Abstract
<title>Abstract</title> <p>Background Dengue fever is an emerging public health threat in Sudan, where recurrent outbreaks occur within a fragile and conflict-affected health system. Physicians play a central role in dengue diagnosis, management, and outbreak response. However, limited evidence exists regarding whether dengue-related knowledge translates into appropriate clinical practice. This study assessed dengue-related knowledge, attitudes, practices, and clinical readiness among physicians in Sudan and examined determinants of high dengue management practice. Methods An online cross-sectional survey was conducted among physicians practicing in Sudan between February and April 2026. A structured questionnaire adapted from a validated dengue knowledge, attitude, and practice (KAP) instrument was used to collect data on dengue disease knowledge, vector knowledge, attitudes, clinical practices, WHO guideline familiarity, resource availability, and healthcare-system readiness. Knowledge and practice scores were classified using Bloom’s cut-off criteria. Multivariable logistic regression was performed to identify factors independently associated with high dengue management practice. Results A total of 633 physicians participated. Only 3.8% demonstrated high disease knowledge, while 48.8% had low disease knowledge. High vector knowledge was observed in 28.8% of participants, whereas 40.0% achieved high practice scores. Important knowledge gaps were identified regarding dengue etiology, vector behavior, diagnostic testing, and breeding sites. Only 36.2% of physicians reported familiarity with WHO dengue guidelines, and 57.7% reported inadequate resources for dengue management. Correlation analysis demonstrated weak relationships between disease knowledge and practice (r = 0.077) and between vector knowledge and practice (r = 0.026), suggesting a knowledge–practice gap. In multivariable analysis, familiarity with WHO dengue guidelines (AOR = 2.66, 95% CI: 1.82–3.89), belief in the usefulness of WHO guidelines (AOR = 4.06, 95% CI: 1.94–8.51), and higher attitude scores (AOR = 1.07, 95% CI: 1.03–1.11) were independently associated with high practice, whereas disease knowledge was not. Conclusions A substantial knowledge–practice gap exists among physicians managing dengue in Sudan. Clinical practice was influenced more strongly by guideline familiarity, perceived guideline usefulness, and attitudes than by disease knowledge alone. Strengthening physician preparedness through practical training, implementation of WHO dengue guidelines, and improved health-system readiness may enhance dengue management in conflict-affected settings.</p>