A new study finds that while nearly all residents of Burao understand chikungunya transmission, poor preventive practices and weak environmental conditions continue to leave Somaliland vulnerable to future outbreaks
HARGEISA — Residents of Burao overwhelmingly understand what chikungunya is and how it spreads, but that knowledge is not translating into meaningful preventive action, according to the first comprehensive scientific study examining public awareness of the mosquito-borne disease in Somaliland.
Published as an accepted manuscript in Scientific Reports, the research surveyed 422 adults across Burao and found that while nearly every participant had heard of chikungunya and most correctly identified mosquitoes as the source of transmission, fewer than half consistently practiced behaviors that reduce infection risk.
The findings arrive as health authorities across the Horn of Africa continue monitoring mosquito-borne diseases following recurring outbreaks in recent years.
“Despite high CHIKV awareness in Burao, positive attitudes and preventive practices remain low, revealing a significant knowledge-behavior gap,” the researchers concluded.
The study was conducted by researchers from Burao Central University between March and June 2025 and examined residents’ knowledge, attitudes and preventive practices regarding chikungunya virus (CHIKV), an illness transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes.
Awareness High, Action Lagging
Researchers found that 97.4% of respondents had heard of chikungunya, while 85.1% correctly identified mosquitoes as the disease’s transmission vector. About 91% recognized fever and severe joint pain as hallmark symptoms, and nearly 92% understood that standing water creates mosquito breeding sites.
Yet the encouraging knowledge levels contrasted sharply with attitudes and day-to-day behavior.
Only 32.7% of participants demonstrated what researchers classified as positive attitudes toward prevention, while just 44.5% reported good preventive practices.
Although two-thirds said they regularly slept under mosquito nets, only 24.9% routinely used mosquito repellents and less than half consistently removed standing water around their homes—one of the most effective methods for limiting mosquito breeding.
The researchers described this disconnect as a “knowledge-practice gap” driven less by lack of information than by environmental and socioeconomic realities.
“Knowledge alone is insufficient to drive preventive behavior and structural and behavioral determinants play decisive roles in shaping community responses to vector-borne disease risks,” the study states.
Education Improves Knowledge — But Not Necessarily Behavior
The analysis revealed notable demographic differences.
People with tertiary education were more than five times as likely to possess strong knowledge about chikungunya compared with those who had no formal education. Students also demonstrated significantly higher knowledge levels, while adults aged 25 to 44 scored better than younger respondents.
However, greater education did not consistently translate into better preventive behavior.
Researchers suggested that structural barriers—including limited water infrastructure, inadequate drainage, poor waste management and economic constraints—may prevent residents from acting on what they know. They also cautioned that educated or employed residents may face competing priorities or perceive themselves to be at lower personal risk, though the study notes those explanations require additional investigation.
Recurrent Outbreaks Keep Risk Alive
The study notes that Burao experienced significant chikungunya outbreaks in 2017 and 2019. More recently, a confirmed outbreak in the Sool region during the first half of 2025 produced hundreds of suspected infections, highlighting the continuing threat posed by mosquito-borne diseases across Somaliland.
Researchers argue that Burao’s rapid urban growth, intermittent water supply, poor drainage and open waste disposal continue to create ideal breeding conditions for Aedes mosquitoes.
Call for Broader Public Health Response
Rather than relying solely on awareness campaigns, the researchers recommend integrating health education with investments in environmental sanitation, waste collection, reliable water infrastructure and stronger disease surveillance.
The study also calls for communication campaigns tailored to different demographic groups, particularly educated and employed residents whose knowledge levels exceed their preventive behaviors, while encouraging greater involvement from community and religious leaders in disease prevention efforts.
The authors conclude that reducing the risk of future outbreaks will require addressing both individual behavior and the broader infrastructure that shapes public health.
“Addressing both informational gaps and the underlying socioeconomic and infrastructural constraints is vital to bridge the knowledge-practice gap, thereby mitigating the risk of future CHIKV outbreaks in Burao and comparable settings.”
The research represents the first detailed assessment of community knowledge, attitudes and preventive behaviors regarding chikungunya in Somaliland and provides evidence that future disease-control strategies should extend beyond awareness campaigns to include sustained improvements in sanitation, urban planning and vector-control systems.
