Post-traumatic stress disorder, depression and anxiety among mpox survivors in central Uganda: a cross-sectional study

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Epidemics, including mpox have negative mental health impacts that are often overlooked during emergency response. We assessed the prevalence and associated factors of anxiety, depression, and posttraumatic stress disorder (PTSD) among mpox survivors in the most affected districts in Uganda. Methods: We conducted a cross-sectional community-based study from February 1–28, 2025, using simple random sampling of mpox survivors from Kampala, Mukono, and Wakiso districts. Survivors were selected from district-specific lists. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and PTSD using the PTSD Checklist. Modified Poisson regression was used to identify associated factors. Results: We enrolled 385 participants with a median age of 29 years (IQR: 25–35); 60% were female, and 59% of these were sex workers. The prevalence of anxiety, depression, and PTSD was 11% (n=43; 95% CI: 8%–14%), 14% (n=53; 95% CI: 11%–18%), and 9% (n=33; 95% CI: 6%–12%), respectively. Overall, 22% (n=84; 95% CI: 18%–26%) reported 1 mental health disorder. Factors associated with increased prevalence of mental health disorders included longer treatment unit stay (>14 days) (aPR=2.1; 95% CI: 1.4–3.2), being a sex worker (aPR=1.7; 95% CI: 1.1–2.8), perceived poor management at the treatment unit (aPR=2.7; 95% CI: 1.4–4.9), moderate (aPR=2.5; 95% CI: 1.3–4.7) or severe Mpox symptoms (aPR=5.3; 95% CI: 3.2–9.7), and perceived stigma (aPR=2.1; 95% CI: 1.4–3.3). Conclusions: Approximately one in five mpox survivors experienced a mental health disorder during illness or recovery, underscoring the psychological impact of the disease. Key associated factors included prolonged hospitalization, sex work, perceived poor care, severe symptoms, and stigma. These findings highlight the need to integrate mental health support into Mpox response efforts through tailored interventions that address stigma, care quality, and social support. Uganda Mpox Anxiety Depression Post traumatic stress disorder. Mental health Figures Figure 1 Figure 2 Introduction Infectious disease epidemics, including mpox have a negative impact on survivors including risks of mental illnesses. Many survivors of infectious epidemics suffer from depression, substance abuse, anxiety, and post-traumatic stress disorder (PTSD) ( 1 , 2 , 3 ) with some symptoms persisting long after the outbreak has ended ( 4 ). Despite this, the mental health consequences of such crises are frequently overlooked, as stakeholders tend to prioritize biomedical and socio-economic impacts during response efforts ( 5 ). This consequently leads to limited interventions during and after the outbreak to address the mental health of affected communities. Known risk factors for mental health disorders during outbreaks include: life threatening symptoms, fear of death, witnessing of people dying, isolation, stigmatization, deterioration of socioeconomic conditions, loss of family members, threat of infection ( 6 ). The first two cases of mpox in Uganda were identified and reported from Kasese District in western Uganda and the outbreak was declared by the Ministry of Health on August 2, 2024. By December 30, 2024, 1,353 cases had been reported across 55 districts. The disease causes painful skin or mucosal lesions lasting 2–4 weeks, often with fever, headache, sore throat, muscle aches, and swollen lymph nodes. It spreads primarily through close contact, with sexual transmission being most common ( 7 ). Severe cases can lead to complications such as corneal infections, pneumonia, sepsis, and encephalitis, all of which significantly impact physical and mental health and can lead to death ( 7 ). Mpox survivors often face stigma and discrimination due to visible rashes or lesions, leading many to self-isolate or withdraw from society. This stigma is exacerbated by the widespread belief that mpox is primarily sexually transmitted, especially among sex workers, fueling moral judgment and labeling survivors as promiscuous( 8 ). Beyond stigma, the psychological burden of contracting a novel infectious disease, marked by fear of death, concern for loved ones, prolonged isolation, and social restriction, is well-documented in literature ( 9 , 10 ) These experiences can trigger a range of emotional responses, including anxiety, grief, anger, and loneliness, and may lead to serious mental health disorders such as depression and PTSD. Despite these risks, there is limited evidence on the mental health impact of mpox in Uganda. Understanding the psychological impact on survivors is essential for informing comprehensive outbreak responses that address both physical and mental health. This study assessed the prevalence and associated factors of anxiety, depression and PTSD in Kampala metropolitan area (KMA) districts in central Uganda. Methods Study design, Study population and study setting We conducted a cross-sectional community-based study utilizing quantitative methods of data collection. Data was collected from February 1–28, 2025. The study population included mpox survivors from Kampala, Wakiso, and Mukono Districts within the Kampala Metropolitan Area (KMA) that were among the most affected (71% of all cases in the country) by the outbreak as of December 2024. Eligible participants were persons who had tested positive for mpox virus by PCR, had recovered, and were alive at the time of data collection. Survivors with a known personal or family history of mental illness were excluded from the study to reduce confounding in assessing post-infection mental health outcomes. Sample size estimation and sampling procedures We estimated a sample size of 424 mpox survivors. The sample size was calculated using the Kish Leslie formula for estimating a single population proportion: \(\:\) \(\:n=\frac{{Z}^{2}P\left(1-P\right)}{{e}^{2}}\) where Z is the standard normal deviate at 95% confidence level (1.96), P is the estimated prevalence of anxiety among mpox survivors (assumed at 50% due to lack of local data), and e is the margin of error (5%). This yielded a minimum sample size of 385 participants. To account for a 10% non-response rate, the sample size was adjusted to 424. We used stratified random sampling using district-specific lists of mpox survivors as sampling frames. Survivors were proportionally allocated based on the total number of eligible individuals in each of the three study districts–Kampala, Wakiso, and Mukono. At the community level, Village Health Team (VHT) members supported the data collection teams in locating the homes or workplaces of eligible survivors. Study Variables The study assessed both independent and outcome variables related to mental health outcomes among Mpox survivors. Independent variables included sociodemographic characteristics such as age, sex, district of residence, occupation, marital status, education level, and economic status. Additional variables included household and clinical factors such as the number of people in the household, whether any household member had Mpox or died from it, admission to a Mpox treatment unit, length and conditions of stay, participation in a survivors’ support program, duration and severity of illness, as well as the presence of family or social support during illness. Experiences of discrimination and stigmatization during and after the illness were also captured. The primary outcomes were the presence or absence of anxiety, depression, and post-traumatic stress disorder (PTSD). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), a validated 14-item questionnaire with two subscales measuring anxiety and depression over the past week. Each item was scored on a 4-point Likert scale ranging from 0 (no impairment) to 3 (severe impairment), with scores of ≥ 8 indicating probable anxiety or depression ( 11 ). PTSD was assessed using the PTSD Checklist for DSM-5 (PCL-5), a 20-item self-report tool that measures how much respondents were bothered by PTSD symptoms in the past month. Responses were rated on a 5-point Likert scale from 0 (not at all) to 4 (extremely), with a total score of ≥ 38 considered indicative of probable PTSD( 12 ). These tools and cut-off scores were chosen based on prior research conducted among Ebola disease survivors and their families in Uganda, which employed similar methodology and thresholds( 13 ). Data collection and Data analysis A structured questionnaire was used to collect data from Mpox survivors, including demographic characteristics and potential factors associated with mental health disorders. Standardized, validated tools were employed to assess participants’ mental health status. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate symptoms of anxiety and depression, while the PTSD Checklist for DSM-5 (PCL-5) was used to assess PTSD. Data were analyzed using Stata version 14 (StataCorp, College Station, TX, USA). Categorical variables were summarized using frequencies and percentages, while continuous variables were described using means and standard deviations. To identify factors associated with mental health disorders, we used modified Poisson regression using linear models, which provide more robust estimates of effect size (prevalence ratios [PRs]) in cross-sectional studies with common binary outcomes, compared to odds ratios from logistic regression ( 14 ). Variables with a p-value < 0.2 in bivariate analysis were included in the multivariable model. Multicollinearity was assessed using the variance inflation factor (VIF), and collinear variables were excluded. The final model was built using forward selection, and statistical significance was determined at a p-value < 0.05, with 95% confidence intervals. Ethical consideration This study was in response to a public health emergency and was therefore determined to be non-research. The Ministry of Health (MoH) gave permission to conduct this study among the survivors of the mpox outbreak. