Zoonotic disease preparedness among frontline healthcare workers in Ghana: Assessing literacy and behaviors in a One Health context

Zoonotic diseases pose a growing global health threat, particularly in low-resource settings where human-animal-environmental interfaces are common. Although Ghana has adopted One Health policies, limited evidence exists on frontline healthcare workers (FHWs) zoonosis preparedness. Thus, this study assessed FHWs knowledge, attitudes, and practices related to zoonoses and One Health in Ghanas Ada East district. We conducted a cross-sectional survey of 250 FHWs across 18 selected health facilities. A 54-item questionnaire measured knowledge, attitudes, and practices regarding priority zoonoses, Ebola virus disease, and the One Health approach. Scores were scaled to 100% and dichotomized using Blooms cut-off, with >60% representing "good knowledge," "positive attitudes," or "good practices." Multivariable logistic regression identified predictors of good knowledge and practices. According to this study, while 79.2% of FHWs scored [≥]60% on the total knowledge scale, classified as "good knowledge" of zoonoses, Ebola virus disease, and One Health, only 22.4% correctly identified >60% of listed zoonoses. Ebola-specific knowledge was high, though misconceptions about transmission and treatment persisted. Only 6.8% scored [≥]60% on the attitude scale, reflecting limited confidence and widespread concern about personal safety, institutional readiness, and community stigma. While 47.2% demonstrated "good" prevention and control practices, institutional protocol use and intersectoral collaboration were limited. Rabies-focused training increased odds of good knowledge (AOR = 3.25, 95% CI: 1.04-11.1) and practices (AOR = 2.46, 95% CI: 1.07-5.87). In-facility training improved practices (AOR = 2.77, 95% CI: 1.34-5.92), whereas government-delivered training and infrequent climate-health engagement were linked to poor knowledge and practices. Gaps in zoonoses literacy and institutional preparedness were evident among FHWs. Targeted staff retraining, peer-led mentorship, and expanded rabies training may offer practical entry points for One Health capacity building. Addressing stigma and embedding climate-health content into community-based risk communication may improve frontline readiness.