A review of the social and behavioural science research landscape for mpox in African settings

Summary

Despite mpox no longer being a global public health emergency as of September 2025, it remained an African Public Health Emergency of Continental Security until 22 January 2026. As the Africa CDC notes, this does not mark the end of mpox in Africa. As of January 2026, a critical gap remains in social and behavioural science (SBS) research on mpox. Expanding the social science research evidence base will be important to future mpox response and public health emergency response more widely.

This report maps and synthesises SBS studies on mpox in sub-Saharan Africa from 2017 until December 2025. Our team conducted a comprehensive scoping exercise using multiple approaches: online database searches, consultation with research networks, funder repository searches, and direct outreach to institutions and researchers across Africa. An online deliberative dialogue in November 2025 brought together researchers to discuss emergent findings and identify gaps in SBS evidence. Our team also built on evidence shared in the mpox symposium held in Kinshasa in November 2025. This iterative approach allowed the review to remain responsive to both published and emerging evidence in a rapidly evolving research environment.

We identified, mapped and reviewed 50 studies that are included in our annex and database. We have subsequently summarised 13 in-depth studies for the thematic synthesis in this report. Most identified studies are small-scale, recent (2024-25), and focused on the DRC outbreak. We identified formal research studies as well as rapid assessments designed to inform immediate operational responses. Research is predominantly descriptive and cross-sectional, often nested within clinical trials or vaccine studies. We excluded studies that are solely quantitative. Recent mpox research focuses predominantly on human-to-human transmission dynamics.

Finally, we identified key SBS gaps to address moving forward, including on:

• intersections between historical and political-economic context in the study locations and vulnerabilities to mpox;
• the experiences of pregnant women, new mothers, and their partners;
• the impact of targeted surveillance on marginalised groups;
• experiences and vulnerabilities of people living with HIV;
• the broader landscape affecting vaccine anxieties and rumour dynamics;
• care and the nature of care received, both medical and alternative;
• cross-context, longer-term studies.

Although mpox SBS research has proliferated in the last 1-2 years, there remain important gaps. The uneven impacts of poverty, extractive economies, conflict, and weak health infrastructure on vulnerabilities to mpox and to associated public health interventions is still poorly understood. It will also be important to maintain a balance of research on human-to-human transmission as well One Health research on the dynamics related to zoonotic transmission, including long-term drivers of disease. It is our view that further investment in robust, contextually-grounded social science research is essential to inform effective and equitable mpox response strategies in the long term. This includes stand-alone social science research or genuine interdisciplinary research. In this context, it is also critical for future One Health studies and clinical trials to accommodate rigorous, anthropologically-driven research questions and approaches in a more systematic way.

Introduction

The most recent mpox public health emergency of international concern (PHEIC) ended in September 2025, but the upsurge of mpox in sub-Saharan Africa (of both Clades I and II in different geographic locations) remained an African Public Health Emergency of Continental Security until 22 January 2026. As the Africa CDC notes, this does not mark the end of mpox in Africa. While social and behavioural science (SBS) studies on mpox have proliferated in the last 1-2 years, the methods and scope of SBS research remain limited. In June 2025, collation of evidence for the World Health Organization (WHO) Emergency Committee (EC) meeting underscored a dearth of SBS research findings that could be identified, including published evidence to assist the committee’s decision-making around mpox as a PHEIC.

In particular, there is limited SBS evidence in the public domain related to upsurges of both Clade I and Clade II of mpox, which have drawn attention since 2017. Gaps in SBS evidence relate to areas such as the factors affecting transmission; the nature and implications of stigma and discrimination; the lived experience of mpox, including for pregnant women; and care seeking/illness management for mpox in different contexts and for different social groups, including factors related to delays in treatment. With spread of mpox to non-endemic countries in East and Southern Africa, a gap has also opened with respect to evidence on these settings.

In this report, we share findings from a mapping and synthesis of SBS studies on mpox in sub-Saharan Africa. We highlight the current state of the evidence (as of December 2025) and identify key gaps and research questions for SBS research on mpox moving forward.

This synthesis and report was commissioned by Elrha and funded by the United Kingdom’s Foreign, Commonwealth & Development Office (FCDO). It was written by team members from the Social Science in Humanitarian Action Platform (SSHAP), which advocates for social and behavioural evidence to inform public health and humanitarian emergency response.

Method: Scoping and mapping social and behavioural science research on mpox

Our work aimed to conduct a proactive search for preliminary findings, unpublished and published evidence so that a more in-depth synthesis of social and behavioural science data on both Clade I and Clade II mpox could be achieved.

This scoping included a mapping of social and behavioural research on mpox and mpox response in several countries. Strengthening the social and behavioural science evidence base has been identified by the WHO as vital for understanding and achieving equitable and inclusive community protection during health emergencies (see the WHO’s ‘Defining community protection’).

Our team used a multipronged approach to search for recently completed and ongoing SBS research and rapid assessments on mpox. We focused on the time period from 2017 to the present, in order to cover the upsurge of mpox Clade I and Clade II. We focused geographically on studies conducted in the WHO Africa region, though projects may include staff and funders based elsewhere.

We gathered both published and emerging unpublished findings from SBS and interdisciplinary mpox research projects and rapid studies, in both French and English. Our aim was not to assess the quality of the evidence, but assess the nature and extent of it, and then identify research gaps.

