Although no longer a public health emergency of international concern (PHEIC), Mpox still is being transmitted in multiple countries, and good knowledge of it is critical from numerous points of view, including prevention and control.
Given the diversity of research on Mpox, multiple studies have been conducted to assess the knowledge of different population targets about Mpox to understand the gap of knowledge that can be covered by appropriate educational tools to increase the knowledge score about this disease and to curb its transmission by following the infection control measures (15, 16, 18, 42). So we have conducted a systematic review and meta-analysis to gain a more comprehensive understanding of the prevalence of good knowledge levels and attitudes of the general population towards Mpox. All relevant studies found through various online search engines were considered to achieve this. Additionally, a subgroup analysis was performed to examine the prevalence of individuals with positive attitudes and a good level of knowledge about Mpox based on the region of study; the population analysed, and the year of publication.
The findings of this study revealed that the combined prevalence of good knowledge about Mpox was 33%, and the subgroup analysis revealed a total prevalence of good knowledge among the general population and healthcare personnel equal to 34% and 32%, respectively. These findings were consistent with a previous study conducted by other authors in Asia (39) among general practitioners in Indonesia, revealing that 36.5% of the participants had good knowledge using a cutoff point for the knowledge scale. Furthermore, another study conducted by Youssef et al. among the general Lebanese population revealed that 33.04% of the participants had good knowledge (22). Moreover, another survey conducted by Nath et al. among the general population in Bangladesh showed that 66.6% had insufficient knowledge about Mpox's different aspects (43). These findings were in contrast with the results obtained from other studies, such as a study conducted by Alshahrani et al. among the general population in Saudi Arabia revealed that 48% of the total participants had high knowledge about Mpox (33), 58.7% of the Nigerian general population had good knowledge, 56.5% of the Chinese general population had a high level of knowledge, and 19.9% of the university students in the Al Ain university in UAE had poor knowledge about the Mpox (28, 29, 35). Healthcare personnel are on the frontline in caring for and dealing with Mpox patients, so several studies have been conducted to assess their knowledge about the Mpox disease. A survey conducted among physicians in Saudi Arabia revealed that 55% of them had good knowledge, 91.1% of the medical workers in a study conducted by Peng et al. reported a high level of common knowledge about Mpox, the overall knowledge score for the healthcare workers in southern Italy in a study undertaken Giudice et al. was 3.4 (minimum 0 and maximum 9) (19, 34, 44). A survey among Lebanese healthcare workers revealed that 33.7% had a good knowledge of monkeypox; another study conducted in Saudi Arabia revealed an overall mean score of knowledge of 14.4/28 and SD of 3.8 (23, 45).
Another result of this study was the combined prevalence of positive attitudes towards Mpox, which was 40%. Different research has assessed this positive attitude towards Mpox, ranging from 12–85% (15, 23, 26, 27, 31, 37). That could be explained by the disparity in how different populations respond to disease severity and adopt protective measures, which may be attributed to socioeconomic, cultural, information access, and distrust in the healthcare system or government policies. It is essential to address these factors to ensure a more equitable and effective response to any disease and promote the adoption of public health measures to benefit the entire population (46, 47).
The subgroup analysis results indicated that the combined proportion of positive attitudes towards Mpox among healthcare workers was 53%, and the general population was 16%. Several studies have been conducted to assess the attitude of the general population, healthcare workers, students, and other targets regarding Mpox disease, which revealed different prevalence scores as the study conducted by Riccò et al. among Italian physicians which showed that 64.4% of them had a positive attitude in terms of being favourable to highly favourable to receive Mpox vaccine (48). A study conducted by Malaeb et al. among Lebanese healthcare workers revealed that 30.7% of them had a good attitude toward Mpox. Another study by Ahmed et al. among the general Iraqi general population showed that 61% had a negative attitude toward Mpox (23, 26). A study by Kumar et al. among university students in Pakistan revealed that 68.5% had a neutral attitude toward Mpox. Furthermore, another study conducted among Turkish physicians revealed that 41.7% of them had a positive attitude toward Mpox, and a survey conducted by Siang et al. reported that 95.2% of the preclinical and 96.8% of the clinical dental students had a positive attitude toward Mpox (31, 37, 49).
