Knowledge, Attitudes, and Predictors of Risky Practices regarding Schistosomiasis among Residents of Hard-to-reach Communities in Olorunda Local Government Area, Osun State, Nigeria

Knowledge, Attitudes, and Predictors of Risky Practices regarding Schistosomiasis among Residents of Hard-to-reach Communities in Olorunda Local Government Area, Osun 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 Knowledge, Attitudes, and Predictors of Risky Practices regarding Schistosomiasis among Residents of Hard-to-reach Communities in Olorunda Local Government Area, Osun State, Nigeria Sunday Charles Adeyemo, Sunday Olakunle Olarewaju, Ifedola Olabisi Faramade, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8618968/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Schistosomiasis remains a major public health burden in Nigeria, especially in Hard-to-reach communities with limited access to water, sanitation, and hygiene (WASH). This study assessed the knowledge, attitudes, and practices (KAP) regarding schistosomiasis and identified predictors of risky practices among residents in such communities in Osun State, Nigeria. Methods A community-based cross-sectional study was conducted among 325 residents (aged ≥ 18 years) in hard-to-reach communities in Olorunda Local Government Area, Osun State. Data were collected using a pre-tested, structured questionnaire. Knowledge, attitude, and practice scores were categorized as "good" or "poor" based on mean scores. Univariate analyses were presented as frequencies and percentages. Associations were tested using Chi-square and Pearson’s correlation at a significance level of p < 0.05. Results The mean age of respondents was 28.7 (± 10.4) years, with 56% being female. Overall, 74.2% had good knowledge of schistosomiasis, 63.9% exhibited a good attitude, but only 52.6% reported good preventive practices. While 97.9% correctly identified water contact as the transmission route, risky practices were prevalent: 64.6% used rivers as a primary water source, 64.6% bathed in open water, and 49.2% had defecated openly within the last three months. A significant negative correlation was found between knowledge and risky practices (r = -0.215, p < 0.001), and between attitude and risky practices (r = -0.221, p < 0.001). Poor attitude (χ² = 16.427, p < 0.001) and lower educational level were significant predictors of risky practices. Conclusion Despite relatively high knowledge and positive attitudes, a substantial proportion of residents in hard-to-reach communities continue to engage in practices that facilitate schistosomiasis transmission, primarily driven by infrastructural deficits and socioeconomic constraints. Control programs must move beyond mass drug administration and knowledge dissemination to integrate sustainable WASH infrastructure development, targeted behavioral change communication, and community-led snail control initiatives. Schistosomiasis Knowledge Attitudes Practices Hard-to-reach Nigeria Water Sanitation and Hygiene (WASH) Introduction Schistosomiasis is a debilitating neglected tropical disease (NTD) caused by blood flukes of the genus Schistosoma . Over 90% of the estimated 250 million global cases occur in sub-Saharan Africa, where it poses a severe threat to public health and socioeconomic development [ 1 , 2 ]. Nigeria bears the greatest burden globally, with approximately 29 million infected individuals and 101 million at risk [ 3 ]. Transmission is perpetuated through human contact with freshwater contaminated by cercariae shed by intermediate snail hosts. Risky practices such as bathing, swimming, washing clothes in infested water, and open defecation/urination near water bodies are key behavioral drivers of transmission [ 4 ]. In hard-to-reach communities, these practices are often entrenched necessities due to the critical lack of access to potable water and improved sanitation [ 5 ]. While preventive chemotherapy with praziquantel via Mass Drug Administration (MDA) is the cornerstone of control, its long-term success is undermined by rapid reinfection in the absence of complementary interventions addressing behavior and environment [ 4 , 6 ]. Understanding the community's knowledge, attitudes, and practices (KAP) is therefore essential for designing effective, integrated, and sustainable control programs [ 7 ]. Despite Nigeria's high burden, there is a scarcity of KAP studies focusing on hard-to-reach populations who are often marginalized in mainstream health interventions. This study aimed to assess the KAP regarding schistosomiasis and identify the predictors of risky practices among residents of hard-to-reach communities in Osun State, Nigeria. The findings will provide evidence to tailor control strategies to the specific needs and contexts of these vulnerable populations. Methods Study Design and Area A community-based descriptive cross-sectional study was conducted in 11th to 18th, June 2025 in selected hard-to-reach communities in Olorunda Local Government Area of Osun State, South-West Nigeria. The communities relies heavily on the Erinle River/Dam for domestic and recreational activities. Communities in this study were classified as "hard-to-reach" based on criteria adapted from established frameworks including the Nigeria Demographic and Health Survey, the World Health Organization's approach to underserved populations [1], and Nigeria's Primary Health Care standards [8]. The selected communities met at least three of the following five criteria: Distance to Primary Health Care: Located >5 kilometers from the nearest functional Primary Health Centre (PHC). Road Access: Lack of all-season, motorable road access; requiring travel via footpaths, waterways, or unpaved roads that become impassable during the rainy season. Absence of Basic Infrastructure: Lack of government-provided grid electricity and piped potable water systems – indicators of marginalization [8]. Limited Communication: Poor mobile network coverage and limited access to mass media (radio, television) – affecting health information access . Socioeconomic Marginalization: Predominance of subsistence-level occupations with low formal education attainment – characteristic of health service exclusion [1]. Study Population and Sampling The study included consenting residents aged 18 years and above who had lived in the community for at least six months. The sample size was calculated using Fisher’s formula, with a prevalence of 27.5% from a previous study [9], a 95% confidence level, and a 5% margin of error. The minimum sample of 306 was increased by 10% to account for non-response, yielding a final sample of 336. Sampling Technique: A multi-stage cluster sampling technique was employed to enhance representativeness. Stage 1 (Selection of Communities): From an enumerated list of nine (9) identified hard-to-reach communities in Olorunda LGA, three (3) communities (Ilie, Owo, and Oba Ile) were selected using simple random sampling (balloting). Stage 2 (Selection of Households): The minimum sample size (336) (was allocated proportionally to the three selected communities based on their estimated adult population sizes (obtained from community leaders/local health post records). The final distribution was: Ilie (n=186), Owo (n=85), Oba Ile (n=65). In each community, systematic sampling technique was used. A central location (the chief’s house) was chosen as a starting point while subsequent houses were selected using kth