{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:06:16Z","timestamp":1791209176036,"version":"4.1.0"},"reference-count":51,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,9,4]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Foodborne trematodiases such as clonorchiasis and opisthorchiasis, alongside bacterial infections linked to eating raw or undercooked freshwater fish, pose major public health concerns in Southeast Asia. However, regional data on the prevalence of this dietary practice remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional survey of 6021 participants from Cambodia, Lao People\u2019s Democratic Republic (PDR), Malaysia, Singapore, Thailand and Vietnam between October 2022 and February 2024. Univariate and multivariable logistic regression analyses were conducted to assess consumption patterns across sociodemographic groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Raw freshwater fish consumption was most common in Cambodia, Lao PDR, Thailand and Vietnam\u2014between 70% and 90% indicated ever consuming high-risk dishes despite relatively high awareness of associated risks (60%\u201380%). Younger individuals and male participants generally reported higher consumption. Notably, participants aged 40 and above were significantly less likely to consume high-risk dishes in Cambodia (adjusted OR (AOR): 0.12, 95%\u2009CI 0.05 to 0.29), Singapore (AOR: 0.47, 95%\u2009CI 0.34 to 0.64), Thailand (AOR: 0.63, 95%\u2009CI 0.47 to 0.85)\u2009and Vietnam (AOR: 0.40, 95%\u2009CI 0.19 to 0.82). In Vietnam, males were more likely to consume high-risk dishes (AOR: 2.16, 95%\u2009CI 1.11 to 4.42). Knowledge was protective in Singapore\u2014participants who were unaware of the risks of consumption were 1.6 times more likely to consume high-risk dishes (AOR: 1.62, 95%\u2009CI 1.16 to 2.26).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Raw freshwater fish consumption remains widespread in Southeast Asia, placing populations at risk of parasitic and bacterial infections. These findings highlight critical gaps in risk communication and can guide targeted interventions to reduce consumption and prevent associated disease outbreaks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004669","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:30:21Z","timestamp":1791207021000},"page":"e004669","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Consumption of raw or undercooked freshwater fish and awareness of risks of associated bacterial and parasitic infections in Southeast Asia: an online multicountry cross-sectional survey"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6241-6623","authenticated-orcid":false,"given":"Sharon Esi Duoduwa","family":"Quaye","sequence":"first","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Worawit","family":"Louthrenoo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Noor Amal","family":"Azmai","sequence":"additional","affiliation":[{"name":"Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguy\u1ec5n Ng\u1ecdc","family":"Ph\u01b0\u1edbc","sequence":"additional","affiliation":[{"name":"University of Agriculture and Forestry, Hue University, Hue, Thua Thien Hue, Viet Nam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somphou","family":"Sayasone","sequence":"additional","affiliation":[{"name":"Lao Tropical and Public Health Institute, Vientiane, Lao People\u2019s Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Leang","sequence":"additional","affiliation":[{"name":"KHANA Center for Population Health Research, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sovannary","family":"Tuot","sequence":"additional","affiliation":[{"name":"KHANA Center for Population Health Research, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyan","family":"Yi","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore"},{"name":"KHANA Center for Population Health Research, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Barkham","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1592-1745","authenticated-orcid":false,"given":"Borame L","family":"Dickens","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026100506301700000_4.4.e004669.1","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.01821-12"},{"key":"2026100506301700000_4.4.e004669.2","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.tifs.2018.11.009","article-title":"Inactivation of parasite transmission stages: Efficacy of treatments on food of animal origin","volume":"83","author":"Franssen","year":"2019","journal-title":"Trends in Food Science & Technology"},{"key":"2026100506301700000_4.4.e004669.3","first-page":"1507","article-title":"Simplified techniques for killing the carcinogenic, Opisthorchis viverrini metacercariae in cyprinid fish","volume":"18","author":"Sripan","year":"2017","journal-title":"Asian Pac J Cancer Prev APJCP"},{"key":"2026100506301700000_4.4.e004669.4","unstructured":"Invasive disease and illness linked to consumption of raw freshwater fish in Southeast Asia. 2024. Available: https:\/\/www.fao.org\/asiapacific\/news\/detail-events\/en\/c\/1412813\/"},{"key":"2026100506301700000_4.4.e004669.