Household Practices Sustaining Lassa Fever Transmission in Hyperendemic Communities of Edo State, Nigeria

Household Practices Sustaining Lassa Fever Transmission in Hyperendemic Communities of Edo State, Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Household Practices Sustaining Lassa Fever Transmission in Hyperendemic Communities of Edo State, Nigeria Joseph Odunayo Igbokwe, Elvis Efe Isere, Olubunmi Adeyemi, Aduragbemi Adebayo, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8574897/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background Lassa fever (LF) remains a major public health threat in Nigeria, with Edo State constituting a hyperendemic hotspot. Despite high community awareness and ongoing public health interventions, transmission has persisted, suggesting that household-level practices play a critical role in sustaining LF transmission. This study investigated household practices associated with LF transmission in Ekpoma communities, Edo State. Methods An analytical cross-sectional study was conducted among household heads or representatives selected through multistage sampling between June and August 2023. Data on socio-demographics, LF knowledge, and household practices were collected using interviewer-administered questionnaire. Associations between household practices and reported household LF incidence within the preceding 12 months were assessed using chi-square test and multivariate logistic regression. Level of significance was set at P < 0.05. Results Among 303 respondents, more than half were male (58.1%) and middle-aged (mean age: 44.6 ± 17.8 years), with farmers (26.4%) and entrepreneurs (26.1%) constituting largest occupational groups. Although 92.4% reported LF awareness and 76.6% had received community sensitisation, most households reported rodent presence (93.7%), while 53.8% stored food in open containers and 19.1% stored food on floor. Multivariate analysis shows storing food on floor (AOR = 2.32; 95% CI: 1.09–4.93) and storing food in uncovered containers (AOR = 5.02; 95% CI: 1.21–20.86) significantly increased odds of household LF risk. Conclusion A critical knowledge-to-practice gap in LF prevention exists within households in hyperendemic communities in Nigeria, with unsafe food storage practices serving as key drivers of household LF risk. Preventive strategies should prioritise structural interventions, including rodent-proof food storage and community-led environmental management. Lassa fever Household practices Rodent control Endemic communities Nigeria Figures Figure 1 Introduction Lassa fever (LF) is a zoonotic, acute viral hemorrhagic illness caused by the Lassa virus (LASV), an enveloped, single-stranded bisegmented RNA virus belonging to the family Arenaviridae [ 1 – 4 ]. Since its clinical discovery in 1969 in Lassa village, Borno State, the disease has evolved from an occasional medical curiosity into a permanent public health crisis in West Africa [ 5 – 6 ]. The World Health Organization currently lists LF as a priority pathogen requiring urgent research and development due to its high case-fatality rate (CFR) and the absence of a licensed vaccine [ 7 ]. In Nigeria, the epidemiological profile of the disease has shifted from seasonal outbreaks to a perennial occurrence, with the Nigeria Centre for Disease Control reporting several confirmed cases and deaths annually [ 8 – 15 ]. As of epidemiological week 50, 2025, Nigeria has reported 1,097 confirmed LF cases with 201 deaths (CFR 18.3%) across 21 states and 103 Local Government Areas (LGAs), with Ondo, Bauchi, Edo, and Taraba accounting for 89% of cases. Edo State in Southern Nigeria serves as one of the national epicentre for LF, consistently accounting for a disproportionate share of the annual national burden and death from LF, particularly within the northern senatorial district of the state comprising administrative hubs like Ekpoma and Irrua [ 17 – 24 ]. The hyperendemicity of this region has been linked to a complex interplay of ecological factors and human behaviour that facilitate the continuous spillover of the virus from its primary reservoir, the "multimammate rat" ( Mastomys natalensis ), to human populations [ 9 , 11 , 25 – 26 ]. Unlike many other rodents, Mastomys species are highly synanthropic, as they thrive in and around human dwellings, utilising domestic spaces for food and shelter [ 27 – 30 ]. The transmission dynamics of LF are primarily driven by household-level interactions [ 11 , 31 – 32 ]. Direct transmission occurs through contact with rodent excreta (urine and feces), through contaminated surfaces or the ingestion of contaminated food materials [ 11 , 31 – 32 ]. Despite extensive public health campaigns, hyperendemic communities in Edo State exhibit a persistent knowledge-practice gap [ 11 , 33 ]. While community members often possess high levels of awareness regarding the symptoms and dangers of the disease, their adherence to preventive household practices remains suboptimal [ 11 , 33 – 34 ]. This disconnect suggests that household practices and behavioural drivers are not merely a result of ignorance but are deeply embedded in socioeconomic realities and traditional lifestyles [ 11 , 35 ]. Some of the reported household practices sustaining transmission include the improper storage of food items. In rural Edo State, many households store grains and flour in open containers or on the floor, providing easy access for rodents [ 11 , 35 ]. Furthermore, the common practice of spread-drying agricultural produce, such as cassava flakes (garri) and grains, along roadsides and open spaces exposes these food sources to rodent activity [ 11 , 35 ]. This environmental interface is a critical point of viral spillover, as the LASV can remain infectious in the environment for several days under specific humidity and temperature conditions [ 11 , 17 , 35 – 37 ] Cultural factors also play a pivotal role in sustaining the LF transmission cycle. The hunting, processing, and consumption of rodents as a source of animal protein remain prevalent in certain sub-populations, leading to direct blood-borne exposure during butchering [ 11 , 38 – 40 ]. Additionally, poor domestic hygiene and inadequate waste management systems within the household create harborage sites where piles of refuse or cluttered storage areas encourage rodent nesting [ 11 , 38 – 40 ]. These practices are often necessitated by the lack of modern infrastructure, making the choice of LF prone behaviour a consequence of structural poverty [ 41 – 42 ]. The persistence of LF in hyperendemic communities suggests that top-down, generalized public health messaging may be insufficient [ 43 – 46 ]. Prevention strategies often focus on clinical management including case isolation and large-scale vector control, yet the most effective barrier against the disease is located at the household level [ 43 – 44 ]. To break the cycle of transmission, there is an urgent need to identify the specific, ingrained household practices that sustain the virus [ 11 , 43 – 44 , 46 ]. This requires a granular understanding of the domestic practices including how food is stored, how waste is disposed of, and how residents interact with their immediate surroundings [ 11 , 43 – 44 ]. Understanding these practices is essential for developing targeted community-level prevention strategies and interventions that are not only scientifically sound but also culturally acceptable and economically feasible for the local population [ 47 ]. This study seeks to investigate the specific household practices that contribute to the continued transmission of LF in hyperendemic communities of Edo State. By investigating the intersection of sanitation, food security, and human-rodent interaction, the research aims to provide a baseline for evidence-based, community-led interventions for future prevention of LF outbreak in Nigeria. Methods Study design An analytical cross-sectional study design was employed to obtain quantitative data adopting the methods utilised in the study by Bonwitt et al [ 48 ]. The study population includes individuals and households. Study Area The study was conducted in Ekpoma, the administrative headquarters of the Esan West LGA, Edo state, Nigeria [ 49 ]. It is surrounded by other high-risk LF towns like Irrua, Uromi and Ubiaja. Ekpoma is estimated to have a growing population of 834,750 with an estimated population growth rate of 3.0 [ 49 ]. The town is classified as mainly, a semi-urban community with a majority of the population engaged in small to medium scale agricultural practices including hunting and collection of wild resources [ 50 ]. Sample size determination To determine the sample size for the study, Kish and Leslie’s formula [ 51 ] for estimating single proportions and estimation for minimum sample size was applied. This resulted in an estimated minimum sample size of 234. (Kish and Leslie’s formula: n = Z 2 P (1 – P)/d 2 where: n = sample size; Z = standard deviation for a 95% confidence level (Z = 1.96); P = prevalence of the attribute (LF household practices); d = acceptable difference (if 5%, d = 0.05); q = 1 – p.) The prevalence estimate was obtained from a previous