number derived from dividing the sample size to be selected in the community by the total number of houses in the community until the estimated quota for that community was reached. This method helped reduce selection bias inherent in pure convenience sampling. Stage 3 (Selection of Respondents): In each selected household, one eligible adult (aged ≥18 years, resident for ≥6 months) was randomly selected. Data Collection Data were collected using a pre-tested, interviewer-administered, structured questionnaire adapted from literature [7]. The tool had four sections: socio-demographics, knowledge (14 items), attitudes (15 items on a 5-point Likert scale), and practices (14 items). Ethical approval was obtained from the Osun State University Health Research Ethics Committee. Informed consent was obtained from all participants. Data Analysis Data were analyzed using IBM SPSS Statistics version 28.0. Descriptive statistics were presented as frequencies and percentages. Knowledge, attitude, and practice scores were computed. The mean score was used as a cut-off to categorize respondents into "Good" or "Poor" for each domain. Pearson’s correlation and Chi-square tests were used to examine relationships between variables. Statistical significance was set at p-value < 0.05. Results Out of 336 questionnaire distributed, 325 questionnaire were properly filled and returned, yielding a response rate of 96.7%. Socio-demographic Characteristics Of the 325 respondents, 182 (56%) were female. The mean age was 28.7 (± 10.4) years, with the largest proportion (43.4%) aged 18–25 years. Most were single (60.3%), Muslim (50.8%), of Yoruba ethnicity (84.9%), and students (44.9%). Over a third (36.6%) had only primary education, while 12% had no formal education. A majority (64.9%) had lived in the community for over five years (Table 1 ). Knowledge of Schistosomiasis Overall, 72.9% (n = 237) had heard of schistosomiasis. Health workers (42.6%) were the primary source of information. Among those aware, knowledge was high: 88.2% correctly defined it as a disease, 97.9% identified water contact as the mode of transmission, and 88.6% recognized abdominal pain as a key symptom. However, misconceptions existed, with 15.6% attributing transmission to witchcraft (Table 2 ). Based on the composite score, 74.2% (n = 241) had good overall knowledge. Table 1 Sociodemographic characteristics of respondents Variable Category Frequency Percentage Gender Male 143 44.0 Female 182 56.0 Age (years) 18–25 141 43.4 26–35 98 30.1 36–45 53 16.3 46–55 13 4.0 > 55 20 6.2 Marital Status Single 196 60.3 Married 129 39.7 Religion Christian 118 36.3 Islam 165 50.8 Traditional 42 12.9 Level of Education No education 39 12.0 Primary 119 36.6 Secondary 92 28.3 Tertiary 75 23.1 Ethnicity Yoruba 276 84.9 Hausa 20 6.2 Igbo 27 8.3 Occupation Skilled (Student, Nurse, Chemist) 172 52.9 Semi- skilled (Tailor, Hairdresser, Trader) 79 24.3 Unskilled (Farmer, Fisherman, Hunter) 118 36.3 Distance to Nearest Health Facility < 5 kilometers 234 72.0 ≥ 5 kilometers 91 28.0 Walking Time to Nearest Water Source 1–2 minutes 120 36.9 3–4 minutes 115 35.4 5 minutes 90 27.7 Table 2 Knowledge of Schistosomiasis Knowledge on Signs and Symptoms Frequency Percentage Abdominal Pain 210 88.6 Diarrhea 175 73.8 Blood in stool 160 67.5 Belly enlargement 120 50.6 Severe fever 90 38.0 Stunted growth 55 23.2 Skin rash 45 19.0 Reduced learning ability 35 14.8 Others (fatigue) 20 8.4 I don’t know 18 7.6 Knowledge on Mode of Transmission Frequency Percentage Contact with water 232 97.9 Witchcraft 37 15.6 Misfortune 29 12.2 Handshake 23 9.7 Vomiting 28 10.6 I don’t know 35 14.8 Knowledge of Diagnosis Methods Frequency Percentage Signs and symptoms 210 88.6 Urine test 150 63.3 Stool test 120 50.6 Ultrasound 110 46.4 I don’t know 70 26.5 Knowledge of Prevention Methods Frequency Percentage Avoid contact with water 235 99.1 Avoid open defecation 210 88.6 Medication 178 75.1 Snail control 162 69.6 Do not walk barefooted 153 64.5 Avoid open urination 145 61.2 Boiling water from river 98 41.3 Avoid eating unwashed vegetables 60 25.3 Avoid uncooked meat 48 20.2 Attitudes towards Schistosomiasis Attitudes were generally positive: 58.1% strongly agreed it is a serious disease, and over 80% acknowledged the importance of avoiding contaminated water and using toilets. However, 30.0% were neutral about the importance of urinating in toilets, and 55.7% agreed that traditional healers could cure the disease (Table 3 ). Overall, 63.9% (n = 207) had a good attitude. Table 3 Attitudes towards Schistosomiasis Statement (SA) (A) (N) (D) (SD) Schistosomiasis is a very serious disease 189 (58.1%) 133 (40.9%) 3 (0.9%) 0 (0%) 0 (0%) It is necessary to prevent infection from schistosomiasis 84 (25.8%) 164 (50.2%) 49 (15.1%) 28 (8.6%) 0 (0%) It is my responsibility to prevent infection from schistosomiasis 67 (20.6%) 230 (70.8%) 11 (3.4%) 17 (5.2%) 0 (0%) It is important to know whether I have schistosomiasis or not 202 (62.2%) 119 (36.7%) 4 (1.2%) 0 (0%) 0 (0%) It is important to avoid contact with contaminated water 68 (20.7%) 257 (78.3%) 0 (0%) 0 (0%) 0 (0%) Defecating in the toilet is important for my health 79 (24.0%) 224 (68.0%) 17 (5.2%) 6 (1.8%) 0 (0%) Urinating in the toilet is important for my health 37 (11.4%) 129 (39.7%) 97 (29.8%) 38 (11.7%) 24 (7.4%) Eating uncooked meat can make someone susceptible to schistosomiasis 23 (7.1%) 107 (33.1%) 172 (53.1%) 11 (3.4%) 10 (3.1%) Eating unwashed vegetables can make someone susceptible to schistosomiasis 125 (38.5%) 196 (60.3%) 4 (1.2%) 0 (0%) 0 (0%) I would take action if I found that I had schistosomiasis 149 (45.8%) 167 (51.3%) 9 (2.8%) 0 (0%) 0 (0%) Taking medication for schistosomiasis is important for my health 89 (27.4%) 206 (63.5%) 27 (8.3%) 3 (0.9%) 0 (0%) Going to hospital can help reduce schistosomiasis 54 (16.6%) 199 (61.0%) 57 (17.5%) 15 (4.6%) 0 (0%) Seeing a traditional health practitioner can cure schistosomiasis 46 (14.1%) 214 (65.7%) 37 (11.4%) 21 (6.4%) 10 (3.1%) It is important for me to be informed about schistosomiasis 29 (8.9%) 237 (72.2%) 36 (11.0%) 23 (7.0%) 0 (0%) Strongly Agree (SA), Agree (A), Neutral (N), Disagree (D), Strongly Disagree (SD) Practices related to Schistosomiasis Risky practices were widespread. The river was the most common water source (64.6%). Activities at water sources included bathing (64.6%), swimming (49.2%), washing clothes (67.7%), and washing utensils (63.1%). Although 96.6% reported having a toilet, 49.2% had defecated openly in the last three months (mostly in the bush, 70.2%), primarily due to a spoilt toilet (58.5%). Similarly, 85.2% had urinated openly, with 46.2% doing so in the bush. Only 52.6% (n = 171) were categorized as having good preventive practices. Predictors and Correlates of Risky Practices Statistical analysis revealed significant negative correlations: individuals with better knowledge (r = -0.215, p < 0.001) and more positive attitudes (r = -0.221, p < 0.001) were less likely to engage in risky practices. Chi-square tests confirmed a significant association between attitude and risky practices (χ² = 16.427, p < 0.001). Furthermore, socio-demographic factors like lower educational level were significantly associated with higher engagement in risky practices (χ² = 19.843, p < 0.01). Discussion This study provides critical insights into the complex dynamics of schistosomiasis-related knowledge, attitudes, and practices within a hard-to-reach