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. §§See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. § 241(d); 5 U.S.C. § 552a; 44 U.S.C. § 3501 et seq. All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda Ministry of Health and were performed in accordance with the Declaration of Helsinki. Prior to data collection, informed consent was obtained from all the participants who were above 18 years (legal age in Uganda). For those below 18 years, consent was obtained from their parents/guardians and assent was also obtained from them prior to participation in the study. Consent for the participants Participation in this study was entirely voluntary. All eligible participants were informed about the study objectives (including publication as an output), procedures, potential risks, and benefits in a language they understood. Written (or thumbprint) consent was obtained before data collection. Participants were assured of confidentiality, the right to refuse to answer any questions, and the option to withdraw at any time without any repercussions. Data collected were anonymized and used solely for research purposes. Results Sociodemographic and clinical characteristics of mpox survivors We interviewed 385 Mpox survivors from Kampala, Wakiso, and Mukono Districts, with the majority (71%) from Kampala. The median age was 29 years (IQR: 25–35), and over half (54%) were aged 25–34 years. Most participants were female (60%), had completed primary education (48%), and nearly half (45%) were married or cohabiting. Sex work was the main occupation for 35% (Table 1 ). Of the participants, 331 (83%) had been admitted to a treatment unit, with an average stay of 7 days (SD ± 6); 92% stayed less than two weeks, and 96% rated the care as good. The average duration of illness was 14 days (SD ± 10), with 28% reporting severe symptoms. Most participants (96%) were not enrolled in a survivor support program. Reports of stigma and discrimination were noted in 24%, and nearly half (49%) had minimal or no social support during illness. Additionally, 5% reported a household death and 15% reported the loss of a friend or family member due to Mpox (Table 1 ). Table 1 Sociodemographic and clinical characteristics of mpox survivors, Uganda, July–December, 2024 Variables n (%) Age* 15–24 77 ( 20 ) 25–34 207 (54) ≥ 35 101 ( 26 ) Sex Female 230 (60) Male 155 (40) Education level None 43 ( 11 ) Primary 184 (48) Secondary 116 ( 30 ) Tertiary 42 ( 11 ) Address Mukono 38 ( 10 ) Wakiso 75 ( 19 ) Kampala 272 (71) Household size 1 104 ( 27 ) 2–4 171 (44) > 4 110 ( 29 ) Marital Status Divorced 45 ( 12 ) Married/cohabiting 172 (45) Single 160 (41) Widowed 8 ( 2 ) Occupation Technician/professional 27 ( 7 ) Sex worker 136 (35) Trader/businessperson 138 (36) Student/pupil 28 ( 7 ) Unemployed 56 ( 15 ) Taken to treatment unit (TU) No 64 ( 17 ) Yes 331 (83) Length of TU stay** ≤14 days 294 (92) >14 days 27 ( 8 ) Length of illness*** ≤14 days 226 (59) >14 days 159 (41) Severity of illness Mild 150 (39) Moderate 128 (33) Severe 107 ( 28 ) Stigmatized No 261 (68) Yes 124 (32) Social support level Satisfactory 198 (51) Non-satisfactory 187 (49) Mpox death in Household No 367 (95) Yes 18 ( 5 ) Friend/family died of mpox No 328 (85) Yes 57 ( 15 ) Management in TU Good 309 (96) Poor 12 ( 4 ) * Medium age, 29 (IQR: 25–35 years); ** Average length of study at TU, 7 days (SD ± 6) *** Average length of illness, 14 days (SD ± 10); TU = Treatment Unit Prevalence of mental health disorders among survivors of mpox The prevalence of a mental health disorder among mpox survivors was 22% (n = 84; 95% CI 18–26%). Prevalence of anxiety alone was 11% (n = 43; 95% CI 8–15%), that of depression alone was 14% (n = 53; 95% CI 11–18%) and of PTSD alone was 9% (n = 33; 95% CI 6–12%) (Fig. 2 ). Factors associated with having ≥ 1 mental health disorder among mpox survivors At multivariate analysis, being a sex worker (aPR = 1.7, 95%CI 1.1–2.8), longer stay at the treatment unit,(> 14 days) (aPR = 2.1, 95%CI 1.4–3.2), reporting poor management at the treatment unit (aPR = 2.7, 95%CI 1.4–4.9), having suffered moderate (aPR = 2.5, 95%CI 1.3–4.7) or severe (aPR = 5.3, 95%CI 32.9–9.7) symptoms of mpox and having felt stigmatized from society (aPR = 2.1, 95%CI 1.4–3.3) were all associated with increased prevalence of mental health disorder (Table 3 ). Table 3 Factors associated with having ≥ 1 mental health disorder among survivors of mpox, Uganda, July–December, 2025 Variables Presence of ≥ 1 MH Disorder Yes No N (%) N (%) cPR (95%CI) aPR (95%CI) Age 25–34 52 ( 25 ) 155 (75) Ref Ref 15–24 8 ( 10 ) 69 (90) 0.4 (0.2–0.8) 0.6 (0.3–1.3) ≥ 35 24 ( 24 ) 77 (76) 0.9 (0.6–1.4) 1.1 (0.7–1.5) Sex Female 55 ( 24 ) 175 (76) Ref Ref Male 29 ( 19 ) 126 (81) 0.8 (0.5–1.1) 0.8 (0.5–1.3) Education level None 10 ( 23 ) 33 (77) Ref - Primary 46 ( 25 ) 138 (75) 1.1 (0.6–1.9) - Secondary 24 ( 21 ) 92 (79) 0.9 (0.5–1.7) - Tertiary 4 ( 10 ) 38 (90) 0.4 (0.1–0.1.2) - Marital Status Divorced 13 ( 29 ) 32 (71) Ref - Married/cohabiting 33 ( 19 ) 139 (81) 0.7 (0.4–1.2) - Single 36 ( 23 ) 124 (76) 0.8 (0.5–1.3) - Widowed 2 ( 25 ) 6 (75) 0.9 (0.2–3.1) - Occupation Other* 37 ( 15 ) 212 (85) Ref Ref Sex worker 47 (35) 89 (65) 2.3 (1.6–3.4) 1.7 (1.1–2.8) Mpox death in Household No 79 ( 22 ) 288 (78) Ref Ref Yes 5 ( 28 ) 13 (72) 1.3 (1-2.6) 0.8 (0.4–1.6) Taken to treatment unit (TU) No 8 ( 13 ) 56 (87) Ref - Yes 76 ( 24 ) 245 (76) 1.9 (1-3.7) - Length of TU stay ≤14 days 56 ( 19 ) 238 (81) Ref Ref >14 days 20 (74) 7 ( 26 ) 3.9 (2.8–5.4) 2.1 (1.4–3.2) Management in TU Good 69 ( 22 ) 240 (78) Ref Ref Poor 7 (58) 5 (42) 2.6 (1.5–4.4) 2.7 (1.4–4.9) Household size 1 25 ( 24 ) 79 (76) Ref - 2–4 35 ( 20 ) 136 (80) 1 (0.5–1.3) - > 4 24 ( 22 ) 86 (78) 0.9 (0.6–1.5) - In survivor’s program No 80 ( 22 ) 290 (78) Ref Ref Yes 4 ( 27 ) 11 (73) 2.5 (1.03–6.2) 1 (0.5–2.2) Length of illness ≤14 days 32 ( 14 ) 194 (86) Ref >14 days 52 (33) 107 (67) 2.3 (1.6–3.4) 0.7 (0.5–1.1) Severity of illness Mild 10 ( 7 ) 140 (93) Ref Ref Moderate 21 ( 16 ) 107 (84) 2.5 (1.2-5.0) 2.5 (1.3–4.7) Severe 53 (50) 54 (50) 7.4 (4-13.9) 5.3 (2.9–9.7) Friend/family died of mpox No 68 ( 21 ) 260 (79) Ref - Yes 16 ( 28 ) 41 (72) 1.4 (0.8–2.2) - Stigmatized No 33 ( 13 ) 228 (87) Ref Ref Yes 51 (41) 73 (59) 3.3 (2.2–4.8) 2.1 (1.4–3.3) Social support level Satisfactory 28 ( 14 ) 170 (86) Ref Ref Non-satisfactory 56 ( 30 ) 131 (70) 2.1 (1.4–3.2) 1.3 (0.8–1.9) TU=Treatment Unit; aPR= adjusted prevalence ratios; cPR= crude prevalence ratios; Bold face represents significant variables (p<0.05); Ref: Reference category Discussion This study assessed the prevalence and associated factors of mental health disorders among Mpox survivors. We found that 11% of survivors experienced anxiety, 14% experienced depression, and 9% experienced PTSD. Overall, one in five Mpox survivors reported at least one mental health disorder. Factors associated with increased prevalence of mental health disorders included being a sex worker, extended hospitalization, perceived poor quality of care at the treatment unit, experiencing moderate to severe Mpox symptoms, and perceived stigma from the community. Taken together, the findings highlight the interplay between disease severity, healthcare experiences, and social vulnerability in shaping survivors’ mental health outcomes. Our study found the prevalence of anxiety among survivors to be 11%, that of depression to be 14% and that of PTSD to be 9%. The prevalence of anxiety and depression reported in our study are consistent with those reported among mpox survivors in other parts of the world including china, UK and Nigeria ( 14 , 15 , 16 ) Comparable mental health outcomes have also been observed in survivors of other infectious disease outbreaks, such as Ebola and COVID-19 ( 4 , 17 , 18 ).This convergence of evidence suggests that the psychological burden of surviving a potentially life-threatening and stigmatizing illness is both substantial and widespread. The presence of anxiety, depression, and PTSD among survivors highlights the need for integrated mental health support in outbreak preparedness and response efforts, particularly in resource-limited settings where such services are often lacking ( 19 ). A longer hospital stay (> 14 days) was significantly associated with higher prevalence of anxiety and depression among Mpox survivors. This aligns with evidence from other infectious disease outbreaks showing that prolonged hospitalization, often a proxy for severe illness and extended isolation, increases psychological distress ( 20 , 21 , 22 ) Additionally, individuals hospitalized for extended periods may experience a sense of loss of control over their health, which has been linked to higher levels of psychological distress ( 22 ). These findings underscore the importance of integrating psychosocial support into clinical care pathways, especially for patients requiring extended admission during outbreaks. Mpox survivors who were sex workers had a higher prevalence of mental health disorders compared to those in other occupations. This finding underscores the intersection of public health, mental health, and social vulnerability. Sex workers often face structural barriers including stigma, legal discrimination, limited access to healthcare, and social marginalization, all of which heighten their psychological vulnerability during public health crises ( 22 , 23 ). In the context of mpox, visible scarring and enforced isolation may further diminish self-esteem and disrupt income-generating activities, intensifying mental health challenges ( 8 ). These results highlight the need to prioritize marginalized populations such as sex workers in mental health interventions for outbreak survivors, ensuring that support services are both inclusive and responsive to the unique challenges they face. Perceived poor management at the treatment unit was associated with an increased prevalence of mental health disorders among survivors of mpox, consistent with studies demonstrating that suboptimal healthcare experiences negatively impact mental well-being in the context of infectious disease outbreaks ( 22 , 23 ).This highlights the crucial role that the quality of care during hospitalization plays in shaping post-recovery psychological outcomes. Inadequate care, such as poor communication, delays in treatment, lack of emotional support, or neglect of psychological needs can heighten feelings of anxiety, helplessness, and distress, increasing the risk of long-term mental health issues ( 22 ). Ensuring patient-centered care and addressing both physical and emotional needs during hospitalization could improve mental health outcomes among mpox survivors. Suffering from moderate or severe symptoms of mpox was