Rodent consumption in khon kaen province, thailand Kanokwan Suwannarong, PhD; Robert S. Chapman, MD MPH; Sara Woldehanna MSc, MPH, and Susan Zimicki, PhD

Background The United States Agency for International Development (USAID) launched an Emerging Pandemic Threats (EPT) program in 2009 with the main objective of combatting any zoonotic emerging diseases that could be harmful to human health. The PREVENT Project, implemented by FHI 360, is one of projects under the EPT program and has been tasked with understanding and addressing the risk of transmission at the interface of human-animal behaviors. This study is part of the PREVENT Project in Thailand

Study Design and Objective Cross-sectional survey Study Objective: This was to determine rodent consumption characteristics in Khon Kaen Province, Thailand, during November to December 2011

Study Areas and Settings This study was conducted at Khon Kaen Province during November – December 2011 3 settings were selected - Urban Agriculture Forest These were within 4 districts - Muang Phu Wieng Wieng Khao Phu Pa Man

Study Respondents and Respondent Selection Criteria Males and females, aged between 18 – 50 years Lived in the study areas before the data collection at least 6 months Respondent Selection Criteria: A two-stage cluster sampling procedure was utilized - In the first stage, villages selected randomly using probability proportional to size (PPS) sampling. In the second stage, independent samples of male and females in households in each village were selected using systematic sampling with different random starts and two research teams were separated for interviewed men and women.

Data Collection Procedures Training and Pre-test: Field researchers were trained by researchers from PREVENT/FHI 360 staff 30 respondents were selected for pre-tested in order to validate translated questionnaire at areas that had similar context with the actual data collection areas Data Collection Tool: Trained field researchers used a questionnaire to conduct in face-to-face interviews to gather information on characteristics of human-animal contact (included on consumption), as well as demographic, socio-economic, environmental and cultural information

Study Variables Independent Variables: Dependent Variable: Rodent consumption characteristics   Independent Variables: Twenty-two independent variables were - Demographic information age and gender Socioeconomic information areas of residence, education attainment level, marital status, occupation, family size, and occupied a car Environmental information sanitation status, main drinking water source, animal have access to drinking water, waste disposal, main cooking fuel, dwelling has fuel wood, dwelling has wooden floor, dwelling has wooden walls, and dwelling has zinc roof Behavioral information numbers of food crops grown, number of cultivation-related tasks, and takes measure to avoid rodent-borne disease Cultural context information knowledge/attitude toward animal-borne disease, aware that rodents can cause human disease, and has heard of leptospirosis

Data Analysis Data were analyzed in 3 steps - Step 1 . Univariate analysis: analysis associations between the dependent variable and each of the independent variables. Crude odds ratio, 95% confidence interval, and p-values for association between the independent and outcome variables were computed by using the chi-square test (χ2) or Fisher exact test at this univariate analysis. Step 2. First multiple logistic regression analysis: eligible independent variables (p ≤ 0.15) from the univariate analysis, was constructed for the dependent variable. Step 3. Second multiple logistic regression analysis: eligible independent variables (p ≤0.15) in the step 2 model, was constructed for each dependent variable. Independent variables with p < 0.05 will be considered as statistically significant factors. SPSS software was used in data analysis

Ethical Consideration This study obtained ethical approvals from – FHI 360 IRB College of Public Health Sciences (CPHS), Chulalongkorn University Ethical Committees This also received an agreement from Khon Kaen Provincial Health Office (KKPHO) that allowed the research team conducting this study at the study areas

Main Findings (1) Among 201 (100 female and 101 male) respondents, we found – 113 respondents (56.2%) (including 39 females and 74 males), reported consuming some type of rodent during the previous one-month or the past 12-month periods. Among these 113 respondents, they consumed in the following: 104 (92.0%) - only rats (not specific species) 4 (3.5%) - field rats 6 (5.3%) – squirrels 33 (29.2%) - burrowing squirrels 19 (16.8%) - flying squirrels 3 (2.7%) - porcupine

Main Findings (2) Final model of logistic regression analysis showed that - Positive association with reported rodent consumption Male gender (OR = 7.45, 95% CI 3.51–15.85, p<0.001) Family size ≥six persons (OR = 2.31, 95% CI 1.10–4.84, p=0.027) Use of rainwater as the main source of drinking water in all seasons (OR = 8.61, 95% CI 3.28–22.57, p<0.001) Negative association with rodent consumption Having proper knowledge/attitudes towards animal-borne disease (OR = 0.96, 95% CI 0.92–0.99, p=0.030)

Conclusion and Discussion The results likely represent the information on rodent consumption activities in northeast Thailand or even in the entire Asia region, and might be able to generalize to other areas that have similar characteristics. These findings should assist to improve knowledge and attitudes towards rodent-borne diseases. This could serve for several PREVENT studies, such as participatory action research, to advance understanding of human-rodent interactions in this province. It will also be important to conduct epidemiologic studies to characterize zoonotic disease risk in relation to rodent consumption and other types of rodent contact. Information from these efforts should provide a sound scientific basis for policies to reduce risk of these diseases.

Acknowledgements This study was funded by FHI 360 through USAID with funds from USAID Cooperative Agreement GHN-A-00-09-00002-00. We sincerely thank: Current and previous Khon Kaen Provincial Chief Medical Officers (PCMO) of Khon Kaen Provincial Health Office (KKPHO) and their staff at health facilities for their cooperation and assistance during research implementation. Local field researchers FHI 360 supporting staff

“The Southeast Asian Journal of Tropical Medicine and Public Health” Published in “The Southeast Asian Journal of Tropical Medicine and Public Health” on September 2014