Abstract: Objective To evaluate the perceptions and understanding of tuberculosis (TB) among the primary school and middle school students before and after a school-based TB health education program in rural China.Methods Stratified cluster sampling method was used to select 4 primary schools and 4 middle schools in 2 counties of Anhui province. A three-month health education program on TB was conducted in the eight schools. Questionnaire surveys were conducted before and after the program to evaluate the effectiveness of the health program, 5309 students were recruited in the study, 5017 valid questionnaires were received in the baseline survey (collecting rate 94.5%) and 5276 valid questionnaires were received from the survey after intervention (collecting rate 99.4%).Results The TB knowledge score of students increased from (2.92±1.57) before the program to (5.48±1.770) after the program, with statistical difference (t=－77.482, P=0.000). The channels getting TB knowledge in different gender were different. Girls acquired TB knowledge through magazines, newspapers and books(46.5%, 1100/2365), school teaching (34.4%, 813/2365), peer education (19.9%, 470/2365), all of which were higher than boys. While boys acquired TB knowledge from video and tape (7.8%, 207/2652) was higher than girls (5.2%, 124/2365).Conclusion Improved awareness rate of TB among students can be got through the school-based TB health education