Abstract
BackgroundDuring 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.MethodsWe 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.ResultsThe 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.ConclusionsDuring 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3416-z) contains supplementary material, which is available to authorized users.
Highlights
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
NiV transmission in Bangladesh is through drinking raw date palm sap contaminated with saliva or urine of fruit bats (Pteropus giganteus), the natural reservoir of NiV [9,10,11,12]
We showed infrared photos of bats drinking or licking raw sap from harvested date palm trees collected during research studies in Bangladesh, as well as showing bats trapped in the sap collection pot [13]
Summary
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. During a NiV outbreak in 2004, qualitative investigators were first invited to join the outbreak investigation team from the Institute of Epidemiology, Disease Control and Research (IEDCR) of the Government of Bangladesh and Parveen et al BMC Public Health (2016) 16:726 icddr,b. Qualitative investigators have been serving as core members of the collaborative outbreak investigation team [15]. They complement the epidemiological and clinical investigations by providing a contextual perspective of the outbreak [15]. The qualitative investigators follow anthropological methods to explore detailed illness histories, the behavioural and cultural factors that influence risk of transmission, causal explanations of the illness and care-seeking behaviour of affected people [14, 15]
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