This descriptive cross-sectional study assessed the knowledge, attitudes and practices of Lassa fever in and around Lafia, Central Nigeria. Structured questionnaires were administered to 200 consenting respondents from urban and sub-urban areas in Lafia. Of the 200 respondents, 87% heard of Lassa fever with 89% and 80% from urban and sub-urban areas. There was no significant difference on the awareness of Lassa fever among respondents from urban and sub-urban areas (P>0.05). There was misperception about species affected and modes of transmission of the disease, nevertheless bleeding was mentioned by 39% of the respondents as the major clinical manifestation. Also, 83% of the respondents had rats/rodents in and around their residence, of which 28% come into contact with urine/feaces of the rodents and 24% consume foods contaminated by the rodents. However, 85% of the respondents do not believe in the existence of Lassa fever. Most respondents (41%) reported that they will show some discriminatory attitudes towards individuals suspected or having Lassa fever. Furthermore, 67% of the respondents were optimistic to accept possible vaccine candidate against the disease. Public health awareness especially among the sub-urban dwellers should be intensified so as to reduce the spread of both the vector and the virus.

1. Knowledge, Attitudes and Practices of Lassa Fever in and Around Lafia, Central Nigeria
IJPHER
Knowledge, attitudes and practices of Lassa fever in
and around Lafia, Central Nigeria
Rine C. Reuben1
* and Silas D. Gyar2
1
Department of Science Laboratory Technology, Nasarawa State Polytechnic, Nigeria
2
Department of Biological Sciences, Nasarawa State University, Keffi, Nigeria.
This descriptive cross-sectional study assessed the knowledge, attitudes and practices of
Lassa fever in and around Lafia, Central Nigeria. Structured questionnaires were administered
to 200 consenting respondents from urban and sub-urban areas in Lafia. Of the 200
respondents, 87% heard of Lassa fever with 89% and 80% from urban and sub-urban areas.
There was no significant difference on the awareness of Lassa fever among respondents from
urban and sub-urban areas (P>0.05). There was misperception about species affected and
modes of transmission of the disease, nevertheless bleeding was mentioned by 39% of the
respondents as the major clinical manifestation. Also, 83% of the respondents had rats/rodents
in and around their residence, of which 28% come into contact with urine/feaces of the rodents
and 24% consume foods contaminated by the rodents. However, 85% of the respondents do not
believe in the existence of Lassa fever. Most respondents (41%) reported that they will show
some discriminatory attitudes towards individuals suspected or having Lassa fever.
Furthermore, 67% of the respondents were optimistic to accept possible vaccine candidate
against the disease. Public health awareness especially among the sub-urban dwellers should
be intensified so as to reduce the spread of both the vector and the virus.
Key words: Attitude, knowledge, Lassa fever, practice, zoonotic.
INTRODUCTION
Lassa fever (LF) is an acute viral hemorrhagic fever that
was first described in 1969 in the town of Lassa in the
North-East of Nigeria (Frame et al., 1970; Ajayi et al.,
2013). It is caused by a single-stranded RNA virus of the
family Arenaviridae. It is an endemic disease in the West
African sub-region (Nigeria, SierraLeone, Guinea, and
Liberia) where about 3-5 million individuals are infected
yearly (Fichet-Calvet and Rogers, 2009). There have
been reports of outbreaks in Ghana and Ivory Coast,
however, several imported cases with hazardous
outcomes have been reported in countries where it is not
endemic (Bowen et al., 2000; Atkin et al., 2009).It is a
severe hemorrhagic fever that presents with fever,
general weakness, headache, sore throat, muscle pain,
cough, chest pain, nausea, vomiting, diarrheoa,
abdominal pain with or without bleeding. It can cause
deafness which has psychosocial impact on the victim as
well as other multisystem complications (Ogbu and
Uneke, 2007). The clinical features are similar to other
febrile illnesses such as malaria and typhoid fever. In
about 80% of people infected the disease has mild or no
symptoms (Richmond and Baglole, 2004).
*Corresponding Author’s: Rine Christopher Reuben,
Department of Science Laboratory Technology,
Nasarawa State Polytechnic, Nigeria. Email:
reubenrine@yahoo.com
International Journal of Public Health and Epidemiology Research
Vol. 2(1), pp. 014-019, January, 2016. © www.premierpublishers.org. ISSN: 2167-0449
Research Article

2. Knowledge, Attitudes and Practices of Lassa Fever in and Around Lafia, Central Nigeria
Reuben and Gyar 014
Although the multimammate rat, Mastomysnatalensis is
widely regarded as the reservoir of infection (Monath et
al, 1974), M. erythroleucus and M. hildbrandtii have also
been proposed to be reservoirs (Anyanwu and
Nwaopara, 2005; CDC, 2004). It is an epidemic prone
disease. The significance of Lassa fever as an epidemic-
prone disease is indicated by an alert threshold of a
single suspected case and an epidemic threshold of a
single confirmed case (FMOH, Nigeria, 2005; 2009).