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0211540","article-title":"Uncooked fish consumption among those at risk of Opisthorchis viverrini infection in central Thailand","volume":"14","author":"Suwannahitatorn","year":"2019","journal-title":"PLoS ONE"},{"key":"2026100506301700000_4.4.e004669.6","first-page":"974","article-title":"Factors related to the consumption of raw fish among the people in Sisaket Province 2016","volume":"28","author":"Lausatianragit","year":"2019","journal-title":"J Health Sci Thai"},{"key":"2026100506301700000_4.4.e004669.7","doi-asserted-by":"crossref","first-page":"102382","DOI":"10.1016\/j.parint.2021.102382","article-title":"Masculinity and misinformation: Social dynamics of liver fluke infection risk in Thailand","volume":"84","author":"Wang","year":"2021","journal-title":"Parasitol Int"},{"key":"2026100506301700000_4.4.e004669.8","unstructured":"Influence of misconceptions and inappropriate eating behaviours on Opisthorchis viverrini infection among at-risk populations undergoing cholangiocarcinoma screening in Northeastern Thailand. Parasitology Research; 2025. Available: https:\/\/link.springer.com\/article\/10.1007\/s00436-023-08003-1"},{"key":"2026100506301700000_4.4.e004669.9","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.3201\/eid2211.160252","article-title":"Group B Streptococcus sequence type 283 disease linked to consumption of raw fish, Singapore","volume":"22","author":"Rajendram","year":"2016","journal-title":"Emerg Infect Dis"},{"key":"2026100506301700000_4.4.e004669.10","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.3201\/eid2312.170596","article-title":"Group B Streptococcus infections caused by improper sourcing and handling of fish for raw consumption, Singapore, 2015-2016","volume":"23","author":"Chau","year":"2017","journal-title":"Emerg Infect Dis"},{"key":"2026100506301700000_4.4.e004669.11","unstructured":"Emerging threat of Group B Streptococcus (GBS) in fish - now in 4 languages . \u0411\u0435\u0437\u043e\u043f\u0430\u0441\u043d\u043e\u0441\u0442\u044c \u0438 \u043a\u0430\u0447\u0435\u0441\u0442\u0432\u043e \u043f\u0438\u0449\u0435\u0432\u044b\u0445 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u043e\u0432 | \u043f\u0440\u043e\u0434\u043e\u0432\u043e\u043b\u044c\u0441\u0442\u0432\u0435\u043d\u043d\u0430\u044f \u0438 \u0441\u0435\u043b\u044c\u0441\u043a\u043e\u0445\u043e\u0437\u044f\u0439\u0441\u0442\u0432\u0435\u043d\u043d\u0430\u044f \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u0430\u0446\u0438\u044f \u043e\u0431\u044a\u0435\u0434\u0438\u043d\u0435\u043d\u043d\u044b\u0445 \u043d\u0430\u0446\u0438\u0439. 2024. Available: https:\/\/www.fao.org\/food-safety\/news\/news-details\/ru\/c\/1565614\/"},{"key":"2026100506301700000_4.4.e004669.12","unstructured":"Risk profile - Group B Streptococcus (GBS) . Streptococcus agalactiae sequence type (ST) 283 in freshwater fish. 2024. Available: https:\/\/openknowledge.fao.org\/items\/983df5e9-a088-49a2-bc3b-bc6c25eb5c3f"},{"key":"2026100506301700000_4.4.e004669.13","unstructured":"Nations F and AO of the U, Network of Aquaculture Centres in Asia-Pacific . Invasive disease linked to raw freshwater fish: group B Streptococcus. 2024. Available: https:\/\/enaca.org\/?id=1157"},{"key":"2026100506301700000_4.4.e004669.14","unstructured":"Gnathostomiasis acquired after consumption of raw freshwater fish in the Amazon region: a report of two cases in Brazil - PMC. 2024. Available: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7670746\/"},{"key":"2026100506301700000_4.4.e004669.15","doi-asserted-by":"crossref","unstructured":"Gnathostomiasis: an emerging infection of raw fish consumers in gnathostoma nematode-endemic and nonendemic countries | Journal of Travel Medicine. Oxford Academic; 2024. Available: https:\/\/academic.oup.com\/jtm\/article\/22\/5\/318\/2563211","DOI":"10.1111\/jtm.12212"},{"key":"2026100506301700000_4.4.e004669.16","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1186\/s12879-022-07244-2","article-title":"Epidemiological characterization of Clonorchis sinensis infection in humans and freshwater fish in Guangxi, China","volume":"22","author":"Xie","year":"2022","journal-title":"BMC Infect Dis"},{"key":"2026100506301700000_4.4.e004669.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008263","article-title":"Familial assimilation in transmission of raw-freshwater fish-eating practice leading to clonorchiasis","volume":"14","author":"Qian","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"2026100506301700000_4.4.e004669.18","unstructured":"MSD Manual Professional Edition . Heterophyiasis and related trematode infections - infectious diseases. 