CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Lassa fever is an acute viral hemorrhagic illness caused by Lassa virus, a member of the virus

family “Arenaviridae”. The disease is endemic in various West African countries including

Nigeria where Lassa fever virus infections rate per annum is estimated at 100,000 to 300,000

with approximately 5,000 deaths (Fall et al., 2019). Outbreaks of the disease have been reported

in various parts of Nigeria since it was first reported in 1969 with the worst outbreak recorded in

2012 where 623 cases including 70 deaths were reported from 19 out of 36 states, and case

fatality rate put at 37.9% (Nwidi, Unigwe & Eke, 2020). The common signs and symptoms

include vomiting and diarrhoea, sore throat, retrosternal pain, conjunctivitis, petechial

haemorrhage, abdominal pains, and bleeding from orifices. However, LF is suspected in patients

who present with fever (>38oC) who do not respond to antimalarial and antibiotic treatment.

Multiple organ damage and sensorineural hearing loss are some complications associated with

LF. The interaction between man and his environment is a major aspect to be considered in

understanding the epidemiology of diseases. The transmission of Lassa fever is closely related to

environmental factors intricately woven around the vector, the rodent Mastomysnatalensis

(Asogun et al., 2019). Other environmental factors such as overcrowding, poor food and personal

hygiene and poor housekeeping are implicated in the transmission of the Lassa virus. Exposed

food items, consumption of uncooked, poorly cooked and inadequately reheated foods are also

important risk considerations.

In 2012, there were 1,723 cases and 112 deaths in Nigeria. Last year, 12 people died out of 375

infected, according to the Nigeria Center for Disease Control. Nigeria had an outbreak of Lassa

fever in the year 2012 with 1,723 cases, 112 deaths, 201 laboratory-confirmed cases, and a case

fatality rate of 6.50 (Dan-Nwafor, 2018). Between January 1 and April 15, 2018, 1,849 suspected

cases have been reported from 21 states (Abia, Adamawa,Anambra, Bauchi, Benue, Delta,

Ebonyi, Edo, Ekiti, Federal Capital Territory, Gombe, Imo, Kaduna, Kogi, Lagos, Nasarawa,

Ondo, Osun, Plateau, Rivers, and Taraba). Out of these, 413 patients were confirmed with Lassa

fever, nine were classified as suspected, 1,422 tested negative, and the remaining five laboratory

results were pending. Of the 413 confirmed and the nine probable Lassa fever cases, 114 deaths

were reported (case fatality rate for confirmed cases is 25.4% and for confirmed and probable

cases combined is 27%). As of April, 27 health care workers in seven states (Abia, Benue,

Ebonyi, Edo, Kogi, Nasarawa, and Ondo) have been infected since January 1, 2018, eight of

whom have died

1.2 Statement of Problem

Lassa fever being a highly contagious disease endemic in West Africa, including Nigeria and

Taraba state needs a robust public measures including early detection, effective treatment and

widespread education on prevention to control its spread and mitigate its impact. The overall

regional and global risks are through its primary mode of transmission through contact with food

or household items contaminated with rat excreta ( McLeroy Bibeau & Steckler, 2019 ). Due to

drying of food items along high ways and outside houses over the night, constant burning of

bushes, poor hygiene practices, and overcrowding in homes which causes logging of baggages

and properties these give rise to these rats gaining entrance into the houses, all these factors put

together may facilitate the increase in rodent man contact or contamination of food source by
infected mastomys rat. A significant challenge lies in the inadequate awareness among

populations at risk, especially in rural and peri-urban areas ( Duvignaud et al., 2020).

Misconceptions about the transmission and prevention of Lassa fever often lead to delayed

healthcare-seeking behavior, contributing to the high mortality rate associated with the disease.

Additionally, healthcare workers, who are on the frontlines of managing Lassa fever cases, may

also exhibit gaps in their knowledge and adherence to recommended infection prevention and

control (IPC) protocols, increasing the risk of nosocomial transmission. This study aimed at

assessing the Knowledge, attitude and Practice on the Prevention of Lassa Fever among 500 Law

students of Ambrose Alli University Ekpoma, Edo State.

1.3 Objectives of the Study

The main objective of the study is to determine the Knowledge, attitude and Practice on the

Prevention of Lassa Fever among 500 Law students of Ambrose Alli University Ekpoma, Edo

State. The specific objectives are;

1. To determine the level of knowledge about Lassa fever among 500 Law students of

Ambrose Alli University Ekpoma, Edo State

2. To describe attitudes toward Lassa fever among 500 Law students of Ambrose Alli

University Ekpoma, Edo State

3. To identify practices related to Lassa fever prevention among 500 Law students of

Ambrose Alli University Ekpoma, Edo State

1.4 Research Questions

1. what is the level of knowledge about Lassa fever among 500 Law students of Ambrose

Alli University Ekpoma, Edo State?

2. What is the attitudes toward Lassa fever among 500 Law students of Ambrose Alli

University Ekpoma, Edo State?

3. What are the practices related to Lassa fever prevention among 500 Law students of

Ambrose Alli University Ekpoma, Edo State?

