title: It's not only what you say, it's also how you say it: communicating nipah virus prevention messages during an outbreak in Bangladesh.
abstract: During a fatal Nipah virus (NiV) outbreak in Bangladesh, residents rejected biomedical explanations of NiV transmission and treatment and lost trust in the public healthcare system. Field anthropologists developed and communicated a prevention strategy to bridge the gap between the biomedical and local explanation of the outbreak.
  
  
  
  We explored residents' beliefs and perceptions about the illness and care-seeking practices and explained prevention messages following an interactive strategy with the aid of photos showed the types of contact that can lead to NiV transmission from bats to humans by drinking raw date palm sap and from person-to-person.
  
  
  
  The residents initially believed that the outbreak was caused by supernatural forces and continued drinking raw date palm sap despite messages from local health authorities to stop. Participants in community meetings stated that the initial messages did not explain that bats were the source of this virus. After our intervention, participants responded that they now understood how NiV could be transmitted and would abstain from raw sap consumption and maintain safer behaviours while caring for patients.
  
  
  
  During outbreaks, one-way behaviour change communication without meaningful causal explanations is unlikely to be effective. Based on the cultural context, interactive communication strategies in lay language with supporting evidence can make biomedical prevention messages credible in affected communities, even among those who initially invoke supernatural causal explanations.
authors: Infectious Diseases Division, icddr,b, Dhaka, Bangladesh. shahana@icddrb.org.|Programme for Emerging Infections, Infectious Diseases Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. shahana@icddrb.org.
authors: Shahana
authors: S
authors: Parveen
authors: Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
authors: M Saiful
authors: MS
authors: Islam
authors: Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
authors: Momtaz
authors: M
authors: Begum
authors: Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
authors: Mahbub-Ul
authors: MU
authors: Alam
authors: Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
authors: Hossain M S
authors: HM
authors: Sazzad
authors: Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
authors: Rebeca
authors: R
authors: Sultana
authors: Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh.
authors: Mahmudur
authors: M
authors: Rahman
authors: Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
authors: Emily S
authors: ES
authors: Gurley
authors: Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.|Medical Research Council Unit (UK), Banjul, The Gambia.
authors: M Jahangir
authors: MJ
authors: Hossain
authors: Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.|Global Health Protection Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.|Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA.
authors: Stephen P
authors: SP
authors: Luby
mesh_terms: D000818:Animals; D001459:Bangladesh / Q000453:epidemiology; D015984:Causality; D002685:Chiroptera / Q000821:virology*; D003140:Communicable Disease Control; D003469:Culture; D004196:Disease Outbreaks; D004326:Drinking; D005247:Feeding Behavior; D015438:Health Behavior; D058015:Health Communication; D007722:Health Knowledge, Attitudes, Practice; D045464:Henipavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D045405:Nipah Virus; D065749:Phoeniceae; D053147:Plant Exudates / Q000009:adverse effects / Q000737:chemistry; D015980:Public Health Practice; D012111:Residence Characteristics
chemical_list: D053147:Plant Exudates
keywords: Anthropological approach; Bangladesh; Communication strategy; Contextual understanding; Nipah virus; Outbreak; Prevention messages