cas de variole du singe Number (n=79) % Yes 7 9 No 72 91 Have already treated monkeypox cases Number (n=79) % Yes 29 36,7 No 50 63,3 Table 2b reveals that 98.7% of respondents identified monkeypox as a zoonotic disease, with the most frequently cited animal sources being monkeys, rodents, and domestic animals. Among these respondents, 75% reported knowing diagnostic methods for the disease, with molecular analyses and clinical signs evaluation being the most commonly mentioned techniques. A minority (36.7%) indicated having received specific training on monkeypox, and 9% reported having provided therapeutic care for monkeypox cases. 4.3. Practices of Respondents Regarding Monkeypox Table 3 presents the practices of clinical veterinarians concerning animals carrying monkeypox. Table 3 Practices of Clinical Veterinarians Regarding Animals Infected with Monkeypox Practices toward sick animals Number of times mentioned Frequencies % Isolation Sampling Symptomatic treatment Notification to health authories Others 74 49 42 65 2 93.7 62 53 82 2.5 World Journal of Advanced Research and Reviews, 2025, 27(02), 667-679 673 No reponse 1 1 Use of diagnostic tools in clinics/offices Number (n=79) % Yes No No reponse 3 74 2 3.8 93.7 2.5 Knowledge of preventive measures against monkeypox Number (n=79) % Yes No 59 20 74.7 25.3 Preventive measures mentioned number of mentions % Isolation of sick animals Wearing personal protective equipment (PPE) Maintaining hygiene and disinfection Respecting barrier measures Following biosecurity and biosafety measures Avoiding direct contact Vaccination Training of healthcare staff Informing authorities 24 26 30 6 6 18 8 1 1 40.6 44 50.8 10 10 30.5 13.5 1.6 1.6 Frequency of PPE use when handling a suspected monkeypox case Number (n=79) % Always Sometimes Never No reponse 34 18 17 10 43 22.8 21.5 12.7 Accessibility of vaccines against Mpox in animals Number (n=79) % Yes No 2 77 2.5 97.4 From Table 3, we note that isolation of animals suspected of having monkeypox and notification of sick animal cases to authorities are the most frequently reported practices among respondents. A small percentage (3.8%) of respondents declared having the necessary equipment to manage monkeypox cases in their workplaces. The majority of respondents reported knowing preventive measures against the disease. Among these preventive measures, hygiene and surface disinfection, use of personal protective equipment (PPE), isolation of sick animals, and avoidance of contact with infected animals were the most commonly cited. 4.4. Perceptions of Respondents on the Epidemiological Risk of Monkeypox and Challenges Encountered Table 4 Perception of the Epidemiological Risk of Monkeypox Epidemiological risk of Mpox for animals is: Number of times mentioned Frequencies % Low Moderate High Very high No reponse 31 16 28 3 1 39.2 20.3 35.4 3.8 1 Risk of zoonotic transmission of Mpox Number (n=79) % World Journal of Advanced Research and Reviews, 2025, 27(02), 667-679 674 Low Moderate High Very high No reponse 10 37 24 6 2 12.6 46.8 30.4 7.6 2.5 Challenges encountered in managing monkeypox cases Number of times mentioned % Lack of reliable information Lack of diagnostic tools Lack of medicines Cost of care Lack of collaboration with health authorities Others 54 61 40 29 54 1 68.3 77.2 50.6 36.7 68.3 1 From Table 4, it appears that opinions among surveyed veterinarians are divided regarding the epidemiological and zoonotic risk of monkeypox. This risk is perceived as low by some, moderate by others, and high or very high by others still. The major challenges identified in managing monkeypox include, in order, the lack of diagnostic tools, absence of reliable information and collaboration with health authorities, shortage of medicines, and the cost of care. 4.5. Epidemiological Surveillance of Monkeypox Table 5 Practices Regarding Epidemiological Surveillance of Monkeypox Is there an epidemiological surveillance program for monkeypox? Number (n=79) Frequencies % Yes No 26 53 33 67 Have participated in monkeypox epidemiological surveillance programs? Yes No 18 61 23 77 Tasks assumed by participants in surveillance programs Number (n=18) % Case reporting Collection of epidemiological data Monitoring of infected animals Others 15 18 11 1 83 100 13.2 5.5 Attendance at workshops or seminars on zoonoses management, including monkeypox Number (n=78) % Yes No 42 36 53.8 46.2 Table 5 shows that 33% of respondents reported the existence of an epidemiological surveillance program for monkeypox, and 23% of them have already participated in this program. The tasks they undertake during surveillance include case reporting, collection of epidemiological data, and monitoring of infected animals. More than half, 53.8%, participate in workshops addressing zoonoses management, including monkeypox. World Journal of Advanced Research and Reviews, 2025, 27(02), 667-679 675 Table 6 Suggestions and Recommendations for the Management of Monkeypox Useful tools to improve veterinarians’ knowledge and practices on MPOX, what is needed to better fight monkeypox in veterinary practice: Useful tools to improve veterinarians’ knowledge and practices on MPOX Tools Number of times mentioned % Additional training Access to diagnostic kits Access to personal protective equipment (PPE) Technical assistance from veterinary authorities Others 74 64 56 56 2 93.6 81 70.8 70.8 2.5 What is needed to better fight monkeypox in veterinary practice: Effective communication among clinical veterinarians Monitoring wildlife movements Multidisciplinary approach in case management Vaccination Funding Training Develop a clear protocol for MPOX management Equip veterinarians with diagnostic tools Implementation of surveillance programs Personal protective equipment (PPE) Experimental research Awareness raising and popularization Monitoring hunters, combating poaching Promotion of wildlife conservation Good hygiene practices Collaboration between human health and veterinary authorities 4 2 3 5 2 21 1 8 3 2 1 8 3 1 6 5 5 2.5 3.8 6.3 2.5 26.5 1 10.1 3.8 2.5 1 10.1 3.8 1 7.5 6.3 Table 6 shows that respondents emphasize the need for training sessions on monkeypox management to better fight the disease. Several other suggestions were made, ranging from improved communication to enhanced collaboration between human health and veterinary authorities. 5. Discussion The Democratic Republic of Congo (DRC) has experienced sporadic cases of monkeypox, and with the resurgence of zoonoses, it was imperative for this study to assess the preparedness and capacity of veterinarians to respond to this disease. This topic allows for an exploration of the impact of veterinary knowledge on epidemiological surveillance and case management, which is vital for public health. The interconnection between human and animal health, highlighted by the "One Health" concept, underscores the importance of an integrated approach to zoonosis control. By assessing veterinarians’ knowledge, this research will facilitate collaboration between veterinarians and human health professionals, thereby promoting a holistic approach to managing monkeypox-related risks. After the first case of monkeypox was documented in Saudi Arabia, a cross-sectional study assessing the knowledge and attitudes of medical students regarding monkeypox was conducted in a medical school in the country in 2022. Subsequently, two other studies [18]; [19]) carried out in Syria and Jordan revealed a low level of Mpox knowledge among healthcare workers in Jordan, which was associated with lower confidence in case management and diagnosis among physicians and nurses [20]). However, no studies on this topic have been reported in the DRC regarding clinical veterinarians, who play an essential role in zoonosis management. Given this research gap, our study aimed to evaluate the knowledge and skills of clinical veterinarians regarding monkeypox in the DRC.