Determinants of mpox vaccine acceptance among peri-urban residents in Sekondi-Takoradi, Western Region of Ghana: A community-based cross-sectional study

Mpox re-emerged as a global public health concern in 2022, and the Western Region of Ghana became the epicentre of the country’s largest recorded outbreak in 2025. Ahead of a sub-national vaccination campaign launched in October 2025, no study had examined the determinants of mpox vaccine acceptance among peri-urban residents of the region using a theoretically grounded framework. This study determined the sociodemographic and Health Belief Model-based determinants of mpox vaccine acceptance among peri-urban residents of the Sekondi-Takoradi Metropolis, Western Region, Ghana. A community-based cross-sectional study was conducted among 580 adults in six purposively selected peri-urban areas and their surrounding communities between July and August 2025, before the vaccination campaign began. Vaccine acceptance was measured as a three-category outcome (accept, hesitant, refuse) and analysed using chi square tests and multinomial logistic regression adjusted for sociodemographic characteristics, Health Belief Model constructs, and peri-urban area. Overall, 75.7% of respondents were willing to accept the vaccine, 12.9% were hesitant and 11.4% would refuse. Perceived vaccine safety was the strongest determinant: respondents who considered the vaccine very safe had markedly lower adjusted odds of hesitancy (adjusted odds ratio 0.02, 95% confidence interval 0.00–0.12) and refusal (0.03, 0.01–0.13) than those who considered it unsafe. Uncertainty about vaccine effectiveness was associated with hesitancy (9.83, 1.95–49.50), and belief in its effectiveness with lower odds of refusal (0.22, 0.06–0.86). Higher educational attainment was associated with lower odds of hesitancy, being a student or employed with lower odds of refusal, and acceptance differed be 1 tween peri-urban areas (55.1% to 95.6%). Knowledge of mpox transmission was associated with acceptance in bivariate analysis (p < 0.001) but not after adjustment. Risk communication that addresses vaccine safety and effectiveness, rather than generic disease-awareness messaging alone, is likely to be most effec tive in improving mpox vaccine acceptance in this population, with unemployed and less-educated residents warranting targeting. As a pre-campaign baseline collected during an active outbreak, these findings can inform the vaccination response in the Western Region and preparedness in comparable peri-urban West African settings.