Epidemiological Survey of Moringa Oleifera Leaves in Bangladesh

Moringa oleifera is a nutrient-rich plant which is cultivated in different regions of Bangladesh. The plant has a number of medicinal as well as dietary benefits. In light of this information, an epidemiological survey has been conducted on 600 (six hundred) participants from the urban and semi-urban regions of Bogra regarding the general consumption of Moringa. The study found that women are more likely to consume it than men. On the other hand, people with lower education levels are more likely to consume moringa leaves. Due to a lack of awareness about the benefits of consuming different parts of moringa plant, some parts are completely ignored such as, flowers and bark. Thus, there has to be widespread educational campaigns to promote the use of moringa oleifera plant in daily life.

Bangladesh is a small country in the Southern part of Asia. With a population exceeding 160 million, it is among the most densely populated countries worldwide. It is natural that the amount of cultivable land is going to decrease by some percentage each year to prepare living space for the ever increasing population. In fact, the agricultural land fell by an average of 66,000 acres per year. If that is to be countered in a productive way then the best option is the multipurpose fruit plant. There is minimal input needed with such plants. One such plant is Moringa (M. oleifera) which offers a lot of versatility. Not only is the plant known for fast growth but it also provides resistance to droughts. Moringa is also known to contain high nutritional contents that can prove to be a difference maker against malnutrition in Bangladesh. The plant is made up of a number of important phytochemicals, fibers a well as proteins. In parts of Africa, it is seen as a superfood that will alleviate poverty and give a boost to the rural economies [1]. So much so that, moringa is seen as having the potential to ensure food security alongside mitigating climate change [2].

Moringa is a part of the country’s landscape in areas such as, Rajshahi, Chapwainawabganj, Kushtia alongside Pabna and Bogra. Studies into the matter have revealed that households in these regions plant it near the homesteads. Additionally, it is planted in some non-rice fields [3]. Previously, the plant has used in certain agro-ecological zones [4]. Any person can grow this tree with little external input which may one day improve food security issues. What makes moringa so special is that, all the parts of the tree are edible and are rich in minerals [5]. Moreover the leaves’ parts are gaining recognition in many countries for their vital role in producing a variety of products. This recognition can be attributed to the bioactive compounds present inside the tree [6].

As mentioned above, there are many ways to use Moringa tree parts. One such use is to make Moringa Oleifera Leaf Powder (MOLP). The leaf extracts are known to contain phenolic-rich extracts that can address malnutrition. In a few countries, MOLP is being seen as an option for making bread and biscuits. As such, it can work well as a low cost staple food [7]. Due to the availability of a large amount of bioactive compounds in moringa, it has commercial use as a food supplement [8].

The objectives of this study are quite a few. To start off, it is imperative to determine the extent to which people in urban and semi-urban regions of Bogra, Bangladesh consume Moringa. This will help to identify the key consumer demographic. The next objective is to gauge the people’s understanding of Moringa’s nutritional and medicinal benefits. If we break it down further, the aim is to find out about people’s knowledge of the different parts of a Moringa plant and the related benefits. The socio-demographic and health factors can help shape people’s perception of Moringa’s consumption.

Attitude and behavior towards moringa in Bangladesh

Over the decades, there have been a number of researches regarding the use of medicinal plants in South Asia. The plants have traditional value attached to them as well [9]. One area that may concern researchers further is the indigenous people’s perception towards herbal as well as allopathic medicine. There obviously has to be certain drivers towards making the decision to use these medicines. According to one research, there are two drivers: “deficit driver” and “community driver”. The deficit driver hints at a number of limitations which may be present in modern medicines. Meanwhile, the second driver is connected with the integrative behavior of modern society [10].