study where 78% of community residents engaged in household practices that make them susceptible to the risk of contacts with Multimammate rat in Ondo state, Nigeria [ 52 ]. A total number of 303 participants were involved in the survey to make room for non-responses. Sampling technique A multistage sampling technique was employed in the study participant selection. In the first stage, the list of all constituent settlements and villages in and around Ekpoma were obtained from the Esan West LGA authorities. Eighteen of these settlements/villages were randomly selected by balloting. The selected settlements varied in size, with an estimated average of 50–100 households per settlement. In Stage Two, households were sampled from each selected settlement using a spatial systematic random sampling with a random start technique. The middle of each settlement was identified, and then a pen was tossed. Sampling started from the house in the direction of the tip of the pen. For settlements with less than 20 houses, one house was skipped, while two houses were skipped for settlements with more than 20 houses. Sampling continued until the required sampling size expected for the settlement was attained. Finally, in Stage three, eligible participants in each selected household who met the inclusion criteria were interviewed. A household was defined as a group of people living together daily in the same house and sharing meals from the same pot [ 53 ]. In a scenario where we encountered a compound with multiple independent households sharing a building, each distinct household unit (with its own head and cooking arrangements) was considered a separate sampling unit, and only one household was randomly selected per compound to maintain the independence of observations. Study population: The study participants were heads of households or their representative from randomly selected settlements in Ekpoma town from June to August 2023 Eligibility Criteria Inclusion criteria : A household selected for the study must have resided for at least 2 years in the settlement prior to the study interview. The respondent must be 18 years and above and voluntarily consent to participate in the study. Exclusion criteria: Selected households were excluded if they met the inclusion criteria, but the head of the household or the representative was absent at the time of visit to the household to administer the questionnaire or they refused to give informed consent to participate in the study. Additionally, potential respondents with poor cognitive function were also excluded from the study. Data collection tools Data collection was conducted using structured quantitative questionnaire for the interviews. A standardized questionnaire was generated from KoboCollect website ( http://kobotoolbox.org ), and was administered to collect respondents’ sociodemographic information, including sex, age, and level of education. Data were also collected on household and behavioural practices that predispose individuals to LF infection, including contact with rodents in homes and farms, contact during hunting activities, and consumption of rodents and food items exposed to rodents. Additional information was obtained on knowledge of LF, as well as bush-burning and food storage practices. For questions on rodent species identification, study participants were provided with pictorial guides to facilitate accurate identification of the type of rat encountered. These guides displayed distinguishing morphological features and the local appearance of the multimammate rat alongside other common domestic rodent species, thereby minimizing rodent species misclassification. The data was collected using smartphones equipped with KoboCollect software ( http://kobotoolbox.org ), and the data were subsequently exported as Microsoft Excel files for analysis. Data Analysis Data were collated and analysed using the Statistical Package for the Social Sciences (SPSS) software (SPSS Inc., Chicago, IL, USA). Respondents’ sociodemographic characteristics were summarised using descriptive statistics, including frequencies and percentages. Proportions of respondents with awareness of LF, knowledge of LF transmission, household and behavioural practices that predispose to LF were estimated. Associations between reported LF cases within households and predisposing behavioural practices were assessed using the Chi-square test. Variables that were statistically significant at the bivariate level (p < 0.05) were included in a multivariate logistic regression model. The study outcome was defined as reported at least one confirmed case of LF within the household in the preceding 12 months (Yes = 1, No = 0). Results from the final model were reported as adjusted odds ratios (AOR) with corresponding 95% confidence intervals (CIs). Results The study recruited 303 participants, with more than half being male (58.1%). The mean age of respondents was 44.6 ± 17.8. Over one third of the participants were aged 50 years and above (40.9%), followed by those under 30 (26.4%). Occupations were diverse, with the largest groups being farmers (26.4%) and entrepreneurs (26.1%). The predominant ethnicity was Esan (76.9%), and most participants were married (70.3%) and Christian (95.7%). Regarding education, nearly half had secondary education (47.5%), while 30.4% completed primary education. Household sizes were large, with over five members (49.2%), and more than one third of the participants had 3–5 children (39.3%) as shown in Table 1. In Table 2 below, most respondents (92.4%) have heard of LF, with 56.6% identifying contaminated food as a source of infection, followed by rats (45.4%) and from contact with infected humans or their body fluid (8.6%). Sensitisation about LF, through radio or verbal means, was reported by 76.6% of participants, while 19.1% had not received such information. Table 3 reveals that majority of respondents (93.7%) reported having rodents in or around their homes, with 89.1% implementing control measures. However, 25.1% had physical contact with rodents, and 23.8% encountered rodent urine or feces. Lassa fever predisposing household practices were prevalent, including hunting rodents for food (37.3%), storing food in open pots (53.8%), and consuming food contaminated with rodent urine or feces (23.8%). Additionally, 62.4% practiced bush burning, potentially increasing rodent exposure. These behaviours indicate widespread practices that heighten the risk of LF transmission. The association between household practices and LF incidence among households in the past year was assessed. Significant findings include the implementation of rodent control measures, which was associated with a lower incidence of LF (p=0.012). Hunting rodents for food also showed a significant association with higher LF cases (p=0.028). Additionally, food storage practices, such as storing food without covers (p=0.018) and on the floor (p=0.016), were significantly linked to higher LF incidence among households. No significant associations were found for other behaviours, including having rodents in or around the house, physical contact with rodents or their excreta, and consuming contaminated food. Table 5 below presents the multivariate analysis of household practices associated with reported LF incidence within households in Ekpoma communities within the preceding 12 months. After adjusting for potential confounders, households that stored food items on the floor had more than twice the odds of reporting LF compared with those that did not (AOR: 2.32; 95% CI: 1.09–4.93; p = 0.028). Similarly, storing food items in containers without covers was strongly associated with increased household LF incidence (AOR: 5.02; 95% CI: 1.21–20.86; p = 0.018). Discussion The findings from this study indicate that the socio-demographic profile of the respondents reflects a population in which over half were male (58.1%), approximately 41% were aged 50 years and above, and farmers (26.4%) and entrepreneurs (26.1%) constituted the largest occupational groups. These characteristics are epidemiologically relevant, as older adults and individuals engaged in farming are more likely to experience sustained exposure to rodent-infested domestic and agricultural environments, thereby increasing the probability of contact with Mastomys natalensis , the primary zoonotic reservoir of LASV [ 4 , 54 ]. Additionally, a significant proportion of the respondents reported high level of general LF awareness (92.4%) and community sensitization (76.6%) with 56.6% of participants correctly identified contaminated food as a source of infection and 45.4% identified rats. However, 53.8% of respondents still reported storing food in open pots indicating a persistent knowledge-to-practice gap. This suggests that in LF hyperendemic communities, structural and economic factors such as the lack of rodent-proof infrastructure often override health knowledge [ 11 , 33 ]. More importantly, households that stored food items on the floor had more than twice the odds of reporting LF incidence, while storage of food in uncovered containers was associated with a five-fold increase in odds. These findings align