LF is an emerging disease with devastating and life
threatening potentials. According to WHO statistics, an
estimated 300 000-500 000 cases and 5000 death occurs
each year worldwide. The case-fatality rate as estimated
by WHO is 1% 15% among hospitalized patients within
14 days of onset in fatal cases (WHO, 2005). The
prevalence of antibodies to the virus in the population is
8-52% in Sierra Leone, 6.4-55% in Guinea, and 7-21% in
Nigeria (Richmond and Baglole, 2004). There have been
reported cases of suspected Lassa fever in Nasarawa,
Edo, Ondo, Gombe, Taraba, Bauchi, Ebonyi, Anambra,
Yobe, Rivers and Plateau States of Nigeria (Ogbu et al,
2007; NCDC, 2012; 2014).
Despite the epidemic and highly contagious nature of LF
in Nigeria and other African countries, the details of
outbreaks and subsequent responses to contain it have
not been well documented in these places, and it is
difficult to learn from these experiences to improve the
management of future outbreaks (Ajayi et al., 2013).
Available Nigerian reports have focused mainly on a
nosocomial outbreaks that occurred almost two decades
ago (Fisher-Hoch et al., 1995), or more recently on
laboratory diagnosis of blood samples of suspected
cases sent to a national reference laboratory (Omilabu et
al., 2005; Ehichioya et al., 2010).This study therefore set
out to assess the knowledge, attitudes and practices of
LFamong individuals in and around Lafia, central Nigeria
and to identify the risk factors associated with LF and the
level of preparedness to LF epidemic.
MATERIALS AND METHODS
Study Area and Population
The study was carried out in Lafia, the capital of
Nasarawa State located in North central geopolitical zone
of Nigeria. Lafia is densely populated with 330,712
inhabitants (Census, 2006). It is located on latitude 8
o
28’N and longitude 8
o
31’E (Hogben et al., 2013), a
sizable area characterized by poor drainage and
sanitation with garbage dumps in close proximity to
residential buildings. These serve as favourable
environments for the breeding of animal reservoir
(multimammate rat) of LF.
Sample Size and its determination: The sample size
was determined using the formula described by
Thrusfield, (1995), using a community awareness
prevalence of 17.2% (Olayinka et al., 2015), 200
respondents were enrolled for this study.
Study Design and Data collection
The study was designed to be a cross-sectional
descriptive study. Self-administered semi-structured
questionnaires were used for data collection from
consenting respondents. The questionnaires captured
information on sociodemographic variables, knowledge,
attitudes and practices regarding Lassa fever.
Ethical Consideration
Informed consent was obtained from the respondents.
They were made to understand that participation is
voluntary and there was no consequence for non-
participation. All information obtained was kept
confidential.
Data Analysis
Information collected from the respondents were entered
and analyzed with Statistical Package for Social Sciences
version (SPSS) 15 software. Descriptive statistics were
done and frequencies and proportions were used to
summarize variables of interest.
RESULTS
Table 1 shows the profiles of the respondents from the
urban (155) and sub-urban (45) areas. Among the 200
respondents, 109 were male and 91 were females.
Majority of the respondents’ age groups included in the
range of 21 – 25 and 16 – 20 years and 66.5% of the
respondents have attended higher education. Most of the
respondents are singles (70.5%), Christians (78.5%) and
are involved in other forms of occupation (56%).
Table 2 shows the Knowledge of the Respondents on
Lassa fever. Most (87%) were aware of the disease.
Majority of the respondents (41.5% and 50%) described
virus as the cause of the disease and rats only as the
species affected while 47% indicated that contact with the
urine of rats only is the mode of transmitting LF. Among
the 200 respondents, 71.5% were aware that rats only
are the animal species affected and 39% claimed that
bleeding manifestations was the obvious clinical
manifestation of LF.
As indicated in table 3, 166 (83%) of the respondents
indicated the presence of rats/rodents in and around their
residence. Some respondents; 57.5%, 24% and 28%
believed that rodents have contact with their foods, they
feed on rodents contaminated foods and they come in
contact with urines, faeces e.t.c of rodents respectively.
