Mpox Awareness and Knowledge Among Residents of the Northern Border Region, Saudi Arabia: Implications for Community Preparedness.

In August 2024, the World Health Organization declared the ongoing mpox upsurge in Africa a Public Health Emergency of International Concern, underscoring mpox as an emerging global threat. In non‑endemic countries such as Saudi Arabia, understanding community awareness is critical for public health preparedness and prevention. This study assessed mpox awareness and knowledge among residents of the Northern Border Region and identified factors associated with better knowledge, to inform targeted community‑based health communication strategies. A community‑based cross‑sectional survey was conducted between 1 March and 20 August 2025 among 1,362 adults. A structured, pre‑validated questionnaire assessed general knowledge, symptom recognition, and preventive measures. Knowledge scores (0-15) were summarized descriptively and categorized as poor, moderate, or good. Ordinal logistic regression and machine‑learning classifiers were used to identify predictors of higher knowledge and to explore the prediction of adequate knowledge from sociodemographic characteristics and prior mpox awareness, supporting risk stratification for community interventions. Among 1,362 participants (78.1% female; 56.8% aged 18-30 years), 48.4% had previously heard of mpox. Overall knowledge was suboptimal (mean 7.64/15; 50.9% correct); 48.3% had poor knowledge, 38.2% moderate, and 13.5% good. Suboptimal knowledge across sociodemographic groups suggests substantial vulnerability to future mpox introductions in this border region. Social media and other internet sources were the main information channels, underscoring their potential as primary platforms for risk communication. In multivariable ordinal regression, prior mpox awareness was the strongest predictor of higher knowledge (adjusted odds = 4.1), alongside higher education and health‑related occupations. Logistic‑regression-based machine‑learning models showed moderate discrimination and acceptable calibration (AUC‑ROC = 0.72; Brier = 0.19), with prior awareness consistently the most important feature. Mpox knowledge in the Northern Border Region is suboptimal and low across sociodemographic groups, particularly among less educated and non‑health‑sector participants. Prior exposure to mpox information is a central, modifiable determinant of adequate knowledge, underscoring the need for targeted, evidence‑based communication strategies, particularly via widely used digital platforms. Tailored community‑level interventions focusing on less educated and non‑health‑sector groups are essential to strengthen mpox preparedness and broader infectious‑disease readiness in this underserved border region.