We conducted a mapping of the existing work through:

• online searches of published, pre-print grey and academic literature, as well as ongoing projects;
• consultation within SSHAP and wider IDS-LSHTM research and practitioner networks, such as the SSHAP listserv;
• searches in funder databases and repositories of recent PhD theses;
• identification of rapid assessment initiatives and review of findings.

We searched the following databases, online search platforms, institutions, and listservs to identify ongoing funded research projects with potential SBS findings, so that we could make direct contact with researchers.

• UK Research and Innovation (UKRI)
• Canadian Institutes of Health Research (CIHR)
• GLOPID-R Pandemic Pact
• European and Developing Countries Clinical Trials Partnership (EDCTP)
• PubMed
• Web of Science
• Google Scholar
• Collective Service mpox dashboard
• U.S. National Institutes of Health (NIH)
• U.S. National Science Foundation (NSF)
• The British Academy
• South African Medical Research Council (SAMRC)
• Mapping ODA Research and Innovation (MODARI)
• Social Science in Humanitarian Action (SSHAP) listserv
• Institut Pasteur
• Centre de Recherche et de Formation en Infectiologie de Guinée (Cerfig)
• National Institute of Public Health – Burundi (INSP)
• ANRS emerging infectious diseases (ANRS MIE)
• French National Research Institute for Sustainable Development (IRD)
• Swiss National Science Foundation (SNSF)
• Le Fonds de la Recherche Scientifique (FNRS Belgique)

We conducted a mapping of further existing research through our contacts and networks, including researchers at:

• Africa CDC
• The University of Lagos
• UNICEF ESARO RCCE working group
• WHO Uganda
• University of Sierra Leone
• Sierra Leone Urban Research Centre
• Infectious Diseases Institute – Uganda
• Makerere University
• WHO Community Resilience Unit and the mpox community of practice
• Institut Pasteur
• Universite Cheikh Ante Diop in Dakar
• UK-PHRST
• Antwerp Institute of Tropical Medicine
• Liverpool School of tropical Medicine
• 2024 WHO meeting participants in Kinshasa, DRC
• 2025 State-of-the-art mpox symposium participants in Kinshasa, DRC

We documented all studies in an Excel spreadsheet (see annex) and include our summary of findings below. We included a wider range of studies in our synthesis and annex (per the inclusion criteria below), however, only in-depth studies were included in our thematic summary as this was based on availability. We did not include surveys with no open-ended questions or rapid assessments with limited available findings, details on method or context.

Inclusion criteria

Studies were included if they met the following criteria:

• Qualitative research, including with both affected populations and/or wider stakeholders such as health workers
• Mixed method research that seeks to understand mpox behavioural aspects, including knowledge, attitudes, and practices (KAP) studies with open-ended survey questions
• Ethnographic research
• Historical enquiries of mpox research, including work on the socio-political contexts of mpox
• Studies focused on zoonotic as well as human to human transmission

Exclusion criteria

Studies were excluded if they met the following criteria:

• Literature reviews
• Quantitative studies, including quantitative surveys (close-ended questions)
• Commentaries and reflections that do not include primary data collection
• Secondary data analysis exclusively
• Randomised control trials
• Cohort studies and other epidemiological study designs

Online deliberative dialogue

Based on our mapping exercise and the identification of researchers who could speak to SBS findings on mpox, we organised and facilitated an Online Deliberative Dialogue on the State of Social and Behavioural Evidence for Mpox Response in the Africa Region (Nov 25th, 2025).  Eight researcher teams presented recent or ongoing projects, and discussed SBS research on mpox, specifically linking findings to operational priorities in different contexts in the Africa region. Findings and research gaps were discussed with a wider group of participants in Anglophone and Francophone breakout rooms and captured on this Miro board.

Challenges

Several factors should be noted which influence the reporting of results, such as studies using small or opportunistic sampling; limited available data and details provided; and limited comparability across datasets due to different ways of operationalizing constructs as well as the time data were collected relevant to stage of an outbreak. Our aim was not to assess the quality of the data, nor to compare outcomes across studies. We do detail the types of evidence, gaps, and key research questions.

As many SBS studies on mpox have just recently ended or were conducted for operational purposes, there is limited available data in the published literature. Our findings section depended on either researchers sharing summary findings (orally or via PowerPoints and other summary documents) or on published literature. We have included available in-depth studies in the thematic synthesis of findings below.

An additional challenge is that SBS research is often viewed as ‘community engagement’ for randomised clinical trials, conflating SBS research with activities that engage community members around trial purpose, enrolment, and findings. To address this challenge, we systematically reviewed information available on project websites and in published literature, retaining only those activities that met our criteria for SBS research (see above). However, as many smaller SBS studies are embedded in larger multi-institutional studies, our ‘investigational’ work (which was required) may mean that some studies were missed because the SBS component in not described in the grant abstract or on the website.

Synthesis of social and behavioural science mpox research

Types of evidence

We mapped and identified 50 studies for inclusion in this report. We found that most studies are very small-scale or are components of larger clinical trials or studies with the goal of addressing vaccine ‘hesitancy’. Several studies are surveys (see inclusion and exclusion criteria for the mapping). Almost all studies are recent, 2024-25, and most focused on the DRC outbreak, with the exception of work in Nigeria (2017 onward). Some studies are self-funded or otherwise funding is short-term. Studies were largely focused on Clade II, with some solely focused on Clade I (Table 1).