1.5 Significance of Study

Findings can guide policymakers and health authorities in developing targeted interventions to

improve knowledge and reduce the prevalence of Lassa fever..It provides valuable insights into

the level of awareness and practices surrounding Lassa fever prevention, which is critical for

designing effective health promotion programs. it will assist Non Governmental Organizations

(NGOs), stakeholders and policy makers in evaluating, improving, and facilitating the

implementation of evidence based strategies to prevent the outbreak of Lassa fever in Nigeria

and Ekpoma, Edo State, Nigeria. This study will also provide relevant information to

stakeholders for Community Health Knowledge Campaigns for Lassa fever. The findings of this

study will serve as a baseline for future research. The study fosters awareness and encourages

behavioral changes at the community level to enhance preventive practices. Identifying gaps in

knowledge and practice among healthcare workers and the general population can help

strengthen infection control measures.

1.6 Scope of study

The study will be limited to 500 Law students of Ambrose Alli University Ekpoma, Edo State.

The study will focus on assessing the Knowledge, attitude and Practice on the Prevention of

Lassa Fever among 500 Law students of Ambrose Alli University Ekpoma, Edo State.

1.7 Operational definition of terms

Knowledge: Awareness and understanding of Lassa fever, including its causes, transmission,

symptoms, and prevention methods.

Attitude: Perceptions, beliefs, and dispositions towards the prevention and control of Lassa

fever.

Practice: Actions and behaviors adopted by individuals to prevent Lassa fever, such as hygiene

practices and rodent control.

Lassa Fever: A viral hemorrhagic illness caused by the Lassa virus, commonly transmitted

through contact with rodent excreta or bodily fluids of infected individuals.

Prevention: Measures taken to reduce the risk of contracting or spreading Lassa fever, including

proper hygiene, food storage, and use of protective equipment.

 CHAPTER TWO

LITERATURE REVIEW

2.1 Conceptual Review

2.1.1 Overview of Lassa fever

Lassa fever (LF) is an acute viral (hemorrhagic that was first discovered in 1969 in the town of

Lassa in North-East of Nigeria (Tobin et al., 2016). It is an acute viral zoonotic illness endemic in

West Africa it was first isolated in 1969 from a missionary who was infected while working as a

nurse at Jos mission hospital in Jos Nigeria . Since then they have been reported outbreak of the

disease in different areas in Nigeria. Lassa fever has a very high rate of fatality and infectivity,

its infectivity, its knowledge remains low in sub-urban and rural communities (). The virus

endemic in West Africa and due to its high morbidity and mortality nature it is also in concern

with regardsto bioterrorism (Mahlaba, Monadjem, & Belmain, 2023).

Lassa fever is cause by the Lassa virus a member of Arenaviridae virus family (Yunusa,

Thairu&Egenti, 2015).clinical cases of the disease has been known to be connected with a viral

pathogen (King, Adams, Castens, &Lefkowitz, 2012), study shows that only 20.2 %(101

respondents), out of 500 community member in urban slums in south west Nigeria are aware of

Lassa fever (Olalekan, 2015). In a similar study in a rural community in the south-western part of

Nigeria conducted by Illesami and Colleagues (2015), only (17.2%) out of 122 respondents had

previously heard of Lassa fever Illesanmi et al (2015) also found out the major source of

knowledge is the mass media and (46.7%) who had tertiary compared to 14(13.1%) respondent

who had secondary education had previously heard about Lassa fever.
2.1.2 Knowledge on Lassa Fever

The environment in which a man lives could influence his/her development and health, among

the common environmental determinants of poor hygiene and poor housing are pressing

problems facing the developing countries (). The resulting problems of planned urbanization and

subsequent unprecedented population growth become more relevant without being implemented

(). Lassa fever occurs in all age groups and both sexes. People at greatest risk are those living in

the rural areas were Mastomys are usually found especially in communities with poor sanitation

or overcrowded living condition (). Health workers caring for Lassa fever patients are at risk, if

there are no proper barrier nursing and infection control practices (). Close contact of people in

traditional burial ceremonies of infected corpse should be avoided in rural communities ().

Communities where polygamy, poor housing, overcrowding, high social support for sick persons

and close contact with people in traditional burial ceremonies of infected corpse are rampart

including the consumption of rodents as a culinary delicacy is at a greater risk of rapid spread in

case of an outbreak (). Farmers and individuals in rural areas with poor food storage facilities

especially those that spread their farm products such as cassava, pepper, melon, maize, rice,

tubers, etc meant to be processed into flour along the road sideways to dry. This practice

encourages the contamination of the food stuff by the virus-carrying rodents which usually come

out of nearby bushes to feed on them (). Exposure may also occur occupational activities as

agricultural works or mining, person to person and laboratory infections occur especially in the

hospital environment through direct contact with blood (including inoculation with contaminated

needles) pharyngeal (throat) secretions or urine of a patient in a rural health care setting without

proper barrier nursing put the health care providers at risk of contracting the virus argues that

men are commonly affected than women, however the case fatality rate id nearly two times
higher in women. Another study argued that Men are more likely to buy food from food