Although 33% of the respondents feed on rodents, 85%
do not believe that Lassa fever virus exists. Majority

3. Knowledge, Attitudes and Practices of Lassa Fever in and Around Lafia, Central Nigeria
Int. J. Pub. Health Epidemiol. Res. 015
Table 1. Sociodemographic Characteristics of Respondents
Number and Percentage of Respondents
Characteristic of Respondents Total(%) Urban(%) Sub-urban(%)
n = 200 n= 155 n= 45
Sex
Male 109 (54.5) 85 (54.8) 24 (53.3)
Female 91 (45.5) 70 (45.2) 21 (46.7)
Age group
<15 10 (5.0) 6 (3.9) 4 (8.9)
16-20 59 (29.5) 52 (33.5) 7 (15.6)
21-25 63 (31.5) 46 (29.7) 17 (37.8)
26-30 35 (17.5) 26 (16.8) 9 (20.0)
30> 33 (16.5) 25 (16.1) 8 (17.8)
Level of Education
Cannot read and write ` 5 (2.5) 2 (1.3) 3 (6.7)
Informal (read and write only) 15 (7.5) 6 (3.9) 9 (20.0)
Primary school 15 (7.5) 7 (4.5) 8 (17.8)
Secondary school 32 (16.0) 18 (11.6) 14(31.1)
Higher education 133 (66.5) 122 (78.7) 11 (24.4)
Occupation
Health profession 26 (13.0) 22 (14.2) 4 (8.9)
Farmer 16 (8.0) 10 (6.5) 6 (13.3)
Merchant 7 (3.5) 6 (3.9) 1 (2.2)
House wife 16 (8.0) 11 (7.1) 5 (11.1)
Jobless 23 (11.5) 15 (9.7) 8 (17.8)
Others 112 (56.0) 91 (58.7) 21 (46.7)
Marital status
Single 141 (70.5) 109 (70.3) 32 (71.1)
Married 54 (27.0) 43 (27.7) 11 (24.4)
Divorced 2 (1.0) 1 (0.6) 1(2.2)
Widow 3 (1.5) 2 (1.3) 1 (2.2)
Religion
Christian 157 (78.5) 125 (80.6) 32 (71.1)
Muslim 38 (19.0) 26 (16.8) 12 (26.7)
Pagan 5 (2.5) 4(2.6) 1 (2.2)
(57%) do not have knowledge of any survival of LF and
43.5%) believed that age group 26-30 years are the most
vulnerable group at risk of the disease. With regards to
attitudes towards people suspected to be infected with
LF, 41% of the respondents indicated that they will show
some discriminatory attitude towards people suspected/
having Lassa fever. Most of the respondents (71%)
agree that if a person has been diagnosed with LF,
he/she must be admitted in Lassa fever treatment centre
while 67% accept to take an approved vaccine that could
prevent LF.
DISCUSSION
The result of the current study has revealed the
importance of LF in the study area. The questionnaire
survey on public awareness indicated that 87% of the
respondents had heard about Lassa fever from different
sources, with 89% and 80% from urban and sub-urban
areas respectively. This finding was in agreement with
the report (82.2%) from Owo, Ondo State, Nigeria by
Olayinka et al. (2015). However, Ochei et al. (2014)
reported a higher proportion (93.1%) in Irrua (an endemic
area) among households in Edo State, Nigeria.
Nevertheless, in Edo State 95% of studied health workers
were aware of LF (Tobin et al., 2013). The apparently
higher levels of knowledge in this study may be due to
the greater attention given to the disease, both by the
government and the press, especially during the recent
outbreak in 2014. Nevertheless, LF in Nasarawa State
and Nigeria is yet to gain the political attention it deserves
by all tiers of government. Respondents from the urban
area were more aware (89%) of LF than those from the
sub-urban (80%). This may be attributed to the easy and
constant access to health information by the urban
dwellers from different sources. More so, they are more
enlightened and have direct access to health care
facilities.
