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

BackgroundMpox, 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 influenced by the populations knowledge and perception. This systematic review and meta-analysis aimed to determine the pooled prevalence of good knowledge and positive perception toward mpox in Africa and to identify associated factors. MethodsFollowing PRISMA guidelines, a comprehensive search was conducted across multiple relevant databases and grey literature sources. Studies conducted in African countries that assessed knowledge and/or perception of mpox were included. Pooled prevalences with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses and meta-regression were performed to explore heterogeneity. ResultsThe analysis incorporated 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 levels varied substantially across subgroups. By participant type, teachers exhibited the highest knowledge (89.43%), followed by medical students (56.02%) and healthcare workers (51.39%), while the general population demonstrated markedly lower knowledge (14.88%). Geographically, 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 (60.32%) 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 significantly associated with several sociodemographic and non-sociodemographic factors. ConclusionsThis study reveals that overall knowledge of mpox across Africa is insufficient, and positive perception is 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.