Studies are often descriptive and cross-sectional, assessing community attitudes toward mpox, disease perceptions, and vaccine acceptance. Many are led by key agencies, e.g. UNICEF, IFRC, WHO, and foreground operational priorities. Few seek to understand the wider political-economic and social context of mpox. Studies are listed by discipline (Table 2).

A recent WHO synthesis of mpox SBS work identified 27 rapid quantitative or mixed-method surveys and 6 rapid qualitative assessments across 13 countries in the African region (WHO Health Emergencies program, 2 Sep 2025). These data are compiled in the Collective Services mpox dashboard. Not all studies met criteria for inclusion in our report.

Rapid quantitative community and mixed methods surveys were/are being carried out by several WHO partners (IFRC, UNICEF, Africa CDC – still ongoing). UNICEF-led mobile phone-based community rapid assessments (DRC, CAR, Kenya, Burundi, Uganda, and Rwanda) were conducted in December 2024 and May 2025. Most of these data are based on self-reported behaviours or attitudes regarding mpox.  UNICEF also collected a U-Report survey in DRC, and across 22 countries in the African region from 2024-25. The regional dataset became available in December 2024 and was included in a WHO internal synthesis. However, these studies are specific to a place, time, and context. Due to their rapid and quantitative design, many of these studies also lack specific context, making it difficult to interpret findings and translate them into response actions. As discussed above, we excluded surveys that were purely quantitative in nature.

Nineteen rapid qualitative assessments and studies were implemented in five countries: Burundi, CAR, DRC, Kenya, Malawi, Rwanda, and Uganda. Two additional studies are currently underway in DRC and Liberia. These rapid studies include:

• Burundi (1 series of RQAs (3 total)): Anthrologica conducted a series of three rapid qualitative assessments (RQAs) on the Mpox response in Burundi (Sep 24-Mar 25). This work was carried out in coordination with the Burundi Red Cross and the National Institute of Public Health (INSP) to gain a better understanding of community dynamics regarding the Mpox virus and the factors that promote and prevent community transmission. Their main report is published here.
• DRC (5 studies): 1 infodemic report in Bumbu/Kinshasa was published based on active listening before, during and after vaccination (12-16 June 2025) and on notes and recordings from community feedback collection sheets, 1 Integrated Outbreak Analytics (IOA) report in Sankuru and 1 in south Kivu, 1 IFRC community feedback report (Ivory Coast and DRC),  1 UNICEF report in South Ubangi and Sankuru.
• Malawi (1 study): A Rapid Qualitative Assessment in Lilongwe District by the Ministry of Health and UNICEF, which aimed to understand community perceptions of mpox, transmission dynamics, and identify insights for response. Interviews (n=21) and focus group discussions (n=4 with 37 people) were conducted with mpox recovered patients, people in ‘hot spots,’ at-groups (female sex workers, men who have sex with men), and health care providers.
• Rwanda (5 studies): Monitoring and program planning visits were conducted by a team consisting of representatives from UNICEF, IFRC, the Rwanda Red Cross and the Rwanda NGO Forum for HIV/AIDS and Health Promotion. The aim was to monitor the impact of training of trainer activities (on community knowledge levels about Mpox and Marburg) and provide key insights for planning of future outbreak response and preparedness activities.
• Uganda (5 studies): WHO-funded rapid anthropological studies (participant observation, interviews, fieldwork in mpox hotspots in Kampala and Nakasongola Districts), integrated analytics, U-Report, and one KAP study led by USAID.

In our Annex 1, we include details (title, authors, years, country, and research findings) from all 50 studies.

Thematic synthesis

In this section, we synthesise key themes and descriptive findings which have emerged from SBS studies, identified per the methods section above, through December 2025.[1] We include findings from 13 more in-depth studies in this section, the thematic synthesis. Themes include socio-historical and ecological considerations, socio-political considerations, health system considerations, stigma and discrimination, contextual vulnerabilities (gender, economic, etc.), local understandings of mpox, traditional medicine and home-based remedies, and vaccines. Where possible, we delineate the nature of the studies contributing findings to each theme, acknowledging that some are small-scale and/or rapid assessments and therefore warrant cautious interpretation and application of their findings.

Socio-historical & ecological considerations

One study examined the historical and ecological dimensions of mpox over time through an ethnohistorical and eco-anthropological analysis conducted in two regions of the Central African Republic (CAR): Lobaye Prefecture, which has experienced one or more outbreaks annually over the past decade, and Sangha-Mbaéré Prefecture, which has a longer history of mpox but less frequent outbreaks (Duda et al., 2024). The study combined participant observation of forest-based activities – such as trap setting and rodent capture – with 40 interviews. It drew attention to how shifting political ecologies in Central Africa have likely shaped the emergence of mpox in urban settings. The authors emphasise the importance of understanding historical environmental and socio-political changes to inform future research on mpox outbreaks in the region. This study also contextualises wild meat consumption in colonial histories of extractivism: “Intensive hunting and heavy dependence on wild meat for consumption and income has deeper historical roots in extractive French colonial policy, initially through concessionary companies and subsequently through commercial enterprises” (Duda et al 2024).

