Mpox knowledge and positive attitudes in Sub-Saharan African healthcare workers after 2022 outbreak of disease: A systematic review and meta-analysis

Background: Mpox remains a public health emergency of international concern, especially in regions beyond its usual endemic areas in Africa. Assessing healthcare workers good knowledge and positive attitudes is essential for effective prevention and control efforts. This systematic review and meta-analysis aim to determine the pooled good knowledge and positive attitudes toward mpox among healthcare workers in Sub-Saharan Africa after the 2022 outbreak. Methods: We searched major databases for relevant studies published up to June 25, 2025. Studies reporting knowledge and/or attitudes toward mpox were included. Study quality was assessed using a standardized appraisal tool, and heterogeneity was assessed using the I2 statistic. Data were extracted using a standardized protocol, and a random-effects model was used to calculate pooled prevalence estimates with 95% confidence intervals. Results: The meta-analysis included sixteen and eight studies in knowledge and attitude analyses, respectively, to estimate the pooled prevalence. The pooled prevalence of good knowledge and positive attitudes toward monkeypox was 45.3% (95% CI: 36.8, 53.9) and 53.8% (95% CI: 43.0, 64.7), respectively. Significant heterogeneity was observed across studies; however, both statistical tests (Egger’s test, p = 0.14; Begg’s test, p = 0.19) indicated no significant publication bias. Conclusion: The good knowledge and positive attitudes of healthcare workers toward mpox were low and unsatisfactory in sub-Saharan Africa. The review result underscores the need for targeted interventions to improve healthcare providers’ understanding of mpox transmission, prevention, and management. Targeted educational programs and training are needed to improve the preparedness of healthcare workers for mpox outbreaks and other emerging diseases. Author summary: Mpox still poses a major public health issue in Sub-Saharan Africa. Healthcare workers stand right on the front lines against these outbreaks. Despite their crucial role, there has been no comprehensive regional assessment of their preparedness in terms of knowledge and attitudes in Sub-Saharan Africa. To address this gap and guide training, we conducted a systematic review and meta-analysis of available cross-sectional studies, pooling data from 16 studies involving 6047 healthcare workers for knowledge and 8 studies involving 3303 healthcare workers for attitude across multiple African countries. We confirmed that fewer than half (45.3%) of healthcare workers had a good knowledge of mpox transmission, clinical signs, and prevention measures. On the other hand, more than half (53.8%) had shown positive attitudes toward controlling the disease. These results demonstrated a critical gap in healthcare workers’ knowledge and their positive attitudes toward responding to the disease outbreak. To improve mpox knowledge and attitudes of healthcare workers, targeted and focused training programs, especially in high-risk and rural areas, are urgently needed. Improving good knowledge and positive attitudes among healthcare workers will enhance outbreak detection and preparedness efforts across Sub-Saharan Africa.