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Abstract

The coronavirus disease 2019 pandemic posed a threat to global health, especially in war-torn countries such as Yemen. With long years of war and a fragile health system, the response of Yemen to the pandemic was not adequate, causing a bigger challenge to the humanitarian crises. This study aimed to assess the levels of knowledge, attitudes, and practices of COVID-19 in the Adeni community in Yemen, while also examining the challenges that hindered proper prevention from the community’s perspective. The main objectives of the study are: 1- To assess the levels of knowledge, attitudes and practices of COVID-19 and prevention in the community of Aden. 2- To understand the challenges that the community faces and to adhere to preventive actions. Methods: This mixed-methods cross-sectional study combined quantitative and qualitative approaches. A semi-structured questionnaire was administered to 400 participants from four districts in Aden using random cluster sampling following the UNICEF-adapted SMART survey methodology. Additionally, 25 in-depth interviews were conducted with every 16th participant from the 400-participant pool to explore perceptions, beliefs, and challenges related to COVID-19 prevention. Data was analysed using STATA and thematic content analysis. Ethical approval and informed consent were obtained. Results: The study revealed that COVID-19 knowledge in Aden was intermediate, accompanied by fair attitudes but poor preventive practices. While most participants identified the virus and understood its transmission, few had accurate knowledge of effective prevention or vaccine benefits. Many were willing to comply with government-enforced measures, yet few actively sought information, and most were reluctant to get vaccinated. Preventive behaviours such as handwashing, mask-wearing, and social distancing were limited; also, vaccine uptake was very low. Education significantly influenced both knowledge and practices, with higher educational levels associated with better understanding and more consistent adherence to preventive measures (P<0.001). According to community members, several challenges hindered COVID-19 prevention efforts. They identified misinformation, stigma, and distrust in health services as major barriers at the community level. They also highlighted that at the governmental level, poor coordination, weak policy enforcement, and limited vaccine supply further constrained the response. Also, healthcare facilities were described as facing critical shortages of supplies, personnel, and testing capacity, alongside overcrowding and inadequate isolation centers. Conclusion: This study exposes weaknesses in Yemen’s pandemic response, from misinformation and low adherence to preventive practices to systemic failures in governance and healthcare delivery. However, it reveals that education can enhance knowledge and that the people in Aden are willing to comply with prevention if supported by strong governance. Vaccine hesitancy remains a pressing issue needing culturally sensitive interventions. Yemen’s fragile context demands urgent, tailored public health strategies to rebuild trust and prepare for future outbreaks. These insights are vital for global health security, especially as the world moves towards a binding WHO pandemic treaty.