Socio-political considerations

Experiences of mpox are shaped by multiple socio-political considerations, particularly the ways in which the disease intersects with stigma, social inequality, and regional dynamics of conflict and displacement.

However, few studies considered the wider social and political-economic context of mpox in West and Central Africa. Some studies considered the post-COVID context, which influenced people’s understanding of mpox, while rapid anthropological work in Uganda identified structural drivers of mpox transmission.

Duda et al. (2024) noted that in the two sites where they collected data in the Central African Republic (CAR), local historical explanations attributed mpox and ill health to broader economic and moral decline (Duda et al 2024). Furthermore, they note that “although CAR and other central and west African countries have experienced recurrent mpox outbreaks in recent decades, mpox was not deemed a major priority for research or intervention until the 2022 global pandemic”, suggesting that the prioritisation of diseases is dependent on global health security agendas  (Duda et al 2024).

In many places, mpox was the first public health emergency after COVID-19. The legacies of COVID-19 response are noted as important, with diverse impacts across contexts. In Uganda, the WHO-funded rapid study found that there were perceptions that mpox response and control is once again political (like COVID-19), as elections are coming up.[2] In this same study, mpox perceptions were linked to experiences with COVID and COVID myths and misinformation.

The mpox outbreak, particularly Clade I in eastern DRC and Clade I and II in urban centres like Kinshasa, has notably affected female sex workers. In DRC, sex workers face stigma and discrimination, whilst in Uganda, sex work is criminalised. In both cases, the findings show how affected sex workers engaged with mpox response efforts. In a study exploring the roles of mpox recovered patients in public health responses (building on findings from a survey (n=253), administered in 2025 in the Pakadjuma health centre, and on qualitative interviews (n=25)), Jules Villa and colleagues found that in Pakadjuma, Kinshasa, sex workers and recovered mpox patients were less likely to take individual action to share information about mpox publicly, but were willing to take collective actions such as speaking with their peers and mobilising people in the informal settlement.[3] Taking individual action was seen as socially ‘riskier,’ compared to acting collectively. Opesen and his team (2024-25) reported how Kampala-based brothel managers and sex workers were less likely to admit public health teams into their space, due to the criminality of sex work. Findings from the team’s interviews and ethnographic observations conducted between 2024-25 in informal settlements in Kawempe Division, Kampala, Uganda showed that teams had to build relationships of trust and negotiate entry. There were also major differences in the outbreak and outbreak response effectiveness for sex workers who were identified as professional sex workers (brothel- and bar-based) and more hidden/transactional sex workers (home- and street-based), who were more difficult to identify and reach. This highlights the heterogeneity of the outbreak, even within “risk” groups like sex workers.

Health system considerations

Controlling mpox requires a functioning primary healthcare infrastructure accessible to those who are at greater risk. Mpox studies from Nigeria (2022-23),[4] Burundi (2024-25)[5] and Sankuru, DRC (2025)[6] focused on health system gaps, but further evidence is needed from other contexts, and many rapid studies did not consider health system gaps. Research highlighted the importance of strengthening primary health care, as community-level mpox detection and response as well as care relies on a strong public health system and primary care (Adegoke et al., 2025; Schmidt-Sane et al., 2024). Frontline public health workers, especially in low-income urban informal settlements, reported strained resources, delays in testing and case confirmation, and taking ‘repair’ measures of their own (e.g., paying for transportation of samples) to fill in the gaps (Schmidt-Sane et al., 2024). Similarly, in Sankuru, rapid operational research suggested that there were long delays between test and lab confirmation and little availability to treat patients in mpox centres. No food was provided to patients in mpox centres (IOA, May 2025, Sankuru, DRC). Sankuru Public Health Department was struggling to supply sampling kits and laboratory consumables. The equipment needed to transport collection kits and samples was limited, and transport costs high, which limited the percentage of samples sent to the public health laboratory (IOA, May 2025, Sankuru, DRC). In Burundi, participants demonstrated awareness that people with mpox symptoms should seek care at health care facilities, but some reported seeking support from traditional healers, pharmacies, or through prayer at church (Anthrologica RQA). In Gitega and Buyenzi, Burundi, long ambulance wait times or shortages contributed to delays in seeking care (Anthrologica RQA, 2025).

Stigma and discrimination

Many of the studies reported on experiences of stigma and discrimination – from the wider community, but also stigma and discrimination within the online gay community in urban Nigeria during the first mpox PHEIC in 2022-23 (Kunnuji et al., 2025).[7] Participants who had mpox at that time reported a hostile social environment within the gay community, and they chose to keep their diagnosis secret – in one instance, a participant had told people he had travelled, but  he was actually hiding at home for over one month until he recovered (Kunnuji, 2025). However, few studies went in-depth into stigma drivers, the social/historical context of discrimination and the nuanced impact that stigma might have on people at higher risk of mpox, including on care-seeking. Emerging findings from Olufadewa, Lees, and Zhao (2025) in Nigeria found that later in 2024-25, more knowledge about mpox likely meant less stigma within the gay community (compared to what Kunnuji described),[8] but stigma from the wider community (directed toward GBMSM) still existed. Stigma directed toward people who had mpox was  reported as widespread in Burundi, affecting people even after recovery from mpox (Anthrologica RQA Burundi, March 2025). All interviewed sex workers faced blame, humiliation, and public disclosure of status (Anthrologica RQA Burundi, March 2025). This coheres with longstanding social science research highlighting how sex workers face stigma and have been blamed as “vectors of disease” (e.g., syphilis, HIV outbreaks). Finally, in Tshopo Province, DRC, stigma and discrimination went beyond the individual patient. The research reports that individuals who were associated with the patient (e.g., an uncle or brother) would also be affected by stigma from the community (Kakule, 2025).[9]

