Abstract
Japanese encephalitis (JE) is a mosquito-borne zoonotic disease that has pigs as the major amplifying hosts. It is the most important cause of viral encephalitis in people in Nepal and is spreading in its geographic distribution in that country. Pig farming is increasing in Nepal due to reducing cultural biases against pigs and government programs to support pig farming for poverty alleviation. Major strategies for JE prevention and control include education, vector control, and immunization of people and pigs. This study used a survey of 400 pig farmers in 4 areas of Nepal with different JE and pig farming histories to explore regional variations in farmer awareness and actions towards JE, the association of awareness and actions with farm and farmer variables, and the implications of these associations for public health education. Exposure to JE risk factors was common across pig farms and pig farming districts but there were significant district level differences in knowledge and practices related to on-farm JE risk reduction. Social factors such as literacy, gender, and cultural practices were associated with farmer attitudes, knowledge and practices for JE control. JE vaccine uptake was almost non-existent and mosquito control steps were inconsistently applied across all 4 districts. Income was not a determining factor of the differences, but all farmers were very poor. The low uptake of vaccine and lack of infrastructure or financial capacity to house pigs indoors or away from people suggest that farmer personal protection should be a priority target for education in Nepal. This study re-enforces the need to attack root causes of people’s personal disease prevention behaviours and take into account local variation in needs and capacities when designing health or agriculture education programs.
Highlights
Japanese encephalitis (JE) is the most important viral encephalitis in Nepal and Asia [1,2]
In this study we used a survey methodology to ascertain information on what pig farmers knew about JE, its risk factors and/or its control in; a long term endemic region (.30yrs) that is the source of most human JE cases in the country (Rupandehi district); a neighbouring endemic district with lower numbers of outbreaks (Kapilvastu near the Indian border); an area of endemic JE with the highest level of pig amplifying hosts (Morang district); and a region of comparatively recent JE emergence in the hill region (Kathmandu valley).Our objective was to determine if there was regional variation in JE knowledge about the disease and practices within pig farm communities to help public health and agriculture extension planners tailor educational material to local needs
In the 5 year period from 2007 to 2011, there were 157 JE human cases reported in Kathmandu, 89 cases reported in Morang, 16 cases reported in Rupandehi and 16 cases reported in Kapilvastu district [18]
Summary
Japanese encephalitis (JE) is the most important viral encephalitis in Nepal and Asia [1,2]. It is a mosquito borne disease caused by a flavivirus that cycles between birds, pigs and people [3]. In recent years expanded and is expected to spread more widely geographically with anticipated changes in climate, land use ( rice and pig farming and urbanization), and access to health care [4,5]. The disease was first confirmed in western Nepal in 1978 [7] in the lowland plains of Terai which borders India, and has regularly occurred since with epidemic peaks every 2–5 years [8]. JE has been documented in 54 of the 75 districts of Nepal, including 24 hill and mountain districts, and is considered to be endemic in the Kathmandu Valley as well as in 24 other districts [8,9,10]
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