A Survey on the Knowledge, Attitudes, and Practices of Students Regarding Schistosomiasis Through a Health Education Model Led by Community Health Volunteers.
Phase: NA
Conditions: Schistosomiasis, Health Education
Sponsor: Pemba Ministry of Health Zanzibar

Health Education Model Led by Community Health Volunteers 
NCT06312462 
24-August-2025 
 
 
 
Study Protocol and Statistical Analysis Plan 
Study Design and Sampling 
A repeated cross-sectional design compared the impact of CHVs-led (CBPR-based) 
health education versus traditional health education on schistosomiasis-related KAP 
over 12 months (February 2024 - February 2025). The CBPR approach included: (1) 
Needs assessment using baseline surveys; (2) Co-design of interventions with 
community stakeholders; (3) Implementation led by trained CHVs; and (4) Mixed-
methods evaluation combining infection rates and questionnaires(Figure 1). The 
process emphasized cultural adaptation, community ownership, and continued 
improvement to ensure sustainable interventions. 
Cluster Sampling Implementation 
A three-stage cluster sampling method was implemented: 
1. 
School selection: Three public primary schools were randomly selected from 
distinct geographical regions of Pemba Island, matched for demographic 
characteristics (student population, gender ratio, and age distribution). 
2. 
Cluster formation: Within each school, grades 4–6 (ages 8–16 years) were 
designated as natural clusters, reflecting the target population exposed to 
schistosomiasis transmission. 
3. 
Participant inclusion: All students meeting eligibility criteria within selected 
grades were enrolled, minimizing selection bias through complete 
enumeration within clusters. 
Intervention allocation: 
 
Intervention group: One school received CBPR-based education led by CHVs. 

 
Control group A and B: Two schools received standard health education from 
PHCs providers.  
Eligibility Criteria 
 
Inclusion: 
（1） Grades 4–6 students aged 8–16. 
（2） Written parental/guardian consent and student assent. 
（3） Permanent residency in the school’s catchment area for ≥2 years. 
 
Exclusion: 
（1） Severe cognitive or communication impairments affecting questionnaire 
completion. 
（2） Temporary enrollment (e.g., visiting students). 
（3） Missing consent documentation or incomplete questionnaires. 
Study design 
Baseline data were collected in February 2024, followed by a six-month 
intervention period. Post-intervention data were collected in August 2024, and 
a follow-up survey was conducted in February 2025 to assess the sustainability 
of the intervention effects. During the survey, face-to-face questionnaires were 
administered by CHVs to assess students’ KAP related to schistosomiasis. 
Additionally, the research team distributed sterile wide-mouth plastic containers 
labeled with unique student identification numbers for morning urine sample 
collection. Each student provided approximately 30–50 mL of urine under 
teacher supervision to ensure proper collection procedures. The questionnaires, 
translated into Kiswahili, were pre-tested and validated. The questionnaire 
covered KAP of schistosomiasis transmission, exposure, and prevention. And 
include a survey on students’ satisfaction with CHVs in the second 
questionnaire. 
Laboratory procedures 
The collected urine samples were transported to the China-Zanzibar 
Pathogen Biology Laboratory located in Pemba Island for analysis. In the 
laboratory, trained technicians performed urine filtration and microscopic 

examination to detect Schistosoma haematobium eggs. The egg counts were 
manually recorded on paper by the technicians and subsequently entered into a 
Microsoft Excel database using a double-data-entry method to ensure accuracy. 
Recruitment and Training of CHVs 
Six CHVs were recruited from local communities. To ensure the quality of the 
intervention, CHVs participated in a two-day training workshop led by public health 
experts. The training covered: 
 
Basic knowledge of schistosomiasis: Life cycle, transmission routes, clinical 
symptoms, diagnosis, and treatment. 
 
Health education skills: Effective use of educational materials (e.g., slides, 
videos, microscopes), communication techniques, and interactive teaching 
methods. 
 
Practical training: Microscopic observation of Schistosoma eggs and 
intermediate host snails, role-playing, and feedback sessions. 
 