with established evidence that indirect exposure through ingestion of food contaminated with rodent urine or faeces represents the dominant transmission pathway in endemic settings, particularly where food is stored at ground level or without physical barriers [ 55 – 57 ]. The persistence of these associations after controlling for other household practices is consistent with prior community-based studies from Nigeria and Sierra Leone, which reported unsafe food storage as a stronger predictor of LF risk than rodent presence alone [ 11 , 58 – 59 ]. Storing food on the floor or in uncovered containers plausibly increases rodent access and the likelihood of environmental contamination, even in households reporting rodent control activities. This provides a possible explanation for the loss of statistical significance observed for rodent control measures in the adjusted statistical model, suggesting that such measures may have limited protective value in the absence of appropriate food storage practices. Although hunting rodents for food was significantly associated with reported LF incidence in the bivariate analysis, this relationship was attenuated in the multivariate model. Previous studies have identified rodent hunting and consumption as important risk factors in rural West African settings [ 60 – 61 ]. The lack of an independent association in this study may reflect contextual differences in dominant exposure pathways, with indirect food contamination exerting a greater influence than direct rodent handling. Additionally, the binary classification of hunting behaviour in this study may not have captured variation in frequency, handling, or preparation practices, resulting in exposure misclassification and bias. Several behaviours frequently implicated in LF transmission [ 59 , 62 – 65 ] including the presence of rodents in or around households, physical contact with rodents or their excreta, reported consumption of contaminated food, and bush burning were not significantly associated with household LF incidence in this study. This pattern is consistent with observations from hyperendemic settings where rodent exposure is widespread, thereby limiting variability and reducing the ability to detect association [ 62 , 65 – 66 ]. Furthermore, exposures such as contact with rodent excreta or consumption of contaminated food are difficult to ascertain accurately and may be underreported, which could further attenuate observed associations [ 66 ]. Overall, these findings indicate that modifiable food storage practices may play a more decisive role in shaping household LF risk than broader environmental or behavioural exposures in LF endemic settings. Interventions that prioritise safe food storage, particularly avoiding ground-level storage and ensuring the use of covered containers, may therefore be more effective than strategies focused solely on rodent presence or general rodent control in communities where rodents are ubiquitous. The implication of these findings for community-led interventions is profound. Since generalised sensitisation has peaked, interventions must move beyond simple awareness toward facilitating household practices that involve environmental and structural modification. Providing households with standardised, air-tight food storage containers and promoting community-wide, synchronised rodent control rather than isolated household efforts could prove more effective [ 28 , 31 , 33 , 43 ]. Study Limitations The findings of this research should be interpreted with the following limitations in view. First, the cross-sectional nature of the study design implies that the associations identified do not establish a definitive causal relationship. While the reported practices and the incidence of LF cases were both situated within a twelve-month timeframe, the potential for reverse causality remains, as a household that previously experienced a confirmed case may have since modified their behaviours due to heightened risk perception. Furthermore, the reliance on self-reported data introduces the possibility of recall bias, particularly concerning events that occurred within a year prior to the interview. There is also a risk of social desirability bias, where participants might under-report practices known to predisposing to LF disease such as rodent hunting or over-report the effectiveness of their rodent control measures to align with public health messaging. Finally, while Ekpoma communities in Edo state represents a critical hyperendemic hotspot, the socio-cultural and ecological factors specific to this region of which may not be perfectly generalisable to other endemic areas in Nigeria or the wider West African sub-region that possess different environmental conditions or behavioural norms. Future research utilising a longitudinal design or multi-site comparative approach would be necessary to establish a more broadly applicable and causal risk profile. Conclusion The findings reveal the complex interplay between socio-demographic factors, knowledge, and household practices in shaping LF risks in endemic communities in Nigeria. While community awareness is high, the persistence of risky behaviours specifically storing food on the floor and using uncovered containers remains a critical driver of LF transmission. The study demonstrates that current individualistic rodent control measures are insufficient in a hyperendemic setting. Effective control and prevention must transition toward community-led, targeted interventions that focus on structural environmental management, such as the mass adoption of rat-proof food storage and synchronised community rodent exclusion programs. Hence, a shift in focus from individual-level health education to sustainable, community-wide modifications of the domestic environment is recommended. Declarations Acknowledgements The authors extend their sincere appreciation to the households who participated in the study, the research assistants and supervisors who collected the data and researchers from the Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua who supported community engagement activities during the pre-planning stage of the research implementation. We will also like to mention and appreciate the contributions of Prof Olayinka Ogunkoya towards the study design and securing of grant to execute it. Funding This work was supported by the Royal Society of Tropical Medicine and Hygiene (RSTMH) and the National Institute for Health Research (NIHR), London, England, United Kingdom. Author information Authors and Affiliations Department of Zoology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria Joseph Odunayo Igbokwe School of Public Health, University of Port Harcourt, Nigeria Elvis Efe Isere Nile University of Nigeria, Abuja & Public Health Department, Health Services and Environment Secretariat, Federal Capital Territory, Abuja Olubunmi Adeyemi Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria Aduragbemi Adebayo Danny Asogun Natural History Museum, Obafemi Awolowo University, Ile-Ife, Osun State Nigeria Ayodeji Olayemi Authors’ contributions JOI conceived the study; JOI and EEI designed the study protocol, JOI and AA carried out the data collection, EEI and OA carried out analysis and interpretation of data , JOI and EEI drafted the manuscript; JOI, EEI, DA and AO critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. JOI and EEI are guarantors of the paper. Corresponding authors Correspondence to Joseph Odunayo Igbokwe, Email: [email protected] Ethical approval The study protocol was reviewed and approved by the Irrua Specialist Hospital Ethics Review Committee, Irrua, Edo State, Nigeria with protocol approval number ISTH/HREC/20230202/444 in accordance with the Declaration of Helsinki and ICH-GCP guidelines. Consent to participate Informed consent was obtained from the respondents. Before data collection, respondents were approached individually by trained research assistants and given a detailed explanation of the study. The research assistants introduced themselves, explained the study’s objectives, and ensured that each respondent understood the purpose of their participation. The explanation was provided in a language (English, Pidgin) that the respondents were comfortable with to enhance comprehension. Respondents were informed that participation was entirely voluntary, meaning they had the right to refuse or withdraw at any time without facing any consequences. They were reassured that their decision would not affect their access to healthcare services or other benefits of the study. To formalise consent, respondents were provided with an Informed Consent Form outlining the study’s purpose, procedures, potential risks, benefits, and confidentiality measures. If literate, they were asked to read and sign the form. If illiterate, a witness who could read and write was asked to interpret the content of the form and explain to the understanding of the respondent, after which the respondent provided consent through a thumbprint, witnessed by the interpreter. Signed or thumbprinted forms were securely stored as proof of consent before proceeding with data collection. Data collected from respondents were kept confidential using a password Kobocollect secured database with access provided only to the principal investigator. Consent for publish All authors reviewed the manuscript’s final version and approved it for submission for publication. Data Availability Statement The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. The corresponding author could be contacted through [email protected] . Clinical trial number: not applicable Competing Interests The authors declare no competing interest. References Reyna RA, Littlefield KE, Shehu N, Makishima T, Maruyama J, Paessler S. The Importance of Lassa Fever and Its Disease Management in West Africa. Viruses. 