community in Osun State, Nigeria. The findings reveal a persistent and troubling knowledge-practice gap, where relatively high levels of awareness and generally positive attitudes fail to translate into adequate preventive behaviors. This disconnect underscores the limitations of conventional health education approaches when implemented in contexts of profound structural deprivation. The Paradox of Knowledge and Practice The finding that 97.9% of aware respondents correctly identified water contact as the transmission route, while 64.6% continued to use rivers for bathing and 49.2% for swimming, represents more than a simple behavioral failure; it highlights a structural coercion where knowledge is overridden by necessity. This phenomenon aligns with the Theory of Planned Behavior, which posits that behavioral intention (influenced by attitude and knowledge) is mediated by perceived behavioral control [ 10 ]. In this community, the perceived (and real) control over avoiding infested water is critically low due to the absence of alternatives. The Erinle River/Dam is not merely a convenience but a critical resource nexus for domestic, agricultural, and economic activities. This creates an "exposure-poverty trap" where residents must engage in high-risk activities to meet basic needs, perpetuating disease transmission despite awareness of the consequences [ 5 ]. Similar findings have been documented in other schistosomiasis-endemic regions, where economic imperatives and water insecurity consistently trump health knowledge [ 4 , 9 ]. Sanitation Infrastructure: Ownership versus Usability A particularly revealing finding concerns sanitation practices. While 96.6% reported toilet ownership, a figure that might suggest adequate coverage, nearly half (49.2%) had defecated openly in the preceding three months. The primary reason cited was a "spoilt toilet" (58.5%). This distinction between physical access and functional access is crucial for public health programming. It reveals that infrastructure provision without robust maintenance systems, community training, and perhaps culturally appropriate design leads to rapid dysfunction. This finding challenges the common metric of "improved sanitation facility" coverage and suggests that monitoring should include functionality and consistent use [ 11 , 12 ]. The high rate of open urination (85.2%) further indicates that even when toilets are available, they may not be deemed necessary or practical for all sanitation needs, influenced by convenience, gender dynamics, or cultural norms [ 13 , 14 ]. Attitudes: Between Modern Medicine and Traditional Beliefs The generally positive attitudes towards modern prevention and treatment are encouraging for MDA compliance. However, the concurrent strong belief in the curative power of traditional healers (55.7% agreement) presents a nuanced picture of health-seeking pluralism. This is not necessarily contradictory; community members may navigate multiple health systems simultaneously. However, it can lead to treatment delays or incomplete therapy if schistosomiasis is first attributed to spiritual causes or treated with ineffective traditional remedies [ 4 ]. Effective health communication must therefore engage respectfully with traditional belief systems, potentially collaborating with trusted traditional healers to channel suspected cases to formal healthcare, rather than attempting to discredit them outright [ 15 ]. The Role of Socio-demographics and the "KAP Gap" The significant association between lower educational attainment and riskier practices underscores education as a key social determinant of health in this context. Education likely enhances both health literacy and the capacity to problem-solve around resource constraints (e.g., finding ways to treat water, repair facilities) [ 6 , 15 ]. The correlation and chi-square analyses confirming the link between poor attitude/knowledge and risky practices validate the theoretical foundations of KAP studies. However, they also highlight that in environments of severe constraint, improving KAP alone has a ceiling effect on behavioral change. This reinforces the need for environmental modification (WASH infrastructure) and economic empowerment as foundational interventions, upon which health education can then have greater efficacy [ 5 , 13 , 15 ]. Implications for Integrated Control Strategies The persistence of risky practices, despite two decades of global scale-up of preventive chemotherapy, signals that MDA is necessary but insufficient for sustained control. Our findings strongly support the World Health Organization's call for integrated control combining chemotherapy, WASH, and snail control [ 4 , 12 , 16 ]. Specifically for hard-to-reach communities: Water Access: Investments must go beyond borehole drilling to include sustainable maintenance models (e.g., community water committees with micro-financing for repairs) and point-of-use water treatment solutions that are low-cost and culturally acceptable. Sanitation: Programs need a "Sanitation as a Service" approach, ensuring long-term functionality of toilets. Community-Led Total Sanitation (CLTS) campaigns could be adapted to address not just open defecation but also the maintenance and proper use of existing facilities. Snail Control: Targeted environmental management or mollusciciding around major transmission foci like the Erinle Dam could reduce cercarial density, providing a direct ecological barrier to complement behavioral and chemotherapeutic interventions. Contextual Health Education: Messaging should shift from "don't go in the water" to practical, feasible risk-reduction strategies (e.g., storing river water for 48 hours before use to allow cercariae to die, using protective footwear during necessary water contact) and focus on correcting specific local misconceptions (e.g., transmission via food). Study Limitations The interpretations of this study must be considered alongside its limitations. The cross-sectional design precludes causal inference. The use of convenience sampling may introduce selection bias, potentially over-representing more accessible or cooperative households. Self-reported data on sensitive practices like open defecation are vulnerable to social desirability bias, suggesting the actual prevalence of risky practices may be even higher. Finally, focusing on a single community limits the generalizability of findings, although it provides valuable depth for this specific hard-to-reach context. Conclusion In conclusion, this study illuminates the complex reality of schistosomiasis control in a Nigerian hard-to-reach community. It moves the discourse beyond quantifying knowledge deficits to analyzing why knowledge fails to protect. The core issue is not a lack of awareness but a lack of agency, the power to act on that awareness due to missing alternatives. Therefore, the path to elimination requires biomedical strategies (MDA) to be inseparably coupled with development strategies that address water poverty and sanitation failure. Empowering communities with sustainable WASH infrastructure is the most effective "vaccine" against the reinfection cycle, turning informed intent into actionable, life-saving practice. Declarations Ethical Approval Ethical approval was granted by the Health Research and Ethics Committee of the College of Health Sciences, Osun State University (UNIOSUNHREC 2025/PBH/002). Informed consent was obtained from all