Ethics statement

The project protocol received approval from the National Ethics Committee prior to the implementation of project activities (Reference No. 2020-9-195, dated September 2, 2020). Authorization was also obtained from the administrative, health, and security authorities in each region. Written informed consent was obtained from household heads or their authorized representatives prior to household-level data collection, and from each individual participant before personal data collection. As all study participants were heads of households or their legal representatives and were adults, no assent or parental/guardian consent was required. For participants who were unable to read or write, the consent form was read aloud in their preferred local language in the presence of an impartial witness, and consent was documented using a thumbprint in accordance with ethical committee recommendations. Participation was entirely voluntary, and respondents were informed of their right to decline participation or withdraw at any stage without any consequences. No financial compensation or incentives were provided to participants. However, as this KAP survey was nested within a prospective national dengue cohort, participants were entitled to free consultation and treatment for suspected dengue and malaria throughout the one-year follow-up period upon presentation of their study identification card at designated health facilities.These procedures ensured full compliance with ethical standards for research involving human participants.

Study sites

The study was conducted nationwide across all 13 regions of Burkina Faso. One urban and one rural locality were selected from each region, resulting in a total of 26 study sites. The study sites are described in S3 Fig.

Participant selection method

The present KAP survey was nested within a nationally representative dengue seroprevalence survey. Therefore, the sample size was determined according to the requirements of the primary serological study. A sampling plan combining stratified and cluster sampling was used. Stratification was based on the country's 13 regions, and in each of these regions on the rural (peri-urban) and urban areas of each capital. Cluster sampling was based on the sampling frame available from the 2019 general population and housing census (GPHC 2019), and the sample was selected at two levels: enumeration areas and households. EAs are geographically delimited administrative census units defined during the GPHC 2019 by the national statistical authorities, each generally comprising approximately 200–250 households for census and survey purposes.

Socio-demographic patterns

A total of 1,601 households were identified and approached for participation across 26 study sites nationwide. In this study, a “site” referred to a selected urban or rural locality within a health region. Accordingly, one urban and one rural locality were selected in each of the 13 health regions of Burkina Faso to ensure balanced geographic and demographic representation. The survey targeted household heads or, in their absence, an adult representative meeting the study eligibility criteria. Of the households approached, 1,568 respondents agreed to participate and were enrolled in the study, resulting in a participation rate of 97.9% and a refusal rate of 2.1%. The distribution of participants by region and site is presented in S1 Fig.

After obtaining informed consent from the participants, their socio-demographic characteristics were collected. These characteristics are presented in Table 1. Among the 1,568 respondents, 52.04% were male and 47.96% female, with a nearly equal distribution between rural and urban areas. The most represented age groups were 35–44 years (24.11%), 25–34 years (21.17%), and 45–54 years (20.15%). Most participants were married in monogamy (57.33%) or polygamy (23.22%). Over half (54.70%) had no formal schooling, and farming was the main occupation (38.26%), followed by trading (13.31%) and unemployment (12.41%).

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Table 1. Socio-Demographic characteristics of study population (n = 1568).

https://doi.org/10.1371/journal.pntd.0014027.t001

Knowledge of Dengue fever

To assess the KAP related to dengue fever, participants were first asked a general question on awareness of the disease (“Are you aware of the existence of a disease called Dengue”). Responses to this question are presented in Table 2. This initial step allowed the identification of respondents who reported awareness of dengue, among whom the subsequent analyses were conducted.

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Table 2. Awareness of dengue fever among study participants according to place of residence in Burkina Faso (n = 1,568).

https://doi.org/10.1371/journal.pntd.0014027.t002

Analysis of household sources of information on dengue fever in Burkina Faso reveals a diversity of channels used by the population to access information. Knowledge of these sources is vital if we are to raise awareness and combat dengue fever more effectively. S2 Fig is a radar diagram illustrating the proportions of information channels on dengue fever used by participants in the cross-sectional survey of the present study.

Table 3 provides insights into participants’ knowledge regarding symptoms of Dengue fever virus infection. Overall, 49.04% of respondents identified dengue as a disease transmitted through mosquito bites, while 14.52% described it as an infectious disease and 29.91% reported that they did not know what dengue is. Only 1.44% mentioned that dengue is caused by virus-like microbes, and 0.29% correctly combined all three aspects (infectious, viral, and mosquito-borne).

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Table 3. Knowledge of dengue fever among study participants in rural and urban settings in Burkina Faso (n = 1,568).

https://doi.org/10.1371/journal.pntd.0014027.t003

Regarding populations affected, 88.27% stated that dengue can affect everyone, whereas 9.04% did not know. Very small proportions indicated that dengue affects only adults (0.58%), children (0.77%), the poor (0.19%), the rich (0.48%), or the elderly (0.67%).

Concerning treatment, 22.50% of respondents reported that a drug exists to treat dengue, 30.96% said no, and 46.54% did not know.

With respect to prevention, 19.57% reported the existence of a vaccine against dengue, 23.83% stated that there is no vaccine, and 56.60% did not know.

Finally, 56.35% indicated that dengue can be repeated, 5.10% said it cannot be repeated, and 38.56% did not know.