associated with increase in the prevalence of anxiety mental health disorders. This is consistent with existing research on the mental health consequences of severe illness ( 24 , 25 , 26 ). Severe physical illness is often accompanied by heightened psychological distress, as individuals are forced to confront the possibility of severe health outcomes, including death, and are often subjected to prolonged discomfort or pain. In the case of mpox, severe symptoms such as painful rashes, fever, fatigue, and other distressing physical manifestations could contribute to heightened fear and anxiety about one’s health and prognosis ( 8 ). These findings underscore the need for integrating psychological support into the clinical care of patients with severe presentations of infectious diseases. Our study found that perceived stigmatization was significantly associated with a higher prevalence of mental health disorders among mpox survivors. This finding is consistent with studies from Australia and the United States, which reported similar associations between stigma and poor mental health outcomes among marginalized Mpox-affected populations ( 27 , 28 ). In the case of mpox, visible skin lesions and other physical symptoms can trigger stigma rooted in fear of contagion, misinformation, or associations with specific groups such as sex workers ( 8 ). Survivors who experience social rejection, discrimination, or hostility as a result may suffer heightened psychological distress, increasing their risk for anxiety, depression, and other mental health challenges ( 29 , 30 ). These findings highlight the need to address stigma as part of comprehensive post-outbreak mental health support. Our findings have key public health and policy implications. First, the high burden of mental health disorders among Mpox survivors highlights the need to integrate mental health and psychosocial support into outbreak response frameworks. Routine screening and targeted support, especially for high-risk groups such as sex workers, those with severe illness, or prolonged hospitalization could be part of standard care for mpox outbreak response. Second, the association between perceived poor care and mental health outcomes underscores the need for improving the quality of mpox clinical services. Health workers could be trained in trauma-informed care and psychological first aid to enhance patient experience during isolation and treatment. Third, at the policy level, mental health indicators could be incorporated into epidemic surveillance systems, and funding allocated for MHPSS in emergency preparedness plans. Further studies are needed to assess the long-term mental health impact of Mpox and to evaluate the effectiveness of integrated mental health interventions in mpox outbreak settings. Study limitations While this study offers valuable insights into the psychological impact of Mpox among survivors, several limitations should be noted. First, the cross-sectional design captures mental health outcomes at a single point in time and does not allow for causal inferences between Mpox infection and the development of anxiety, depression, or PTSD. Longitudinal studies are needed to understand the long-term psychological effects of Mpox. Second, reliance on self-reported data may introduce information bias, particularly in reporting symptoms and experiences. This may have underestimated the prevalence of mental health disorder in the current study and biased our associations towards null. Third, the absence of pre-infection mental health data limits our ability to determine whether some symptoms were pre-existing. To mitigate this, individuals with a known history of mental illness were excluded from participation. Conclusion Approximately one in five mpox survivors in this study experienced a mental health disorder during illness or recovery, underscoring the significant psychological impact of mpox. Several factors were significantly associated with an increased prevalence of mental health disorders, including longer hospitalization (> 14 days), being a sex worker, perceived poor quality of care at the treatment unit, moderate to severe disease symptoms, and experiencing stigma. These findings highlight the multifaceted nature of post-Mpox recovery and the urgent need to integrate mental health support into outbreak response and survivor care. Beyond clinical management, tailored interventions could address key psychosocial factors, including the quality of care received during hospitalization, experiences of stigma, and the availability of social and occupational support systems. Healthcare providers should consider adopting a holistic approach that prioritizes both physical and psychological recovery. Future studies should explore the long-term mental health outcomes of Mpox survivors and to better inform the development of context-specific, evidence-based mental health interventions. Abbreviations CDC: Centers for Disease Control and Prevention; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, fifth edition; HADs: Hospital anxiety and depression scale; MoH: Ministry of Health; MHP: Mental health problems; PCL-5: PTSD checklist from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition; PTSD: Posttraumatic stress disorder; KMA: Kampala Metropolitan Area Declarations Ethics approval This study was in response to a public health emergency and was therefore determined to be non-research. The Ministry of Health (MoH) gave permission to conduct this study among the survivors of the mpox outbreak. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. §§See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq. All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda Ministry of Health and were performed in accordance with the Declaration of Helsinki. Prior to data collection, informed consent was obtained from all the participants who were above 18 years (legal age in Uganda). For those below 18 years, consent was sought from their parents/guardians and assent was also obtained from them to participate in the study. Participant Consent Participation in this study was entirely voluntary. All eligible participants were informed about the study objectives (including publication as an output), procedures, potential risks, and benefits in a language they understood. Written (or thumbprint) consent was obtained before data collection. Participants were assured of confidentiality, the right to refuse to answer any questions, and the option to withdraw at any time without any repercussions. Data collected were anonymized and used solely for research purposes. Availability of data and materials The datasets upon which our findings are based belong to the Uganda Public Health Fellowship Program. For confidentiality reasons, the datasets are not publicly available. The datasets can be availed upon reasonable request from the corresponding author with permission from the Uganda National Institute of Public Health. Competing interest The authors declare no competing interests Funding and disclaimer This study was supported by the Korea Foundation for International Healthcare (KOFIH) under the project titled, “Strengthening Health Systems to Prevent, Detect and Respond to Infectious Diseases in Uganda,” implemented in collaboration with the Uganda National Institute of Public Health (UNIPH) and the Ministry of Health. Authors’ contributions EOO conceptualized the study idea, participated in data collection, analyzed data collected, and wrote draft zero of the manuscript; JM, EM, JOK, JN, CM, PK, GA, BA and VN, supported in data collection; RM, KOK, HLS, IL, DA, PK, RK, IP, LB, BK and ARA supported in editing, and reviewing of the manuscript. All authors read and approved the final manuscript. Acknowledgement We appreciate and acknowledge the support rendered by all the division staff of Kampala City Council Authority especially the Division surveillance focal persons and the implementing partners that supported in the identification and investigation of mpox cases. Much appreciation to KIFIH for the funding support and the Uganda Field Epidemiology Training Program, for the technical oversight. We in a special way want to appreciate and acknowledge our research assistants Dorothy Aliro, Ken Enabu Okalany and Sylvia Iradikunda for their efforts in data collection. References Zürcher SJ, Kerksieck P, Adamus C, Burr CM, Lehmann AI, Huber FK, et al. Prevalence of Mental Health Problems During Virus Epidemics in the General Public, Health Care Workers and Survivors: A Rapid Review of the Evidence. Front Public Health [Internet]. 2020 Nov 11 [cited 2024 Nov 29];8. 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Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: practical considerations for the COVID-19 pandemic. Singapore Med J. 2020 Jul;61(7):350–6. Snaith RP. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes. 2003 Aug 1;1(1):29. Geier TJ, Hunt JC, Nelson LD, Brasel KJ, deRoon-Cassini TA. Detecting PTSD in a traumatically injured population: The diagnostic utility of the PTSD Checklist for DSM-5. Depress Anxiety. 2019;36(2):170–8. Agaba B, Nelly HN, Wanyana MW, Zalwango JF, Simbwa B, Akunzirwe R, et al. Prevalence of and factors associated with anxiety, depression and post-traumatic stress disorder among Sudan ebolavirus disease survivors and family members, Uganda, January 2023: a cross-sectional study. Discov Psychol. 2024 Jul 22;4(1):87. Martinez BAF, Leotti VB, Silva G de S e, Nunes LN, Machado G, Corbellini LG. Odds Ratio or Prevalence Ratio? An Overview of Reported Statistical Methods and Appropriateness of Interpretations in Cross-sectional Studies with Dichotomous Outcomes in Veterinary Medicine. Front Vet Sci [Internet]. 2017 Nov 10 [cited 2025 Feb 3];4. Available from: https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2017.00193/full Fu L, Wang B, Wu K, Yang L, Hong Z, Wang Z, et al. Epidemiological characteristics, clinical manifestations, and mental health status of human mpox cases: A multicenter cross-sectional study in China. J Med Virol. 2023;95(10):e29198. Torales J, Barrios I, Castaldelli-Maia JM, Ventriglio A. The Mpox outbreak is a public health emergency of international concern: Implications for mental health and global preparedness. Int J Soc Psychiatry. 