Bridging Knowledge and Practice Gaps in Lassa Fever Prevention: Awareness, Attitudes, and Infection Control Measures Among Healthcare Workers and Residents in Edo, Ondo, and Kwara States (Preprint)

BACKGROUND Lassa fever, an acute viral hemorrhagic illness endemic in West Africa, remains a significant public health concern in Nigeria, particularly in Edo, Ondo, and Kwara States. Despite recurrent outbreaks, limited data exist on the knowledge, attitudes, and practices (KAP) of residents and healthcare personnel across these states, creating a critical research gap. Effective prevention and control require a thorough understanding of these factors to inform targeted interventions and policy decisions. OBJECTIVE This study aimed to assess the KAP of residents and primary healthcare (PHC) personnel regarding Lassa fever across Edo, Ondo, and Kwara States. Specifically, it examined awareness levels, preventive behaviors, misconceptions about transmission, and compliance with infection control measures, including the use of personal protective equipment (PPE). The findings provide insights for evidence-based interventions to reduce the burden of Lassa fever in these endemic regions. METHODS A cross-sectional survey was conducted among 3,582 residents and 540 PHC personnel across Edo, Ondo, and Kwara States. Data were collected through structured questionnaires assessing knowledge, attitudes, and practices related to Lassa fever. Statistical analyses, including cross-tabulations and the Relative Importance Index (RII), were employed to identify patterns and disparities across different residential and professional groups. RESULTS Among residents, 80.1% recognized Lassa fever as a severe illness, yet only 6.9% had participated in awareness campaigns. Preventive behaviors were inadequate, with only 12.1% storing food in rodent-proof containers and 25.4% engaging in frequent environmental sanitation. Knowledge gaps persisted, as only 3% were aware of the disease’s 1–21-day incubation period, and 0.3% acknowledged sexual transmission. Socioeconomic disparities significantly influenced compliance with sanitation measures (p < 0.001), with higher-income households demonstrating better adherence. Furthermore, preventive practices such as using traps (14.5%) and participating in sanitation campaigns (6.8%) varied significantly by residence type (p < 0.001). PHC personnel demonstrated strong theoretical knowledge, with an RII of 0.960 for key facts, including the classification of Lassa fever as a viral hemorrhagic illness and the identification of rats as primary reservoirs. However, only 84% recognized alternative reservoirs such as bats and mosquitoes. PPE adherence was poor, particularly for facemasks and eye protection (RII = 0.217), highlighting significant gaps in infection control practices. CONCLUSIONS The study reveals critical gaps in awareness, preventive behaviors, and infection control measures across Edo, Ondo, and Kwara States. While healthcare workers displayed strong theoretical knowledge, practical compliance with PPE use was insufficient, posing a risk of disease transmission. Addressing these gaps is essential for effective Lassa fever control. Targeted health education campaigns should be implemented to enhance public awareness and dispel misconceptions about Lassa fever transmission. Strengthened training programs for PHC personnel, stricter PPE compliance policies, and improved access to sanitation resources should be prioritized. Additionally, community-based interventions, including regular environmental sanitation and rodent control, should be encouraged to reduce exposure risks. Bridging the knowledge and practice gaps in Lassa fever prevention is essential to mitigating outbreaks, reducing fatalities, and strengthening public health resilience in Edo, Ondo, Kwara States, and other endemic regions.