Vulnerabilities to mpox

Many of the SBS studies spoke to the contextual vulnerabilities driving mpox across settings – these vulnerabilities are also intersectional, with gender, economic precarity, and livelihood, as well as age shaping vulnerability. However, fewer studies looked at context in-depth. For example, several rapid studies would point to gendered differences in results but not provide further information. In the following sections, we focus on the more in-depth studies.

Gender. Informal interviews with sex workers, peer educators and ‘ecurie’ [group or network of sex workers] leaders as part of a study looking at mpox within the context of transactional sex in informal settings in Pakadjuma explored social structure and hierarchies within these networks. The study highlighted the need to engage leaders in ecuries in mpox responses, to compensate sex workers for gaps in income potentially resulting from public health responses, and to clearly and openly communicate on amounts of compensation (Ishoso and Reyniers 2025). Involving survivors in Pakadjuma in mpox responses was shown to enhance trust and improve access to marginalised social networks, such as of sex workers and MSM (Villa 2025). Small scale rapid studies with sex workers and bar attendants suggested that participants had limited ways to protect oneself, and limited ability to stop sex due to livelihood needs, exacerbated by stigma (Anthrologica RQA Burundi; WHO study in Uganda). These accounts align with Leonard and Quay 2024 desk-based gender analysis of mpox in DRC, [10] which highlighted the need for including assessments on the potential impact of mpox public health interventions on livelihoods and income for both men and women, as well as for considering social protection interventions that “prevent reliance on transactional sex”.

Economic precarity. Evidence from the Sankuru Province in DRC, a setting characterised by economic insecurity, accounts for socio-economic and other challenges to accessing healthcare facilities. Barriers include distance from most households with generally very high transport costs, as well as the poor state of the roads (for instance, obstruction by natural obstacles such as rivers). When treatment centres are full, patients are sent home for outpatient care. Thus long distances to health facilities and associated transport costs poses challenges to care (CAI, May 2025, Sankuru, DRC).

Livelihood based vulnerabilities. Several studies pointed to mpox vulnerabilities based on livelihood, particularly for sex workers due to the risks of mpox transmission via sexual contact/sexual transmission. One study focused specifically on livelihoods and vulnerability. Opesen’s work on behalf of the WHO in Uganda detailed urban livelihood–sex work dynamics, high mobility, and crowded spaces that likely fuelled sustained mpox transmission in the disease hotspots in Nakasongola and Kampala. Other vulnerable groups included: fisherfolk who are highly mobile in this context and live in crowded conditions, mobile business persons, and boda boda drivers (they also act as community “ambulances” and are vulnerable because of this work) (Opesen, 2025).

Local understandings, perceptions and misconceptions of mpox

Local perceptions of mpox were reported across studies, and were highly dependent on sociocultural context, stage of the outbreak, and population – including communities’ past experiences with outbreaks and outbreak response.

Some similarities were reported across studies, such as confusion of mpox with other more commonly known diseases like measles or chickenpox (Anthrologica RQA, 2025; Adegoke et al., 2025; Olufadewa et al., 2025).

Mpox is often confused with other diseases. Differing risk severity perceptions were reported – some people perceive it to be very dangerous, others see it as one of many things they have to contend with (Anthrologica RQA Burundi, March 2025 Infographic). Thus authors of a study in urban Nigeria contend that mpox was not necessarily perceived of as a health emergency by community members but rather just as one of many challenges in people’s lives (Adegoke et al., 2025). In many cases, mpox was perceived to be a “common” disease (Opesen, 2025) – equivalent to measles or chickenpox. In Uganda, the outbreak overlapped with high rates of HIV amongst fisherfolk in landing sites, though more research is needed to unpack the experiences of people living with HIV.  For those with severe mpox, patients thought it was an STI like herpes, syphilis, etc. In a rapid qualitative assessment in Burundi, women provided more detailed explanations of mpox symptoms than men (Anthrologica RQA Burundi, April 2025 Report). People considered mpox to be divine punishment in Tshopo Province, DRC (Kakule, 2025).

In Sierra Leone, study participants viewed mpox as a serious health threat, but had low personal perception of risk (Njai, 2025).[11] Knowledge was high, but people did not feel the need to take preventive measures, or could not, in the case of those from lower socioeconomic backgrounds (Njai, 2025). In Nigeria, a study in 2022-23 during the first PHEIC at an HIV service provider for key populations found that knowledge of mpox was very low and many misconceptions prevailed as people had alarmist views of the disease.[12] This fueled stigma within the gay community where messages about mpox spread via social media (e.g., mpox will kill you).