In the case of Bangladesh, there is a huge community of people using herbal medicines. The usage is frequent around the rural areas which can raise a question about the people’s perception of such medicinal approach [11]. For many parts of South Asia, moringa has been seen as this “miracle tree”. In some parts, it is also known as the drumstick tree [12]. Given its nutritional values, moringa tree has to be planted more often. The plant has its use as food, fertilizer, fuel as well as for reforestation. Additionally, moringa has medicinal benefits that are being capitalized on in different parts of the world. There is practice of providing breastfeeding women with moringa-based product to fend off malnutrition in Asian countries alongside African countries [13]. Moreover, the plant can be the source of micronutrient in the case of poultry. Moringa has been previously used as dietary supplement to positively affect broiler performance [14]. Different studies have revealed that a large majority of people in Asia and other continents may not be as aware of moringa’s medicinal benefits [15].

This epidemiological survey has been designed to investigate the knowledge, attitude and practices related to Moringa consumption among the residents of urban and semi-urban areas of Bogra, Bangladesh. The sample size is 600 (six hundred) and the selection has been completed by using a stratified random sampling method. One reason for choosing this method is to ensure representation across different segments of the population. A structured questionnaire has been developed and disseminated among the public by trained researchers belonging to the Health and Disease Research Center for Rural Peoples (HDRCRP).

The questionnaire gathered information based on; Moringa consumption: Frequency, quantity along with parts of Moringa plant (leaves, roots, barks, flowers and drumsticks) being consumed. Knowledge and Attitude: Awareness regarding the nutritional and medicinal benefits of Moringa consumption. Socio-demographic characteristics: Age, gender, education level, income and lastly occupation of respondents. Health status: Self-reported prevalence of diabetes and hypertension, smoking and tobacco consumption habits.

The collected data has been compiled, coded and analyzed with the help of IBM SPSS Statistics. This is a software known for providing statistical analysis and assists with data management [16]. Statistical analysis has been conducted by incorporating descriptive statistics (mean, median, standard deviation, percentage) for characterizing the sample. One major classification of the participants is the User vs. Non-user status. In this case, user refers to the participants who consume Moringa and Non-user are participants who do not consume it. Pearson’s chi-square tests have been employed to assess the connection between categorical variables, for instance, Moringa use and education level. Univariate and multivariate logistic regression analysis had been conducted to determine factors that are linked to Moringa consumption. The odds Ratio (OR) and confidence Interval (CI) were calculated to ascertain the strength alongside statistical significance of the connections. A p-value of < 0.05 has been considered to be statistically significant.

The variables can be classified as Dependent Variable: Moringa consumption (user vs. non-user) or frequency of consumption. It is the variable that researchers are trying to explain or predict. And Independent Variable: Age, education level, income, prevalence of diseases (diabetes and hypertension), smoking habit, and lastly tobacco consumption. These are the variables believed to have an influence on Moringa consumption. Gender and occupation are independent variables as well.

In a way, the study is aimed towards determining whether and in what way the independent variables are connected to Moringa consumption patterns.

Prior to the survey, the consent was taken from the participants about the research. This research only includes information from those who have given their permission. At the same time, the research has been approved of by the authority of Health and Disease Research Center for Rural Peoples (HDRCRP).

The survey as mentioned above, had been conducted on six hundred participants. These respondents were classified on the basis of their gender, lifestyle factors (smoking habit and tobacco consumption), educational level (no education, primary education, secondary education and higher education), marital status (single and unmarried), occupation (housewife, self-employment, government job holder, non-government job holder, business, day labor and others), monthly income (< 10,000 Taka and > = 10,000 Taka), religion (Muslim and Hindu), and lastly, disease characteristics (type 2 diabetes and hypertension).

In table 1, these socio-demographic characteristics were determined through Mean for age of the participants and percentage in other portions. Here, the socio-demographic representation should assist to understand the profile of the participants.