2025 Feb 1;71(1):203–8. Ahmed SK, Abdulqadir SO, Hussein SH, Omar RM, Ahmed NA, Essa RA, et al. The impact of monkeypox outbreak on mental health and counteracting strategies: A call to action. Int J Surg. 2022 Oct;106:106943. Kaputu-Kalala-Malu C, Musalu EM, Walker T, Ntumba-Tshitenge O, Ahuka-Mundeke S. PTSD, depression and anxiety in Ebola virus disease survivors in Beni town, Democratic Republic of the Congo. BMC Psychiatry. 2021 Dec;21(1):342. Kumar M, Akbarialiabad H, Kouhanjani MF, Kiburi S, Shidhaye P, Taghrir MH, et al. Association of major disease outbreaks with adolescent and youth mental health in low-and middle-income countries: a systematic scoping review. JAMA Psychiatry. 2022;79(12):1232–40. Matalon N, Dorman-Ilan S, Hasson-Ohayon I, Hertz-Palmor N, Shani S, Basel D, et al. Trajectories of post-traumatic stress symptoms, anxiety, and depression in hospitalized COVID-19 patients: A one-month follow-up. J Psychosom Res. 2021 Apr 1;143:110399. Lucijanic D, Mihaljevic Peles A, Piskac Zivkovic N, Lucijanic M, Kranjcevic M, Muzinic Marinic L. Relationship of Anxiety, Depression, Stress, and Post-Traumatic Stress Disorder Symptoms with Disease Severity in Acutely Ill Hospitalized COVID-19 Patients. Behav Sci. 2023 Sep;13(9):734. Sullivan E, Shelley J, Rainey E, Bennett M, Prajapati P, Powers MB, et al. The association between posttraumatic stress symptoms, depression, and length of hospital stay following traumatic injury. Gen Hosp Psychiatry. 2017 May 1;46:49–54. Rössler W, Koch U, Lauber C, Hass AK, Altwegg M, Ajdacic-Gross V, et al. The mental health of female sex workers. Acta Psychiatr Scand. 2010;122(2):143–52. Martín-Romo L, Sanmartín FJ, Velasco J. Invisible and stigmatized: A systematic review of mental health and risk factors among sex workers. Acta Psychiatr Scand. 2023;148(3):255–64. Alzahrani N. The effect of hospitalization on patients’ emotional and psychological well-being among adult patients: An integrative review. Appl Nurs Res. 2021 Oct 1;61:151488. Weber C, Monero Flores V, Wheele TP, Miedema E, White EV. Patients’ Health & Well-Being in Inpatient Mental Health-Care Facilities: A Systematic Review. Front Psychiatry [Internet]. 2022 Jan 3 [cited 2025 Apr 5];12. Available from: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.758039/full Hatch R, Young D, Barber V, Griffiths J, Harrison DA, Watkinson P. Anxiety, Depression and Post Traumatic Stress Disorder after critical illness: a UK-wide prospective cohort study. Crit Care. 2018 Nov 23;22(1):310. James PB, Wardle J, Steel A, Adams J. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Trop Med Int Health. 2019;24(6):671–91. Smith AKJ, Storer D, Lancaster K, Haire B, Newman CE, Paparini S, et al. Mpox Illness Narratives: Stigmatising Care and Recovery During and After an Emergency Outbreak. Qual Health Res. 2024 Oct 1;34(12):1161–74. Nerlich B, Jaspal R. Mpox in the news: social representations, identity, stigma and coping. Med Humanit. 2025 Mar 1;51(1):161–71. Additional Declarations No competing interests reported. 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National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Joyce","middleName":"Owens","lastName":"Kobusingye","suffix":""},{"id":505905028,"identity":"d706ba23-847c-4120-988f-25668a03502d","order_by":8,"name":"Joanita Nalwanga","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Joanita","middleName":"","lastName":"Nalwanga","suffix":""},{"id":505905029,"identity":"c9c5bbd0-5c9c-4bd3-81b7-d4fb6758a252","order_by":9,"name":"Charity Mutesi","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Charity","middleName":"","lastName":"Mutesi","suffix":""},{"id":505905030,"identity":"6066ea31-8678-4234-a681-366fbf58273f","order_by":10,"name":"Patrick Kwizera","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"","lastName":"Kwizera","suffix":""},{"id":505905031,"identity":"f5c3b1bf-2fd2-42ef-9cd5-905b885b982a","order_by":11,"name":"Gertrude Abbo","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Gertrude","middleName":"","lastName":"Abbo","suffix":""},{"id":505905032,"identity":"6323f199-1eea-4e8c-9858-f3f72be6d568","order_by":12,"name":"Brian Agaba","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Brian","middleName":"","lastName":"Agaba","suffix":""},{"id":505905033,"identity":"c0662987-def0-43fc-80b6-031c92d00b91","order_by":13,"name":"Vivian Ntono","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Vivian","middleName":"","lastName":"Ntono","suffix":""},{"id":505905034,"identity":"6b4d4d31-e815-4673-8b95-865394d7c649","order_by":14,"name":"Dansan Atim","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Dansan","middleName":"","lastName":"Atim","suffix":""},{"id":505905035,"identity":"3c3abbee-8cc9-47dd-8325-f87f8ee73e98","order_by":15,"name":"Prichard Kavuma","email":"","orcid":"","institution":"Korea Foundation for International Healthcare","correspondingAuthor":false,"prefix":"","firstName":"Prichard","middleName":"","lastName":"Kavuma","suffix":""},{"id":505905036,"identity":"0b209b9c-c191-42a4-9b20-99cb645d3e83","order_by":16,"name":"Ruth Kaliisa","email":"","orcid":"","institution":"Korea Foundation for International Healthcare","correspondingAuthor":false,"prefix":"","firstName":"Ruth","middleName":"","lastName":"Kaliisa","suffix":""},{"id":505905037,"identity":"fdec489d-3813-40a4-a4f9-1e88eea93265","order_by":17,"name":"Inyeong Park","email":"","orcid":"","institution":"Korea Foundation for International Healthcare","correspondingAuthor":false,"prefix":"","firstName":"Inyeong","middleName":"","lastName":"Park","suffix":""},{"id":505905038,"identity":"5e391c61-e3f3-4a7f-a218-f96873e5d991","order_by":18,"name":"Lilian Bulage","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Lilian","middleName":"","lastName":"Bulage","suffix":""},{"id":505905039,"identity":"559181d3-1b72-491a-aab8-e4c1d3529bfd","order_by":19,"name":"Benon Kwesiga","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Benon","middleName":"","lastName":"Kwesiga","suffix":""},{"id":505905040,"identity":"cb4db0cd-ad13-48ec-9405-024f3d75d342","order_by":20,"name":"Alex Riolexus Ario","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Alex","middleName":"Riolexus","lastName":"Ario","suffix":""}],"badges":[],"createdAt":"2025-07-30 11:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7252487/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7252487/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90314565,"identity":"f24fb22f-5f66-44c6-a215-44cb24a3cb59","added_by":"auto","created_at":"2025-09-01 10:09:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":121133,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLocation of study area (Kampala, Wakiso and Mukono Districts)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7252487/v1/a560675c89d6c7b23f77915a.png"},{"id":90314553,"identity":"7fa9389c-1d6d-4f8c-94c6-1d555a831959","added_by":"auto","created_at":"2025-09-01 10:09:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":21697,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of mental health disorders among mpox survivors, Uganda, July–December, 2024\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7252487/v1/1a88eabe4a39a6a5aa0e4c0e.png"},{"id":90670018,"identity":"bd6526e0-9b0f-472e-8661-159dfe9a31f3","added_by":"auto","created_at":"2025-09-05 13:23:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2064578,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7252487/v1/91caf178-bd0e-4df9-8eed-a3c00cb71764.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Post-traumatic stress disorder, depression and anxiety among mpox survivors in central Uganda: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfectious disease epidemics, including mpox have a negative impact on survivors including risks of mental illnesses. Many survivors of infectious epidemics suffer from depression, substance abuse, anxiety, and post-traumatic stress disorder (PTSD) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) with some symptoms persisting long after the outbreak has ended (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Despite this, the mental health consequences of such crises are frequently overlooked, as stakeholders tend to prioritize biomedical and socio-economic impacts during response efforts (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This consequently leads to limited interventions during and after the outbreak to address the mental health of affected communities. Known risk factors for mental health disorders during outbreaks include: life threatening symptoms, fear of death, witnessing of people dying, isolation, stigmatization, deterioration of socioeconomic conditions, loss of family members, threat of infection (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe first two cases of mpox in Uganda were identified and reported from Kasese District in western Uganda and the outbreak was declared by the Ministry of Health on August 2, 2024. By December 30, 2024, 1,353 cases had been reported across 55 districts. The disease causes painful skin or mucosal lesions lasting 2–4 weeks, often with fever, headache, sore throat, muscle aches, and swollen lymph nodes. It spreads primarily through close contact, with sexual transmission being most common (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Severe cases can lead to complications such as corneal infections, pneumonia, sepsis, and encephalitis, all of which significantly impact physical and mental health and can lead to death (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMpox survivors often face stigma and discrimination due to visible rashes or lesions, leading many to self-isolate or withdraw from society. This stigma is exacerbated by the widespread belief that mpox is primarily sexually transmitted, especially among sex workers, fueling moral judgment and labeling survivors as promiscuous(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Beyond stigma, the psychological burden of contracting a novel infectious disease, marked by fear of death, concern for loved ones, prolonged isolation, and social restriction, is well-documented in literature (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) These experiences can trigger a range of emotional responses, including anxiety, grief, anger, and loneliness, and may lead to serious mental health disorders such as depression and PTSD. Despite these risks, there is limited evidence on the mental health impact of mpox in Uganda. Understanding the psychological impact on survivors is essential for informing comprehensive outbreak responses that address both physical and mental health. This study assessed the prevalence and associated factors of anxiety, depression and PTSD in Kampala metropolitan area (KMA) districts in central Uganda.