Two studies in the DRC noted that public health response teams should counter rumours with ‘good information’ via discussions. Information spreads quickly from the village chief down to the households. (Esaie Kindombe Luzolo; Kakule, 2025). Community feedback collected in DRC & Ivory Coast by IFRC identified rumours about mpox as a disease brought into the population for demographic or extractive reasons, as well as to test new vaccines on local populations (IFRC 2024).

One study in CAR documented that residents interviewed in 2022 in selected villages of the Lobaye and Sangha-Mbaere prefectures had little knowledge on mpox. The authors noted divergences between sites, including different terms used (Duda et al 2024). In both sites people described diseases based on symptoms and mpox was not generally understood as a zoonotic disease. This research showed that Lobaye informants were more familiar with mpox than Sangha-Mbaere informants, with several interviewees describing mpox as a new disease imported from DRC.

Traditional medicine, herbal medicine, home-based remedies

Several studies examined the use of traditional cultural practices and herbal medicine by community members as a response to mpox infection. In rural DRC, mpox was perceived to have spiritual causes, and the study lead expressed the view that response stakeholders should engage with traditional healers (Luzolo, 2025). SBS evidence points to the use of home remedies and traditional herbal medicines across contexts (Opesen, 2025; Adegoke et al., 2025).[13] In rural DRC, the use of traditional remedies like casava leaves was documented in areas where government health facilities were not easy to access. In Tshopo Province, DRC, people with severe cases would then resort to biomedical treatment (Kakule, 2025). This was also the case in urban Nigeria, where people with more severe disease would go to health centres or hospitals. If not considered severe, people would isolate and treat at home, including with remedies purchased over the counter in drug shops (Adegoke et al., 2025).

Mpox vaccine attitudes and perceptions

We identified qualitative studies of vaccine attitudes within larger vaccine clinical trials. Few standalone SBS studies examined mpox vaccine attitudes and none identified discussed the wider factors that could influence vaccine hesitancy and vaccine confidence.

One study in Nigeria by Olufadewa and colleagues (2025), nested within the larger CIHR-funded International Monkeypox Response Consortium, found that the anticipated rollout of mpox vaccine elicited mixed reactions. Some participants were willing to be vaccinated, whilst other expressed concerns about vaccine side effects and safety.

A community feedback activity in Kinshasa similarly found that the major proportion of concerns reflect a legitimate need for information rather than outright opposition, and concluded that a culturally and socially appropriate approach is essential. The study authors argued that community engagement should be prioritised over top-down and unilateral communication (Bumbu/Kinshasa LC-16m8 vaccination Launch Community feedback analysis, June 2025). There were concerns about the impact of the vaccine on fertility (Bumbu/Kinshasa LC-16m8 vaccination Launch Community feedback analysis, June 2025).[14]

Methodological and thematic gaps identified in the existing mpox SBS evidence

Our scoping identified several key methodological and thematic gaps in the current evidence base. A majority of SBS studies were rapid, small-scale, or specific to acute stages in an mpox outbreak. Many of the knowledge, attitudes, and practices studies conducted early in an outbreak may miss how knowledge and perceptions change over time, particularly as more information becomes available and community members become more aware of mpox signs and symptoms. Rapid studies provided timely information about a particular place and time, but longer-term and in-depth research could uncover the broader context of mpox as well as structural drivers of disease.

We also identified several thematic gaps in the evidence base. These gaps were identified through our synthesis and by authors of the studies, through discussions in the November 2025 webinar, and in the December 2025 Kinshasa Mpox Symposium.

• Deeper understanding of context(s): intersections between historical and political-economic context in the study locations and vulnerabilities to mpox. The uneven impacts of poverty, extractive economies, conflict, and weak health infrastructure on vulnerabilities to mpox and to associated public health interventions is still poorly understood.
• Household dynamics: Our synthesis confirmed a lack of data on domestic roles of men in DRC, and how this affects transmission. This gap was identified by desk-based gender analysis (gender analysis DRC). A further gap relates to intra-household dynamics and how this affects transmission to children (research from Burundi – INSP).
• Living with HIV: Experiences of HIV positive people with mpox received limited attention in the research, such as their experiences of care-seeking, and stigma related to mpox.
• Vaccination: This synthesis confirmed identified lack of data on vaccine access for child-headed and poor households (gender analysis DRC), and more broadly on effective engagement strategies for children in relation to vaccination uptake.
• Health systems: More nuanced information is needed on the context of health systems and health systems gaps in relation to mpox care seeking and treatment. Data is also lacking on how to better integrate childcare into isolation requirements for parents and carers. Research on community social protection mechanisms and mutuality in care in different contexts is also lacking.
• One Health research: It will also be important to maintain a balance of research on human-to-human transmission as well as zoonotic transmission dynamics. This would include One Health research, including on long-term drivers of disease.
• Informal care, traditional and herbal medicine, and home-based care. One significant gap in the evidence base is the role of care outside the formal health system. This includes traditional healers and herbalists and how and why people have managed mpox at home. Further, the long-term impact of mpox on people is not fully understood.

Key social and behavioural science research questions for future mpox research

Our synthesis points to key SBS research questions for future mpox research. These questions are based on gaps identified in the current SBS research landscape and also on discussions during our online deliberative dialogue in November 2025, where participants were asked to reflect on evidence gaps and operational implications.