2024 Feb 7;16(2):266. Naeem A, Zahid S, Hafeez MH, Bibi A, Tabassum S, Akilimali A. Re-emergence of Lassa fever in Nigeria: A new challenge for public health authorities. 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J Community Med Prim Health Care. 2019;31(2):26–35. Shaffer M, Fischer RJ, Gallogly S, Ginn O, Munster V, Bibby K. Environmental persistence and disinfection of Lassa virus. Emerg Infect Dis. 2023;29(11):2285–2291. doi:10.3201/eid2911.230678. Smither SJ, Eastaugh LS, Findlay JS, O'Brien LM, Lever MS. Survival of Lassa Virus in Blood and Tissue Culture Media and in a Small Particle Aerosol. Pathogens. 2020 Aug 21;9(9):680. doi: 10.3390/pathogens9090680. Nchom JI, Abubakar AS, Arimoro FO, Mohammed BY. The role of weather in the spread of Lassa fever in parts of Northern Nigeria. Int J Trop Dis Health. 2021;42(23):33–40. Ogbu O, Ajuluchukwu E, Uneke CJ. Lassa fever in West African sub-region: an overview. J Vector Borne Dis. 2007;44(1):1–11 Ogboghodo EO, Adam VY, Omuemu VO, Okojie OH. Knowledge, attitude and preventive practices against Lassa fever among residents in a rural community in Southern Nigeria. West Afr J Med . 2019;36(2):165–171. Adebimpe W, Salaudeen AG, Kayode B, Atolagbe J. The challenges of curtailing the outbreak and spread of Lassa fever in Nigeria. Malta J Health Sci. 2020;7(1):20–31. doi:10.14614/LASSAFEVER/6/20. Kobie AG, Okeibunor JC, Kanu MS. Socio-cultural determinants of Lassa fever transmission in Kailahun and Kenema Districts, Sierra Leone. Texila Int J Acad Res. 2025;12(3):Art019. doi:10.21522/TIJAR.2014.12.03.Art019. Kamara ABS, Moseray A, Fatoma P, Lamin JM, Sankoh OA, Rogers MK. Socioeconomic and environmental predictors of Lassa fever transmission in Lower Bambara Chiefdom, Kenema District, Eastern Sierra Leone. BMC Public Health . 2025;25:3710. doi:10.1186/s12889-025-xxxx-x. Agbajelola VI, Orum TG. Revisiting the threat of Lassa fever in Nigeria: a call for strategic and inclusive action. J Interv Epidemiol Public Health. 2025;8(4):102. Bassey AU, Odinko CC. Evaluating the access, awareness and public response to mass media messages on health communication during the 2024 Lassa fever outbreak in Nigeria. Akungba Commun Media J. 2025;2(1):40–54 Wogu JO, Chukwu CO, Nwafor KA, Anikpe EA, Ugwuoke JC, Ugwulor-Onyinyechi CC, Eseadi C. Mass media reportage of Lassa fever in Nigeria: a viewpoint. J Int Med Res. 2020 Jan;48(1):300060518821552. doi: 10.1177/0300060518821552. Nigeria Centre for Disease Control and Prevention . Advocacy Toolkit for Lassa Fever: Influencing key decision-makers through a multisectoral One Health approach [Internet]. Abuja: NCDC; 2025 [cited 2025 Dec 29]. Available from: https://ncdc.gov.ng/themes/common/docs/protocols/359_1739532942.pdf Richmond JK, Baglole DJ. Lassa fever: epidemiology, clinical features, and social consequences. BMJ. 2003 Nov 29;327(7426):1271-5. doi: 10.1136/bmj.327.7426.1271. Erratum in: BMJ. 2004 Jan 10;328(7431):96. Bonwitt J, Kelly AH, Ansumana R, Agbla S, Sahr F, Saez AM, Borchert M, Kock R, Fichet-Calvet E. Rat-atouille: A Mixed Method Study to Characterize Rodent Hunting and Consumption in the Context of Lassa Fever. Ecohealth. 2016 Jun;13(2):234-47. doi: 10.1007/s10393-016-1098-8. Ehiaghe AD, Barrow A. Parental Knowledge, Willingness, and Attitude towards Contraceptive Usage among Their Unmarried Adolescents in Ekpoma, Edo State, Nigeria. Int J Reprod Med. 2022 Jun 23;2022:8533174. doi: 10.1155/2022/8533174. Tenebe IT, Babatunde EO, Ogarekpe NM, Emakhu J, Etu E-E, Edo OC, Omeje M, Benson NU. Detection and Measurement of Bacterial Contaminants in Stored River Water Consumed in Ekpoma. Water . 2024; 16(18):2696. https://doi.org/10.3390/w16182696 Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch. Orofac. Sci. 2006; 1: 9–14 Tinuola FR. Formal Education and Lassa fever Risks Behaviour among Households’ Heads in Akoko Region of Ondo State Nigeria. Gusau International Journal of Management and Social Sciences, Federal University, Gusau, 2021; 4 (1): 2021 225-247 Isere EE, Ajayi I, Adejugbagbe AM, Abiona SF, Omorogbe NE, Akinrinade OT, Okunade FT, Folarin T. Perceived Risk and Associated Factors towards COVID-19 infection among the residents of Ondo State, Southwest Nigeria. Global Biosecurity, 2022; 4. Ezenwa-Ahanene A, Salawu AT. & Adebowale AS. Descriptive epidemiology of Lassa fever, its trend, seasonality, and mortality predictors in Ebonyi State, South- East, Nigeria, 2018—2022. BMC Public Health, 2024; 24: 3470. https://doi.org/10.1186/s12889-024-20840-y McCormick JB, Webb PA, Krebs JW, Johnson KM, Smith ES. A prospective study of the epidemiology and ecology of Lassa fever. J Infect Dis. 1987 Mar;155(3):437-44. doi: 10.1093/infdis/155.3.437. Fichet-Calvet E, Rogers DJ. Risk Maps of Lassa Fever in West Africa. PLoS Negl Trop Dis. 2009; 3(3): e388. https://doi.org/10.1371/journal.pntd.0000388 Bonner PC, Schmidt WP, Belmain SR, Oshin B, Baglole D, Borchert M. Poor housing quality increases risk of rodent infestation and Lassa fever in refugee camps of Sierra Leone. American Journal of Tropical Medicine and Hygiene. 2020; 102(2), 378–386. Richmond JK, Baglole DJ. Lassa fever: epidemiology, clinical features, and social consequences. BMJ. 2003 Nov 29;327(7426):1271-5. doi: 10.1136/bmj.327.7426.1271. Erratum in: BMJ. 2004 Jan 10;328(7431):96. Tobin EA, Asogun D, Happi C, Ogbaini E, & Gunther S. Risk factors for Lassa fever in endemic communities of Edo State, Nigeria. IJID, 2014; 21: 258–259. https://doi.org/10.1016/j.ijid.2014.03.958 Frame JD, Baldwin JM Jr, Gocke DJ, Troup JM. Lassa fever, a new virus disease of man from West Africa. I. Clinical description and pathological findings. Am J Trop Med Hyg. 1970 Jul;19(4):670-6. doi: 10.4269/ajtmh.1970.19.670. Olayemi A, Obadare A, Oyeyiola A, Oyeyiola A, Fichet-Calvet E, et al . Small mammal diversity and dynamics within Nigeria, with emphasis on reservoirs of the Lassa virus. Syst Biodivers . 2017;16(2):1–10. doi:10.1080/14772000.2017.1358220. Happi AN, Olumade TJ, Ogunsanya OA, Sijuwola AE, Ogunleye SC, Oguzie JU, et al . Increased prevalence of Lassa fever virus-positive rodents and diversity of infected species found during human Lassa fever epidemics in Nigeria. Microbiol Spectr . 2022;10(4):e00366-22. doi:10.1128/spectrum.00366-22. Ben-Enukora CA, Oyero OS , Oyesomi KO and Adeyeye BK. Combating Lassa fever for sustainable development: Interplay of perceived behavioural control and current preventive practices in most endemic States in Nigeria. African Journal of Reproductive Health November 2021; 25 (5s):126 Olayemi A & Ogbu O. Ecological determinants of Lassa virus spillover in rural Nigeria. Scientific Reports, 2016; 6 : 28452. https://doi.org/10.1038/srep28452 Akhmetzhanov AR, Asai Y, Nishiura H. Quantifying the seasonal drivers of transmission for Lassa fever in Nigeria. Philos Trans R Soc Lond B Biol Sci. 2019 Jun 24;374(1775):20180268. doi: 10.1098/rstb.2018.0268. Ilesanmi OS, Owoeye-Lawal OT, Aro AJ, Afolabi AA, Kareem AO, Abejegah C, Ayodeji OO. Risk factors for Lassa fever infection among survivors at the Federal Medical Center, Owo, Ondo State, Nigeria, Int. J. One Health, 2021; 7(1): 128-134. Tables Tables 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8574897","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":592185851,"identity":"a2ea7ea0-271b-42b9-a31b-bfe178708da1","order_by":0,"name":"Joseph Odunayo Igbokwe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYBACxgbGBmYGhgQGBvYGINdADiRoQKQWngMgxcaEtYAARItEAohNhBbm9ubm1wUVaYn9ko8PfuYpALqMvXmbBOOOWtwO6znYZj3jTE7izNlpydI8BkCX8Rwrk2A8cxy3lhmJbca8bRW5G27nGAC1/ElskMgxk2BsO0ZYy/6bZ4x/A22pb5B/Q1BL82PetpzcDRI8ZiCHJTAAGUAtNXj9wjzjTFo9EKdZzjEwMGzjSSu2SGw7gFOLYXv7488FFcnG/O2HD99488dAnp/98MYbH9vqcGtpYGCTQBFhAxEJDIdxapEHRs0HbBK4bRkFo2AUjIIRBwD6GlNb1a7Z2QAAAABJRU5ErkJggg==","orcid":"","institution":"Obafemi Awolowo University","correspondingAuthor":true,"prefix":"","firstName":"Joseph","middleName":"Odunayo","lastName":"Igbokwe","suffix":""},{"id":592185852,"identity":"70d3d8ec-c20e-4bec-8183-9452bce5f7b6","order_by":1,"name":"Elvis Efe Isere","email":"","orcid":"","institution":"University of Port Harcourt","correspondingAuthor":false,"prefix":"","firstName":"Elvis","middleName":"Efe","lastName":"Isere","suffix":""},{"id":592185853,"identity":"20d55a00-208f-4004-95aa-9efa157ea536","order_by":2,"name":"Olubunmi Adeyemi","email":"","orcid":"","institution":"Nile University of Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Olubunmi","middleName":"","lastName":"Adeyemi","suffix":""},{"id":592185854,"identity":"a2db785a-4e90-4257-9db4-070e35413eda","order_by":3,"name":"Aduragbemi Adebayo","email":"","orcid":"","institution":"Irrua Specialist Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Aduragbemi","middleName":"","lastName":"Adebayo","suffix":""},{"id":592185855,"identity":"ace684e2-41fa-4ecb-8ce3-6af8330c77ab","order_by":4,"name":"Danny Asogun","email":"","orcid":"","institution":"Irrua Specialist Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Danny","middleName":"","lastName":"Asogun","suffix":""},{"id":592185856,"identity":"428c7d96-7a74-4b2f-8fea-1becd6aff194","order_by":5,"name":"Ayodeji Olayemi","email":"","orcid":"","institution":"Obafemi Awolowo University","correspondingAuthor":false,"prefix":"","firstName":"Ayodeji","middleName":"","lastName":"Olayemi","suffix":""}],"badges":[],"createdAt":"2026-01-11 16:53:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8574897/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8574897/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103017469,"identity":"c5185f43-1d90-4e2b-94f6-c13be3c0345b","added_by":"auto","created_at":"2026-02-19 17:01:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":158164,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Nigeria, Edo state and Esan west highlighting the study areas\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8574897/v1/d5653df2c394633231289d36.png"},{"id":103051310,"identity":"286b8879-4562-4ccc-a835-aec6401b3a32","added_by":"auto","created_at":"2026-02-20 07:59:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":948216,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8574897/v1/225e473f-54c7-48be-95e5-97debdd3ef1e.pdf"},{"id":103049989,"identity":"46b3d0fe-6460-42b6-abe9-f57979b03bf3","added_by":"auto","created_at":"2026-02-20 07:47:34","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35809,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8574897/v1/0415678f1926cbc3eb3b7ee8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Household Practices Sustaining Lassa Fever Transmission in Hyperendemic Communities of Edo State, Nigeria","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLassa fever (LF) is a zoonotic, acute viral hemorrhagic illness caused by the Lassa virus (LASV), an enveloped, single-stranded bisegmented RNA virus belonging to the family \u003cem\u003eArenaviridae\u003c/em\u003e [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Since its clinical discovery in 1969 in Lassa village, Borno State, the disease has evolved from an occasional medical curiosity into a permanent public health crisis in West Africa [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The World Health Organization currently lists LF as a priority pathogen requiring urgent research and development due to its high case-fatality rate (CFR) and the absence of a licensed vaccine [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Nigeria, the epidemiological profile of the disease has shifted from seasonal outbreaks to a perennial occurrence, with the Nigeria Centre for Disease Control reporting several confirmed cases and deaths annually [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. As of epidemiological week 50, 2025, Nigeria has reported 1,097 confirmed LF cases with 201 deaths (CFR 18.3%) across 21 states and 103 Local Government Areas (LGAs), with Ondo, Bauchi, Edo, and Taraba accounting for 89% of cases.\u003c/p\u003e \u003cp\u003eEdo State in Southern Nigeria serves as one of the national epicentre for LF, consistently accounting for a disproportionate share of the annual national burden and death from LF, particularly within the northern senatorial district of the state comprising administrative hubs like Ekpoma and Irrua [\u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21 CR22 CR23\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The hyperendemicity of this region has been linked to a complex interplay of ecological factors and human behaviour that facilitate the continuous spillover of the virus from its primary reservoir, the \"multimammate rat\" (\u003cem\u003eMastomys natalensis\u003c/em\u003e), to human populations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Unlike many other rodents, \u003cem\u003eMastomys\u003c/em\u003e species are highly synanthropic, as they thrive in and around human dwellings, utilising domestic spaces for food and shelter [\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe transmission dynamics of LF are primarily driven by household-level interactions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Direct transmission occurs through contact with rodent excreta (urine and feces), through contaminated surfaces or the ingestion of contaminated food materials [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Despite extensive public health campaigns, hyperendemic communities in Edo State exhibit a persistent knowledge-practice gap [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. While community members often possess high levels of awareness regarding the symptoms and dangers of the disease, their adherence to preventive household practices remains suboptimal [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This disconnect suggests that household practices and behavioural drivers are not merely a result of ignorance but are deeply embedded in socioeconomic realities and traditional lifestyles [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSome of the reported household practices sustaining transmission include the improper storage of food items. In rural Edo State, many households store grains and flour in open containers or on the floor, providing easy access for rodents [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Furthermore, the common practice of spread-drying agricultural produce, such as cassava flakes (garri) and grains, along roadsides and open spaces exposes these food sources to rodent activity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This environmental interface is a critical point of viral spillover, as the LASV can remain infectious in the environment for several days under specific humidity and temperature conditions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eCultural factors also play a pivotal role in sustaining the LF transmission cycle. The hunting, processing, and consumption of rodents as a source of animal protein remain prevalent in certain sub-populations, leading to direct blood-borne exposure during butchering [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Additionally, poor domestic hygiene and inadequate waste management systems within the household create harborage sites where piles of refuse or cluttered storage areas encourage rodent nesting [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. These practices are often necessitated by the lack of modern infrastructure, making the choice of LF prone behaviour a consequence of structural poverty [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe persistence of LF in hyperendemic communities suggests that top-down, generalized public health messaging may be insufficient [\u003cspan additionalcitationids=\"CR44 CR45\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Prevention strategies often focus on clinical management including case isolation and large-scale vector control, yet the most effective barrier against the disease is located at the household level [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. To break the cycle of transmission, there is an urgent need to identify the specific, ingrained household practices that sustain the virus [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This requires a granular understanding of the domestic practices including how food is stored, how waste is disposed of, and how residents interact with their immediate surroundings [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Understanding these practices is essential for developing targeted community-level prevention strategies and interventions that are not only scientifically sound but also culturally acceptable and economically feasible for the local population [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study seeks to investigate the specific household practices that contribute to the continued transmission of LF in hyperendemic communities of Edo State. By investigating the intersection of sanitation, food security, and human-rodent interaction, the research aims to provide a baseline for evidence-based, community-led interventions for future prevention of LF outbreak in Nigeria.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eAn analytical cross-sectional study design was employed to obtain quantitative data adopting the methods utilised in the study by Bonwitt et al [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. The study population includes individuals and households.