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy design, Study population and study setting\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe conducted a cross-sectional community-based study utilizing quantitative methods of data collection. Data was collected from February 1–28, 2025. The study population included mpox survivors from Kampala, Wakiso, and Mukono Districts within the Kampala Metropolitan Area (KMA) that were among the most affected (71% of all cases in the country) by the outbreak as of December 2024. Eligible participants were persons who had tested positive for mpox virus by PCR, had recovered, and were alive at the time of data collection. Survivors with a known personal or family history of mental illness were excluded from the study to reduce confounding in assessing post-infection mental health outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size estimation and sampling procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe estimated a sample size of 424 mpox survivors. The sample size was calculated using the Kish Leslie formula for estimating a single population proportion:\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\)\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n=\\frac{{Z}^{2}P\\left(1-P\\right)}{{e}^{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003ewhere \u003cem\u003eZ\u003c/em\u003e is the standard normal deviate at 95% confidence level (1.96), \u003cem\u003eP\u003c/em\u003e is the estimated prevalence of anxiety among mpox survivors (assumed at 50% due to lack of local data), and \u003cem\u003ee\u003c/em\u003e is the margin of error (5%). This yielded a minimum sample size of 385 participants. To account for a 10% non-response rate, the sample size was adjusted to 424.\u003c/p\u003e\u003cp\u003eWe used stratified random sampling using district-specific lists of mpox survivors as sampling frames. Survivors were proportionally allocated based on the total number of eligible individuals in each of the three study districts–Kampala, Wakiso, and Mukono.\u003c/p\u003e\u003cp\u003eAt the community level, Village Health Team (VHT) members supported the data collection teams in locating the homes or workplaces of eligible survivors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Variables\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study assessed both independent and outcome variables related to mental health outcomes among Mpox survivors. Independent variables included sociodemographic characteristics such as age, sex, district of residence, occupation, marital status, education level, and economic status. Additional variables included household and clinical factors such as the number of people in the household, whether any household member had Mpox or died from it, admission to a Mpox treatment unit, length and conditions of stay, participation in a survivors’ support program, duration and severity of illness, as well as the presence of family or social support during illness. Experiences of discrimination and stigmatization during and after the illness were also captured. The primary outcomes were the presence or absence of anxiety, depression, and post-traumatic stress disorder (PTSD). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), a validated 14-item questionnaire with two subscales measuring anxiety and depression over the past week. Each item was scored on a 4-point Likert scale ranging from 0 (no impairment) to 3 (severe impairment), with scores of ≥ 8 indicating probable anxiety or depression (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePTSD was assessed using the PTSD Checklist for DSM-5 (PCL-5), a 20-item self-report tool that measures how much respondents were bothered by PTSD symptoms in the past month. Responses were rated on a 5-point Likert scale from 0 (not at all) to 4 (extremely), with a total score of ≥ 38 considered indicative of probable PTSD(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These tools and cut-off scores were chosen based on prior research conducted among Ebola disease survivors and their families in Uganda, which employed similar methodology and thresholds(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection and Data analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA structured questionnaire was used to collect data from Mpox survivors, including demographic characteristics and potential factors associated with mental health disorders. Standardized, validated tools were employed to assess participants’ mental health status. The \u003cem\u003eHospital Anxiety and Depression Scale (HADS)\u003c/em\u003e was used to evaluate symptoms of anxiety and depression, while the \u003cem\u003ePTSD Checklist for DSM-5 (PCL-5)\u003c/em\u003e was used to assess PTSD.\u003c/p\u003e\u003cp\u003eData were analyzed using Stata version 14 (StataCorp, College Station, TX, USA). Categorical variables were summarized using frequencies and percentages, while continuous variables were described using means and standard deviations. To identify factors associated with mental health disorders, we used modified Poisson regression using linear models, which provide more robust estimates of effect size (prevalence ratios [PRs]) in cross-sectional studies with common binary outcomes, compared to odds ratios from logistic regression (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Variables with a p-value \u0026lt; 0.2 in bivariate analysis were included in the multivariable model. Multicollinearity was assessed using the variance inflation factor (VIF), and collinear variables were excluded. The final model was built using forward selection, and statistical significance was determined at a p-value \u0026lt; 0.05, with 95% confidence intervals.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical consideration\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study was in response to a public health emergency and was therefore determined to be non-research. The Ministry of Health (MoH) gave permission to conduct this study among the survivors of the mpox outbreak. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. §§See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §\u0026nbsp;241(d); 5 U.S.C. §\u0026nbsp;552a; 44 U.S.C. §\u0026nbsp;3501 et seq.\u0026nbsp;All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda Ministry of Health and were performed in accordance with the Declaration of Helsinki. Prior to data collection, informed consent was obtained from all the participants who were above 18 years (legal age in Uganda). For those below 18 years, consent was obtained from their parents/guardians and assent was also obtained from them prior to participation in the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConsent for the participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipation in this study was entirely voluntary. All eligible participants were informed about the study objectives (including publication as an output), procedures, potential risks, and benefits in a language they understood. Written (or thumbprint) consent was obtained before data collection. Participants were assured of confidentiality, the right to refuse to answer any questions, and the option to withdraw at any time without any repercussions. Data collected were anonymized and used solely for research purposes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eSociodemographic and clinical characteristics of mpox survivors\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe interviewed 385 Mpox survivors from Kampala, Wakiso, and Mukono Districts, with the majority (71%) from Kampala. The median age was 29 years (IQR: 25\u0026ndash;35), and over half (54%) were aged 25\u0026ndash;34 years. Most participants were female (60%), had completed primary education (48%), and nearly half (45%) were married or cohabiting. Sex work was the main occupation for 35% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Of the participants, 331 (83%) had been admitted to a treatment unit, with an average stay of 7 days (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;6); 92% stayed less than two weeks, and 96% rated the care as good. The average duration of illness was 14 days (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;10), with 28% reporting severe symptoms. Most participants (96%) were not enrolled in a survivor support program. Reports of stigma and discrimination were noted in 24%, and nearly half (49%) had minimal or no social support during illness. Additionally, 5% reported a household death and 15% reported the loss of a friend or family member due to Mpox (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic and clinical characteristics of mpox survivors, Uganda, July\u0026ndash;December, 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(54)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(60)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(40)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(48)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR30\" 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size\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried/cohabiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(45)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTechnician/professional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(35)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrader/businessperson\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent/pupil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTaken to treatment unit (TU)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(83)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLength of TU stay**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;14 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(92)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;14 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLength of illness***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;14 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;14 