vendorsespecially at launch time while women are more likely to eat personally cooked food,

contamination of food from this source may be responsible for higher incidence of Lassa fever in

men (Enriaet al, 2011).Oladeindeet al (2014), reported grave misconception about the mode of

transmission and prevention of Lassa fever in communities in Edo State, a total of 15(53.4%)

and 16(57.1%) of respondents are aware of the disease but had no idea of any vehicle of

transmission the television is the most popular source of knowledge in the study area. According

to the Columbia Encyclopedia, symptoms present fever and general malaise, later stage of the

disease may include abdominal pain, diarrhea vomiting and petechiae (tiny purplish spot on the

skin caused by leakage of blood from the capillaries) heart and kidney failure may occur in

severe cause and morbidity and mortality is high ranging from about 15% to as much as 60%

among pregnant women (The Columbia Encyclopedia, 2016).

Early treatment using Ribavirin was pioneered by Joe McCormick in 1985.After testing,

administration of Ribavirin was determined to be critical recovery;it is almost twice effective

administered intravenous as when taken orally (Bond, Schiefflin, Moses, Benette &Bausch,

2013). Tobin et al, (2013) show that 35% of health workers are not aware of drugs for treatment

of Lassa fever in the rural areas. Ribavirin is effective in the early stage of the infection,

especially when administered within the first six days of the infection Bausch, Hadi, Khan,&

Lertora, 2010). The treatment also include supportive measures such as electrolyte and fluid

replacement, correction of hypotension as well as treatment of any other complicating infections

and not generally acceptable nor available in the hospital (Pannetier, et al, 2011). Studies show

poor knowledge of treatment and management of Lassa fever cases in rural areas (Kakade,
2012).There is no vaccine that protects against Lassa fever but several candidates are under

development and results of trials involving non human primates have been encouraging

Attitude on Lassa Fever

The fear surrounding Lassa fever is often heightened due to its high fatality rate and the severe

symptoms associated with the disease. Many individuals equate the disease with death, which

leads to panic and anxiety when cases are reported in a community. This fear can drive people to

delay seeking medical care, either because they feel treatment is futile or because they fear being

ostracized. Individuals who contract Lassa fever often face significant stigma and

discrimination. In many communities, survivors are viewed as carriers of the virus even after

recovery. This stigmatization discourages people from reporting symptoms or seeking care,

thereby increasing the likelihood of community transmission. Furthermore, families of those who

succumb to the disease may also face societal exclusion, making it challenging to reintegrate into

their communities. Cultural beliefs and traditional practices play a critical role in shaping

attitudes toward Lassa fever. For instance, some communities attribute the disease to witchcraft

or spiritual causes rather than a viral infection. This belief system often leads individuals to seek

help from traditional healers instead of healthcare facilities, delaying diagnosis and treatment.

Misconceptions about the disease's transmission—such as the belief that it spreads through

casual contact rather than through exposure to infected rodents or bodily fluids—also contribute

to inappropriate preventive measures. A community’s knowledge about Lassa fever significantly

influences attitudes and behaviors. In areas where awareness campaigns have been robust,

individuals are more likely to adopt preventive practices such as rodent control, proper food

storage, and hygiene measures. Conversely, low levels of knowledge often lead to fatalistic

attitudes, with individuals believing that nothing can be done to prevent the disease. This lack of
awareness also contributes to myths about treatment, such as skepticism about the efficacy of

Ribavirin or distrust in the healthcare system. The attitude toward seeking medical care for Lassa

fever is influenced by several factors, including fear of diagnosis, financial constraints, and trust

in healthcare systems. In many rural areas, individuals are reluctant to visit healthcare facilities

due to concerns about cost or the perception that healthcare workers are not adequately equipped

to handle Lassa fever cases. Others may avoid hospitals altogether, fearing that they will contract

the disease while seeking care. Lassa fever also impacts disease management. In some cases, fear

and lack of training lead to hesitancy in treating suspected cases. Positive attitudes toward Lassa

fever prevention and control are often observed in communities where engagement and

participation are prioritized. Programs that involve community leaders, local organizations, and

healthcare workers in awareness campaigns tend to be more successful. When communities are

educated about the disease’s transmission and prevention, they are more likely to adopt

preventive measures and support affected individuals. Several barriers hinder the development of

positive attitudes toward Lassa fever. These include inadequate health infrastructure, limited

access to accurate information, and cultural resistance to change. Additionally, the lack of

government support for disease control initiatives, including funding for research and healthcare

facilities, perpetuates negative attitudes by creating an impression of neglect.

2.1.3 Preventive measures of Lassa fever

In as much as there is no vaccine available for protection against Lassa fever, there is evidence

that they will be produced in the nearest future. Researches done with non human primate have

revealed that survivors exhibit fever lesions and a lower viral load than non survivors (Ute,

2012).Findings by Olayinka et al (2015), in South-Western Nigeria have shown that good

housing standard and clean environment has been considered as part of the measures of Lassa
fever prevention and control, it’s an effective way of tackling the spread of the disease and

control of the disease and control of the vector.

