Mpox knowledge and perception in Africa: a systematic review and meta-analysis

Mpox, a zoonotic disease long endemic in Africa, has gained renewed global attention due to recent outbreaks. Effective control of the virus relies on public adherence to preventive measures, which is largely shaped by the population's knowledge and perceptions. This systematic review and meta-analysis aimed to determine the pooled prevalence of good knowledge and positive perceptions of mpox in Africa and to identify associated factors.

Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Web of Science, Scopus Embase, CINAHL, ScienceDirect, African Journals Online. Studies conducted in African countries that assessed knowledge and/or perception of mpox were included. Pooled prevalence with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses and meta-regression were performed to explore heterogeneity.

The analysis included 38 studies with 23,648 participants from 15 African countries. The pooled prevalence of good mpox knowledge was 43.12% (95% CI: 34.38-52.32), indicating significant gaps in awareness. Knowledge varied substantially across subgroups. By participant type, teachers had the highest knowledge prevalence (89.43%), followed by healthcare workers (50.54%), while the general population had markedly lower knowledge (14.88%). Regionally, Southern Africa had the highest knowledge prevalence (77.92%), whereas Central Africa had the lowest (19.20%). At the country level, South Africa (77.92%) and Kenya (68.31%) recorded the highest levels, while Libya (5.34%) and Somalia (9.68%) had the lowest. The pooled prevalence of a positive perception or attitude toward mpox was 54.22% (95% CI: 44.94-63.21). Pregnant women (81.43%) and healthcare workers (57.37%) reported the most positive perceptions, whereas community health workers showed the least (10.19%). Positive perception was highest in Northern Africa (63.02%) and lowest in Central Africa (7.27%). Individual levels of mpox knowledge and perception were associated with age, gender, education and profession.

This study reveals that overall knowledge of mpox across Africa is insufficient, and that positive perceptions are only moderate, with considerable disparities across different populations and regions. The findings underscore an urgent need for targeted educational campaigns, enhanced training for healthcare workers, and context-specific communication strategies to boost awareness, improve attitudes, and strengthen continent-wide outbreak control and preparedness.