participants. The ethical principles and guidelines set out by the Declaration of Helsinki, the Belmont Report, and other relevant documents were followed during the conduct of the study. Consent for publication Not applicable Clinical trial Not applicable Availability of data and material The data for this study is provided within the manuscript Author’s contribution SCA, SOO, and IOF worked on the study design; SOO, INA, and OPT collected data; SOO, OEA and SCA supervised the project; SCA, EDO, OA and ARA analyzed the data while SOO, OO and SCA ensured ethical compliance. SOO, EDO and SCA were major contributors in writing the manuscript. All authors read and approved the final manuscript. Acknowledgements The authors thank the community leaders and residents of the communities where the study was carried out for their participation and cooperation. We also acknowledge the support of the Department of Public Health, Osun State University. Funding The authors did not receive any funding for the study. Competing interests The authors know no competing interest for this study. References World Health Organization. (2022). 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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-8618968","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":578202558,"identity":"58c6143d-a160-4009-b2c1-c8ef4a66636b","order_by":0,"name":"Sunday Charles 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University","correspondingAuthor":false,"prefix":"","firstName":"Sunday","middleName":"Olakunle","lastName":"Olarewaju","suffix":""},{"id":578202560,"identity":"8675472c-2bce-4772-b9a9-18dab2f71810","order_by":2,"name":"Ifedola Olabisi Faramade","email":"","orcid":"","institution":"Osun State University","correspondingAuthor":false,"prefix":"","firstName":"Ifedola","middleName":"Olabisi","lastName":"Faramade","suffix":""},{"id":578202561,"identity":"65f70cda-a363-4921-b9b7-be331dd8dc79","order_by":3,"name":"Ideraoluwa Neemotallahi Adejumo","email":"","orcid":"","institution":"Osun State University","correspondingAuthor":false,"prefix":"","firstName":"Ideraoluwa","middleName":"Neemotallahi","lastName":"Adejumo","suffix":""},{"id":578202562,"identity":"3349a52e-b470-4dab-949a-365ef5500307","order_by":4,"name":"Eniola Dorcas Olabode","email":"","orcid":"","institution":"Institut Superieure de 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Trust","correspondingAuthor":false,"prefix":"","firstName":"Obehi","middleName":"","lastName":"Are-Daniel","suffix":""},{"id":578202566,"identity":"c179b9b9-774c-44d6-8a1b-0f20f10c6536","order_by":8,"name":"Ayodele Raphael Ajayi","email":"","orcid":"","institution":"Afe Babalola University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ayodele","middleName":"Raphael","lastName":"Ajayi","suffix":""},{"id":578202567,"identity":"7c3364bd-2908-436a-bf4e-51ec8a137c69","order_by":9,"name":"Oladunni Opeyemi","email":"","orcid":"","institution":"Adeleke University","correspondingAuthor":false,"prefix":"","firstName":"Oladunni","middleName":"","lastName":"Opeyemi","suffix":""}],"badges":[],"createdAt":"2026-01-16 13:10:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8618968/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8618968/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101297248,"identity":"b5c0abd4-7674-4a03-93e0-4647340d5e4a","added_by":"auto","created_at":"2026-01-28 09:26:10","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":45179,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptHTR.docx","url":"https://assets-eu.researchsquare.com/files/rs-8618968/v1/0d5be8e33d81de9ded7a5a80.docx"},{"id":100991070,"identity":"6a33ab5f-e314-48f2-911d-ab637cc1abce","added_by":"auto","created_at":"2026-01-23 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10:05:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1090425,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8618968/v1/decaccc1-7444-4f73-86d0-38425e3ddbf1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, Attitudes, and Predictors of Risky Practices regarding Schistosomiasis among Residents of Hard-to-reach Communities in Olorunda Local Government Area, Osun State, Nigeria","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSchistosomiasis is a debilitating neglected tropical disease (NTD) caused by blood flukes of the genus \u003cem\u003eSchistosoma\u003c/em\u003e. Over 90% of the estimated 250\u0026nbsp;million global cases occur in sub-Saharan Africa, where it poses a severe threat to public health and socioeconomic development [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nigeria bears the greatest burden globally, with approximately 29\u0026nbsp;million infected individuals and 101\u0026nbsp;million at risk [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTransmission is perpetuated through human contact with freshwater contaminated by cercariae shed by intermediate snail hosts. Risky practices such as bathing, swimming, washing clothes in infested water, and open defecation/urination near water bodies are key behavioral drivers of transmission [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In hard-to-reach communities, these practices are often entrenched necessities due to the critical lack of access to potable water and improved sanitation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile preventive chemotherapy with praziquantel via Mass Drug Administration (MDA) is the cornerstone of control, its long-term success is undermined by rapid reinfection in the absence of complementary interventions addressing behavior and environment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Understanding the community's knowledge, attitudes, and practices (KAP) is therefore essential for designing effective, integrated, and sustainable control programs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite Nigeria's high burden, there is a scarcity of KAP studies focusing on hard-to-reach populations who are often marginalized in mainstream health interventions. This study aimed to assess the KAP regarding schistosomiasis and identify the predictors of risky practices among residents of hard-to-reach communities in Osun State, Nigeria. The findings will provide evidence to tailor control strategies to the specific needs and contexts of these vulnerable populations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Area\u003c/p\u003e\n\u003cp\u003eA community-based descriptive cross-sectional study was conducted in 11th to 18th, June 2025 in selected hard-to-reach communities in Olorunda Local Government Area of Osun State, South-West Nigeria. The communities relies heavily on the Erinle River/Dam for domestic and recreational activities.\u003c/p\u003e\n\u003cp\u003eCommunities in this study were classified as \u0026quot;hard-to-reach\u0026quot; based on criteria adapted from established frameworks including the Nigeria Demographic and Health Survey, the World Health Organization\u0026apos;s approach to underserved populations [1], and Nigeria\u0026apos;s Primary Health Care standards [8].\u003c/p\u003e\n\u003cp\u003eThe selected communities met at least three of the following five criteria:\u003c/p\u003e\n\u003cp\u003eDistance to Primary Health Care:\u0026nbsp;Located \u0026gt;5 kilometers from the nearest functional Primary Health Centre (PHC).\u003c/p\u003e\n\u003cp\u003eRoad Access:\u0026nbsp;Lack of all-season, motorable road access; requiring travel via footpaths, waterways, or unpaved roads that become impassable during the rainy season.