Studies carried out in Sierra Leone by Hadi, Goba, Khan, Bangura, Sangura, Sankoh& Koroma

(2010), have indicated that there is a significant relationship between poor housing quality and

external hygiene and rodent burrows. Early detection of cases reduces the risk of outbreaks

related to person to person transmission especially among family members and health care

workers, (ECDC, 2014). In endemic areas, standard precautions measures should be applied

when caring for patients, irrespective of their diagnosis (WHO, 2016)b. when caring for patients,

with suspected or confirmed Lassa fever, measures should focus on preventing contact with the

patient’s blood and body fluids, contaminated surfaces or materials (Nikisins, Rieger, Patel,

Muller, Guntther, &Niedrig, 2015).

The risk of infection among health workers can be significantly reduced through strict isolation

of cases appropriate use of infection control precautions, such as use of personal protective

equipments (such as gloves, masks, gowns and goggles) (ECDC, 2014).

Early detection, prompt reporting of suspected cases, early diagnosing, isolation of confirmed

cases, and quarantine of suspected cases within the duration of the incubation period and contact,

tracing should be taken seriously in endemic areas, establishment of functionable diagnostic

facilities in disease endemic zones that can provide rapid molecular testing has been identified in

a study by Inegbinebor, Okuson&Inegbinebor (2010) in Nigeria.

Avoidance of spreading of food items on the road or compound or roof as practiced in most rural

areas, uncovered or improperly covered food in stores which could be contaminated by either the

urine or faeces of the Multimammate rat was found to be a very important way of preventing
contact with food items by the Multimammate rat in a study among rural dwellers in Sierra

Leone (Daniel, Bailor, Ross, Temple, Moses & Bausch, 2013).Studies by Oladeindeet al (2014)

shows that they is low level of knowledge on preventive measure in rural communities in

Nigeria, respondents reported that the television was the major source of knowledge, while

9(32.1%) mentioned mosquito bites, 7(27%) mentioned dog bites 7(25%) mentioned eating of

ratcontaminated food. 2(7.1%) respondents reported sleeping under mosquito nets and intake of

herbal concoction as the best method of prevention.

This protective equipment should undergo infective control measures such as complete

equipment sterilization and isolation of infected patients from contacts with unprotected persons

until the disease has run its course ().

Contact tracing, monitoring and collection of samples for laboratory investigation must be done

to persons who had made direct contacts with persons suspected or confirmed with Lassa

hemorrhagic fever, those who test positive must immediately be isolated and be placed on

ribavirin therapy (viral hemorrhagic fever consortium, 2011).Research carried out by Hadi et al,

(2010) stated that body secretions and other materials suspected to be contaminated should be

disposed properly usually by burning or handled with care if not disposable and autoclaved

immediately. Inegbeneboret al (2010), opined that health education and promotion should be

centered on rodent control and avoidance of contact with rodent excreta and body secretions

among people living in endemic regions, other strategies of prevention should also be

emphasized. The European Centre for Disease Control and prevention (ECDC)(2016), also

emphasized that preventive measures should focus on reduction of exposure to rodent excreta

with appropriate community hygiene practices (safe storage of food, waste management,

avoiding consumption of rodents and reduction of rodent population in and around homes.
Practices Related to Lassa Fever Prevention

Despite its public health significance, Lassa fever remains underreported due to inadequate

surveillance systems and low awareness in endemic areas. This underreporting contributes to

delays in diagnosis, treatment, and containment efforts, further exacerbating its impact on

communities. The absence of a widely available vaccine and the limited accessibility of antiviral

treatments like ribavirin emphasize the importance of preventive measures as the cornerstone for

controlling the spread of the disease. These preventive practices must be tailored to address both

individual behaviors and broader environmental and community-level risk factors. At the

individual level, prevention efforts include proper hand hygiene, safe food storage, and the

avoidance of contact with rodents or their excreta. Handwashing with soap and water is a simple

yet effective practice that can significantly reduce the risk of transmission. Proper storage of

food in sealed, rodent-proof containers is another critical measure, as it minimizes the likelihood

of contamination by infected rodents. In many endemic regions, however, these practices are

often hindered by socioeconomic factors, such as inadequate access to clean water and proper

storage facilities. Environmental measures are equally crucial in the fight against Lassa fever.

Community-level interventions play a pivotal role in Lassa fever prevention. Public health

education campaigns can help raise awareness about the modes of transmission and the

importance of early reporting of symptoms. Healthcare workers, often at the forefront of

managing outbreaks, require adequate training and resources to ensure the implementation of

infection prevention and control measures. Personal protective equipment (PPE), proper

sterilization of medical tools, and isolation of suspected or confirmed cases are essential

practices within healthcare settings. The role of research and innovation in prevention cannot be

overstated. While efforts to develop a vaccine are ongoing, understanding the sociocultural and
behavioral factors that influence compliance with preventive practices is equally important.

Studies have shown that traditional beliefs, misconceptions about the disease, and resistance to

change can hinder the adoption of preventive measures. Addressing these barriers through

culturally sensitive and community-engaged approaches is essential for achieving sustainable

results.

