Knowledge, Risk Perception, and Socio-Behavioral Factors Associated with mpox in Western Area, Sierra Leone

Abstract

Background: Mpox, a re-emerging zoonotic viral disease driven by the Monkeypox virus (MPXV), shares a close genetic lineage with the smallpox virus. In January 2025, Sierra Leone recorded its first confirmed case, which triggered a swift surge in infections across the Western Area, particularly within the densely populated capital of Freetown. This sudden outbreak quickly revealed critical vulnerabilities in community awareness, risk perception, and preventative behaviors. Containment efforts have been further hindered by deeply embedded socio-cultural traditions, widespread misinformation, social stigma, and restricted access to reliable clinical insights. To design impactful public health interventions and reinforce national emergency readiness, it is vital to map how local knowledge, risk attitudes, and socio-behavioral dynamics interact. 

Methods: This study utilized a mixed-methods, cross-sectional design to investigate community dynamics within the Waterloo neighborhood of Sierra Leone's Western Rural District. A structured sampling strategy was used to enroll 150 community participants. Quantitative data were gathered via questionnaires that evaluated participant familiarity with mpox symptoms, transmission vectors, prevention protocols, personal risk appraisal, and lifestyle practices. To capture underlying cultural views, community attitudes, and behavioral drivers, qualitative data were collected through open-ended responses and targeted interviews. Quantitative variables were assessed using descriptive statistics and chi-square tests, while

qualitative narratives were evaluated using thematic analysis. 

Results: The baseline data showed that while most participants could readily identify prominent symptoms like fever and physical rashes, along with direct physical contact and unsafe sexual practices as primary transmission routes, significant misconceptions persisted regarding animal-to-human transmission and the safety of consuming wild game. A stark mismatch was observed between systemic and personal risk awareness: although 85.4% of respondents viewed mpox as a severe public health issue, a mere 23.3% believed they were personally vulnerable to contracting it. Strong statistical correlations emerged pairing baseline knowledge with community risk perception (x²= 14.72, p < 0.05), as well as knowledge with the execution of preventative behaviors (x² = 10.88, p < 0.05). Nevertheless, actual prevention practices remained highly inconsistent; many participants reported poor hand hygiene or expressed a strong preference for traditional healers. The qualitative narratives emphasized that entrenched cultural traditions, financial reliance on the bushmeat trade, and spiritual interpretations of disease origins serve as powerful drivers behind these community behaviors. 

Conclusion: The findings indicate that despite a broad awareness of mpox across Sierra Leone’s Western Area, major gaps remain regarding personal vulnerability and the routine practice of protective measures. Local public health responses continue to be shaped by complex socio-cultural traditions and economic realities. Effectively managing and controlling future outbreaks will depend on rolling out culturally adapted health education campaigns, refining risk communication, involving local religious and community leaders, and addressing barriers to formal healthcare. Ultimately, embedding behavioral science and community-centric strategies into national preparedness frameworks will significantly strengthen Sierra Leone's resilience against emerging zoonotic threats. 

Key words: Mpox; Risk Perception; Socio-Behavioural Factors; Zoonotic Disease; Public Health Engagement; Sierra Leone.