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Area\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in Ekpoma, the administrative headquarters of the Esan West LGA, Edo state, Nigeria [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. It is surrounded by other high-risk LF towns like Irrua, Uromi and Ubiaja. Ekpoma is estimated to have a growing population of 834,750 with an estimated population growth rate of 3.0 [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. The town is classified as mainly, a semi-urban community with a majority of the population engaged in small to medium scale agricultural practices including hunting and collection of wild resources [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eTo determine the sample size for the study, Kish and Leslie\u0026rsquo;s formula [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] for estimating single proportions and estimation for minimum sample size was applied. This resulted in an estimated minimum sample size of 234. (Kish and Leslie\u0026rsquo;s formula: n\u0026thinsp;=\u0026thinsp;Z\u003csup\u003e2\u003c/sup\u003eP (1 \u0026ndash; P)/d\u003csup\u003e2\u003c/sup\u003e where: n\u0026thinsp;=\u0026thinsp;sample size; Z\u0026thinsp;=\u0026thinsp;standard deviation for a 95% confidence level (Z\u0026thinsp;=\u0026thinsp;1.96); P\u0026thinsp;=\u0026thinsp;prevalence of the attribute (LF household practices); d\u0026thinsp;=\u0026thinsp;acceptable difference (if 5%, d\u0026thinsp;=\u0026thinsp;0.05); q\u0026thinsp;=\u0026thinsp;1 \u0026ndash; p.) The prevalence estimate was obtained from a previous study where 78% of community residents engaged in household practices that make them susceptible to the risk of contacts with Multimammate rat in Ondo state, Nigeria [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. A total number of 303 participants were involved in the survey to make room for non-responses.\u003c/p\u003e\n\u003ch3\u003eSampling technique\u003c/h3\u003e\n\u003cp\u003e A multistage sampling technique was employed in the study participant selection. In the first stage, the list of all constituent settlements and villages in and around Ekpoma were obtained from the Esan West LGA authorities. Eighteen of these settlements/villages were randomly selected by balloting. The selected settlements varied in size, with an estimated average of 50\u0026ndash;100 households per settlement. In Stage Two, households were sampled from each selected settlement using a spatial systematic random sampling with a random start technique. The middle of each settlement was identified, and then a pen was tossed. Sampling started from the house in the direction of the tip of the pen. For settlements with less than 20 houses, one house was skipped, while two houses were skipped for settlements with more than 20 houses. Sampling continued until the required sampling size expected for the settlement was attained.\u003c/p\u003e \u003cp\u003eFinally, in Stage three, eligible participants in each selected household who met the inclusion criteria were interviewed. A household was defined as a group of people living together daily in the same house and sharing meals from the same pot [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. In a scenario where we encountered a compound with multiple independent households sharing a building, each distinct household unit (with its own head and cooking arrangements) was considered a separate sampling unit, and only one household was randomly selected per compound to maintain the independence of observations.\u003c/p\u003e\n\u003ch3\u003eStudy population:\u003c/h3\u003e\n\u003cp\u003eThe study participants were heads of households or their representative from randomly selected settlements in Ekpoma town from June to August 2023\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEligibility Criteria\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eA household selected for the study must have resided for at least 2 years in the settlement prior to the study interview. The respondent must be 18 years and above and voluntarily consent to participate in the study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eExclusion criteria:\u003c/h3\u003e\n\u003cp\u003eSelected households were excluded if they met the inclusion criteria, but the head of the household or the representative was absent at the time of visit to the household to administer the questionnaire or they refused to give informed consent to participate in the study. Additionally, potential respondents with poor cognitive function were also excluded from the study.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData collection tools\u003c/h2\u003e \u003cp\u003eData collection was conducted using structured quantitative questionnaire for the interviews. A standardized questionnaire was generated from KoboCollect website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://kobotoolbox.org\u003c/span\u003e\u003cspan address=\"http://kobotoolbox.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), and was administered to collect respondents\u0026rsquo; sociodemographic information, including sex, age, and level of education. Data were also collected on household and behavioural practices that predispose individuals to LF infection, including contact with rodents in homes and farms, contact during hunting activities, and consumption of rodents and food items exposed to rodents. Additional information was obtained on knowledge of LF, as well as bush-burning and food storage practices.\u003c/p\u003e \u003cp\u003e For questions on rodent species identification, study participants were provided with pictorial guides to facilitate accurate identification of the type of rat encountered. These guides displayed distinguishing morphological features and the local appearance of the multimammate rat alongside other common domestic rodent species, thereby minimizing rodent species misclassification.\u003c/p\u003e \u003cp\u003eThe data was collected using smartphones equipped with KoboCollect software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://kobotoolbox.org\u003c/span\u003e\u003cspan address=\"http://kobotoolbox.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), and the data were subsequently exported as Microsoft Excel files for analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were collated and analysed using the Statistical Package for the Social Sciences (SPSS) software (SPSS Inc., Chicago, IL, USA). Respondents\u0026rsquo; sociodemographic characteristics were summarised using descriptive statistics, including frequencies and percentages. Proportions of respondents with awareness of LF, knowledge of LF transmission, household and behavioural practices that predispose to LF were estimated.\u003c/p\u003e \u003cp\u003eAssociations between reported LF cases within households and predisposing behavioural practices were assessed using the Chi-square test. Variables that were statistically significant at the bivariate level (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were included in a multivariate logistic regression model. The study outcome was defined as reported at least one confirmed case of LF within the household in the preceding 12 months (Yes\u0026thinsp;=\u0026thinsp;1, No\u0026thinsp;=\u0026thinsp;0). Results from the final model were reported as adjusted odds ratios (AOR) with corresponding 95% confidence intervals (CIs).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study recruited 303 participants, with more than half being male (58.1%). The mean age of respondents was 44.6 ± 17.8. Over one third of the participants were aged 50 years and above (40.9%), followed by those under 30 (26.4%). Occupations were diverse, with the largest groups being farmers (26.4%) and entrepreneurs (26.1%). The predominant ethnicity was Esan (76.9%), and most participants were married (70.3%) and Christian (95.7%). Regarding education, nearly half had secondary education (47.5%), while 30.4% completed primary education. Household sizes were large, with over five members (49.2%), and more than one third of the participants had 3–5 children (39.3%) as shown in Table 1.\u003c/p\u003e\n\u003cp\u003eIn Table 2\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ebelow, most respondents (92.4%) have heard of LF, with 56.6% identifying contaminated food as a source of infection, followed by rats (45.4%) and from contact with infected humans or their body fluid (8.6%). Sensitisation about LF, through radio or verbal means, was reported by 76.6% of participants, while 19.1% had not received such information.\u003c/p\u003e\n\u003cp\u003eTable 3 reveals that majority of respondents (93.7%) reported having rodents in or around their homes, with 89.1% implementing control measures. However, 25.1% had physical contact with rodents, and 23.8% encountered rodent urine or feces. Lassa fever predisposing household practices were prevalent, including hunting rodents for food (37.3%), storing food in open pots (53.8%), and consuming food contaminated with rodent urine or feces (23.8%). Additionally, 62.4% practiced bush burning, potentially increasing rodent exposure. These behaviours indicate widespread practices that heighten the risk of LF transmission.