Community perceptions and health-seeking behaviour towards mpox during an outbreak in Burundi: a qualitative socio-ecological analysis

Mpox remains a public health concern in Burundi and other African countries. Community knowledge, perceptions, and behaviors play an important role in disease prevention and control. This study explored perceptions of mpox, stigma and discrimination, healthcare-seeking behaviors, and other social and behavioral factors related to mpox in Burundi. A qualitative exploratory descriptive study was conducted between March and December 2025 in five provinces of Burundi as part of a multi-country study. A total of 44 purposively selected individuals participated as key informants or in-depth interviews including; recovered patients, caregivers, community members, healthcare workers, religious leaders, and traditional leaders. Data were collected through in-depth and key informant interviews using a semi-structured interview guide. Interviews were transcribed, translated into English when needed, and analyzed thematically using NVivo 14 software. Most participants had heard about mpox and recognized it as a contagious disease. However, misconceptions were common, with some people confusing mpox with measles or believing that it came only from monkeys or supernatural causes. Community health workers, health facilities, local leaders, places of worship, and radio programs were important sources of information. Some participants reported delays in seeking healthcare because symptoms were not recognized early, traditional remedies were used first, or fear of stigma discouraged timely care. Participants also described experiences of stigma and social exclusion, which sometimes affected healthcare-seeking behavior. The findings suggest that mpox prevention and control in Burundi are influenced by community knowledge, beliefs, and social experiences. Improving public awareness through trusted community actors, reducing stigma, and encouraging early healthcare seeking may strengthen efforts to prevent and control mpox outbreaks.