Community knowledge and perceptions of social, ecological, and behavioural risk factors for mpox in Burundi: A nationwide cross-sectional survey

Mpox remains an important public health concern in Africa, particularly following the spread of clade Ib in several countries. In Burundi, limited information is available on population knowledge, risk perception, preventive behaviours, and willingness to accept mpox vaccination. This study assessed social and behavioural factors associated with mpox preparedness among the general population. We conducted a nationwide cross-sectional survey between March and December 2025 across five provinces of Burundi. A total of 5,177 participants aged 15 years and older were interviewed using a structured questionnaire adapted from the Africa CDC behavioural and social sciences framework for mpox. Sampling weights were not applied; therefore, findings should be interpreted as estimates among surveyed participants rather than nationally weighted population estimates. Univariate analyses were conducted to describe key variables, while bivariate and multivariable analyses using modified Poisson regression models with generalized estimating equations were performed to identify factors associated with mpox knowledge and prevention and control practices. Overall, most participants had heard about mpox (94.7%). Many correctly identified skin rash (94.4%) and fever (84.3%) as common symptoms, and most recognized direct contact as a mode of transmission (86.6%). However, 21.4% of participants incorrectly identified bacteria as the causative agent and 24.5% did not know the causative agent. Radio was the main source of information (82.0%) and the most trusted source (87.0%). Higher income was associated with better mpox knowledge. Prevention and control practices varied by knowledge level, income, marital status, and HIV status. Although most participants (86.1%) were unaware of the availability of a vaccine, 76.5% reported willingness to accept vaccination if available. Despite high awareness and willingness to accept vaccination, important gaps in mpox knowledge remain, particularly among lower-income groups. Strengthening accessible and targeted risk communication strategies will be essential to improve mpox preparedness in Burundi.