\u003c/p\u003e\n\u003cp\u003eAbsence of Basic Infrastructure: Lack of government-provided grid electricity and piped potable water systems \u0026ndash; indicators of marginalization [8].\u003c/p\u003e\n\u003cp\u003eLimited Communication: Poor mobile network coverage and limited access to mass media (radio, television) \u0026ndash; \u003cem\u003eaffecting health information access\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eSocioeconomic Marginalization: Predominance of subsistence-level occupations with low formal education attainment \u0026ndash; \u003cem\u003echaracteristic of health service exclusion\u003c/em\u003e [1].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included consenting residents aged 18 years and above who had lived in the community for at least six months. The sample size was calculated using Fisher\u0026rsquo;s formula, with a prevalence of 27.5% from a previous study [9], a 95% confidence level, and a 5% margin of error. The minimum sample of 306 was increased by 10% to account for non-response, yielding a final sample of 336.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Technique:\u003c/strong\u003eA\u003cstrong\u003emulti-stage cluster sampling technique\u003c/strong\u003e was employed to enhance representativeness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStage 1 (Selection of Communities):\u003c/strong\u003e From an enumerated list of nine (9) identified hard-to-reach communities in Olorunda LGA,\u0026nbsp;\u003cstrong\u003ethree (3) communities\u003c/strong\u003e (Ilie, Owo, and Oba Ile) were selected using\u0026nbsp;\u003cstrong\u003esimple random sampling\u003c/strong\u003e (balloting).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStage 2 (Selection of Households):\u003c/strong\u003e The minimum sample size (336) (was allocated proportionally to the three selected communities based on their estimated adult population sizes (obtained from community leaders/local health post records). The final distribution was: Ilie (n=186), Owo (n=85), Oba Ile (n=65). In each community, systematic sampling technique was used. A central location (the chief\u0026rsquo;s house) was chosen as a starting point while subsequent houses were selected using kth number derived from dividing the sample size to be selected in the community by the total number of houses in the community until the estimated quota for that community was reached. This method helped reduce selection bias inherent in pure convenience sampling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStage 3 (Selection of Respondents):\u003c/strong\u003e In each selected household, one eligible adult (aged \u0026ge;18 years, resident for \u0026ge;6 months) was randomly selected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003eData were collected using a pre-tested, interviewer-administered, structured questionnaire adapted from literature [7]. The tool had four sections: socio-demographics, knowledge (14 items), attitudes (15 items on a 5-point Likert scale), and practices (14 items). Ethical approval was obtained from the Osun State University Health Research Ethics Committee. Informed consent was obtained from all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData Analysis\u003c/p\u003e\n\u003cp\u003eData were analyzed using IBM SPSS Statistics version 28.0. Descriptive statistics were presented as frequencies and percentages. Knowledge, attitude, and practice scores were computed. The mean score was used as a cut-off to categorize respondents into \u0026quot;Good\u0026quot; or \u0026quot;Poor\u0026quot; for each domain. Pearson\u0026rsquo;s correlation and Chi-square tests were used to examine relationships between variables. Statistical significance was set at p-value \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of 336 questionnaire distributed, 325 questionnaire were properly filled and returned, yielding a response rate of 96.7%.\u003c/p\u003e\n\u003ch3\u003eSocio-demographic Characteristics\u003c/h3\u003e\n\u003cp\u003eOf the 325 respondents, 182 (56%) were female. The mean age was 28.7 (\u0026plusmn;\u0026thinsp;10.4) years, with the largest proportion (43.4%) aged 18\u0026ndash;25 years. Most were single (60.3%), Muslim (50.8%), of Yoruba ethnicity (84.9%), and students (44.9%). Over a third (36.6%) had only primary education, while 12% had no formal education. A majority (64.9%) had lived in the community for over five years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eKnowledge of Schistosomiasis\u003c/h3\u003e\n\u003cp\u003eOverall, 72.9% (n\u0026thinsp;=\u0026thinsp;237) had heard of schistosomiasis. Health workers (42.6%) were the primary source of information. Among those aware, knowledge was high: 88.2% correctly defined it as a disease, 97.9% identified water contact as the mode of transmission, and 88.6% recognized abdominal pain as a key symptom. However, misconceptions existed, with 15.6% attributing transmission to witchcraft (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Based on the composite score, 74.2% (n\u0026thinsp;=\u0026thinsp;241) had good overall knowledge.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u0026ndash;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoruba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHausa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIgbo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSkilled (Student, Nurse, Chemist)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemi- skilled (Tailor, Hairdresser, Trader)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnskilled (Farmer, Fisherman, Hunter)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistance to Nearest Health Facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 kilometers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5 kilometers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWalking Time to Nearest Water Source\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge of Schistosomiasis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge on Signs and Symptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal Pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood in stool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelly enlargement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere fever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStunted growth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin rash\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced learning ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers (fatigue)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge on Mode of Transmission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFrequency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePercentage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContact with water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWitchcraft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMisfortune\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandshake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge of Diagnosis Methods\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFrequency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePercentage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigns and symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStool test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUltrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge of Prevention Methods\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFrequency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePercentage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvoid contact with water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvoid open defecation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSnail control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not walk barefooted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvoid open urination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoiling water from river\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvoid eating unwashed vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvoid uncooked meat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes towards Schistosomiasis\u003c/h2\u003e \u003cp\u003eAttitudes were generally positive: 58.1% strongly agreed it is a serious disease, and over 80% acknowledged the importance of avoiding contaminated water and using toilets. However, 30.0% were neutral about the importance of urinating in toilets, and 55.7% agreed that traditional healers could cure the disease (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Overall, 63.9% (n\u0026thinsp;=\u0026thinsp;207) had a good attitude.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitudes towards Schistosomiasis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(SA)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(A)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(D)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchistosomiasis is a very serious disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189 (58.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133 (40.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt is necessary to prevent infection from schistosomiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e164 (50.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt is my responsibility to prevent infection from schistosomiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e230 (70.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt is important to know whether I have schistosomiasis or not\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e202 (62.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt is important to avoid contact with contaminated water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e257 (78.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefecating in the toilet is important for my health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e224 (68.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinating in the toilet is important for my health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38 (11.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEating uncooked meat can make someone susceptible to schistosomiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107 (33.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e172 (53.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEating unwashed vegetables can make someone susceptible to schistosomiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e125 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e196 (60.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI would take action if I found that I had schistosomiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e149 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaking medication for schistosomiasis is important for my health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e206 (63.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoing to hospital can help reduce schistosomiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e199 (61.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeeing a traditional health practitioner can cure schistosomiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214 (65.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt is important for me to be informed about schistosomiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e237 (72.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStrongly Agree (SA), Agree (A), Neutral (N), Disagree (D), Strongly Disagree (SD)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePractices related to Schistosomiasis\u003c/h3\u003e\n\u003cp\u003eRisky practices were widespread. The river was the most common water source (64.6%). Activities at water sources included bathing (64.6%), swimming (49.2%), washing clothes (67.7%), and washing utensils (63.1%). Although 96.6% reported having a toilet, 49.2% had defecated openly in the last three months (mostly in the bush, 70.2%), primarily due to a spoilt toilet (58.5%). Similarly, 85.2% had urinated openly, with 46.2% doing so in the bush. Only 52.6% (n\u0026thinsp;=\u0026thinsp;171) were categorized as having good preventive practices.\u003c/p\u003e\n\u003ch3\u003ePredictors and Correlates of Risky Practices\u003c/h3\u003e\n\u003cp\u003eStatistical analysis revealed significant negative correlations: individuals with better knowledge (r = -0.215, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and more positive attitudes (r = -0.221, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were less likely to engage in risky practices. Chi-square tests confirmed a significant association between attitude and risky practices (χ\u0026sup2; = 16.427, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, socio-demographic factors like lower educational level were significantly associated with higher engagement in risky practices (χ\u0026sup2; = 19.843, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides critical insights into the complex dynamics of schistosomiasis-related knowledge, attitudes, and practices within a hard-to-reach community in Osun State, Nigeria. The findings reveal a persistent and troubling knowledge-practice gap, where relatively high levels of awareness and generally positive attitudes fail to translate into adequate preventive behaviors. This disconnect underscores the limitations of conventional health education approaches when implemented in contexts of profound structural deprivation.\u003c/p\u003e \u003cp\u003eThe Paradox of Knowledge and Practice\u003c/p\u003e \u003cp\u003eThe finding that 97.9% of aware respondents correctly identified water contact as the transmission route, while 64.6% continued to use rivers for bathing and 49.2% for swimming, represents more than a simple behavioral failure; it highlights a structural coercion where knowledge is overridden by necessity. This phenomenon aligns with the Theory of Planned Behavior, which posits that behavioral intention (influenced by attitude and knowledge) is mediated by perceived behavioral control [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this community, the perceived (and real) control over avoiding infested water is critically low due to the absence of alternatives. The Erinle River/Dam is not merely a convenience but a critical resource nexus for domestic, agricultural, and economic activities. This creates an \"exposure-poverty trap\" where residents must engage in high-risk activities to meet basic needs, perpetuating disease transmission despite awareness of the consequences [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Similar findings have been documented in other schistosomiasis-endemic regions, where economic