Assessment: CHVs were evaluated through written tests and simulated 
teaching sessions. Only those who passed the assessment were allowed to 
participate in the intervention. 
Structured health education sessions 
The 6-month intervention (February-August 2024) featured (Table 1): 
Table 1 CBPR-Integrated Schistosomiasis structured health education sessions. 
Session 
Core Content 
CEPEM Components Duration 
Framework 
Alignment 
1 
Schistosomiasis life 
cycle & transmission 
•Using local water 
source photos 
•Analyzing common 
exposure behaviors 
(laundry, farming) 
Community 
Embedding 
•Culturally-grounded 
case studies 
•Trust capital 
utilization 
2 hours 
CHVs as 
Cultural 
Insiders 

2 
Microscopic 
observation of host 
snails 
•Local snail 
specimens 
•High-risk 
transmission zone 
identification 
Participatory 
Methodology 
•Hands-on learning 
2.5 
hours 
Interactive 
Sessions 
3 
Pathological impacts 
on organs 
•Anatomical model 
demonstration 
•Symptom self-check 
forms 
Systems 
Reinforcement 
•Household practice 
extension 
2 hours 
Household-
School 
Linkage 
4 
Prevention knowledge 
games 
•Schistosomiasis quiz 
•Risk behavior 
simulation 
Participatory 
Methodology 
•Peer-facilitated 
learning 
1.5 
hours 
Peer-Led 
Learning 
5 
Preventive measures 
poster exhibition 
•Safe water source 
guidelines 
•Hygiene practice 
visualization 
Systems 
Reinforcement 
•Infrastructure 
advocacy 
2 hours 
Infrastructure 
Advocacy 
6 
Key message 
reinforcement 
•Educational booklet 
distribution 
Community 
Embedding 
•Community 
resource mobilization 
1 hours 
Trust Capital 
Utilization 

•Core knowledge 
retention test 
Traditional Intervention 
The control group schools A and B received traditional health education 
delivered by PHCs providers, following the standard health education practices 
recommended by the Ministry of Health Tanzanian, Tanzania. The health 
education content focused on general disease prevention and hygiene promotion, 
key topics included: 
 
Avoiding consumption of untreated water (e.g., “Do not drink untreated water 
from rivers, lakes, or ponds”). 
 
Promoting proper sanitation practices (e.g., “Do not defecate in open areas”). 
 
Encouraging safe recreational activities (e.g., “Avoid swimming or playing in 
cercaria-infested water bodies”). 
Statistical analysis 
The data were double-entered into Microsoft Excel, systematically organized, 
coded, and verified for accuracy before being imported into IBM SPSS Statistics 26.0 
for analysis. S. haematobium egg counts were stratified into light intensity (1–49 
eggs/10 ml of urine) or heavy-intensity (≥ 50 eggs/10 ml of urine) infection, based on 
WHO guidelines . For the KAP questionnaire: Knowledge scores were calculated based 
on correct responses (1 point per correct answer, maximum 10 points). Attitudes were 
evaluated using a 5-point Likert scale with a maximum score of 55 points. Behavioral 
patterns were scored according to frequency (1-3 points per item), totaling a maximum 
of 30 points. All scores were converted into percentage equivalents and categorized as 
"good" (80-100%), "moderate" (60-80%), or "poor" (<60%) . Satisfaction ratings were 
quantified with 1 point for "dissatisfied," 2 points for "neutral," and 3 points for 
"satisfied," yielding a maximum satisfaction score of 6 points. 
Demographic and KAP data were analyzed descriptively: continuous variables 
were expressed as Mean ± SD (normally distributed) or median [IQR] (non-normal). A 
two-way repeated-measures ANOVA with Bonferroni correction assessed temporal 

effects (baseline/post-intervention/follow-up) and group differences. For ordinal data 
violating ANOVA assumptions (normality/homoscedasticity via Q-Q plots/Levene’s 
test), the Kruskal-Wallis test was applied.