Attitudes as a Critical Mediator Between Schistosomiasis Knowledge and Practices Among Students, with Implications for Behavior Change Interventions — Pemba Island, Zanzibar, Tanzania, 2024

What is already known about this topic?: Despite mass drug administration (MDA) programs in Zanzibar, schistosomiasis transmission persists due to behavioral gaps, and prior studies in sub-Saharan Africa consistently reveal significant knowledge-practice disparities where improved knowledge alone fails to translate into preventive behaviors. What is added by this report?: We quantified that attitudes are a pivotal mediator, accounting for 68.35% of knowledge's effect on schistosomiasis prevention practices among Zanzibari students. This finding, from a 2024 cross-sectional study on Pemba Island, shifts the focus from knowledge dissemination alone to attitude transformation as the central strategy for effective behavior change interventions. What are the implications for public health practice?: Public health interventions must prioritize attitude transformation (mediated 68.35% of knowledge's effect on practices) through education (e.g., peer role-playing) while concurrently improving WASH infrastructure, as attitudes are the critical pathway to behavior change in endemic communities.