Factors Associated with Mpox Case Notification by Community Health Workers in the Karisimbi, Goma, and Nyiragongo Health Zones, Democratic Republic of the Congo

Background Community-based surveillance is a key component of early mpox detection in the Democratic Republic of the Congo (DRC), where the disease remains endemic. Community health volunteers (relais communautaires, RECO) play a central role in reporting suspected cases, yet the determinants of their performance are not well documented. This study assessed factors associated with mpox case notification in the health zones of Goma, Karisimbi, and Nyiragongo in North Kivu. Methods A cross-sectional analytical mixed-methods study was conducted among 543 RECO for the quantitative component, selected through multistage stratified sampling, and 24 RECO for the qualitative component (8 per health zone), selected through purposive sampling. Quantitative data were analyzed with SPSS using chi-square tests and multivariable logistic regression to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI) for frequent notification (≥30 notifications), using SPSS software. Qualitative data from in-depth interviews and focus group discussions were analyzed thematically using MAXQDA. Results Factors positively associated with frequent notification included female sex (aOR = 4.22; 95% CI: 2.52–7.07), secondary (aOR = 3.23; 95% CI: 2.27–12.78) or university education (aOR = 9.60; 95% CI: 4.07–25.00), having an income-generating activity (aOR = 4.30; 95% CI: 2.89–19.91), good knowledge of suspected case signs (aOR = 4.53; 95% CI: 2.89–16.94), trust in health institutions (aOR = 4.18; 95% CI: 2.20–8.31), high perceived epidemic risk (aOR = 3.75; 95% CI: 1.94–7.25), recent surveillance training (aOR = 6.18; 95% CI: 2.09–19.36), availability of reporting tools (aOR = 5.35; 95% CI: 1.39–13.97), and access to personal protective equipment (aOR = 2.31; 95% CI: 1.37–3.90). Negatively associated factors, identified through qualitative triangulation, included insufficient supervision, lack of feedback, stock-outs of reporting tools, community misinformation, stigma, and demotivation linked to lack of institutional recognition. Conclusions Mpox notification performance among RECO is shaped by multilevel determinants, with organizational support and training playing a major role. Integrated interventions are needed to sustainably strengthen community-based surveillance.