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSeverity of illness\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(33)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStigmatized\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e261\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(68)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(32)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSocial support level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSatisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-satisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(49)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMpox death in Household\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(95)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFriend/family died of mpox\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eManagement in TU\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e*\u003cb\u003eMedium age, 29 (IQR: 25\u0026ndash;35 years);\u003c/b\u003e **\u003cb\u003eAverage length of study at TU, 7 days (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;6)\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e***\u003cb\u003eAverage length of illness, 14 days (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;10); TU\u0026thinsp;=\u0026thinsp;Treatment Unit\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrevalence of mental health disorders among survivors of mpox\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe prevalence of a mental health disorder among mpox survivors was 22% (n\u0026thinsp;=\u0026thinsp;84; 95% CI 18\u0026ndash;26%). Prevalence of anxiety alone was 11% (n\u0026thinsp;=\u0026thinsp;43; 95% CI 8\u0026ndash;15%), that of depression alone was 14% (n\u0026thinsp;=\u0026thinsp;53; 95% CI 11\u0026ndash;18%) and of PTSD alone was 9% (n\u0026thinsp;=\u0026thinsp;33; 95% CI 6\u0026ndash;12%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFactors associated with having\u0026thinsp;\u0026ge;\u0026thinsp;1 mental health disorder among mpox survivors\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt multivariate analysis, being a sex worker (aPR\u0026thinsp;=\u0026thinsp;1.7, 95%CI 1.1\u0026ndash;2.8), longer stay at the treatment unit,(\u0026gt;\u0026thinsp;14 days) (aPR\u0026thinsp;=\u0026thinsp;2.1, 95%CI 1.4\u0026ndash;3.2), reporting poor management at the treatment unit (aPR\u0026thinsp;=\u0026thinsp;2.7, 95%CI 1.4\u0026ndash;4.9), having suffered moderate (aPR\u0026thinsp;=\u0026thinsp;2.5, 95%CI 1.3\u0026ndash;4.7) or severe (aPR\u0026thinsp;=\u0026thinsp;5.3, 95%CI 32.9\u0026ndash;9.7) symptoms of mpox and having felt stigmatized from society (aPR\u0026thinsp;=\u0026thinsp;2.1, 95%CI 1.4\u0026ndash;3.3) were all associated with increased prevalence of mental health disorder (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors associated with having\u0026thinsp;\u0026ge;\u0026thinsp;1 mental health disorder among survivors of mpox, Uganda, July\u0026ndash;December, 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u003cp\u003ePresence of \u0026ge;\u0026thinsp;1 MH Disorder\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ecPR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eaPR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(0.2\u0026ndash;0.8)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.3\u0026ndash;1.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.6\u0026ndash;1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.7\u0026ndash;1.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.5\u0026ndash;1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.5\u0026ndash;1.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.6\u0026ndash;1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.5\u0026ndash;1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.1\u0026ndash;0.1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried/cohabiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.4\u0026ndash;1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.5\u0026ndash;1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.2\u0026ndash;3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(1.6\u0026ndash;3.4)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e(1.1\u0026ndash;2.8)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMpox death in Household\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(1-2.6)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.4\u0026ndash;1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTaken to treatment unit (TU)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(1-3.7)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLength of TU stay\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;14 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e238\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;14 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e3.9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(2.8\u0026ndash;5.4)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2.1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e(1.4\u0026ndash;3.2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eManagement in TU\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(1.5\u0026ndash;4.4)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2.7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e(1.4\u0026ndash;4.9)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHousehold size\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.5\u0026ndash;1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.6\u0026ndash;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIn survivor\u0026rsquo;s program\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(1.03\u0026ndash;6.2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.5\u0026ndash;2.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLength of illness\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;14 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;14 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(1.6\u0026ndash;3.4)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.5\u0026ndash;1.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSeverity of illness\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(1.2-5.0)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e(1.3\u0026ndash;4.7)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e7.4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(4-13.9)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e5.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e(2.9\u0026ndash;9.7)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFriend/family died of mpox\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.8\u0026ndash;2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStigmatized\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e3.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(2.2\u0026ndash;4.8)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2.1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e(1.4\u0026ndash;3.3)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSocial support level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSatisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-satisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e(1.4\u0026ndash;3.2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.8\u0026ndash;1.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cb\u003eTU=Treatment Unit; aPR= adjusted prevalence ratios; cPR= crude prevalence ratios; Bold face represents significant variables (p\u0026lt;0.05); Ref: Reference category\u003c/b\u003e\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the prevalence and associated factors of mental health disorders among Mpox survivors. We found that 11% of survivors experienced anxiety, 14% experienced depression, and 9% experienced PTSD. Overall, one in five Mpox survivors reported at least one mental health disorder. Factors associated with increased prevalence of mental health disorders included being a sex worker, extended hospitalization, perceived poor quality of care at the treatment unit, experiencing moderate to severe Mpox symptoms, and perceived stigma from the community. Taken together, the findings highlight the interplay between disease severity, healthcare experiences, and social vulnerability in shaping survivors\u0026rsquo; mental health outcomes.\u003c/p\u003e\u003cp\u003eOur study found the prevalence of anxiety among survivors to be 11%, that of depression to be 14% and that of PTSD to be 9%. The prevalence of anxiety and depression reported in our study are consistent with those reported among mpox survivors in other parts of the world including china, UK and Nigeria (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Comparable mental health outcomes have also been observed in survivors of other infectious disease outbreaks, such as Ebola and COVID-19 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).This convergence of evidence suggests that the psychological burden of surviving a potentially life-threatening and stigmatizing illness is both substantial and widespread. The presence of anxiety, depression, and PTSD among survivors highlights the need for integrated mental health support in outbreak preparedness and response efforts, particularly in resource-limited settings where such services are often lacking (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA longer hospital stay (\u0026gt;\u0026thinsp;14 days) was significantly associated with higher prevalence of anxiety and depression among Mpox survivors. This aligns with evidence from other infectious disease outbreaks showing that prolonged hospitalization, often a proxy for severe illness and extended isolation, increases psychological distress (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) Additionally, individuals hospitalized for extended periods may experience a sense of loss of control over their health, which has been linked to higher levels of psychological distress (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). These findings underscore the importance of integrating psychosocial support into clinical care pathways, especially for patients requiring extended admission during outbreaks.