title: Raw Sap Consumption Habits and Its Association with Knowledge of Nipah Virus in Two Endemic Districts in Bangladesh.
abstract: Human Nipah virus (NiV) infection in Bangladesh is a fatal disease that can be transmitted from bats to humans who drink contaminated raw date palm sap collected overnight during the cold season. Our study aimed to understand date palm sap consumption habits of rural residents and factors associated with consumption. In November-December 2012 the field team interviewed adult respondents from randomly selected villages from Rajbari and Kushtia Districts in Bangladesh. We calculated the proportion of people who consumed raw sap and had heard about a disease from raw sap consumption. We assessed the factors associated with raw sap consumption by calculating prevalence ratios (PR) adjusted for village level clustering effects. Among the 1,777 respondents interviewed, half (50%) reported drinking raw sap during the previous sap collection season and 37% consumed raw sap at least once per month. Few respondents (5%) heard about NiV. Thirty-seven percent of respondents reported hearing about a disease transmitted through raw sap consumption, inclusive of a 10% who related it with milder illness like diarrhea, vomiting or indigestion rather than NiV. Respondents who harvested date palm trees in their household were more likely to drink sap than those who did not own date palm trees (79% vs. 65% PR 1.2, 95% CI 1.1-1.3, p<0.001). When sap was available, respondents who heard about a disease from raw sap consumption were just as likely to drink it as those who did not hear about a disease (69% vs. 67%, PR 1.0, 95% CI 0.9-1.1, p = 0.512). Respondents' knowledge of NiV was low. They might not have properly understood the risk of NiV, and were likely to drink sap when it was available. Implementing strategies to increase awareness about the risks of NiV and protect sap from bats might reduce the risk of NiV transmission.
authors.affiliation: ICDDRB, Dhaka, Bangladesh.|Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Nazmun
authors.initials: N
authors.lastname: Nahar
authors.affiliation: ICDDRB, Dhaka, Bangladesh.
authors.forename: Repon C
authors.initials: RC
authors.lastname: Paul
authors.affiliation: ICDDRB, Dhaka, Bangladesh.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Sultana
authors.affiliation: ICDDRB, Dhaka, Bangladesh.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Gurley
authors.affiliation: FHI360, Washington DC Office, Washington, D.C., United States of America.
authors.forename: Fernando
authors.initials: F
authors.lastname: Garcia
authors.affiliation: ICDDRB, Dhaka, Bangladesh.
authors.forename: Jaynal
authors.initials: J
authors.lastname: Abedin
authors.affiliation: ICDDRB, Dhaka, Bangladesh.
authors.forename: Shariful Amin
authors.initials: SA
authors.lastname: Sumon
authors.affiliation: ICDDRB, Dhaka, Bangladesh.
authors.forename: Kajal Chandra
authors.initials: KC
authors.lastname: Banik
authors.affiliation: ICDDRB, Dhaka, Bangladesh.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Asaduzzaman
authors.affiliation: ICDDRB, Dhaka, Bangladesh.
authors.forename: Nadia Ali
authors.initials: NA
authors.lastname: Rimi
authors.affiliation: Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh.
authors.forename: Mahmudur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, United States of America.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D004032:Diet; D004196:Disease Outbreaks; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D045464:Henipavirus Infections / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D045405:Nipah Virus / Q000502:physiology*; D065749:Phoeniceae; D066256:Raw Foods / Q000821:virology*