Among the respondents, 19 (9.5%) and 63 (31.5%) had
misunderstanding on the cause of LF, attributing it to
bacteria and animals while 35 (17.5%) do not have

4. Knowledge, Attitudes and Practices of Lassa Fever in and Around Lafia, Central Nigeria
Reuben and Gyar 016
Table 2. Knowledge of the Respondents on Lassa fever
Number and Percentage of Respondents
Parameter Total(%) Urban(%) Sub-urban(%)
n = 200 n= 155 n= 45
Awareness about Lassa fever
Yes 174 (87.0) 138(89.0) 36 (80.0)
No 26 (13.0) 17 (11.0) 9 (20.0)
Cause of Lassa fever
Virus 83 (41.5) 61 (39.4) 22 (48.9)
Bacterium 19 (9.5) 16 (10.3) 3 (6.7)
Animal 63 (31.5) 54 (34.8) 9 (20.0)
I don’t know 35 (17.5) 24 (15.5) 11 (24.4)
Species affected by Lassa fever virus
Rats only 100 (50.0) 77 (49.7) 23 (51.1)
Rats and human 15 (7.5) 11 (7.1) 4 (8.9)
Human and other animals 85 (42.5) 67 (43.2) 18 (40.0)
Means of transmission
Contact with the urine of rats only 94 (47.0) 70 (45.2) 24 (53.3)
Contact with faeces of rats only 6 (3.0) 5 (3.2) 1 (2.2)
Eating bush meat 39 (19.5) 28 (18.1) 11 (24.4)
Exposure to open cuts or sores 7 (3.5) 6 (3.9) 1 (2.2)
Other fluids from an infected person 54 (27.0) 46 (29.7) 8 (17.8)
Animal species that transmit Lassa fever virus to human
Rabbits only 10 (5.0) 21 (13.5) 4 (8.9)
Rats only 143 (71.5) 96 (61.9) 32 (71.1)
Rats and squirrels 33 (16.5) 26 (16.8) 7 (15.6)
Other animals 14 (7.0) 12 (7.7) 2 (4.4)
Signs and symptoms of Lassa fever
Sore throat 28 (14.0) 21 (13.5) 7 (15.6)
Restrosternal pain and cough 33 (16.5) 26 (16.8) 7 (15.6)
Bleeding manifestations 78 (39.0) 58 (37.4) 20 (44.4)
Nausea and vomiting 52 (26.0) 42 (27.1) 10 (22.2)
Gastrointestinal manifestation 9 (4.5) 8 (5.2) 1 (2.2)
knowledge of the cause of LF. Also, the respondents
believed that rats are the only species affected by the
disease, the misunderstanding are higher in sub-urban
area. With regards to transmission, most of the
respondents (47%) and (27%) believed that contact with
the urine of rats alone and other fluids from infected
persons are the modes of transmission of LF.
According to the current findings, the respondents have
good knowledge of the signs and symptoms of LF from
both the urban and from sub-urban areas. Sore throat,
restrosternal pain and cough, bleeding manifestation,
nausea and vomiting and gastrointestinal manifestations
were pointed out by 14%, 16.5%, 39%, 26% and 4.5%) of
the respondents respectively. This is similar to the
findings of Tobin et al. (2013) and Olayinka et al. (2015).
Majority (83%) of the respondents; 82.6% and 84.4%
from urban and sub-urban areas indicated the presence
of rats and other rodents in and around their residence.
Some of the respondents 24%, 28% and 33% feed on
food contaminated by rodents, come in contact with
urine/faeces/other products of rodents and consume
rodents. Although rodent consumption is quite common in
the study area as a form of delicacy, was recognized as a
risk factor for the transmission of LF. It is possible that
though the respondents were aware that the
multimammate rats (Mastomysnatalensis) are the vector
for the transmission of LF, they might find it difficult to
stop the consumption because it is considered as a
cheap source of meat. A study in Republic of Guinea
have shown that rodent infestation was much higher,
food was more often stored uncovered and most
strikingly, peridomestic rodents were hunted as a protein
source by 91.5% of the population (TerMeulen et al.,
1996). Furthermore, most of the respondents (85%) do
not believed in the existence of LF virus, that is why most
of them feed on rodents and foods contaminated by
rodents without caution. Bonner et al. (2007) stated that
the poorer state of houses increase risk for rodents
infestation and for transmission of Lassa virus in the
houses’ immediate surroundings. Also, the use of houses
for both residential and commercial purposes also had
increased risk for transmission of LF disease (Ochei et
al., 2014). Findings by Olayinka et al. (2015), stated that
good housing standard and clean environment are
recognized as part of the methods of preventing and
controlling the spread of LF; this is an effective method to

5. Knowledge, Attitudes and Practices of Lassa Fever in and Around Lafia, Central Nigeria
Int. J. Pub. Health Epidemiol. Res. 017
Table 3. Attitudes and Practices of Respondents
Number and Percentage of Respondents
Parameter Total(%) Urban(%) Sub-urban(%)
n = 200 n= 155 n= 45
Are there rats or Rodents in/around your house?