2.2 Theoretical review

The Health Belief Model (HBM) was used to explain Knowledge, attitude and Practice on the

Prevention of Lassa Fever among 500 Law students of Ambrose Alli University Ekpoma, Edo

State.

Health Belief Model (HBM)

HBM has been widely used and is considered as one of the most useful models in health care

prevention and promotion (Costa, 2020). It offers the ability to understand the different

behaviours or attitudes Residents may develop under the same condition by following or not

following certain guidelines or requirements. The model was originally developed by four

psychologists, Hochbaum, Kegels, Rosenstock and Leventhal in the 1950s as a way to examine

the reasons that prevented Residents from using free programs, which would detect or prevent

diseases, and considers that positive factors increase pro-health behaviour s while negative

factors decrease or inhibit them (Rosenstock, 1974). The original model had four constructs,

supplemented later by more. It is based on two axes: a) the perceived threat for acquiring a

disease, which incorporates the perceived susceptibility and perceived severity constructs. The

additional constructs were supplemented later in order to overcome some limitations the model
showed. Therefore, the self-efficacy and cues to action were added. In addition, when using this

model, other factor like social and demographics factors must be taken into account. According

to Jones et al. (2016), the main constructs of the model are:

Perceived susceptibility, refers to a person's subjective perception of the risk of acquiring an

illness or disease. There is wide variation in a person's feelings of personal vulnerability to an

illness or disease.

Perceived severity, refers to a person's feelings on the seriousness of contracting an illness or

disease (or leaving the illness or disease untreated). There is wide variation in a person's feelings

of severity, and often a person considers the medical consequences (e.g., death, disability) and

social consequences (e.g., family life, social relationships) when evaluating the severity.

Perceived benefits, refers to a person's perception of the effectiveness of various actions

available to reduce the threat of illness or disease (or to cure illness or disease). The course of

action a person takes in preventing (or curing) illness or disease relies on consideration and

evaluation of both perceived susceptibility and perceived benefit, such that the person would

accept the recommended health action if it was perceived as beneficial.

Perceived barriers, refers to a person's feelings on the obstacles to performing a recommended

health action. There is wide variation in a person's feelings of barriers, or impediments, which

lead to a cost/benefit analysis. The person weighs the effectiveness of the actions against the

perceptions that it may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful),

timeconsuming, or inconvenient.
Cue to action, is the stimulus needed to trigger the decision-making process to accept a

recommended health action. These cues can be internal (e.g., chest pains, wheezing, etc.) or

external (e.g., advice from others, illness of family member, newspaper article, etc.).

Self-efficacy, refers to the level of a person's confidence in his or her ability to successfully

perform a behaviour. This construct was added to the model most recently in mid-1980. Self-

efficacy is a construct in many behaviour al theories as it directly relates to whether a person

performs the desired behaviour.

Modifying factors, include personality variables; patient satisfaction; and socio-demographic

factors/variables.

Application of the HBM to the study

The HBM is a psychosocial model that tries to predict health seeking behaviour. In this study the

HBM is used to portray how Residents adopt self-care guidelines and utilize healthcare services

in the prevention and treatment of lassa fever. All constructs of the HBM are underpinned by a

Residents’s background and experiences including demographic characteristics, socioeconomic

status, Knowledge, attitude and Practice on the Prevention of Lassa Fever. According to the

HBM, if women are aware and have adequate on knowledge on lassa fever, it increases the likely

hood of adherence to prevention guidelines and seeking for adequate treatment. The HBM lays

emphases on the knowledge of women on the causes, mode of transmission, prevention,

treatment and consequences of infection with lassa fever to their health and that of the unborn

child. It is centered on an understanding that a woman will take a health related action if she

perceives that lassa fever can be avoided, or has a rational anticipation or knowledge that by
carrying out a suggested action, he/she will avoid adverse health outcomes for her and her

unborn child.

Perceived threat and its predicates—perceived susceptibility and perceived severity—make the

HBM well-suited to studying or modifying behaviour s that may contribute to adverse health

outcomes. In the HBM, an individual is considered more likely to take appropriate action if the

perceived threat of the disease is large (Costa, 2020). In turn, the perceived threat will be larger if

the perceived severity is larger—that is, the disease is regarded as a serious problem.

Perceived susceptibility corresponds to knowledge and belief about lassa fever. Perceived

severity investigates the personal belief regarding individual suffering of the disease process and

intensity of symptoms. Women’s perceptions of the risks and severity of contracting and

transmitting lassa fever in the context of the HBM, women may be poised to act most directly

and most powerfully on these constructs (Costa, 2020).