The difference in the prevalence estimates of the knowledge and the attitude score between our findings and other individual papers may be justified by the difference in the culture of the population from one country to another, the difference in the target group (general population, medical students and healthcare workers), the difference in the timeline at which each study was conducted, the difference in the survey methods used in the assessment of the knowledge and the attitude, and other factors that should be taken into our consideration.
It was recommended by the World Health Organization (WHO) and The Center for Disease Control and Prevention (CDC) to vaccinate certain groups of the population who are at risk of developing Mpox in terms of pre-exposure and postexposure prophylaxis using JYNNEOS, ACAM2000, and LC16m8 vaccines (50–52). The secondary outcome revealed that the prevalence of the intention to vaccinate against Mpox was 58%, consistent with a meta-analysis conducted by Ulloque-Badaracco et al., which reported that the prevalence of Mpox vaccine acceptance equals 56% (53). This finding was reported in other studies, such as a study conducted by Winters et al. among the US public, which reported that 46% of the participants intended to get vaccinated if recommended (54). A study conducted in France and Belgium found that 55.4% of the healthcare workers involved in the study would accept the Mpox vaccine. However, in case of the disease emergence among the general population, 79.1% would receive vaccination (55). A study conducted by Gallè et al. among Italian adults reported that 54.2% of them were hesitant to Mpox vaccines, besides another survey conducted by Pan et al. among Chinese healthcare workers reported that 90.12% of them were willing to be vaccinated against Mpox (56, 57). A study conducted by Peptan et al. among the Romanian population found that 29.30% of the participants were willing to be immunised against Mpox; another survey conducted among men who have sex with men in China reported that 13.85% of the participants were hesitant to be vaccinated (58, 59).
Finally, subgroup analysis based on the year of publication was conducted. The combined prevalence of good knowledge and positive attitude towards Mpox was higher in 2023, at 38% and 44% respectively (15–41). That could be explained by two key factors: the effectiveness of educational intervention programs and the successful implementation of information media. Educational intervention programs have reached more individuals and communities, providing them with essential information about the nature of the disease, its symptoms, prevention methods, and treatment options. This increased awareness has led to a more positive attitude towards Mpox and a better understanding of the importance of preventive measures.
On the other hand, media campaigns have played a crucial role in disseminating clear and accurate messages about Mpox. By reaching diverse demographic groups, these campaigns have demystified the disease and encouraged the pursuit of evidence-based knowledge. As a result, people now show greater openness towards preventing and treating Mpox, leading to increased adherence to recommended health measures and greater empathy towards those affected by the disease. These factors have contributed to a positive shift in society's perception and response to Mpox (13, 60, 61).
We recommend that further research is needed to cover the knowledge of the different population groups, including the general public, healthcare professionals, and students, regarding Mpox disease, especially in countries with missing data. Further research is needed in countries with many Mpox-infected patients at different intervals to track the change in the people's knowledge, attitude, intention to get vaccinated, and their maintenance on tracking the infection control measures.
4.1. Strengths and limitations of the study
This systematic review is considered the first to determine the prevalence of good knowledge and positive attitudes towards Mpox, which provide a high quality of evidence data that can be used by policymakers in tracking and improving Mpox knowledge and attitude. The present research includes using a comprehensive electronic search strategy across various datasets to determine the overall levels of knowledge and attitudes towards Mpox, using quality assessment through "JBI-MAStARI." Limitations included the absence of a standardised measurement of "good knowledge" and "positive attitude" among different population groups in the published research. The lack of a similar previous study makes it very difficult to compare the findings of this study.