In addition to these questions, there is a clear and vital need for more joined-up and cross-context studies that move beyond single points in time (e.g., early in the outbreak/late in the outbreak). For single context studies, there is a need to connect contextual and localised accounts of mpox to structural drivers, as well as paying attention to sampling and recruitment. This would advance more thorough analyses of the contextual specificities in the SBS of mpox.

Key research questions for further investigation include:

1. Context: Understanding the historical, political-economic, and social context of mpox as well as the One Health dynamics. How do histories of colonial and postcolonial resource extraction, conflict, or weakened health infrastructures shape mpox transmission and experience, particularly in marginalised settings? How does urban informality shape mpox transmission and experience in populated urban centres? How do human-animal-environment interactions (and their context) shape mpox?
2. Pregnant women: Further studies on the experience of pregnant women and new mothers who have had/survived mpox. What role do women’s partners play in supporting mpox treatment and recovery? What health access barriers exist to women seeking treatment early?
3. Marginalisation: Understanding the experience of marginalised groups – what does targeted surveillance mean for people’s lives in a context of repression/stigma/discrimination? What are the implications of framing the disease as a sexually transmitted infection? What kinds of specific community engagement approaches might work (e.g., building on action research findings in Pakadjuma, Kinshasa)?
4. Vaccines: There is a need to account for ethical challenges associated with research vaccine hesitancy in settings where vaccines may not be available to study participants. This is also a gap in more robust studies contextualising mpox rumours (some are very similar to Ebola and COVID rumours). What is the wider context of mpox vaccine confidence and root drivers of vaccine hesitancy? What rumours are circulating and what are the contexts of these rumours? How do they represent particular anxieties (or not)? What is the uptake and perceptions of novel technologies like RDTs, mRNA vaccines in the mpox response?
5. Recovery and survival: Undertaking psychosocial studies on the long-term impact of mpox. What are the experiences of long-term mpox sequelae, such as survivor’s stigma?
6. Living with HIV: What are the experiences of people living with HIV and regarding mpox vulnerability and care? What forms of intersecting stigma and discrimination do people living with HIV face when experiencing mpox? How does that shape their care seeking?
7. Care: What forms of alternative care are being sought, where are people seeking care outside the formal health system, and how and in what circumstances do people manage mpox at home? How do people judge the severity of mpox and decide when to seek further care?
8. Health systems: How do gaps (and successes) in the health system shape people’s understanding of mpox and care seeking, as well as trust in mpox response and responders?
9. One Health: How are specific practices and broader ecological changes facilitating spillovers and emergence of mpox understood by local communities? How do gendered dynamics shape vulnerabilities related to animal-human mpox transmission? How are interventions and/or public health advice (such as rodent control measures) implemented, negotiated or resisted in indifferent contexts?

Key identified researchers conducting social and behavioural mpox research in Africa

• Dr Ferdinand Nsengimana & Rémy NIMUBONA, Institut National de Sante Publique (Burundi)
• Prof Michael Kunnuji, University of Lagos
• Prof Alhaji Njai, University of Sierra Leone
• Dr Chris Opesen, Makerere University
• Prof Tamara Giles-Vernick, Institut Pasteur
• Dr Jules Villa, Institut Pasteur
• Dr Romain Duda (CNRS)
• Mr Deogracias Kakule (WHO)
• Prof Shelley Lees (LSHTM) & SRIHN Isaac Ofadiwa, Nigeria
• Dr Almudena Marisaez (IRD)
• Mr Esaie Kindombe Luzolo (INRB, Kinshasa)
• Dr Patrick Katoto (Catholic University of Bukavu)
• Dr Nadia Sam-Agudu, VERDI Project (University of Minnesota Medical School)
• Thijs Reyniers (ITM, Belgique)
• Daniel Ishoso (ESP-UNIKIN, DRC)
• Dr Jean Corneille Lembebu Zubul (Center for Tropical Diseases and Global Health, Catholic University of Bukavu)

Conclusion

Our synthesis included a scoping and mapping approach that was multipronged, from searching online databases to reaching out to researchers via our collective contacts and networks. We identified 50 SBS studies and synthesised available findings in this report. Our work points to the need for further in-depth SBS research on specific key topics, but also cross-context and longer-term research for ongoing mpox response efforts.

More broadly, there is a need for sustainability and investment in social and behavioural science research in and on public health emergencies in order to create a robust body of evidence on outbreak preparedness and response. This includes stand-alone social science research or genuine interdisciplinary research. In this context, it is critical for future One Health studies and clinical trials to accommodate rigorous anthropologically driven research questions and approaches more systematically. A sustainable community of practice would also assist in building a wider evidence base, not only for mpox, but for future outbreaks of other diseases as well.

Additional resources

https://writingonthewall.org.uk/projects/mpox-whats-your-story/ [UK based but interesting Community-Centred Creative Campaign for Public Health]

Collective Service Mpox Evidence Dashboard

Mpox society: https://www.linkedin.com/company/110142259 [Active LinkedIn page created after the 2025 mpox symposium in Kinshasa]

https://mpoxsymposium.com/visuals-and-presentations [posters from the 2025 mpox symposium available on the Website]

Acknowledgements

This work was funded by Elrha and the UK’s FCDO.