Perceived benefits concern the effectiveness of the behaviour al mechanisms adopted to prevent

the infection. Perceived barriers approach the difficulties in respecting norms and instructions for

protection and prevention of lassa fever. There are factors like socioeconomic status, gender,

literacy, and household income that influence the awareness/knowledge, beliefs, and preventive

health behaviour of an individual. It is important to identify the influence of these factors to form

an effective plan for the control and prevention of any disease (Siddiqui et al., 2016).
2.3 Empirical Review

Asogun, Adomeh and Ehimuan (2012), stated that an infected individual should be rushed and

admitted and treated in a special centre of there is no facility, barrier-nursing should be instituted

and relatives and family members must wear protective clothing’s and all body fluids and

excrements of the person must be proposal handled with at most care and precaution and

disposed. Findings on knowledge of Lassa fever and its control measures in Edo state by Tobin

and colleagues (2012), indicated that 97.0% of respondent have knowledge of Lassa fever,

overall knowledge was poor in terns if control of the disease hand gloves was the major method

of personal protection. At the community level, legislation is needed to put a stop to bush

burning, traditional autopsies, widowhood rites and preparation of garri (Cassava fever) and

other stapler foods in unhygienic conditions, Animal husbandry should be encouraged in order to

provide alternative sources of firstclass proteins for rat consumers.

Studies by Ilesanmi and colleagues (2015) shows that out of 122 respondents only 21% have the

knowledge of Lassa fever, 95.2% and 95.2% mentioned proper storage of food and clean

environment respectively the least mentioned was avoidance of rodent consumption by 47.6%,

only 85% mentioned good housing standard as a method of controlling Lassa fever. Titus (2010),

Opined that, at the community level, legislation is need to put a stop to bush burning, traditional

autopsies, widowhood rites and preparation of garri and other staple foods in unhygienic

condition. Animal husbandry should be encouraged in order to provide alternative source of first

class protein s for rat consumers. The use of rodenticide for reduction of rat population in and

around the home, engagement of the community and community participation is a key measure

in controlling the diseases, community knowledge using the mass media in the mode of
transmission, infectivity and mortality of the virus (Ochei, Agbejegah, Okoh, and Abah, 2014).

Findings from a study conducted by Oladeinde and colleagues (2014), demonstrated that only 28

(7.4%) respondents reported of being aware of Lassa fever, vehicles of transmission mentioned

include mosquito bite 9 (32.1%), Dog bite 7 (25%) and eating of rat-contaminated food 2 (7.1%).

A total of 15(52.4%) and 16(57.1%) of respondents of persons aware of the disease are not aware

of any mode of prevention or control. Asogunet al (2010), also reported that 72% dependents do

not use any means of control due to lack of knowledge, and 43% of respondents encourage bush

burning.

Illesanmi and colleagues (2015) advocated that regular health education should be carried out for

health workers; food seller should be regularly enlightened on the advantages of avoiding food

contamination with Lassa fever, left-over foods and grains should be covered

properly. .However, the NCDC (2015) has advised that emphasis should be placed on measures

of control of viral transmission from confirmed or suspect cause which include routine and

consistence use of standard precautions, isolation of suspected cases and surveillance of contacts.

Ossai et al., (2020) in a descriptive cross-sectional study in Abakaliki metropolis, Southeast

Nigeria examined the preventive measures against. A higher proportion (66.4%) demonstrated

good preventive practices against Lassa fever. In another cross sectional study, Uduak (2018),

assessed the practice of shop owners of 4 community markets in a Military Barrack in Kaduna

State towards Lassa fever Virus. They found that 52.5% of the respondents knew there is no

approved vaccination but 63% knew there is treatment for Lassa fever. All respondents affirmed

that it was good to wash hands with soap and water as often as possible, avoid direct contact with

dead rats and undertakers should always wear protective clothing. While, 82.5% said that they
store food stuffs in sealed containers, 67.5% said they would remove rat feces from food stuffs

and consume the food. Also, 65.5% said that they would not drink traditional herbs to treat Lassa

fever. Most of the respondents (94%) agreed that protective gear should be worn when nursing

an infected person.
 CHAPTER THREE

METHODOLOGY

Introduction

This section provides the research methods that will be used in the study. The subsections

include; Research design of the study, Target population, Sample size determination, sampling

technique, data analysis, instruments for data collection, instrument validity instrument

reliability, method of data collection, method of data analysis and ethical considerations of the

study.

3.1 Research Design

The study will adopt a descriptive cross-sectional research design. This design is chosen because

it allows the collection and analysis of data at a single point in time.

3.2The Study Setting

Ekpoma is located in Esan West Local Government Area of Edo State, Nigeria. It is

geographically located in 6o 8O’E/6. 75 oN, and 6.13330E. Esan West Local Government Area is

the headquarter with an area of 502km 2 and a population of 125,842 as at the 2006 population

census. In term of religion, the people of Esan West LGA are major Christians and traditional

religious worshippers. However, Islamic worship exists also who are majorly migrants from

outside the LGA. It is a town with different communities which include: Emuado,

Ihumudumu ,Ujoelen, Eguare,and so on. They are predominantly farmers.

3.3Target Population

The target population for this study will be 500L Law student.

3.4 Sample Size Determination

The sample size will be determined by applying the Taro Yamane formula (1976) as follows:

n= N

I+N (e2)

n= the sample size

e= the level of precision (assumed to be 0.05 at 95% confidence level)

N = population size

3.5 Sampling Technique

The study will adopts the Purposive and convenience sampling techniques. The participants will

be randomly selected from 500L Law student.

