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. 2012 Apr;16(4):e262-7.
doi: 10.1016/j.ijid.2011.12.006. Epub 2012 Jan 31.

Betel quid use in relation to infectious disease outcomes in Cambodia

Pramil N Singh  1 , Zuhair Natto, Daravuth Yel, Jayakaran Job, Synnove Knutsen
Affiliations

Betel quid use in relation to infectious disease outcomes in Cambodia

Pramil N Singh et al. Int J Infect Dis. 2012 Apr.

Abstract

Objectives: The habitual chewing of betel quid (areca nut, betel leaf, tobacco) is estimated to occur among 600 million persons in Asia and the Asia-Pacific Region. Emerging data from rural Asia indicate that the betel quid is part of traditional medicine practices that promote its use for a wide range of ailments, including infectious disease. In the present study, we examined the association between betel quid, traditional medicine, and infectious disease outcomes.

Methods: For the purpose of a nationwide, interviewer-administered, cross-sectional survey of tobacco use (including betel quid), we conducted a stratified three-stage cluster sampling of 13 988 adults aged 18 years and older from all provinces of Cambodia.

Results: We found an association between the intensity of betel quid use and HIV/AIDS (odds ratio (OR) 2.06, 95% CI 1.09-3.89), dengue fever (OR 2.40, 95% CI 1.55-2.72), tuberculosis (OR 1.50, 95% CI 0.96-2.36), and typhoid (OR 1.48, 95% CI 0.95-2.30). These associations were even stronger in women - the primary users of betel quid in Cambodia. Multivariable analyses that controlled for age, gender, income, education, urban versus rural dwelling, receiving care from traditional medicine practitioners, and cigarette smoking did not alter the betel quid-infectious disease association.

Conclusions: Our findings raise the possibility of a role of betel quid use in the transmission of infectious disease through pathways such as immunosuppression, oral route of entry for a pathogen (i.e., through injury to the oral mucosa), and contamination (i.e., fecal-oral) of the betel quid ingredients.

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Conflict of interest statement

Conflict of interest: No conflict of interest to declare.

Figures

Figure 1
Figure 1
Multi-state model linking betel quid use to infectious disease through causal, intermediate, and reverse causal pathways.
See this image and copyright information in PMC

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