Peer-led versus routine health education for schistosomiasis knowledge improvement among primary school students in Wuhan, China.

<h4>Background</h4>Schistosomiasis, a neglected tropical disease (NTD), remains a public health concern in China. Health education is a fundamental intervention for its control. Even in transmission-interrupted areas like Wuhan, sustained awareness is crucial. However, recent literature on school-based interventions evaluating knowledge, attitudes and practices (KAP) among children in such areas is limited.<h4>Objective</h4>This study aimed to evaluate and compare the effectiveness of peer-led education versus routine health education in improving schistosomiasis-related KAP among elementary students in an urban area where schistosomiasis transmission has been interrupted.<h4>Methods</h4>A quasi-experimental school-level trial was conducted from October 2021 to January 2022 among 1013 fourth- and fifth-grade students of Yucai Hankou and Dijiao primary schools in Jiang'an district, Wuhan, China. Students were randomly assigned to two groups. Group I (n = 524) received peer-led education, while Group II (n = 489) received routine health education. Schistosomiasis-related KAP were assessed via standardized questionnaires at baseline and one month post-intervention. Statistical analyses followed the intention-to-treat principle, using multiple imputation for missing baseline data. Intervention effects were evaluated via analysis of covariance (ANCOVA) and multivariable logistic regression, adjusting for baseline scores and demographic covariates.<h4>Results</h4>Following the intervention, both peer-led and routine health education interventions significantly improved schistosomiasis-related KAP scores among schoolchildren. For knowledge scores, both groups showed significant improvement from baseline to follow-up (within-group change: 2.93 for Group I vs. 0.98 for Group II, both P < 0.001). After adjusting for baseline scores, age, sex, and grade, Group I demonstrated a significantly higher adjusted mean score of 8.73 (95% CI: 8.63, 8.84) compared to Group II, which had an adjusted mean of 7.21 (95% CI: 7.10, 7.32). The adjusted mean difference (AMD) was 1.52 (95% CI: 1.37, 1.68), which was statistically significant (P < 0.001). For attitude scores, both groups exhibited small but statistically significant increases from baseline (within-group change: 0.20 for Group I vs. 0.21 for Group II, both P < 0.001). However, the between-group comparison revealed no significant difference at follow-up. For practice scores, significant within-group improvements were observed in both Group I and Group II (within-group change: 0.30 vs. 0.33, both P < 0.001). The adjusted mean was 3.95 (95% CI: 3.93, 3.97) in Group I and 3.97 (95% CI: 3.95, 4.00) in Group II. The AMD was -0.02 (95% CI: -0.06, 0.01), and this between-group difference was not statistically significant (P = 0.237). In terms of binary outcomes, the odds of achieving good knowledge were 6.04 times higher in Group I compared to Group II (aOR = 6.04, 95% CI: 4.43 to 8.24, P < 0.001), while no significant effects were observed on positive attitude or favorable practices between the two groups.<h4>Conclusion</h4>Peer-led education is more effective than routine health education in improving schistosomiasis-related knowledge among primary school students in a transmission-interrupted area. Although both approaches enhanced KAP, the peer-led model demonstrated superior knowledge gains. These findings support the integration of peer-led strategies into sustainable school-based health education programmes to maintain schistosomiasis awareness and support ongoing control efforts in post-transmission settings.