{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:53:33Z","timestamp":1785412413611,"version":"3.56.0"},"reference-count":35,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008968","name":"National Research Council of Sri Lanka","doi-asserted-by":"publisher","award":["NRC 20-118"],"award-info":[{"award-number":["NRC 20-118"]}],"id":[{"id":"10.13039\/100008968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council of Australia","doi-asserted-by":"publisher","award":["APP1194462"],"award-info":[{"award-number":["APP1194462"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"award":["APP1194462"],"award-info":[{"award-number":["APP1194462"]}],"id":[{"id":"https:\/\/ror.org\/011kf5r70","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Human intestinal nematode infections (HINIs) remain a public health concern despite reduced prevalence following mass drug administration (MDA) in low- and middle-income countries. Children continue to bear a substantial burden of infection, and caregiver knowledge and practices may influence their risk of acquiring infection. Sustaining control during the transition of prevention programmes to surveillance-based strategies requires an understanding of behavioural determinants of transmission. Therefore, we assessed caregiver knowledge, attitudes, and practices (KAP) and their associations with sociodemographic characteristics and child infection status. A community-based cross-sectional study was conducted among 945 caregivers of primary school children in Anuradhapura, a low-prevalence setting where school-based MDA ceased in 2019, to assess caregiver KAP and child HINI status. An interviewer-administered questionnaire assessed KAP, sociodemographic, water, sanitation, hygiene (WASH), and behavioural factors. Participants were predominantly mothers (89.5%). Good knowledge was observed in 61.7%, positive attitudes in 95.6% and good practices in 99.2%. Knowledge gaps persisted regarding transmission and complications. Higher caregiver knowledge (OR = 0.52; 95% CI: 0.36\u20130.72) and regular deworming (OR = 0.58, 95% CI: 0.40\u20130.83) were associated with lower odds of infection, whereas attitudes and practices were not independently associated. Caregiver knowledge remains a key determinant of infection risk. Gaps in knowledge, misconceptions, and practices may sustain transmission even in low-prevalence settings. Strengthening health education, school-based hygiene promotion, and community engagement remains essential to reinforce preventive behaviours and support long-term control as countries transition from routine MDA to elimination-oriented strategies.<\/jats:p>","DOI":"10.3390\/tropicalmed11070191","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:16:22Z","timestamp":1783592182000},"page":"191","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Behavioural Determinants of Intestinal Nematode Infection Risk Among Children in a Post-Mass-Drug-Administration Setting in Sri Lanka: A Survey of Caregiver Knowledge, Attitudes, and Practices"],"prefix":"10.3390","volume":"11","author":[{"given":"Nalini","family":"Jayakody","sequence":"first","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Wayamba University of Sri Lanka, Kuliyapitiya 60200, Sri Lanka"},{"name":"Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura 60200, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1509-5220","authenticated-orcid":false,"given":"Catherine A.","family":"Gordon","sequence":"additional","affiliation":[{"name":"QIMR Berghofer Medical Research Institute, Infection and Inflammation Program, Applied Tropical and Molecular Parasitology Laboratory, Brisbane, QLD 4006, Australia"},{"name":"Faculty of Medicine, The University of Queensland, Brisbane, QLD 4067, Australia"},{"name":"Center for Tropical Health and Emerging Diseases, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjana","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura 60200, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6025-6022","authenticated-orcid":false,"given":"Nuwan","family":"Wickramasinghe","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura 50300, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2046-1093","authenticated-orcid":false,"given":"Susiji","family":"Wickramasinghe","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, University of Peradeniya, Kandy 20400, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Collinson","sequence":"additional","affiliation":[{"name":"QIMR Berghofer Medical Research Institute, Infection and Inflammation Program, Applied Tropical and Molecular Parasitology Laboratory, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7059-6079","authenticated-orcid":false,"given":"Asela","family":"Wijayasekara","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Wayamba University of Sri Lanka, Kuliyapitiya 60200, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2945-5088","authenticated-orcid":false,"given":"Chanaka","family":"Karunarathne","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, Wayamba University of Sri Lanka, Kuliyapitiya 60200, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harshi","family":"Weerakoon","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura 50300, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjula","family":"Weerasinghe","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura 50300, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2536-0227","authenticated-orcid":false,"given":"Nilanthi de","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosala","family":"Weerakoon","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura 60200, Sri 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