Knowledge, Attitudes, and Predictors of Risky Practices regarding Schistosomiasis among Residents of Hard-to-reach Communities in Olorunda Local Government Area, Osun State, Nigeria

Background Schistosomiasis remains a major public health burden in Nigeria, especially in Hard-to-reach communities with limited access to water, sanitation, and hygiene (WASH). This study assessed the knowledge, attitudes, and practices (KAP) regarding schistosomiasis and identified predictors of risky practices among residents in such communities in Osun State, Nigeria. Methods A community-based cross-sectional study was conducted among 325 residents (aged ≥ 18 years) in hard-to-reach communities in Olorunda Local Government Area, Osun State. Data were collected using a pre-tested, structured questionnaire. Knowledge, attitude, and practice scores were categorized as "good" or "poor" based on mean scores. Univariate analyses were presented as frequencies and percentages. Associations were tested using Chi-square and Pearson’s correlation at a significance level of p < 0.05. Results The mean age of respondents was 28.7 (± 10.4) years, with 56% being female. Overall, 74.2% had good knowledge of schistosomiasis, 63.9% exhibited a good attitude, but only 52.6% reported good preventive practices. While 97.9% correctly identified water contact as the transmission route, risky practices were prevalent: 64.6% used rivers as a primary water source, 64.6% bathed in open water, and 49.2% had defecated openly within the last three months. A significant negative correlation was found between knowledge and risky practices (r = -0.215, p < 0.001), and between attitude and risky practices (r = -0.221, p < 0.001). Poor attitude (χ² = 16.427, p < 0.001) and lower educational level were significant predictors of risky practices. Conclusion Despite relatively high knowledge and positive attitudes, a substantial proportion of residents in hard-to-reach communities continue to engage in practices that facilitate schistosomiasis transmission, primarily driven by infrastructural deficits and socioeconomic constraints. Control programs must move beyond mass drug administration and knowledge dissemination to integrate sustainable WASH infrastructure development, targeted behavioral change communication, and community-led snail control initiatives.