Yes 166 (83.0) 128 (82.6) 38 (84.4)
No 34 (17.0) 27 (17.4) 7 (15.6)
Do rodents have contact with your foods?
Yes 115 (57.5) 90 (58.1) 25 (55.6)
No 85 (42.5) 65 (41.9) 20 (44.4)
Do you feed on rodents contaminated foods?
Yes 48 (24.0) 34 (21.9) 14 (31.1)
No 152 (76.0) 121 (78.1) 31 (68.9)
Do you have contact with urines, faeces e.t.c of rodents?
Yes 56 (28.0) 45 (29.0) 11 (24.4)
No 144 (72.0) 110 (71.0) 34 (75.6)
Do you eat rodents?
Yes 66 (33.0) 52 (33.5) 14 (31.1)
No 134 (67.0) 103 (66.5) 31 (68.9)
Do you believe Lassa fever virus exists?
Yes 170 (85.0) 130(83.9) 40 (88.9)
No 30 (15.0) 25 (16.1) 5 (11.1)
Have you heard of people that have survived Lassa fever?
Yes 86 (43.0) 67 (43.2) 19 (42.2)
No 114 (57.0) 88 (56.8) 26 (57.8)
Age group at risk
<15 17 (8.5) 15 (9.7) 2 (4.4)
16-20 56 (28.0) 45 (29.0) 11 (24.4)
21-25 24 (12.0) 21 (13.5) 3 (6.7)
26-30 87 (43.5) 61 (39.4) 26 (57.8)
31> 16 (8.0) 13 (8.4) 3 (6.7)
Attitudes towards people suspected to be infected with Lassa fever
Would keep the
Information secret if a 71 (35.5) 59 (38.1) 12 (26.7)
Family member contact
Lassa Fever .
Would not buy from a shopkeeper 47 (23.5) 35 (22.6) 12 (26.7)
who had contacted Lassa Fever.
Would show some discriminatory
attitude towards people 82 (41) 61 (39.4) 21 (46.7)
suspected or having lassa Fever
Attitudes towards treatment options of people infected/suspected with Lassa fever
Agree that if a person has been
diagnosed with Lassa Fever 142 (71) 105 (67.7) 37 (82.2)
he/she must be admitted in Lassa
fever treatment centre.
Agree that people who have direct
contact with a person who has been 58 (29) 50 (32.3) 8 (17.8)
diagnosed with Lassa fever must be
quarantined for some weeks
Attitudes towards vaccines against Lassa fever
Accept to take an approved
vaccine that could prevent 134 (67.0) 106 (68.4) 28 (62.2)
Lassa fever.
Accept to give an approved
vaccine to my children that 66 (33.0) 49 (31.6) 17 (37.8)
could prevent Lassa fever.
control the vector. Similar studies conducted in Sierra
Leone have shown that there is a significant relationship
between poor housing quality and external hygiene and
rodent burrows (Kelly et al., 2003; Moses et al., 2009).

6. Knowledge, Attitudes and Practices of Lassa Fever in and Around Lafia, Central Nigeria
Reuben and Gyar 018
With regards to attitudes of the respondents towards
people suspected to be infected with LF, 41% of the
respondents would show some discriminatory attitudes
towards such individuals whereas 35.5% will keep the
information secret if a family member is suspected to be
infected with LF. Whereas 71% agreed that individuals
diagnosed with LF must be admitted in LF treatment
centre, 29% agreed that those tested positive for LF must
be quarantined for some weeks. Attitudes of the
respondents towards vaccination against LF showed that
67% will accept to take vaccine against LF whereas 33%
will accept to give such vaccines to their children/wards
as a preventive measure against the disease.
Respondents were generally ignorant of the nonexistence
of a vaccine for the disease as noted in a study by Tobin
et al. (2013). The absence of a vaccine calls for higher
attention to prevention of infection particularly among
vulnerable individuals in the study area and other
endemic regions.
The high virulence, significant mortality and morbidity and
non-specific mode of presentation of LF has made it to
become a disease of public health significance not just at
the community level but also at the international/global
level. It is therefore important that campaigns and
counselling should be carried out to create awareness
about the disease.
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Accepted 11 January, 2016.
Citation: Reuben CR, Gyar SD (2016). Knowledge,
attitudes and practices of Lassa fever in and around
Lafia, Central Nigeria. International Journal of Public
Health and Epidemiology Research, 2(1): 014-019.
Copyright: © 2016 Reuben and Gyar. This is an open-
access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium,
provided the original author and source are cited.