Introduction: Lassa fever (LF) causes significant morbidity and mortality worldwide with estimated 3-5 million individuals being infected yearly. In West Africa, the disease is endemic in Nigeria, Sierra Leone, Guinea and Liberia. Liberia recorded its first outbreak in 1972. We determined knowledge, attitudes, and practices (KAP) toward LF disease, to identify practices related to LF transmission, determine differences in KAP and to identify factors associated with LF among adult populations in endemic and non-endemic counties of Liberia.

Methods: We conducted a cross-sectional study among 858 respondents in all 15 counties in Liberia. A combination of probability sampling techniques were used to obtain the desired sample size. We used electronic semi-structured questionnaires for data collection. We summarized data using counts, proportions, 95%CI and Chi-square.

Results: Of the 858 respondents from all 15 counties in Liberia, only 24(3%) had good knowledge generally about LF management (P-value=0.02), 250(29%) had a positive attitude towards LF (P-value=0.6), and 217(25%) carried out good LF-related practices (P-value=0.1). A higher level of education was associated with good knowledge and positive attitudes in endemic and non-endemic counties. (P-value=0.01).

Conclusion: KAP of LF was low in both endemic and non-endemic counties. There was no difference seen in attitudes and practices among endemic and non-endemic counties. We recommended that Ministry of Health and National Public Health Institute of Liberia increase awareness of LF in Liberia and work with the Ministry of Education to introduce modules on LF in all schools.