Avian influenza preparedness in Ghana: a cross-sectional assessment of knowledge, attitudes, and practices among residents of Nsawam-Adoagyiri Municipality, Eastern Region

Background: Avian influenza (AI) represents a persistent threat to public health, food security, and livelihoods in Ghana, where outbreaks of H5N1 and H9N2 have occurred. This cross-sectional study evaluated the knowledge, attitudes, and practices (KAP) related to avian influenza among residents of the Nsawam-Adoagyiri Municipality; an area characterized by intensive poultry production with the aim of delineating deficits in community-level preparedness and guiding evidence-based public health interventions. Methods: A community-based cross-sectional study was conducted from May to July 2025 using a four-stage sampling technique. We surveyed 321 adults via structured questionnaires, evaluating socio-demographics and KAP related to AI. Scale reliability was assessed using KR-20 (knowledge) and Cronbach’s alpha (attitudes/practices), with construct validity examined through exploratory factor analysis. Scores were categorized using modified Bloom’s taxonomy (≥ 70% indicating good knowledge, positive attitudes, or safe practices). Data were analyzed in STATA 17 using descriptive statistics, chi-square tests, and multivariable logistic regression. Results: Most respondents demonstrated good knowledge of AI (81.6%; 95% CI: 77.0–85.5) and positive attitudes toward prevention (74.5%; 95% CI: 69.4–78.9). However, only 26.2% (95% CI: 21.6–31.3) reported adherence to recommended preventive practices. Poultry ownership was significantly associated with positive attitudes (χ² = 10.44, p = 0.001) and better practices (χ² = 10.30, p = 0.001). Female participants and those with lower educational attainment had significantly lower knowledge and attitude scores. Strong correlations were observed between knowledge, attitudes, and practices (all p < 0.001), underscoring their interdependence. Conclusion: While awareness and positive perceptions of AI are high in Nsawam-Adoagyiri, a substantial knowledge-practice gap remains. Community-level interventions including hands-on training, access to affordable protective equipment, and strengthened One Health collaboration are urgently needed to translate awareness into actionable biosafety behaviours and reduce outbreak risk.