3.6 Instrument for data collection

Data will be collected using questionnaire on Knowledge, attitude and Practice on the Prevention

of Lassa Fever among 500 Law students of Ambrose Alli University Ekpoma, Edo State,

developed by the researcher. The questions were generated from reviewed literature based on the

objectives set for the study. The instrument has four sections. Section A comprised of items on
socio-demographic characteristic of respondents which where (6). Section B was made up of

items which Assess level of knowledge about Lassa fever. which were (9). Section C was made

up of items which describe attitudes toward Lassa fever which were (11). Section D was made

up of items which explore identify practices related to Lassa fever prevention which were (10).

All were scored on Yes or No.

3.7 Validity of Instrument

The face and content validity will be carried out by the project supervisor in the Department of

Nursing Sciences, Ambrose Alli University. The project supervisor examined the research

questions in line with the stated objectives and corrections were made on the generated items.

3.8 Reliability of Instrument

The test-retest reliability technique will be used to ascertain the reliability coefficient of the

instrument. The Spearman Brown Co-efficient will be used to obtain the reliability Co-efficient

of the instrument with a range of (0.6 – 0.8).

3.9 Method for Data Collection

With an introductory letter from the Head of Department of Nursing Sciences, Ambrose Alli

University, Ekpoma, Edo State, the researcher will visits to research facilities. The visit will

provide a forum for introduction and establishment of rapport between the researcher and the

respondents. The researcher and research assistants will administer copies of the questionnaire

directly to women in primary health center Ujoelen, Edo State, and the duration of administration

and retrieval is expected to be done within one month.

3.10. Method of Data Analysis

Descriptive statistics analysis such as frequency and percentage will be use to analyze the

retrieved data.

3.11 Ethical Consideration

An ethical clearance was obtained from PHC coordinator of Esan West L.G.A. In carrying this

research, the principles of voluntary participation, anonymity, confidentiality, informed consent,

beneficence, autonomy, fair treatment will be observed as ethical approval will be sought before

data collection begins. The purpose, content and implications will be explained to those

involved. They were not forced to participate in the study as they will be allowed to use their free

will to participate and principle of confidentiality, privacy, anonymity and justice where strictly

observed. After the study the researcher left contact details for any questions or concerns that

may have arisen during and after the study as a result of their participation.
 REFERENCES

Mahlaba, T. A. A., Monadjem, A., & Belmain, S. R. (2023). Domestic cats and dogs create a
landscape of fear for pest rodents around rural homesteads. PloS one, 12(2), e0171593.

Smith, K. F., Dobson, A. P., McKenzie, F. E., Real, L. A., Smith, D. L., & Wilson, M. L. (2017).
Ecological theory to enhance infectious disease control and public health policy. Frontiers in
ecology and the environment, 3(1), 29–37.
https://doi.org/10.1890/15409295(2017)003[0029:ETTEID]2.0.CO;2

Abdullahi, I. N., Anka, A. U., Ghamba, P. E., Onukegbe, N. B., Amadu, D. O., & Salami, M. O.
(2020). Need for preventive and control measures for Lassa fever through the One Health
strategic approach. Proceedings of Singapore Healthcare, 29(3), 190–194.
https://doi.org/10.1177/2017105820932616

McLeroy, K. R., Bibeau, D., & Steckler, A.. (2019). An ecological perspective on health
promotion programs. Health Education Quarterly, 15(4), 351–377.
https://doi.org/10.1177/109019818801500401

Tobin, E. A., Asogun, D., Akpede, N., Adomeh, D., Odia, I., & Gunther, S. (2016). Lassa fever
in Nigeria: Insights into seroprevalence and risk factors in rural Edo State: A pilot study. Journal
of medicine in the tropics, 17(2), 51-55

Akpede, G. O., Asogun, D. A., Okogbenin, S. A., Dawodu, S. O., Momoh, M. O., Dongo, A. E.,
Ike, C., & Tobin, E., 2019). Caseload and Case Fatality of Lassa fever in Nigeria, 2016–2018: A
Specialist Center's Experience and Its Implications. Frontiers in public health. 7:170.
https://doi.org/10.3389/fpubh.2019.00170

Akpede, G. O., Asogun, D. A., Okogbenin, S. A., &Okokhere, P. O. (2018). Lassa fever
outbreaks in Nigeria. Expert Review of Anti-infective Therapy. 16:663–666.
https://doi.org/10.1080/14787210.2018.1512856

Ehichioya, E. U., Asogun, D. A., Ehimuan, J., Okokhere, P. O., Pahlmann, M., Ölschläger, S.,
Becker-Ziaja, B., Günther, S., &Omilabu, S. A. (2022). Hospital‐based surveillance for Lassa
fever in Edo State, Nigeria, 2017–2018. Tropical Medicine & International Health, 17 (8),
10011004. https://doi.org/10.1111/j.1365-3156.2017.03010.x

Okoro, O. A., Bamgboye, E., Dan-Nwafor, C., Umeokonkwo, C., Ilori, E., Yashe, R., Balogun,
M., Nguku, P. &Ihekweazu, C. (2020). Descriptive epidemiology of Lassa fever in Nigeria,
2017-2017. Pan African Medical Journal. 37:15.
https://doi.org/10.11604/pamj.2020.37.15.21160

