Urogenital schistosomiasis affects >112 million people in Africa south of the Sahara, with 56 million women suffering from female genital schistosomiasis. Community knowledge, attitudes, and practices (KAP) are essential for sustained control, but no systematic review has synthesized KAP evidence across the region. We estimated the pooled prevalence of good knowledge, positive attitudes, and good preventive practices to inform the WHO 2030 NTD Roadmap.
We searched PubMed, Scopus, Web of Science, African Journals Online, and WHO Global Index Medicus from inception to 21 November 2025. Cross-sectional studies reporting quantitative KAP data from Africa south of the Sahara were included. Two independent reviewers performed screening, data extraction, and JBI risk-of-bias assessment. Random-effects meta-analyses, subgroup analyses, meta-regression, sensitivity analyses, and publication bias tests were conducted. GRADE certainty was assessed.
Twenty-one studies (total 9,681 participants) contributed to the knowledge analysis; 15 studies (total 8,205 participants) to the attitude analysis; and 16 studies (total 8,538 participants) to the practice analysis. Note that participants from studies reporting multiple outcomes are counted separately in each analysis. Regional pooled estimates ranged from 46.45% to 69.76% (knowledge), 52.33% to 61.88% (attitudes), and 39.71% to 56.43% (practices). Continent-wide estimates were 51.73% (knowledge), 57.40% (attitudes), and 45.12% (practices), but are heavily weighted towards West Africa. Extreme heterogeneity (I² = 98–99%) limits confidence; individual study ranges: 23.3–91.2% (knowledge), 22.7–82.9% (attitudes), 13.9–85.4% (practices). A descriptive attitude-practice gap of 12.28 percentage points was observed. No publication bias was detected. Meta-regression suggested a tentative decline in preventive practices over time (p = 0.024), but this finding is hypothesis-generating given persistent high heterogeneity; no temporal trends were observed for knowledge or attitudes. GRADE certainty was low due to serious inconsistency.
KAP towards urogenital schistosomiasis in Africa south of the Sahara remains suboptimal, with less than half of at-risk individuals adopting preventive behaviors. The wide range of findings highlights the need for context-specific interventions. Behavior change communication, school- and reproductive-health education, and WASH investments are urgently needed. Restriction to English-language articles is a major limitation.
}, year = {2026}, journal = {Acta Tropica}, volume = {280}, month = {06/2026}, publisher = {Elsevier BV}, issn = {0001-706X}, doi = {10.1016/j.actatropica.2026.108200}, language = {ENG}, }