Knowledge of Crimean-Congo Haemorrhagic Fever Among Mawakib Food Handlers During the Arbaeen Mass Gathering in Iraq, 2022

Abstract

Background: During the 2022 Arbaeen pilgrimage, Mawakib food handlers routinely slaughtered and processed livestock along pilgrimage routes in Iraq while the country was experiencing an active Crimean-Congo haemorrhagic fever (CCHF) outbreak. Because CCHF has no licensed vaccine and prevention depends on behavioural measures, occupational knowledge is a critical protective factor. Objectives: This study assessed awareness and substantive knowledge of CCHF among Mawakib food handlers during the 2022 Arbaeen mass gathering in Iraq and identified independent sociodemographic predictors of CCHF awareness. Methods: A cross-sectional survey was conducted from 10 to 17 September 2022 among 1,207 Mawakib food handlers recruited via convenience sampling along routes to Karbala, Iraq. A 20-item structured electronic questionnaire was administered face-to-face. The primary outcome, CCHF awareness, was operationally defined as an affirmative response to the item “Have you ever heard of CCHF?”, a first-level proxy for name recognition that does not imply substantive understanding. Knowledge was assessed across five domains. Multivariable binary logistic regression was used to identify independent predictors of awareness. Results: Overall, 76.5% of participants (n = 923) were aware of CCHF, whereas 23.5% had no prior name recognition. Social media was the dominant information source among aware respondents (71.0%). Despite relatively high name recognition, substantive knowledge was poor: correct-response rates were 53.9% for the causative agent, 44.0% for tick-bite transmission, 29.0% for the absence of curative treatment, and 17.0% for eye-shield use. Education level was the strongest independent predictor of awareness (adjusted odds ratio [aOR] for university vs. illiterate = 13.68; 95% confidence interval [CI]: 7.85 - 23.83), followed by urban residence (aOR = 1.61; 95% CI: 1.20 - 2.17) and male sex (aOR = 1.80; 95% CI: 1.16 - 2.78). Age was not independently associated with awareness. Conclusions: This exploratory study identified substantial CCHF knowledge deficits across all assessed domains in a high-risk food-handler population during an active outbreak. These findings are consistent with the knowledge-attitudes-practices literature and suggest that health communication targeting low-education and rural subgroups and leveraging social media channels should be evaluated in future prospective studies.