The Knowledge-Practice Gap in Lymphatic Filariasis Prevention among Adults in Southeastern Nigeria: A Critical Narrative Review

Abstract

Lymphatic filariasis remains a preventable cause of chronic lymphoedema, hydrocele, disability and stigma in endemic settings, yet successful elimination depends on adults repeatedly converting preventive knowledge into action. In southeastern Nigeria, the behavioural problem is often framed as inadequate awareness, but available evidence suggests a more complex knowledge-practice gap: recognition of elephantiasis or hydrocele may coexist with incorrect causal beliefs, inconsistent mosquito-net use, traditional treatment preferences, missed preventive chemotherapy, delayed biomedical care and limited adoption of morbidity-management practices. This critical narrative review synthesises evidence on that gap among adults in Abia, Anambra, Ebonyi, Enugu and Imo States, while using Nigerian and sub-Saharan African evidence to interpret mechanisms where regional studies are sparse. Literature published from 1 January 2000 to 17 July 2026 was prioritised, with selected earlier studies retained for conceptual continuity. The regional evidence base is small and dominated by cross-sectional surveys, qualitative studies and non-randomised implementation research. It nevertheless consistently indicates that factual knowledge is neither unitary nor sufficient: adults may know the visible manifestations of disease while misunderstanding mosquito-borne transmission, may own preventive commodities without using them consistently, and may accept public-health messages while facing opportunity constraints, distrust, stigma, treatment concerns or weak access to appropriate services. Evidence from southeastern Nigeria also shows that long-lasting insecticidal nets can reduce vector infection, tailored social and behaviour change communication is associated with higher net use, integrated self-care can improve patient-level outcomes, and culturally embedded public education can improve reported knowledge and practices, although causal inference is limited. The review therefore reframes the gap as an interaction among capability, opportunity and motivation rather than a simple information deficit. Priority research needs include longitudinal measurement of individual knowledge-practice concordance, adult-specific mass-drug-administration adherence histories, implementation trials that measure observed behaviour, and state-stratified studies linking communication exposure, service access, trust and preventive uptake.