Endnotes

[1] We include findings from studies that have outputs published online or investigators shared draft outputs, or information was shared via the November deliberative dialogue or in December in the mpox symposium in Kinshasa. For some of the listed studies (Annex 1), results are not yet publicly available or investigators did not respond to requests for further information. We also did not extensively synthesise Knowledge, Attitude, Practices studies as these were highly contextualised and specific to place and stage of the outbreak or purely quantitative studies (meeting our exclusion criteria).

[2] This WHO-funded study led by an anthropologist, Chris Opesen, in Nakasongola District and Kampala, Uganda was conducted in late 2024. It broadly identified the structural drivers of mpox amongst high risk groups, such as boda boda drivers, sex workers, and children, and also highlighted other findings for response. This was an ethnographic action research study, which used participant observation, key informant interview, group discussions, in-depth interviews, and document review.

[3] This ELHRA-funded project is led by anthropologist Jules Vila combines a survey and qualitative interviews to document the experiences of mpox-recovered patients in Pakadjuma, Kinshasa, DRC and their roles and contributions to mpox sensitisation.

[4] This ESRC-funded study was led by Hayley MacGregor and Ayodele Jegede in southwestern Nigeria (Ogun, Oyo, and Lagos states). Fieldwork took place in 2022-23 and included in-depth interviews with people affected by mpox and their families, public health officials and health care providers, participant observation and transect walks.

[5] This is the Anthrologica-led RQA in Burundi (see note on methods above).

^[6] This analysis from May 2025 was led by UNICEF Integrated Outbreak Analytics cell in DRC,  to understand the main causes of the recurrence (resurgence) of the disease in all health zones of Sankuru, and more specifically in the six (6) health zones of Lodja, Dikungu, Omendjadi, Katako-Kombe, Tshumbe, and Wembo-Nyama, despite almost five months of response, in order to better guide appropriate responses, and to: understand the level of perception, knowledge (identification of suspected, tested, and confirmed cases), and understanding of the disease by the community and healthcare personnel, as well as the dynamics and potential risks associated with its management. The analysis built on a wide range of information and sources, however the report does not provide details on the methodology.

[7] From the ESRC funded study in Nigeria referenced above.

[8] This ongoing study, led by Shelley Lees, Isaac Olufadewa, Yang Zhao and colleagues under the UK-PHRST, used citizen ethnography, in-depth interviews, and deliberative engagement in 2025-present in Ogun State, Nigeria to understand community perceptions of mpox risk and severity, and barriers to the uptake of health care.

[9] Deogratias Kakule has reported on findings from a rapid assessment for community protection from Sep-Oct 2025 in Tshopo Province, DRC on behalf of the WHO. The assessment sought to understand how communities perceive and respond to mpox, how they seek care, and how they engage with the response. It included 27 focus group discussions and 37 key informant interviews with a total of 292 people, including sex workers, people living with HIV, and moto-taxi drivers. See one poster from this work here.

[10] This Rapid Gender Analysis written by the Gender in Emergencies Group through the UK Public Health Rapid Support Team draws together secondary data sources to analyse the context of gender roles and relations prior to the mpox public health emergency and assess the impact of mpox on gender roles and relations and vice versa.

[11] This study in Sierra Leone led by Alhaji Njai used a mixed-methods quantitative and qualitative research design to evaluate knowledge, risk perception and socio-behavioural factors in the community. It also included focus group discussions and semi-structured interviews of interviews of survivors, close contacts and community members.

[12] From the ESRC funded study, in an article published by Kunnuji et al., 2025.

[13] Olufunke Adegoke’s article (2025) is based on work conducted under the ESRC funded study (PI: Hayley MacGregor). Findings are published here.

[14] Based on 113 community feedback collectedby relais communautaires in the of the Bumbu health zone

Authors: Diane Duclos (London School of Hygiene and Tropical Medicine), Megan Schmidt-Sane (Institute of Development Studies, IDS), and Hayley MacGregor (IDS).

Acknowledgements: This work was funded by Elhra and the FCDO.

Suggested citation: Duclos, D., Schmidt-Sane, M. and MacGregor, H. (2026). A review of the social and behavioural science research landscape for mpox in African settings. Social Science in Humanitarian Action Platform (SSHAP). www.doi.org/10.19088/SSHAP.2026.002

Published by the Institute of Development Studies: February 2026.

Copyright: © Institute of Development Studies 2026.

This is an Open Access paper distributed under the terms of the Creative Commons Attribution 4.0 International licence (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited and any modifications or adaptations are indicated.

Contact: Hayley MacGregor ([email protected])

About SSHAP: The Social Science in Humanitarian Action (SSHAP) is a partnership between the Institute of Development Studies, Anthrologica , CRCF Senegal, Gulu University, Le Groupe d’Etudes sur les Conflits et la Sécurité Humaine (GEC-SH), the London School of Hygiene and Tropical Medicine, the Sierra Leone Urban Research Centre, University of Ibadan, and the University of Juba. This work was supported by the UK Foreign, Commonwealth & Development Office (FCDO) and Wellcome 225449/Z/22/Z. The views expressed are those of the authors and do not necessarily reflect those of the funders, or the views or policies of the project partners.

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