imperatives and water insecurity consistently trump health knowledge [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSanitation Infrastructure: Ownership versus Usability\u003c/p\u003e \u003cp\u003eA particularly revealing finding concerns sanitation practices. While 96.6% reported toilet ownership, a figure that might suggest adequate coverage, nearly half (49.2%) had defecated openly in the preceding three months. The primary reason cited was a \"spoilt toilet\" (58.5%). This distinction between physical access and functional access is crucial for public health programming. It reveals that infrastructure provision without robust maintenance systems, community training, and perhaps culturally appropriate design leads to rapid dysfunction. This finding challenges the common metric of \"improved sanitation facility\" coverage and suggests that monitoring should include functionality and consistent use [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The high rate of open urination (85.2%) further indicates that even when toilets are available, they may not be deemed necessary or practical for all sanitation needs, influenced by convenience, gender dynamics, or cultural norms [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAttitudes: Between Modern Medicine and Traditional Beliefs\u003c/p\u003e \u003cp\u003eThe generally positive attitudes towards modern prevention and treatment are encouraging for MDA compliance. However, the concurrent strong belief in the curative power of traditional healers (55.7% agreement) presents a nuanced picture of health-seeking pluralism. This is not necessarily contradictory; community members may navigate multiple health systems simultaneously. However, it can lead to treatment delays or incomplete therapy if schistosomiasis is first attributed to spiritual causes or treated with ineffective traditional remedies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Effective health communication must therefore engage respectfully with traditional belief systems, potentially collaborating with trusted traditional healers to channel suspected cases to formal healthcare, rather than attempting to discredit them outright [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Role of Socio-demographics and the \"KAP Gap\"\u003c/p\u003e \u003cp\u003eThe significant association between lower educational attainment and riskier practices underscores education as a key social determinant of health in this context. Education likely enhances both health literacy and the capacity to problem-solve around resource constraints (e.g., finding ways to treat water, repair facilities) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The correlation and chi-square analyses confirming the link between poor attitude/knowledge and risky practices validate the theoretical foundations of KAP studies. However, they also highlight that in environments of severe constraint, improving KAP alone has a ceiling effect on behavioral change. This reinforces the need for environmental modification (WASH infrastructure) and economic empowerment as foundational interventions, upon which health education can then have greater efficacy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImplications for Integrated Control Strategies\u003c/p\u003e \u003cp\u003eThe persistence of risky practices, despite two decades of global scale-up of preventive chemotherapy, signals that MDA is necessary but insufficient for sustained control. Our findings strongly support the World Health Organization's call for integrated control combining chemotherapy, WASH, and snail control [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Specifically for hard-to-reach communities:\u003c/p\u003e \u003cp\u003eWater Access: Investments must go beyond borehole drilling to include sustainable maintenance models (e.g., community water committees with micro-financing for repairs) and point-of-use water treatment solutions that are low-cost and culturally acceptable.\u003c/p\u003e \u003cp\u003eSanitation: Programs need a \"Sanitation as a Service\" approach, ensuring long-term functionality of toilets. Community-Led Total Sanitation (CLTS) campaigns could be adapted to address not just open defecation but also the maintenance and proper use of existing facilities.\u003c/p\u003e \u003cp\u003eSnail Control: Targeted environmental management or mollusciciding around major transmission foci like the Erinle Dam could reduce cercarial density, providing a direct ecological barrier to complement behavioral and chemotherapeutic interventions.\u003c/p\u003e \u003cp\u003eContextual Health Education: Messaging should shift from \"don't go in the water\" to practical, feasible risk-reduction strategies (e.g., storing river water for 48 hours before use to allow cercariae to die, using protective footwear during necessary water contact) and focus on correcting specific local misconceptions (e.g., transmission via food).\u003c/p\u003e \u003cp\u003eStudy Limitations\u003c/p\u003e \u003cp\u003eThe interpretations of this study must be considered alongside its limitations. The cross-sectional design precludes causal inference. The use of convenience sampling may introduce selection bias, potentially over-representing more accessible or cooperative households. Self-reported data on sensitive practices like open defecation are vulnerable to social desirability bias, suggesting the actual prevalence of risky practices may be even higher. Finally, focusing on a single community limits the generalizability of findings, although it provides valuable depth for this specific hard-to-reach context.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study illuminates the complex reality of schistosomiasis control in a Nigerian hard-to-reach community. It moves the discourse beyond quantifying knowledge deficits to analyzing why knowledge fails to protect. The core issue is not a lack of awareness but a lack of agency, the power to act on that awareness due to missing alternatives. Therefore, the path to elimination requires biomedical strategies (MDA) to be inseparably coupled with development strategies that address water poverty and sanitation failure. Empowering communities with sustainable WASH infrastructure is the most effective \"vaccine\" against the reinfection cycle, turning informed intent into actionable, life-saving practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the Health Research and Ethics Committee of the College of Health Sciences, Osun State University (UNIOSUNHREC 2025/PBH/002). Informed consent was obtained from all participants. The ethical principles and guidelines set out by the Declaration of Helsinki, the Belmont Report, and other relevant documents were followed during the conduct of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data for this study is provided within the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSCA, SOO, and IOF worked on the study design; SOO, INA, and OPT collected data; SOO, OEA and SCA supervised the project; SCA, EDO, OA and ARA analyzed the data while SOO, OO and SCA ensured ethical compliance. SOO, EDO and SCA were major contributors in writing the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the community leaders and residents of the communities where the study was carried out for their participation and cooperation. We also acknowledge the support of the Department of Public Health, Osun State University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funding for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors know no competing interest for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. (2022). Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021\u0026ndash;2030. Geneva: WHO. https://www.who.int/publications/i/item/9789240010352\u003c/li\u003e\n\u003cli\u003eLi, Q., Li, Y.-L., Guo, S.-Y., Li, S.-Z., Wang, Q., Lin, W.-N., Zhang, L.-J., Li, S.-Z., Zhou, X.-N., \u0026amp; Xu, J. (2025). Global trends of schistosomiasis burden from 1990 to 2021 across 204 countries and territories: Findings from GBD 2021 study. \u003cem\u003eActa Tropica\u003c/em\u003e, \u003cem\u003e261\u003c/em\u003e, 107504. https://doi.org/10.1016/j.actatropica.2024.107504\u003c/li\u003e\n\u003cli\u003eFederal Ministry of Health, Nigeria. (2022). Neglected Tropical Diseases Master Plan 2023\u0026ndash;2027. Abuja: FMOH. Available at https://espen.afro.who.int/sites/default/files/content/document/Nigeria%20NTD%20Master%20Plan%202023%20-%202027.pdf. 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The role of water, sanitation and hygiene interventions in reducing soil-transmitted helminths: interpreting the evidence and identifying next steps. \u003cem\u003eParasites \u0026amp; vectors\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1), 273. https://doi.org/10.1186/s13071-019-3532-6\u003c/li\u003e\n\u003cli\u003eTrippler, L., Ali, S. M., Ali, M. N., Mohammed, U. A., Suleiman, K. R., Ndum, N. C., Juma, S., Ame, S. M., Kabole, F., Hattendorf, J., \u0026amp; Knopp, S. (2025). Adaptive integrated intervention approaches for schistosomiasis elimination in Pemba: A 4-year intervention study and focus on hotspots. \u003cem\u003ePLoS neglected tropical diseases\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(6), e0013079. https://doi.org/10.1371/journal.pntd.0013079\u003c/li\u003e\n\u003cli\u003eAnyolitho, M. K., Poels, K., Huyse, T., Tumusiime, J., Mugabi, F., Tolo, C. U., Masquillier, C., \u0026amp; Nyakato, V. N. (2022). Knowledge, attitudes, and practices regarding schistosomiasis infection and prevention: A mixed-methods study among endemic communities of western Uganda. \u003cem\u003ePLoS neglected tropical diseases\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(2), e0010190. https://doi.org/10.1371/journal.pntd.0010190\u003c/li\u003e\n\u003cli\u003eOleribe, O. O., Momoh, J., Uzochukwu, B. S., Mbofana, F., Adebiyi, A., Barbera, T., Williams, R., \u0026amp; Taylor-Robinson, S. D. (2019). Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions. \u003cem\u003eInternational journal of general medicine\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e, 395\u0026ndash;403. https://doi.org/10.2147/IJGM.S223882\u003c/li\u003e\n\u003cli\u003eAdeyemo, S. C., Olarewaju, S., Olabode, E. D., Ajayi, A. R., Aderinwale, A. D., Awodele, K., Odunlami, A. J., \u0026amp; Fasanu, O. (2025). 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Accessed on 15th January, 2026.\u003c/li\u003e\n\u003c/ol\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":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Schistosomiasis, Knowledge, Attitudes, Practices, Hard-to-reach, Nigeria, Water Sanitation and Hygiene (WASH)","lastPublishedDoi":"10.21203/rs.3.rs-8618968/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8618968/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSchistosomiasis remains a major public health burden in Nigeria, especially in Hard-to-reach communities with limited access to water, sanitation, and hygiene (WASH). This study assessed the knowledge, attitudes, and practices (KAP) regarding schistosomiasis and identified predictors of risky practices among residents in such communities in Osun State, Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA community-based cross-sectional study was conducted among 325 residents (aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years) in hard-to-reach communities in Olorunda Local Government Area, Osun State. Data were collected using a pre-tested, structured questionnaire. Knowledge, attitude, and practice scores were categorized as \"good\" or \"poor\" based on mean scores. Univariate analyses were presented as frequencies and percentages. Associations were tested using Chi-square and Pearson\u0026rsquo;s correlation at a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of respondents was 28.7 (\u0026plusmn;\u0026thinsp;10.4) years, with 56% being female. Overall, 74.2% had good knowledge of schistosomiasis, 63.9% exhibited a good attitude, but only 52.6% reported good preventive practices. While 97.9% correctly identified water contact as the transmission route, risky practices were prevalent: 64.6% used rivers as a primary water source, 64.6% bathed in open water, and 49.2% had defecated openly within the last three months. A significant negative correlation was found between knowledge and risky practices (r = -0.215, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and between attitude and risky practices (r = -0.221, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Poor attitude (χ\u0026sup2; = 16.427, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and lower educational level were significant predictors of risky practices.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDespite relatively high knowledge and positive attitudes, a substantial proportion of residents in hard-to-reach communities continue to engage in practices that facilitate schistosomiasis transmission, primarily driven by infrastructural deficits and socioeconomic constraints. Control programs must move beyond mass drug administration and knowledge dissemination to integrate sustainable WASH infrastructure development, targeted behavioral change communication, and community-led snail control initiatives.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitudes, and Predictors of Risky Practices regarding Schistosomiasis among Residents of Hard-to-reach Communities in Olorunda Local Government Area, Osun State, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 14:31:51","doi":"10.21203/rs.3.rs-8618968/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-18T15:21:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235918713570879541783388398153834198128","date":"2026-04-18T14:45:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103976191471063062330102093646332975735","date":"2026-02-16T11:43:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T09:48:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54726257399246523142549123280471275258","date":"2026-01-26T13:43:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235918713570879541783388398153834198128","date":"2026-01-21T14:22:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-21T13:31:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-20T07:08:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T08:46:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-19T08:41:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-01-16T12:06:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d925f8b-02ae-4700-88a4-ceb15ee0404f","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-23T14:31:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-23 14:31:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8618968","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8618968","identity":"rs-8618968","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}