Abstract / Summary
Abstract Background Mpox remains a public health concern, particularly in settings where access to reliable health information, vaccination and health services may be limited. University students are an important population for mpox prevention because of their social interactions and potential influence on health behaviours. This study assessed knowledge, attitudes and perceptions of mpox and examined factors associated with reported mpox vaccine hesitancy among students in Sierra Leone. Methods A cross-sectional study was conducted among 422 students from three constituent colleges of the University of Sierra Leone between January and June 2026. Data were collected using a structured questionnaire assessing knowledge, attitudes, perceptions and vaccination intention. Vaccine hesitancy was defined as reporting that the participant would not take an mpox vaccine if it were available. Univariable and multivariable binary logistic regression were performed to identify factors associated with reported hesitancy, with crude and adjusted odds ratios (CORs and AORs) and 95% confidence intervals (CIs) reported. Results Of 422 participants, 287 (68.0%) reported willingness to receive an mpox vaccine, while 135 (32.0%) were classified as hesitant. Good knowledge was observed in 332 (78.7%) participants, while 174 (41.2%) had a positive attitude and 249 (59.0%) had a positive perception. In multivariable analysis, good knowledge was associated with lower odds of reported hesitancy (AOR 0.203, 95% CI 0.116–0.356; p < 0.001), as was positive perception (AOR 0.562, 95% CI 0.328–0.962; p = 0.036). Compared with FBC students, hesitancy was lower among students from COMAHS (AOR 0.093, 95% CI 0.032–0.266; p < 0.001) and IPAM (AOR 0.508, 95% CI 0.293–0.882; p = 0.016). Students in Years 1–2 and 3–4 had lower odds of hesitancy than those in Year 5+ (AOR 0.344, 95% CI 0.120–0.984; p = 0.047 and AOR 0.228, 95% CI 0.082–0.632; p = 0.005, respectively). Positive attitude was not independently associated with hesitancy (AOR 0.952, 95% CI 0.549–1.651; p = 0.860). Conclusions Although two-thirds of students expressed willingness to receive an mpox vaccine, reported hesitancy remained substantial. Knowledge and perception were independently associated with hesitancy, while differences across colleges and levels of study suggest an important role for educational context. Mpox preparedness should therefore combine targeted risk communication with trusted healthcare-professional engagement and affordable, convenient access to vaccination. Because vaccination intention was assessed hypothetically, these findings indicate potential demand rather than actual vaccine uptake.