2024. Available: https:\/\/www.msdmanuals.com\/professional\/infectious-diseases\/trematodes-flukes\/heterophyiasis-and-related-trematode-infections"},{"key":"2026100506301700000_4.4.e004669.19","unstructured":"The occurrence of heterophyid metacercariae in freshwater fish from reservoirs | Request PDF. ResearchGate; 2024. Available: https:\/\/www.researchgate.net\/publication\/228845160_The_occurrence_of_heterophyid_metacercariae_in_freshwater_fish_from_reservoirs"},{"key":"2026100506301700000_4.4.e004669.20","unstructured":"SFA . GBS and the consumption of raw freshwater fish. 2024. Available: https:\/\/www.sfa.gov.sg\/food-information\/risk-at-a-glance\/gbs-and-the-consumption-of-raw-fish"},{"key":"2026100506301700000_4.4.e004669.21","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007421","article-title":"One hypervirulent clone, sequence type 283, accounts for a large proportion of invasive Streptococcus agalactiae isolated from humans and diseased tilapia in Southeast Asia","volume":"13","author":"Barkham","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"2026100506301700000_4.4.e004669.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008268","article-title":"A prospective study of bloodstream infections among febrile adolescents and adults attending Yangon General Hospital, Yangon, Myanmar","volume":"14","author":"Myat","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"2026100506301700000_4.4.e004669.23","doi-asserted-by":"crossref","first-page":"106133","DOI":"10.1016\/j.actatropica.2021.106133","article-title":"Current status of human liver fluke infections in the Greater Mekong Subregion","volume":"224","author":"Sripa","year":"2021","journal-title":"Acta Trop"},{"key":"2026100506301700000_4.4.e004669.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.parint.2011.08.014"},{"key":"2026100506301700000_4.4.e004669.25","doi-asserted-by":"crossref","first-page":"105221","DOI":"10.1016\/j.actatropica.2019.105221","article-title":"Behaviour-related risk factors for opisthorchiasis-associated cholangiocarcinoma among rural people living along the Mekong River in five Greater Mekong Subregion countries","volume":"201","author":"Songserm","year":"2020","journal-title":"Acta Trop"},{"key":"2026100506301700000_4.4.e004669.26","doi-asserted-by":"crossref","DOI":"10.1186\/s40249-024-01191-7","article-title":"Natural variables separate the endemic areas of Clonorchis sinensis and Opisthorchis viverrini along a continuous, straight zone in Southeast Asia","volume":"13","author":"Zheng","year":"2024","journal-title":"Infect Dis Poverty"},{"key":"2026100506301700000_4.4.e004669.27","doi-asserted-by":"crossref","first-page":"S158","DOI":"10.1016\/j.actatropica.2010.07.006","article-title":"Opisthorchiasis and Opisthorchis-associated cholangiocarcinoma in Thailand","volume":"120 Suppl 1","author":"Sripa","year":"2011","journal-title":"Acta Trop"},{"key":"2026100506301700000_4.4.e004669.28","doi-asserted-by":"crossref","DOI":"10.1186\/s40249-024-01201-8","article-title":"Prevalence estimates of Opisthorchis viverrini and Clonorchis sinensis infection in the Greater Mekong Subregion: a systematic review and meta-analysis","volume":"13","author":"Sota","year":"2024","journal-title":"Infect Dis Poverty"},{"key":"2026100506301700000_4.4.e004669.29","doi-asserted-by":"crossref","first-page":"287","DOI":"10.2478\/helm-2023-0036","article-title":"Fish and food-fatale: food-borne trematode Opisthorchis viverrini and cholangiocarcinoma","volume":"60","author":"Tan","year":"2023","journal-title":"Helminthologia"},{"key":"2026100506301700000_4.4.e004669.30","doi-asserted-by":"crossref","DOI":"10.3390\/tropicalmed7100313","article-title":"Prevalence and risk factors of Opisthorchis viverrini infection in Sakon Nakhon Province, Thailand","volume":"7","author":"Perakanya","year":"2022","journal-title":"Trop Med Infect Dis"},{"key":"2026100506301700000_4.4.e004669.31","first-page":"2761","article-title":"Raw fish consuming behaviour related to liver fluke among the population at risk for cholangiocarcinoma in Nakhon Ratchasima Province, Thailand","volume":"17","author":"Chavengkun","year":"2016","journal-title":"Asian Pac J Cancer Prev APJCP"},{"key":"2026100506301700000_4.4.e004669.32","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.actatropica.2013.03.016","article-title":"Raw fish consumption in liver fluke endemic areas in rural southern Laos","volume":"127","author":"Xayaseng","year":"2013","journal-title":"Acta Trop"},{"key":"2026100506301700000_4.4.e004669.33","doi-asserted-by":"crossref","DOI":"10.1186\/s13071-017-2179-4","article-title":"Clonorchis sinensis granulin: identification, immunolocalisation, and function in promoting the metastasis