The table 1 shows that the average age of the participants is 42.7 years (± 11.8 years), which seem to indicate that majority of them lean towards middle-age. Out of the participants, 61.6% were female and 38.4% were males so there was a higher representation of females in the study. Of the participants, a small quantity (7.1%) had smoking habit while another (6%) group had the habit of tobacco consumption. More than half (51.7%) of the participants completed primary education so they have basic educational background. Since females make up most of the participants, 29.4% of them are housewives and a large portion (40.4%) are self-employed. The monthly income for more than half (60.2%) of the participants is beyond Tk. 10,000. This information about income level has been collected to see if the purchasing power plays any role in Moringa consumption. As Islam is the main religion of Bangladesh, the majority (96.3%) of the participants are Muslim. Among the respondents a small group (14.6%) has hypertension while another smaller group (11.9%) suffers from diabetes. It is well known that moringa leaves can lower blood sugar as well as blood pressure and its use among the age group of 45-64 indicates awareness of moringa’s health benefits. When it comes the moringa consumption, majority (76.4%) are moringa users while almost one-fourth (25.4%) are moringa non-users.

In table 2, there is a classification of user and non-user. User in this case, means the people who consume Moringa and Non-user being people who do not consume it. The p value is estimated after conducting an independent sample t-test.

Values are presented percentage (%).*p < 0.05. Based on Pearson Chi-square test.

The table 2 concludes that there is a higher percentage of Moringa consumption among women than in men (p = 0.011). It can be traced to the traditional beliefs that Moringa consumption can improve family health. The education level of Moringa users is on the lower side. In the future, any awareness campaign has to target both lower and higher educated groups.

Since the diabetic people use Moringa more (p = 0.027), it may be suggested that they use it as a natural remedy. Due to Moringa’s overall health benefits regarding blood sugar regulation, there is a strong correlation. Moreover, hypertension is on the lower end among Moringa users (11.5%) in comparison with non-users (23.5%) (p = 0.015) so, there may well be potential cardiovascular benefits.

Participants with higher-income (≥ 10,000 Tk) have a higher chance of consuming Moringa (p < 0.001). So, it can be suggested that affordability can play a role in Moringa consumption.

On the other hand, self-employed people alongside housewives are the primary users. It means that there is a preference for Moringa as a home cooked meal.

While women have a higher chance of Moringa consumption (Table 2), it is men who have a higher chance of consuming Moringa leaves. The p-value (0.049) is an indication that of statistically significant age difference in Moringa consumption. As older individuals (40-49) are more likely to consume Moringa leaves, it can be related to health concerns. People from lower income group (≤ 10,000 Tk) consume more Moringa leaves (p < 0.001) (Table 2) whereas people from higher income group consume more Moringa in general. Here it can be said that, Moringa leaves are more affordable for lower income groups. Meanwhile, higher income groups prefer drumsticks as well as processed Moringa products.

On the other hand, diabetes is more prevalent among the Moringa users (14.5%). However, among Moringa leaves users, the prevalence is lower (5.6%). It can be said that, people suffering from diabetes have a preference for Moringa in various forms (such as, drumstick or powder) instead of leaves. Meanwhile, the hypertension levels are similar among Moringa leaves users and non-users. There is no clear correlation in this case.

Participants with smoking habit are likely to consume Moringa leaves (Table 3) but have a lower chance of using Moringa overall (Table 2). There is a probability that smokers are using moringa leaves in hopes of a detoxification effect. In addition, non-government employees are consuming Moringa leaves more due to a dietary preference but it is unclear.

The table 4 shows that the drumstick is widely popular among all age groups while the middle-aged participants (45-64) have shown diversification in terms of usage. These people are using leaves or flowers for the perceived health benefits. Roots and bark are not used anywhere near the same level as drumstick due to the lack of traditional use.

Given that the p-value is higher than 0.05, there is little to no statistical significance when it comes to age groups. Hence, the variations are likely to result from random chance in place of preference trends.

