Knowledge and practices related to Brugian Filariasis among communities in filariasis-affected and control areas of Puttalam district, Sri Lanka

Brugian Filariasis (BF), previously eliminated in Sri Lanka by 1967 through vector control targeting Mansonia mosquitoes, has re-emerged in Puttalam District with 109 cases reported between 2005 and 2021, the highest being 51 cases in Puttalam. This study investigated the socio-demographic and environmental factors associated with BF transmission and community knowledge and practices. A community-based cross-sectional study was conducted from December 2021 to March 2022 across three test sites, Puruduwella, Nelumpokuna, and Thummodara, and one control site, Karavitagara. A total of 320 individuals were surveyed using an interviewer-administered questionnaire. Of the respondents, 40.3% (n=129) demonstrated good knowledge and 40% (n=128) exhibited good practices related to filariasis infection and control. Knowledge (8.8±0.2) and practices (2.3±0.1) were significantly higher in test sites than the control (p<0.001), with strong positive correlation (r=0.348; p<0.001). Education level (p=0.011), income (p=0.002), and age (p=0.032) were significantly associated with good knowledge, while good practices were significantly associated with lower education (p=0.029) and younger age groups (p<0.001). Notably, respondents without formal education (p=0.011) and those earning <20,000 LKR/month (p=0.002) showed significantly better knowledge. Residents with BF cases in the household had significantly higher knowledge (r=0.138; p=0.013), though practice was not correlated (p=0.470). A rise in the number of reservoir hosts, such as dogs and cattle, in BF-positive areas, together with high mosquito densities observed during entomological surveys, suggests the potential for zoonotic transmission. These findings underscore the need for targeted and inclusive health education and vector control strategies across socio-economic strata to sustain filariasis elimination in endemic regions.