\u003c/p\u003e\n\u003cp\u003eThe association between household practices and LF incidence among households in the past year was assessed. Significant findings include the implementation of rodent control measures, which was associated with a lower incidence of LF (p=0.012). Hunting rodents for food also showed a significant association with higher LF cases (p=0.028). Additionally, food storage practices, such as storing food without covers (p=0.018) and on the floor (p=0.016), were significantly linked to higher LF incidence among households. No significant associations were found for other behaviours, including having rodents in or around the house, physical contact with rodents or their excreta, and consuming contaminated food.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u0026nbsp;\u003c/strong\u003ebelow presents the multivariate analysis of household practices associated with reported LF incidence within households in Ekpoma communities within the preceding 12 months. After adjusting for potential confounders, households that stored food items on the floor had more than twice the odds of reporting LF compared with those that did not (AOR: 2.32; 95% CI: 1.09–4.93; p = 0.028). Similarly, storing food items in containers without covers was strongly associated with increased household LF incidence (AOR: 5.02; 95% CI: 1.21–20.86; p = 0.018).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings from this study indicate that the socio-demographic profile of the respondents reflects a population in which over half were male (58.1%), approximately 41% were aged 50 years and above, and farmers (26.4%) and entrepreneurs (26.1%) constituted the largest occupational groups. These characteristics are epidemiologically relevant, as older adults and individuals engaged in farming are more likely to experience sustained exposure to rodent-infested domestic and agricultural environments, thereby increasing the probability of contact with \u003cem\u003eMastomys natalensis\u003c/em\u003e, the primary zoonotic reservoir of LASV [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, a significant proportion of the respondents reported high level of general LF awareness (92.4%) and community sensitization (76.6%) with 56.6% of participants correctly identified contaminated food as a source of infection and 45.4% identified rats. However, 53.8% of respondents still reported storing food in open pots indicating a persistent knowledge-to-practice gap. This suggests that in LF hyperendemic communities, structural and economic factors such as the lack of rodent-proof infrastructure often override health knowledge [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMore importantly, households that stored food items on the floor had more than twice the odds of reporting LF incidence, while storage of food in uncovered containers was associated with a five-fold increase in odds. These findings align with established evidence that indirect exposure through ingestion of food contaminated with rodent urine or faeces represents the dominant transmission pathway in endemic settings, particularly where food is stored at ground level or without physical barriers [\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe persistence of these associations after controlling for other household practices is consistent with prior community-based studies from Nigeria and Sierra Leone, which reported unsafe food storage as a stronger predictor of LF risk than rodent presence alone [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Storing food on the floor or in uncovered containers plausibly increases rodent access and the likelihood of environmental contamination, even in households reporting rodent control activities. This provides a possible explanation for the loss of statistical significance observed for rodent control measures in the adjusted statistical model, suggesting that such measures may have limited protective value in the absence of appropriate food storage practices.\u003c/p\u003e \u003cp\u003eAlthough hunting rodents for food was significantly associated with reported LF incidence in the bivariate analysis, this relationship was attenuated in the multivariate model. Previous studies have identified rodent hunting and consumption as important risk factors in rural West African settings [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. The lack of an independent association in this study may reflect contextual differences in dominant exposure pathways, with indirect food contamination exerting a greater influence than direct rodent handling. Additionally, the binary classification of hunting behaviour in this study may not have captured variation in frequency, handling, or preparation practices, resulting in exposure misclassification and bias.\u003c/p\u003e \u003cp\u003eSeveral behaviours frequently implicated in LF transmission [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan additionalcitationids=\"CR63 CR64\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e] including the presence of rodents in or around households, physical contact with rodents or their excreta, reported consumption of contaminated food, and bush burning were not significantly associated with household LF incidence in this study. This pattern is consistent with observations from hyperendemic settings where rodent exposure is widespread, thereby limiting variability and reducing the ability to detect association [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Furthermore, exposures such as contact with rodent excreta or consumption of contaminated food are difficult to ascertain accurately and may be underreported, which could further attenuate observed associations [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOverall, these findings indicate that modifiable food storage practices may play a more decisive role in shaping household LF risk than broader environmental or behavioural exposures in LF endemic settings. Interventions that prioritise safe food storage, particularly avoiding ground-level storage and ensuring the use of covered containers, may therefore be more effective than strategies focused solely on rodent presence or general rodent control in communities where rodents are ubiquitous.\u003c/p\u003e \u003cp\u003eThe implication of these findings for community-led interventions is profound. Since generalised sensitisation has peaked, interventions must move beyond simple awareness toward facilitating household practices that involve environmental and structural modification. Providing households with standardised, air-tight food storage containers and promoting community-wide, synchronised rodent control rather than isolated household efforts could prove more effective [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eThe findings of this research should be interpreted with the following limitations in view. First, the cross-sectional nature of the study design implies that the associations identified do not establish a definitive causal relationship. While the reported practices and the incidence of LF cases were both situated within a twelve-month timeframe, the potential for reverse causality remains, as a household that previously experienced a confirmed case may have since modified their behaviours due to heightened risk perception. Furthermore, the reliance on self-reported data introduces the possibility of recall bias, particularly concerning events that occurred within a year prior to the interview. There is also a risk of social desirability bias, where participants might under-report practices known to predisposing to LF disease such as rodent hunting or over-report the effectiveness of their rodent control measures to align with public health messaging. Finally, while Ekpoma communities in Edo state represents a critical hyperendemic hotspot, the socio-cultural and ecological factors specific to this region of which may not be perfectly generalisable to other endemic areas in Nigeria or the wider West African sub-region that possess different environmental conditions or behavioural norms. Future research utilising a longitudinal design or multi-site comparative approach would be necessary to establish a more broadly applicable and causal risk profile.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings reveal the complex interplay between socio-demographic factors, knowledge, and household practices in shaping LF risks in endemic communities in Nigeria. While community awareness is high, the persistence of risky behaviours specifically storing food on the floor and using uncovered containers remains a critical driver of LF transmission. The study demonstrates that current individualistic rodent control measures are insufficient in a hyperendemic setting. Effective control and prevention must transition toward community-led, targeted interventions that focus on structural environmental management, such as the mass adoption of rat-proof food storage and synchronised community rodent exclusion programs. Hence, a shift in focus from individual-level health education to sustainable, community-wide modifications of the domestic environment is recommended.