Here the odds ratio is going to be a measurement for the degree of strength of every independent variable in relation to moringa usage. OR > 1: This factor is going to increase the chances of moringa usage. OR < 1: This factor is going to decrease the chances of moringa usage (has not been observed in the case). OR = 1: Has no impact on moringa usage.

In order to present the findings more clearly, there is a further breakdown of the ORs to further demonstrate the findings: The OR for “age” is 1.02, indicating that every additional year of age lifts the chances of moringa usage by 2%. The OR for “gender” is 4.00, indicating that one gender group has 4 times more likelihood of moringa usage than the other. The OR for “income” is 1.60, indicating that people with higher income have a 60% more likelihood of using moringa. The OR for “smoking habit” is 2.03, indicating that people who smoke are 2 times more likely to intake moringa. The OR for “tobacco use” is 2.76, indicating that tobacco users have a 2.76 times more likelihood of moringa consumtion. The OR for “type 2 diabetes” is 2.63, indicating that diabetic people have a 2.63 times more likelihood of moringa consumption. The OR for “hypertension” is 3.40, indicating that hypertensive people have a 3.4 times chance of using moringa.

Now, it is also imperative to assess the Confidence Intervals (CI) for their statistical significance. With a 95% CI, there is a range inside which the true OR can be expected to fall 95% of the time. For CI, the width is likely to indicate the preciseness of the estimate: Narrow CI – Better precision for estimation of the OR. Wide CI – Greater uncertainty for estimation of the OR.

For a better understanding for the CI, there is a further breakdown; the CI range for “age” is 1.02-1.03, it is quite narrow CI, indicating greater precision. The CI range for “gender” is 2.73-5.86, even with a moderate range, there is some statistical significance. The CI range for “income” is 1.08-2.38, here the CI is wider and indicates a small degree of variability in income’s effect. The CI range for “smoking habit” is 1.50-2.76, with a moderate range, there is still some statistical significance. The CI range for “tobacco use” is 2.09-3.65, with a moderate range, there is a strong association towards Moringa consumption. The CI range for “type 2 diabetes” is 1.98-3.50, with a moderate range, there is a strong association towards Moringa consumption. The CI range for “hypertension” is 2.49-4.64, as the range is high, there is a strong association with Moringa consumption.

As every CI crosses 1, every variable has a statistically significant positive link to moringa usage. Since the narrowest CI belongs to age, this variable has the most precision in terms of estimates. On the other hand, as income has a wider CI, there is lesser precision regarding the estimation of its impact on moringa usage.

While it also shows that the health conditions have been key drivers for moringa consumption. Whereas age and income may have smaller influences but it is significant enough to suggest a trend of moringa usage having more popularity among older and higher earning individuals.

The findings of the epidemiological survey relies on the consumption patterns, demographic influences along with awareness levels related to Moringa oleifera in the urban and semi-urban regions of Bogra, Bangladesh. A key point to note is the disparity that exists based on socio-demographic factors regarding Moringa consumption with ties to gender, education level, and income as well as health conditions. There is a significant disparity in consumption based on gender. It is found that women have a higher likelihood of consuming Moringa than men (Table 2, p = 0.011). The trend can be attributed to traditional household roles in which women are in charge of meal preparation and ensuring family nutrition. This consumption pattern gives a generalized view. When the participants were asked about the consumption of specific parts of the plant for instance, the leaves, the result varied. It is men who consume the leaves more frequently than women (Table 3, p = 0.002). There is a belief that gender not only influences Moringa consumption but also influences which parts are consumed. It may be due to the perceived value in terms of dietary and health benefits of consuming certain parts more than others.