\u003c/p\u003e\u003cp\u003eMpox survivors who were sex workers had a higher prevalence of mental health disorders compared to those in other occupations. This finding underscores the intersection of public health, mental health, and social vulnerability. Sex workers often face structural barriers including stigma, legal discrimination, limited access to healthcare, and social marginalization, all of which heighten their psychological vulnerability during public health crises (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In the context of mpox, visible scarring and enforced isolation may further diminish self-esteem and disrupt income-generating activities, intensifying mental health challenges (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These results highlight the need to prioritize marginalized populations such as sex workers in mental health interventions for outbreak survivors, ensuring that support services are both inclusive and responsive to the unique challenges they face.\u003c/p\u003e\u003cp\u003ePerceived poor management at the treatment unit was associated with an increased prevalence of mental health disorders among survivors of mpox, consistent with studies demonstrating that suboptimal healthcare experiences negatively impact mental well-being in the context of infectious disease outbreaks (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).This highlights the crucial role that the quality of care during hospitalization plays in shaping post-recovery psychological outcomes. Inadequate care, such as poor communication, delays in treatment, lack of emotional support, or neglect of psychological needs can heighten feelings of anxiety, helplessness, and distress, increasing the risk of long-term mental health issues (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Ensuring patient-centered care and addressing both physical and emotional needs during hospitalization could improve mental health outcomes among mpox survivors.\u003c/p\u003e\u003cp\u003eSuffering from moderate or severe symptoms of mpox was associated with increase in the prevalence of anxiety mental health disorders. This is consistent with existing research on the mental health consequences of severe illness (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Severe physical illness is often accompanied by heightened psychological distress, as individuals are forced to confront the possibility of severe health outcomes, including death, and are often subjected to prolonged discomfort or pain. In the case of mpox, severe symptoms such as painful rashes, fever, fatigue, and other distressing physical manifestations could contribute to heightened fear and anxiety about one\u0026rsquo;s health and prognosis (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These findings underscore the need for integrating psychological support into the clinical care of patients with severe presentations of infectious diseases.\u003c/p\u003e\u003cp\u003eOur study found that perceived stigmatization was significantly associated with a higher prevalence of mental health disorders among mpox survivors. This finding is consistent with studies from Australia and the United States, which reported similar associations between stigma and poor mental health outcomes among marginalized Mpox-affected populations (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In the case of mpox, visible skin lesions and other physical symptoms can trigger stigma rooted in fear of contagion, misinformation, or associations with specific groups such as sex workers (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Survivors who experience social rejection, discrimination, or hostility as a result may suffer heightened psychological distress, increasing their risk for anxiety, depression, and other mental health challenges (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). These findings highlight the need to address stigma as part of comprehensive post-outbreak mental health support.\u003c/p\u003e\u003cp\u003eOur findings have key public health and policy implications. First, the high burden of mental health disorders among Mpox survivors highlights the need to integrate mental health and psychosocial support into outbreak response frameworks. Routine screening and targeted support, especially for high-risk groups such as sex workers, those with severe illness, or prolonged hospitalization could be part of standard care for mpox outbreak response. Second, the association between perceived poor care and mental health outcomes underscores the need for improving the quality of mpox clinical services. Health workers could be trained in trauma-informed care and psychological first aid to enhance patient experience during isolation and treatment. Third, at the policy level, mental health indicators could be incorporated into epidemic surveillance systems, and funding allocated for MHPSS in emergency preparedness plans. Further studies are needed to assess the long-term mental health impact of Mpox and to evaluate the effectiveness of integrated mental health interventions in mpox outbreak settings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhile this study offers valuable insights into the psychological impact of Mpox among survivors, several limitations should be noted. First, the cross-sectional design captures mental health outcomes at a single point in time and does not allow for causal inferences between Mpox infection and the development of anxiety, depression, or PTSD. Longitudinal studies are needed to understand the long-term psychological effects of Mpox. Second, reliance on self-reported data may introduce information bias, particularly in reporting symptoms and experiences. This may have underestimated the prevalence of mental health disorder in the current study and biased our associations towards null. Third, the absence of pre-infection mental health data limits our ability to determine whether some symptoms were pre-existing. To mitigate this, individuals with a known history of mental illness were excluded from participation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eApproximately one in five mpox survivors in this study experienced a mental health disorder during illness or recovery, underscoring the significant psychological impact of mpox. Several factors were significantly associated with an increased prevalence of mental health disorders, including longer hospitalization (\u0026gt;\u0026thinsp;14 days), being a sex worker, perceived poor quality of care at the treatment unit, moderate to severe disease symptoms, and experiencing stigma. These findings highlight the multifaceted nature of post-Mpox recovery and the urgent need to integrate mental health support into outbreak response and survivor care. Beyond clinical management, tailored interventions could address key psychosocial factors, including the quality of care received during hospitalization, experiences of stigma, and the availability of social and occupational support systems. Healthcare providers should consider adopting a holistic approach that prioritizes both physical and psychological recovery. Future studies should explore the long-term mental health outcomes of Mpox survivors and to better inform the development of context-specific, evidence-based mental health interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCDC: Centers for Disease Control and Prevention; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, fifth edition; HADs: Hospital anxiety and depression scale; MoH: Ministry of Health; MHP: Mental health problems; PCL-5: PTSD checklist from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition; PTSD: Posttraumatic stress disorder; KMA: Kampala Metropolitan Area\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was in response to a public health emergency and was therefore determined to be non-research. The Ministry of Health (MoH) gave permission to conduct this study among the survivors of the mpox outbreak. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. §§See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq. All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda Ministry of Health and were performed in accordance with the Declaration of Helsinki. Prior to data collection, informed consent was obtained from all the participants who were above 18 years (legal age in Uganda). For those below 18 years, consent was sought from their parents/guardians and assent was also obtained from them to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipation in this study was entirely voluntary. All eligible participants were informed about the study objectives (including publication as an output), procedures, potential risks, and benefits in a language they understood. Written (or thumbprint) consent was obtained before data collection. Participants were assured of confidentiality, the right to refuse to answer any questions, and the option to withdraw at any time without any repercussions. Data collected were anonymized and used solely for research purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets upon which our findings are based belong to the Uganda Public Health Fellowship Program. For confidentiality reasons, the datasets are not publicly available. The datasets can be availed upon reasonable request from the corresponding author with permission from the Uganda National Institute of Public Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding and disclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Korea Foundation for International Healthcare (KOFIH) under the project titled, “Strengthening Health Systems to Prevent, Detect and Respond to Infectious Diseases in Uganda,” implemented in collaboration with the Uganda National Institute of Public Health (UNIPH) and the Ministry of Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEOO conceptualized the study idea, participated in data collection, analyzed data collected, and wrote draft zero of the manuscript;\u0026nbsp;JM, EM, JOK, JN, CM, PK, GA, BA and VN, supported in data collection; RM, KOK, HLS, IL, DA, PK, RK, IP, LB, BK and ARA\u0026nbsp;supported in editing, and reviewing of the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate and acknowledge the support rendered by all the division staff of Kampala City Council Authority especially the Division surveillance focal persons and the implementing partners that supported in the identification and investigation of mpox cases. Much appreciation to KIFIH for the funding support and the Uganda Field Epidemiology Training Program, for the technical oversight. We in a special way want to appreciate and acknowledge our research assistants Dorothy Aliro, Ken Enabu Okalany and Sylvia Iradikunda for their efforts in data collection.