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere appreciation to the households who participated in the study, the research assistants and supervisors who collected the data and researchers from the Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua who supported community engagement activities during the pre-planning stage of the research implementation. We will also like to mention and appreciate the contributions of Prof Olayinka Ogunkoya towards the study design and securing of grant to execute it.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Royal Society of Tropical Medicine and Hygiene (RSTMH) and the National Institute for Health Research (NIHR), London, England, United Kingdom.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepartment of Zoology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJoseph Odunayo Igbokwe\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSchool of Public Health, University of Port Harcourt, Nigeria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eElvis Efe Isere\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNile University of Nigeria, Abuja \u0026amp; Public Health Department, Health Services and \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;Environment Secretariat, Federal Capital Territory, Abuja\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOlubunmi Adeyemi\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIrrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAduragbemi Adebayo\u003c/p\u003e\n\u003cp\u003eDanny Asogun\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNatural History Museum, Obafemi Awolowo University, Ile-Ife, Osun State Nigeria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAyodeji Olayemi\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJOI conceived the study; JOI and EEI designed the study protocol, JOI and AA carried out the data collection, EEI and OA carried out analysis and interpretation of data\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eJOI and EEI drafted the manuscript; JOI, EEI, DA and AO critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. JOI and EEI are guarantors of the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Joseph Odunayo Igbokwe, Email: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Irrua Specialist Hospital Ethics Review Committee, Irrua, Edo State, Nigeria with protocol approval number ISTH/HREC/20230202/444 in accordance with the Declaration of Helsinki and ICH-GCP guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the respondents. Before data collection, respondents were approached individually by trained research assistants and given a detailed explanation of the study. The research assistants introduced themselves, explained the study’s objectives, and ensured that each respondent understood the purpose of their participation. The explanation was provided in a language (English, Pidgin) that the respondents were comfortable with to enhance comprehension. Respondents were informed that participation was entirely voluntary, meaning they had the right to refuse or withdraw at any time without facing any consequences. They were reassured that their decision would not affect their access to healthcare services or other benefits of the study.\u003c/p\u003e\n\u003cp\u003eTo formalise consent, respondents were provided with an Informed Consent Form outlining the study’s purpose, procedures, potential risks, benefits, and confidentiality measures. If literate, they were asked to read and sign the form. If illiterate, a witness who could read and write was asked to interpret the content of the form and explain to the understanding of the respondent, after which the respondent provided consent through a thumbprint, witnessed by the interpreter. Signed or thumbprinted forms were securely stored as proof of consent before proceeding with data collection. Data collected from respondents were kept confidential using a password Kobocollect secured database with access provided only to the principal investigator.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript’s final version and approved it for submission for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. The corresponding author could be contacted through [email protected]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eReyna RA, Littlefield KE, Shehu N, Makishima T, Maruyama J, Paessler S. The Importance of Lassa Fever and Its Disease Management in West Africa. Viruses. 2024 Feb 7;16(2):266.\u003c/li\u003e\n\u003cli\u003eNaeem A, Zahid S, Hafeez MH, Bibi A, Tabassum S, Akilimali A. Re-emergence of Lassa fever in Nigeria: A new challenge for public health authorities. Health Sci Rep. 2023 Oct 24;6(10):e1628. doi: 10.1002/hsr2.1628.\u003c/li\u003e\n\u003cli\u003eAlex GS, Gbayisomore TJ, Okon II, Okesanya OJ. 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One Health, 2021; 7(1): 128-134.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lassa fever, Household practices, Rodent control, Endemic communities, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-8574897/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8574897/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLassa fever (LF) remains a major public health threat in Nigeria, with Edo State constituting a hyperendemic hotspot. Despite high community awareness and ongoing public health interventions, transmission has persisted, suggesting that household-level practices play a critical role in sustaining LF transmission. This study investigated household practices associated with LF transmission in Ekpoma communities, Edo State.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn analytical cross-sectional study was conducted among household heads or representatives selected through multistage sampling between June and August 2023. Data on socio-demographics, LF knowledge, and household practices were collected using interviewer-administered questionnaire. Associations between household practices and reported household LF incidence within the preceding 12 months were assessed using chi-square test and multivariate logistic regression. Level of significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 303 respondents, more than half were male (58.1%) and middle-aged (mean age: 44.6\u0026thinsp;\u0026plusmn;\u0026thinsp;17.8 years), with farmers (26.4%) and entrepreneurs (26.1%) constituting largest occupational groups. Although 92.4% reported LF awareness and 76.6% had received community sensitisation, most households reported rodent presence (93.7%), while 53.8% stored food in open containers and 19.1% stored food on floor. Multivariate analysis shows storing food on floor (AOR\u0026thinsp;=\u0026thinsp;2.32; 95% CI: 1.09\u0026ndash;4.93) and storing food in uncovered containers (AOR\u0026thinsp;=\u0026thinsp;5.02; 95% CI: 1.21\u0026ndash;20.86) significantly increased odds of household LF risk.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eA critical knowledge-to-practice gap in LF prevention exists within households in hyperendemic communities in Nigeria, with unsafe food storage practices serving as key drivers of household LF risk. Preventive strategies should prioritise structural interventions, including rodent-proof food storage and community-led environmental management.\u003c/p\u003e","manuscriptTitle":"Household Practices Sustaining Lassa Fever Transmission in Hyperendemic Communities of Edo State, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 17:01:17","doi":"10.21203/rs.3.rs-8574897/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-13T16:40:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T14:01:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T13:21:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-28T06:36:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270220975138356994874984929048413684114","date":"2026-03-21T02:59:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215850708116560018829523673037769237365","date":"2026-03-19T11:32:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158154860937391810828815692327359556450","date":"2026-03-18T15:56:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21989228226520634444617580430776748189","date":"2026-03-18T10:19:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116469919530117427913012968452501790423","date":"2026-03-18T06:31:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65813505630245041921445998300793253944","date":"2026-02-21T11:06:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296697633452922134567525760913692008181","date":"2026-02-16T11:53:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-16T10:29:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-16T10:29:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-27T19:22:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-24T13:23:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-01-24T13:13:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75a05deb-c4bf-4817-96e1-74636a8f9914","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T15:11:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-19 17:01:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8574897","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8574897","identity":"rs-8574897","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}