Attitudes towards Dengue prevention and treatment

Dengue-related behaviours among participants, encompassing personal protection, self-treatment, and home care for relatives are listed in Table 4. Regarding personal protection, 80.19% of respondents reported sleeping under a mosquito net, 49.04% reported eliminating stagnant water, and 45.38% reported using mosquito repellent. Only 22.21% reported wearing long, loose clothing, while 7.12% stated that they do nothing to protect themselves from dengue. Other preventive actions such as cleaning the living environment were rarely mentioned (0.48%).

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Table 4. Attitudes towards Dengue Fever.

https://doi.org/10.1371/journal.pntd.0014027.t004

When experiencing symptoms suggestive of dengue, 98.56% of respondents reported that they would consult a doctor. Very few indicated self-medication (1.25%), use of medicinal plants (5.87%), consultation of a traditional healer (0.38%), prayer (2.12%), or doing nothing (0.67%).

If they suspected someone else had dengue, 98.65% stated that they would advise the person to go to a health centre. Only small proportions reported advising traditional treatment (0.10%), self-medication (0.38%), or doing nothing (0.87%).

Household practices towards Dengue prevention and treatment

Participants’ practices for dengue prevention and treatment are recorded in Table 5 below.

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Table 5. Practices towards dengue fever.

https://doi.org/10.1371/journal.pntd.0014027.t005

Overall, 67.60% of respondents reported sleeping under a mosquito net all the time, while 32.40% did not. Only 8.46% of households had mosquito netting on windows and 3.65% had netting on doors.

Most respondents (82.60%) reported using mosquito repellent spirals or sprays to control mosquitoes, whereas 18.08% used repellent herbs or plants and 4.81% reported other methods such as environmental hygiene or eliminating stagnant water.

Regarding treatment practices, 98.46% stated that they use modern medicine when they notice signs of dengue fever, while 1.15% reported using traditional medicine and 0.38% did not know.

Socio-demographic characteristics and spatial distribution of study participants across rural and urban settings in Burkina Faso

This nationwide survey achieved a balanced representation of rural and urban populations across all thirteen regions of Burkina Faso, allowing meaningful comparisons of dengue-related knowledge, attitudes, and practices between residential settings. The study population was predominantly composed of adults aged 25–54 years, with a nearly equal distribution between males and females. Marked socio-demographic disparities were observed between rural and urban participants, particularly regarding educational level and occupation.

More than half of respondents had no formal education, especially in rural areas, whereas higher educational attainment was more frequent in urban settings. Farming predominated in rural communities, while urban participants were more engaged in trade and public or private employment sectors. Similar results on the sex ratio and age range were obtained in other KAP studies among patients attending Health Facilities in Lagos, Nigeria and on health care workers in Somalia during a cross-sectional study [13,14]. These disparities may influence access to health information and the adoption of dengue prevention measures. Lower educational attainment and predominantly outdoor occupations in rural areas may increase vulnerability to mosquito exposure and limit understanding of dengue transmission and prevention. The findings therefore highlight the importance of tailoring dengue awareness strategies according to socio-demographic and geographic contexts.

Dengue awareness, knowledge levels, and sources of information among rural and urban populations in Burkina Faso

The study revealed moderate overall awareness of dengue fever, with important differences between urban and rural populations. Urban residents consistently demonstrated better knowledge regarding dengue transmission, recurrence, and prevention compared with rural populations.

Approximately two-thirds of respondents had heard about dengue fever, although awareness remained substantially lower in rural areas. Similar urban–rural disparities have been reported in other African and Asian settings [15,16]. These differences may reflect unequal access to health information, media exposure, and healthcare services. Rural populations often have fewer opportunities to access structured health communication campaigns.

The media and healthcare workers emerged as the main sources of dengue-related information, highlighting their central role in disseminating prevention messages. Comparable findings have been reported in previous studies conducted in dengue-endemic countries, where television, radio, and healthcare professionals constitute the primary communication channels during outbreaks [17,18].

S2 Fig extends this analysis by showing the different combinations of information sources reported by respondents. The most frequently reported combination is “health workers + media” (25.12%), which confirms the complementary nature of institutional information and media dissemination. This was followed by “friends + media” (15.88%), “health workers + friends” (12.13%), and “health workers + friends + media” (8.66%), reflecting the importance of informal exchanges as a relay for official campaigns. Certain combinations including four sources are very poorly represented, as are those involving neighbours or the “other” category, suggesting a selective and hierarchical use of information channels. Overall, more than half of the participants had been exposed to at least two sources of information. The frequent combination of multiple information sources observed in this study may contribute to better knowledge acquisition and reinforcement of preventive behaviors [19,20]. These findings highlight the strategic role of mass media and health workers in dengue prevention in Burkina Faso, while emphasizing the need to strengthen community networks and develop integrated, multi-source communication strategies to improve awareness and equitable access to health information, particularly in rural areas. Despite moderate awareness, important misconceptions persisted. Only a minority correctly identified dengue as a viral infectious disease, and many respondents remained uncertain regarding treatment availability, vaccination, and the possibility of reinfection. These findings are consistent with previous studies in sub-Saharan Africa linking limited formal education and insufficient health communication to poor dengue knowledge. [13].