Raabe, V., & Koehler, J. (2017). Laboratory Diagnosis of Lassa fever. Journal of clinical
microbiology, 55(6), 1629–1637. https://doi.org/10.1128/JCM.00170-17
Woyessa, A. B., Maximore, L., Keller, D. Dogba, J., Pajibo, M., Johnson, K., Saydee, E.,
Monday, J., Tuopileyi, R., Mahmoud, N. (2017). Lesson learned from the investigation and
response of Lassa fever outbreak, Margibi County, Liberia, 2018: case report. BMC Infectious
Diseases, 19, 610 (2019). https://doi.org/10.1186/s12879-019-4257-z

Duvignaud, A., Jaspard, M., Etafo, I. C., Serra, B., Abejegah, C., Gabillard, D., & Doutchi, M.
(2020). Lassa fever clinical course and setting a standard of care for future randomized trials: A
protocol for a cohort study of Lassa-infected patients in Nigeria (LASCOPE). Travel medicine
and infectious disease, 101557. Advance online
publication.https://doi.org/10.1016/j.tmaid.2020.101557

Denue, B. A., Stephen, M., &Dauvoux, I. (2017). The unending threat of Lassa fever in Nigeria,
what can be done; what should be done. Port Harcourt medical journal, 11(3), 113-121

Uzoaru, O. C., & Festus, M. O. (2021). Environmental adult education for preventing Lassa
fever outbreak in Nigeria. Int J Health Psychol Res, 6, 1-12.

Manning, J. T., Forrester, N., &Paessler, S. (2016). Lassa virus isolates from Mali and the Ivory
Coast represent an emerging fifth lineage. Frontiers in microbiology, 6, 1037.
https://doi.org/10.3389/fmicb.2016.01037.

Dan-Nwafor, I. E. (2018). Re-emerging Lassa fever outbreaks in Nigeria: Re-enforcing “One

Health” community surveillance and emergency response practice. Infectious Diseases of
Poverty, 7, 37 (2018). https://doi.org/10.1186/s40249-018-0421-8

Agboeze, J., Onoh, R., Eze, J., Nwali, M., Ukaegbe, C. (2019). Clinical Profile of Lassa fever
Patients in Abakaliki, Southeastern Nigeria. Annals of medical & health sciences research, 9:
598-602

Aigbiremolen, A. O., Lawal-Luka, R. K., Abejegah, C., Aigberemwon, J. A., Abah, E. O., &
Abah, S. O. (2017). Environmental risk factors in the transmission of Lassa fever in college
students hostels in Ekpoma, a semi urban town in south-south Nigeria. Annals, 3, 37-42.

Akhuemokhan, O. C., Ewah-Odiase, R. O., Akpede, N., Ehimuan, J., Adomeh, D. I., Odia, I.
Olomu, S. C., &Akpede, G. O. (2017). Prevalence of Lassa Virus Disease (LVD) in Nigerian
children with fever or fever and convulsions in an endemic area. PLoS neglected tropical
diseases, 11(7), e0005711. https://doi.org/10.1371/journal.pntd.0005711

Asogun, D. A., Günther, S., Akpede, G. O., Ihekweazu, C., &Zumla, A. (2019). Lassa fever:
Epidemiology, Clinical Features, Diagnosis, Management and Prevention. Infectious disease
clinics of North America, 33(4), 933–951. https://doi.org/10.1016/j.idc.2019.08.002

Fall, I. S., Rajatonirina, S., Yahaya, A. A., Zabulon, Y. &Talisuna, A. O. (2019). Integrated
Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives
for the future in Africa. BMJ global health, 4(4), e001427. https://doi.org/10.1136/bmjgh-
2019001427
Hallam, H. J., Hallam, S., Rodriguez, S. E. & Reece, L. M. (2018). Baseline mapping of Lassa
fever virology, epidemiology and vaccine research and development. npj Vaccines 3, 11 (2018).
https://doi.org/10.1038/s41541-018-0049-5

Usifoh, S. F., Ighedosa, S. U., Aighewi, I. T., Asemota, O. D., Odigie, E. A., &Faboya, T.
(2018). Impact of lassa fever on the practice and consumption of stored food by university of
Benin community, in Benin city, Nigeria. Journal of Community Medicine and Primary Health
Care, 30(1), 66-76.

Nwidi, D. U., Unigwe, U. & Eke, M. (2020). Prevalence and outcome of Lassa fever among
hospitalized patients in Ebonyi State, Nigeria, 2018-2019. Virus research, 285, 198000.
https://doi.org/10.1016/j.virusres.2020.198000

Musa, E. O., Woldetsadik, S. F., Lasuba, C., Alemu, W., Ihekweazu, C., & Nigeria Lassa Fever
National Response Team (2019). Epidemiologic and Clinical Features of Lassa fever Outbreak
in Nigeria, January 1-May 6, 2018. Emerging infectious diseases, 25(6), 1066–1074.
https://doi.org/10.3201/eid2506.181035