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZ\u0026uuml;rcher SJ, Kerksieck P, Adamus C, Burr CM, Lehmann AI, Huber FK, et al. 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An evaluation of psychological distress and social support of survivors and contacts of Ebola virus disease infection and their relatives in Lagos, Nigeria: a cross sectional study \u0026minus; 2014. BMC Public Health. 2015 Aug 27;15(1):824. \u003c/li\u003e\n\u003cli\u003eAcharibasam JW, Chireh B, Menegesha HG. Assessing anxiety, depression and insomnia symptoms among Ebola survivors in Africa: A meta-analysis. PLOS ONE. 2021 Feb 5;16(2):e0246515. \u003c/li\u003e\n\u003cli\u003eTucci V, Moukaddam N, Meadows J, Shah S, Galwankar SC, Kapur GB. The Forgotten Plague: Psychiatric Manifestations of Ebola, Zika, and Emerging Infectious Diseases. J Glob Infect Dis. 2017 Dec;9(4):151. \u003c/li\u003e\n\u003cli\u003eMpox [Internet]. [cited 2024 Nov 29]. Available from: https://www.who.int/news-room/fact-sheets/detail/mpox\u003c/li\u003e\n\u003cli\u003eOrsini D, Sartini M, Spagnolo AM, Cristina ML, Martini M. Mpox:\u0026ldquo;the stigma is as dangerous as the virus\u0026rdquo;. Historical, social, ethical issues and future forthcoming. J Prev Med Hyg. 2024;64(4):E398. \u003c/li\u003e\n\u003cli\u003eBrooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The lancet. 2020;395(10227):912\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eChew QH, Wei KC, Vasoo S, Chua HC, Sim K. Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: practical considerations for the COVID-19 pandemic. Singapore Med J. 2020 Jul;61(7):350\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eSnaith RP. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes. 2003 Aug 1;1(1):29. \u003c/li\u003e\n\u003cli\u003eGeier TJ, Hunt JC, Nelson LD, Brasel KJ, deRoon-Cassini TA. Detecting PTSD in a traumatically injured population: The diagnostic utility of the PTSD Checklist for DSM-5. Depress Anxiety. 2019;36(2):170\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAgaba B, Nelly HN, Wanyana MW, Zalwango JF, Simbwa B, Akunzirwe R, et al. Prevalence of and factors associated with anxiety, depression and post-traumatic stress disorder among Sudan ebolavirus disease survivors and family members, Uganda, January 2023: a cross-sectional study. Discov Psychol. 2024 Jul 22;4(1):87. \u003c/li\u003e\n\u003cli\u003eMartinez BAF, Leotti VB, Silva G de S e, Nunes LN, Machado G, Corbellini LG. Odds Ratio or Prevalence Ratio? An Overview of Reported Statistical Methods and Appropriateness of Interpretations in Cross-sectional Studies with Dichotomous Outcomes in Veterinary Medicine. Front Vet Sci [Internet]. 2017 Nov 10 [cited 2025 Feb 3];4. Available from: https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2017.00193/full\u003c/li\u003e\n\u003cli\u003eFu L, Wang B, Wu K, Yang L, Hong Z, Wang Z, et al. Epidemiological characteristics, clinical manifestations, and mental health status of human mpox cases: A multicenter cross-sectional study in China. J Med Virol. 2023;95(10):e29198. \u003c/li\u003e\n\u003cli\u003eTorales J, Barrios I, Castaldelli-Maia JM, Ventriglio A. The Mpox outbreak is a public health emergency of international concern: Implications for mental health and global preparedness. Int J Soc Psychiatry. 2025 Feb 1;71(1):203\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAhmed SK, Abdulqadir SO, Hussein SH, Omar RM, Ahmed NA, Essa RA, et al. The impact of monkeypox outbreak on mental health and counteracting strategies: A call to action. Int J Surg. 2022 Oct;106:106943. \u003c/li\u003e\n\u003cli\u003eKaputu-Kalala-Malu C, Musalu EM, Walker T, Ntumba-Tshitenge O, Ahuka-Mundeke S. PTSD, depression and anxiety in Ebola virus disease survivors in Beni town, Democratic Republic of the Congo. BMC Psychiatry. 2021 Dec;21(1):342. \u003c/li\u003e\n\u003cli\u003eKumar M, Akbarialiabad H, Kouhanjani MF, Kiburi S, Shidhaye P, Taghrir MH, et al. Association of major disease outbreaks with adolescent and youth mental health in low-and middle-income countries: a systematic scoping review. JAMA Psychiatry. 2022;79(12):1232\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eMatalon N, Dorman-Ilan S, Hasson-Ohayon I, Hertz-Palmor N, Shani S, Basel D, et al. Trajectories of post-traumatic stress symptoms, anxiety, and depression in hospitalized COVID-19 patients: A one-month follow-up. J Psychosom Res. 2021 Apr 1;143:110399. \u003c/li\u003e\n\u003cli\u003eLucijanic D, Mihaljevic Peles A, Piskac Zivkovic N, Lucijanic M, Kranjcevic M, Muzinic Marinic L. Relationship of Anxiety, Depression, Stress, and Post-Traumatic Stress Disorder Symptoms with Disease Severity in Acutely Ill Hospitalized COVID-19 Patients. Behav Sci. 2023 Sep;13(9):734. \u003c/li\u003e\n\u003cli\u003eSullivan E, Shelley J, Rainey E, Bennett M, Prajapati P, Powers MB, et al. The association between posttraumatic stress symptoms, depression, and length of hospital stay following traumatic injury. Gen Hosp Psychiatry. 2017 May 1;46:49\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eR\u0026ouml;ssler W, Koch U, Lauber C, Hass AK, Altwegg M, Ajdacic-Gross V, et al. The mental health of female sex workers. Acta Psychiatr Scand. 2010;122(2):143\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003eMart\u0026iacute;n-Romo L, Sanmart\u0026iacute;n FJ, Velasco J. Invisible and stigmatized: A systematic review of mental health and risk factors among sex workers. Acta Psychiatr Scand. 2023;148(3):255\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eAlzahrani N. The effect of hospitalization on patients\u0026rsquo; emotional and psychological well-being among adult patients: An integrative review. Appl Nurs Res. 2021 Oct 1;61:151488. \u003c/li\u003e\n\u003cli\u003eWeber C, Monero Flores V, Wheele TP, Miedema E, White EV. Patients\u0026rsquo; Health \u0026amp;amp; Well-Being in Inpatient Mental Health-Care Facilities: A Systematic Review. Front Psychiatry [Internet]. 2022 Jan 3 [cited 2025 Apr 5];12. Available from: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.758039/full\u003c/li\u003e\n\u003cli\u003eHatch R, Young D, Barber V, Griffiths J, Harrison DA, Watkinson P. Anxiety, Depression and Post Traumatic Stress Disorder after critical illness: a UK-wide prospective cohort study. Crit Care. 2018 Nov 23;22(1):310. \u003c/li\u003e\n\u003cli\u003eJames PB, Wardle J, Steel A, Adams J. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Trop Med Int Health. 2019;24(6):671\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eSmith AKJ, Storer D, Lancaster K, Haire B, Newman CE, Paparini S, et al. Mpox Illness Narratives: Stigmatising Care and Recovery During and After an Emergency Outbreak. Qual Health Res. 2024 Oct 1;34(12):1161\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eNerlich B, Jaspal R. Mpox in the news: social representations, identity, stigma and coping. Med Humanit. 2025 Mar 1;51(1):161\u0026ndash;71. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Uganda, Mpox, Anxiety, Depression, Post traumatic stress disorder. Mental health","lastPublishedDoi":"10.21203/rs.3.rs-7252487/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7252487/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Uganda declared a monkeypox (mpox) outbreak on July 24, 2024; by the year’s end, 1,353 cases had been reported in 55 districts, two-thirds of them in the Kampala Metropolitan Area (KMA). Epidemics, including mpox have negative mental health impacts that are often overlooked during emergency response. We assessed the prevalence and associated factors of anxiety, depression, and posttraumatic stress disorder (PTSD) among mpox survivors in the most affected districts in Uganda.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted a cross-sectional community-based study from February 1–28, 2025, using simple random sampling of mpox survivors from Kampala, Mukono, and Wakiso districts. Survivors were selected from district-specific lists. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and PTSD using the PTSD Checklist. Modified Poisson regression was used to identify associated factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eWe enrolled 385 participants with a median age of 29 years (IQR: 25–35); 60% were female, and 59% of these were sex workers. The prevalence of anxiety, depression, and PTSD was 11% (n=43; 95% CI: 8%–14%), 14% (n=53; 95% CI: 11%–18%), and 9% (n=33; 95% CI: 6%–12%), respectively. Overall, 22% (n=84; 95% CI: 18%–26%) reported 1 mental health disorder. Factors associated with increased prevalence of mental health disorders included longer treatment unit stay (\u0026gt;14 days) (aPR=2.1; 95% CI: 1.4–3.2), being a sex worker (aPR=1.7; 95% CI: 1.1–2.8), perceived poor management at the treatment unit (aPR=2.7; 95% CI: 1.4–4.9), moderate (aPR=2.5; 95% CI: 1.3–4.7) or severe Mpox symptoms (aPR=5.3; 95% CI: 3.2–9.7), and perceived stigma (aPR=2.1; 95% CI: 1.4–3.3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Approximately one in five mpox survivors experienced a mental health disorder during illness or recovery, underscoring the psychological impact of the disease. Key associated factors included prolonged hospitalization, sex work, perceived poor care, severe symptoms, and stigma. These findings highlight the need to integrate mental health support into Mpox response efforts through tailored interventions that address stigma, care quality, and social support.\u003c/p\u003e","manuscriptTitle":"Post-traumatic stress disorder, depression and anxiety among mpox survivors in central Uganda: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 10:09:05","doi":"10.21203/rs.3.rs-7252487/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"499d29ef-5c49-4f26-b366-768eb5234bee","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-18T18:23:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-01 10:09:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7252487","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7252487","identity":"rs-7252487","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}