of cholangiocarcinoma and hepatocellular carcinoma","volume":"10","author":"Wang","year":"2017","journal-title":"Parasit Vectors"},{"key":"2026100506301700000_4.4.e004669.34","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0011987","article-title":"Clonorchis sinensis on the prognosis of patients with spontaneous rupture of hepatocellular carcinoma: an inverse probability of treatment weighting analysis","volume":"18","author":"Ni","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"key":"2026100506301700000_4.4.e004669.35","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/bs.apar.2018.10.001","article-title":"Update on pathogenesis of opisthorchiasis and cholangiocarcinoma","volume":"102","author":"Sripa","year":"2018","journal-title":"Adv Parasitol"},{"key":"2026100506301700000_4.4.e004669.36","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0b013e3282fbf9b3"},{"key":"2026100506301700000_4.4.e004669.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.parint.2016.11.013"},{"key":"2026100506301700000_4.4.e004669.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2003.01.002"},{"key":"2026100506301700000_4.4.e004669.39","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.pt.2017.06.002","article-title":"Prospects and challenges towards sustainable liver fluke control","volume":"33","author":"Sripa","year":"2017","journal-title":"Trends Parasitol"},{"key":"2026100506301700000_4.4.e004669.40","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.3748\/wjg.14.2297","article-title":"Opisthorchiasis in Thailand: review and current status","volume":"14","author":"Kaewpitoon","year":"2008","journal-title":"WJG"},{"key":"2026100506301700000_4.4.e004669.41","doi-asserted-by":"crossref","first-page":"838","DOI":"10.4269\/ajtmh.19-0864","article-title":"An epidemiological survey of Opisthorchis viverrini infection in a lightly infected community, Eastern Thailand","volume":"102","author":"Boondit","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"2026100506301700000_4.4.e004669.42","unstructured":"Wilski S . TGM research. 2025. Available: https:\/\/tgmresearch.com\/https%3A%2F%2Ftgmresearch.com%2F"},{"key":"2026100506301700000_4.4.e004669.43","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/irv.12785","article-title":"Population anxiety and positive behaviour change during the COVID-19 epidemic: cross-sectional surveys in Singapore, China and Italy","volume":"15","author":"Lim","year":"2021","journal-title":"Influenza Other Respir Viruses"},{"key":"2026100506301700000_4.4.e004669.44","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25973","article-title":"Application of the network scale\u2010up method to estimate the sizes of key populations for HIV in Singapore using online surveys","volume":"26","author":"Quaye","year":"2023","journal-title":"J Int AIDS Soc"},{"key":"2026100506301700000_4.4.e004669.45","unstructured":"Software \u2013 REDCap. 2024. Available: https:\/\/projectredcap.org\/software\/"},{"key":"2026100506301700000_4.4.e004669.46","unstructured":"R: the R Project for Statistical Computing. 2024. Available: https:\/\/www.r-project.org\/"},{"key":"2026100506301700000_4.4.e004669.47","unstructured":"Spatial without compromise. QGIS Web Site; 2024. Available: https:\/\/www.qgis.org\/"},{"key":"2026100506301700000_4.4.e004669.48","doi-asserted-by":"crossref","first-page":"777","DOI":"10.31557\/APJCP.2020.21.3.777","article-title":"Sustainable prevention of cholangiocarcinoma through community participation in a high-incidence area in Thailand","volume":"21","author":"Songserm","year":"2020","journal-title":"Asian Pac J Cancer Prev"},{"key":"2026100506301700000_4.4.e004669.49","unstructured":"Holmes O , France-Presse A . Thai doctor fights against carcinogenic raw fish dish that killed his parents. The Guardian; 2017. Available: https:\/\/www.theguardian.com\/world\/2017\/jun\/28\/thai-doctor-fights-against-carcinogenic-raw-fish-dish-that-killed-his-parents"},{"key":"2026100506301700000_4.4.e004669.50","unstructured":"MOH . News highlights. 2024. Available: https:\/\/www.moh.gov.sg\/news-highlights\/details\/freshwater-fish-banned-from-ready-to-eat-raw-fish-dishes"},{"key":"2026100506301700000_4.4.e004669.51","unstructured":"Writer G . Hon Kee Porridge: serving fresh raw fish porridge in Petaling Street since 1949. SETHLUI.com; 1949. Available: https:\/\/sethlui.com\/hon-kee-porridge-malaysia\/"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004669","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:30:29Z","timestamp":1791207029000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":51,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,10,5]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bmjph-2025-004669"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004669","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}