Socio-Behavioral Drivers of Mpox Risk in Congo: A Cross-Sectional Analysis of Knowledge, Attitudes, and Practices

Background: In 2024–2025, the resurgence of Mpox in Central Africa, driven by Clade I transmission and sustained community spread, prompted renewed global and regional alerts. Despite incresing incidence in the Democratic Republic of the Congo and cross-border spread into the Republic of the Congo, evidence on community knowledge, perceptions, and preventive behaviors remains limited. This study assessed Mpox-related knowledge, attitudes, and practices (KAP) within a socio-ecological framework to inform risk communication and outbreak control strategies. Methods: A community-based cross-sectional survey was conducted from March to June 2025 across four departments of Congo (Brazzaville, Likouala, Cuvette, Plateaux). Using a WHO-recommended 40-cluster sampling design, participants aged ≥ 15 years were interviewed using a structured REDCap-administered questionnaire. Descriptive statistics, bivariate analyses, and multivariable regression models were used to identify determinants of comprehensive knowledge and adequate prevention practices. Results: Only 48.4% of participants had previously received Mpox information, and comprehensive biomedical knowledge was extremely low (5.4%). Nearly one-third held misconceptions, including spiritual causation or disbelief in disease reality. Mpox prevention adherence was limited (26.0%), with major gaps in self-isolation and testing intentions despite frequent willingness to seek clinical care. Low income strongly predicted poor knowledge, whereas tuberculosis and STI history were independently associated with higher knowledge. Comprehensive knowledge was the strongest predictor of prevention (PR = 2.04; 95% CI: 1.50–2.76). Trading/business occupation was inversely associated with both knowledge and prevention. Stigma remained widespread, and attitudes toward Mpox vaccination were highly uneven: while 72.8% declared willingness to be vaccinated, 17.8% refused and 9.3% were unsure, illustrating a deep divide in trust and confidence within the population. Conclusion: Mpox control in Congo is hindered by substantial informational, socio-economic, and behavioral barriers. Message exposure alone is insufficient to generate accurate knowledge or sustained preventive practices. Strengthening context-adapted risk communication, reducing misconceptions and stigma, improving community engagement, and addressing structural vulnerabilities are essential to interrupt community transmission.