This study also reveals that educational level can play a significant role in Moringa consumption. Participants with a lower level of education are more likely to consume it over those with higher level of education (Table 2, p = 0.003). It can be due to traditional knowledge and practices having a higher level of prevalence among those with lower education level. Meanwhile, the participants with a higher level of education may prefer other dietary supplements. Income is also another determinant of Moringa consumption. Participants whose earnings exceed Tk. 10,000 are more likely to consume it over those whose earnings are below Tk. 10,000 (Table 2, p < 0.001). It is interesting to note that the higher-income individuals who consume Moringa more but lower-income respondents were more inclined to consume Moringa leaves specifically (Table 3, p < 0.001). So, it can be said that affordability has a role to play in determining the form of Moringa consumption. Additionally, the Moringa leaves appear to be more accessible as an option for lower-income participants.

Health status also strongly influenced Moringa consumption. Participants with type 2 diabetes and hypertension were more likely to consume Moringa (Table 2, p = 0.027 and p = 0.015, respectively). This aligns with existing literature that highlights Moringa’s hypoglycemic and anti-hypertensive properties. However, while overall Moringa consumption was higher among diabetics, Moringa leaf consumption was lower in this group (Table 3, p = 0.256), indicating a preference for other parts such as drumsticks or processed forms.

The study has also found an association between moringa consumption and chronic health conditions. Due to the usage pattern of moringa by diabetic individuals alongside hypertensive people, there is certainly a belief among the consumers about moringa’s role as the natural supplement. Previous studies have revealed that moringa has hypoglycemic as well as anti-hypertensive characteristics [17]. According to the univariate analysis, variables such as, age, income as well as lifestyle factors can influence moringa consumption. The logistic regression analysis (Table 5) further confirmed these associations, showing that age, gender, income, smoking habits, and health conditions all significantly influence Moringa consumption. Notably, hypertensive individuals had a 3.4 times higher likelihood of consuming Moringa (OR = 3.40, p < 0.001), reinforcing its perceived benefits for managing blood pressure. Similarly, diabetics had a 2.63 times higher likelihood of consuming Moringa (OR = 2.63, p < 0.001). These findings suggest that individuals with chronic illnesses are actively seeking natural dietary interventions to complement conventional treatments.

The sample size for the study is insufficient to conduct any further test in SPSS Statistics. If the number of participants were more, it would suffice to conduct a multivariate logistic regression in the software. There is an ongoing debate to conduct the study in a larger scale in order to get a comprehensive analysis of the consumption patterns and knowledge about Moringa oleifera. Additionally, the reliability of self-reported data has to be called into question. The participants may overstate their Moringa consumption or understate it. In a similar way, they may overstate or understate their health status.

Another limitation is the geographical scope. Since the survey has been conducted in the urban and semi-urban parts of Bogra, it does not represent the rural population of that district. There may well be a different dietary habit and conception about Moringa in the rural parts. The study’s design may also raise concern since it’s a cross-sectional design capturing data at a single point in time. It limits the ability to establish causality between Moringa consumption and health benefits or socio-demographic factors. Moreover, there are a number of dietary factors that have not been accounted for but could influence Moringa consumption. These dietary factors are access to other natural supplements, cultural preferences and quality of diet. While the study has found out that certain parts (flowers, root and bark) of Moringa tree are underutilized, it cannot investigate about the issue at the moment.

The study has underscored the growing popularity of Moringa oleifera plant as a source of nutrition. With that said, the medicinal benefits are not widely known to the people. According to the survey’s findings, moringa consumption may be common but there are disparities on the basis of socio-demographic factors such as, gender, income, and age as well as health status. The higher usage of parts of the moringa plant are amongst women and lower-income groups suggest that there is need for disseminating information to more people about its usage.

There are positive correlation among moringa consumption and positive health outcomes. It strongly suggests the need for taking up public health initiatives. As such, the awareness programs have to put some emphasis on the medicinal benefits for those at-risk population. Meanwhile, affordability seems to be an issue when consuming different parts of Moringa oleifera plant with the leaves being a cheaper option. There also needs to be initiatives regarding the price of other parts of the plant. Any future research has to explore the long-term benefits towards health for moringa consumptions. Lastly, the potential it has for broader application also has to be explored.

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