Abstract

Background: Urinary schistosomiasis remains a major public health challenge in Madagascar, particularly in the Sofia Region. While chemotherapy is the standard treatment, sustainable control requires effective health and environmental education.
Objective: This study evaluated the impact of an integrated environmental and health education program on the knowledge, attitudes, and behaviors of populations in endemic villages in the Mandritsara district.
Methods: A cross-sectional survey was conducted in March 2023, comparing 400 individuals from four intervention villages (beneficiaries of educational activities) with 100 individuals from a control village. Data were collected via structured questionnaires and analyzed using chi-square tests.
Results: Knowledge of the disease was significantly higher in the intervention area (82.0% awareness) compared to the control village (6.0%, $p < 0.001$). However, significant gaps remain: 46.6% of respondents in sensitized areas could not cite a single preventive measure, and 42.0% were unaware of the intermediate snail host’s role. While modern treatment seeking was higher in the intervention group (63.2% vs 35.9%), high-risk water-contact behaviors persisted. Only 33.0% of respondents in intervention villages reported adopting preventive behaviors, although home-based bathing increased significantly (21.7% vs 8.3%, $p < 0.001$).
Conclusion: Environmental education significantly improves theoretical knowledge of schistosomiasis, but behavioral change is slow. Integrated strategies combining sustained health education with improved access to safe water and sanitation are essential for disease elimination.