While 88.27%, the vast majority of respondents correctly acknowledged that dengue can affect everyone with a higher proportion of correct responses in urban areas (53.37%) than in rural areas (34.90%), misconceptions such as dengue affecting only children or the poor were still present in a minority, indicating relatively good awareness on disease susceptibility. This reinforces the importance of targeted public education to address persistent myths [21]. Knowledge about treatment and prevention was also inadequate. Only 22.5% believed there is a drug to treat dengue, with urban participants (16.54%) being more likely to say yes than rural participants (5.96%), while 46.54% did not know. Similarly, more than half (56.60%) were unaware of the existence of a vaccine, reflecting a missed opportunity to promote immunization, particularly in high-risk areas. This uncertainty reflects either a lack of accurate information or confusion between supportive care and curative treatment. A majority of participants (56.35%) correctly stated that dengue can occur more than once. This awareness was higher among urban respondents (30.58%) compared to rural ones (25.77%). However, over one-third (38.56%) still answered “don’t know,” indicating the need to strengthen knowledge about disease recurrence and immunity. These findings demonstrate that urban populations generally have greater knowledge about dengue fever than rural populations, particularly regarding transmission, reinfection, and treatment. However, misinformation and lack of awareness remain widespread in both settings. Targeted health education campaign-especially in rural are essential to improve understanding of dengue prevention and control.

Attitudes and preventive practices toward dengue fever and associated health-seeking behaviors in rural and urban populations of Burkina Faso

The study demonstrated generally favorable health-seeking attitudes toward dengue fever, with most participants reporting that they would seek care at health facilities in case of suspected illness. However, preventive practices differed substantially between rural and urban populations. Mosquito net use was the most commonly reported preventive measure, reflecting the long-standing impact of malaria prevention programs in Burkina Faso. While mosquito nets remain an important tool for protection against mosquito-borne diseases, dengue prevention requires additional strategies because Aedes mosquitoes, the primary vectors of dengue, are predominantly active during the daytime, whereas Anopheles mosquitoes, which transmit malaria, mainly bite at night. Urban residents were more likely to adopt environmental and structural preventive measures, such as eliminating stagnant water and using repellents, whereas rural populations more frequently relied on protective clothing and plant-based repellents. Similar urban–rural differences in dengue prevention practices have been described in other endemic settings [22–24]. The overwhelming preference for consulting healthcare professionals rather than relying on self-medication or traditional healers represents an encouraging finding for dengue control efforts. This pattern suggests a generally positive perception of formal healthcare services and may facilitate early diagnosis and case management. Nevertheless, some preventive measures, particularly environmental management practices, remained insufficiently adopted in both settings. These findings emphasize the need for integrated dengue prevention strategies combining environmental control, personal protection, and strengthened community engagement. Public health interventions should also capitalize on the widespread use of mosquito nets as an entry point for broader dengue prevention messaging.

Household-level dengue prevention practices and treatment-seeking behaviors: urban–rural differentials in Burkina Faso

This study identified important differences in household-level dengue prevention strategies between rural and urban communities. Urban households generally had greater access to structural and chemical prevention tools, while rural households relied more heavily on traditional and personal protective measures.

Mosquito net use remained common overall, although structural barriers such as window and door screens were significantly more frequent in urban households. Likewise, the use of mosquito repellents and sprays was substantially higher in urban settings, likely reflecting better economic access and market availability [25–27]. In contrast, rural households more commonly used repellent plants and herbs, consistent with traditional practices reported in other African settings [28].

Environmental control measures were less frequently reported overall, suggesting limited community engagement in source reduction activities. Similar findings have been documented in other dengue-endemic regions, where household prevention efforts often focus more on personal protection than environmental management [28].

Treatment-seeking practices were largely dominated by the use of modern medicine across both rural and urban populations. This favorable behavior may contribute positively to dengue surveillance and management efforts. However, the persistence of limited traditional medicine use indicates that culturally adapted health education remains necessary.

Taken together, these findings demonstrate that dengue prevention practices are strongly influenced by socio-economic conditions, access to resources, and local cultural practices. Tailored public health interventions addressing these contextual differences are therefore essential to improve dengue prevention and control in Burkina Faso.[3,28,29].

Limitations of the study

This study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design limits the ability to infer causal relationships between knowledge, attitudes, and practices regarding dengue fever, as data were collected at a single point in time.

Second, the use of self-reported data may introduce recall bias and social desirability bias, particularly for preventive practices such as mosquito net use and health-seeking behavior, which may have been overreported by participants.

Third, although the study assessed knowledge, attitudes, and practices, the measurement of attitudes was limited. The questionnaire mainly captured behavioral intentions and preventive actions rather than psychological constructs. No Likert-scale-based measures (e.g., perceived severity, perceived susceptibility, or perceived benefits of prevention) were included, which limits the ability to fully characterize the attitudinal dimension of dengue-related perceptions.

Fourth, the reliance on household heads or their representatives as respondents may have introduced selection bias, as their responses may not fully reflect the knowledge and practices of all household members.