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A Controlled Trial to Reduce the Risk of Human Nipah Virus Exposure in Bangladesh

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Abstract

Human Nipah virus (NiV) infection, often fatal in Bangladesh, is primarily transmitted by drinking raw date palm sap contaminated by Pteropus bats. We assessed the impact of a behavior change communication intervention on reducing consumption of potentially NiV-contaminated raw sap. During the 2012–2014 sap harvesting seasons, we implemented interventions in two areas and compared results with a control area. In one area, we disseminated a “do not drink raw sap” message and, in the other area, encouraged only drinking sap if it had been protected from bat contamination by a barrier (“only safe sap”). Post-intervention, 40% more respondents in both intervention areas reported knowing about a disease contracted through raw sap consumption compared with control. Reported raw sap consumption decreased in all areas. The reductions in the intervention areas were not significantly greater compared to the control. Respondents directly exposed to the “only safe sap” message were more likely to report consuming raw sap from a protected source than those with no exposure (25 vs. 15%, OR 2.0, 95% CI 1.5–2.6, P < 0.001). While the intervention increased knowledge in both intervention areas, the “only safe sap” intervention reduced exposure to potentially NiV-contaminated sap and should be considered for future dissemination.

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Acknowledgements

Support for this study was provided by FHI 360 with funds from USAID Cooperative Agreement GHN-A-00-09-00002-00; this study was made possible by the generous support of the American people through the United States Agency for International Development (USAID). icddr,b acknowledges with gratitude the commitment of FHI 360 to the Centre’s research efforts. icddr,b is thankful to the Governments of Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support. We are grateful to all the study participants for their valuable time. We are thankful to the quantitative data collection team. We acknowledge the continuous support of Professor Marcel Tanner from Swiss Tropical and Public Health Institute.

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Authors and Affiliations

  1. icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh

    Nazmun Nahar, Repon C. Paul, Rebeca Sultana, Shariful Amin Sumon, Kajal Chandra Banik, Jaynal Abedin, Mohammad Asaduzzaman & Emily S. Gurley

  2. Swiss Tropical and Public Health Institute, Basel, Switzerland

    Nazmun Nahar

  3. University of Basel, Basel, Switzerland

    Nazmun Nahar

  4. FHI 360, 1825 Connecticut Avenue NW, Washington, DC, 20009, USA

    Fernando Garcia & Susan Zimicki

  5. Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh

    Mahmudur Rahman

  6. Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA

    Stephen P. Luby

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  1. Nazmun Nahar
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  2. Repon C. Paul
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Correspondence to Nazmun Nahar.

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Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study. Human subject review committees at icddr,b and FHI 360 approved the study protocol. The study protocol was registered as a clinical trial on clinicaltrials.gov (NCT01811784).

Appendix

Appendix

See Tables 8, 9, 10 and 11.

Table 8 Reported Community and gachhi Exposure to Information about NiV at Baseline and Endline from the “No Raw Sap” and “Only Safe Sap” Intervention and Control Areas, Bangladesh 2012 to 2014
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Table 9 Reporting of gachhis on Receiving NiV Information and Behavior Related to Raw Sap, During Baseline and Endline Data Collection from the “No Raw Sap,” “Only Safe Sap” and Control Areas, Bangladesh 2013 to 2014
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Table 10 Observation of Date Palm Sap Harvesting, Consumption and Selling at gachhis’ Households at 5.25–9.45 am Until gachhis Finished the Raw Sap Selling and/or Start Making Molasses During 2012–2013 and 2013–2014 Sap Harvesting Seasons
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Table 11 Endline Data on Community Respondents’ Exposure to Nipah Prevention Intervention During 2012–2013 and 2013–2014 Sap Seasons from the “No Raw Sap” and the “Only Safe Sap” Intervention Area, Bangladesh
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Nahar, N., Paul, R.C., Sultana, R. et al. A Controlled Trial to Reduce the Risk of Human Nipah Virus Exposure in Bangladesh. EcoHealth 14, 501–517 (2017). https://doi.org/10.1007/s10393-017-1267-4

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  • DOI: https://doi.org/10.1007/s10393-017-1267-4

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