the study was conducted in 3 communities in ghana : kwamang ( population 8,000 ) , forikrom ( population 3,800 ) , and buoyem ( population 3,900 ) .
kwamang is part of the ashanti province ; buoyem and forikrom are in brong ahafo province ( figure 1 ) .
ethics approval was obtained from the committee for human research , publications and ethics of komfo anokye teaching hospital and school of medical sciences , kwame nkrumah university of science and technology , kumasi . human 
red circles indicate sources of bush meat . the main techiman market is situated in the techiman municipality ( blue circle ) ; this market is 15 km from buoyem and is the largest and most economically active market in the brong ahafo region .
accra and kumasi , the largest cities in ghana , also receive supplies of bat meat from the techiman market . in each of the 3 communities ,
buoyem leaders described an activity called the yam festival , a hunting festival during which men took ladders to caves on wednesday evenings and caught bats as they returned from feeding .
these bats were described as fruit bats and thus were possibly rousettus aegyptiacus bats , the species most commonly identified in buoyem caves .
the night s catch was collected by the women ; menstruating women were excluded from participation in yam activities for reasons explained as cleanliness . in recent years ,
yam activities had been discontinued because of chieftaincy disputes and conflict over ownership of cave lands .
traditional authorities in kwamang and forikrom did not report similar cultural activities in connection with bats .
regular human activities were directly observed at all cave sites , including the mprisi ( figure 2 , panel a ) and dwamerewa caves in bouyem , boten cave in forikrom , and mmframabuom and ohene abutia caves in kwamang ( figure 2 , panel b ) .
the ohene abutia cave served as one of the major water sources in the kwamang community .
typical situations in which direct and indirect bat  human contact occurred in ghana , 20112012 .
the liquid poured before entering the cave is liquor . note the number of deposited empty bottles , indicating the frequency of cave entries .
c , d ) typical examples of roasted bats widely offered and consumed in markets and public places in ghana .
structured household survey questionnaires were received back from 1,274 respondents : 32.3% from buoyem , 28.4% from forikrom , and 39.2% from kwamang .
contact with bats was reported by 841 ( 66% ) respondents ; bat bites , scratches , or urine exposure was reported by 476 ( 37.4% ) respondents .
almost half ( 594 [ 46.6% ] ) of respondents visited bat caves frequently ; 217 ( 17% ) reported coming into contact with bats only in their normal living or work environment ( table ) .
the proportion of respondents who deliberately visited caves was significantly higher than the proportion exposed only in their living and work environments ( p<0.001 ) . * data based on focus group discussions and stratified household surveys ( technical appendix ) .
bat species identification was based on observations and standard illustrated field guides ( 10 ) . focus group participants identified bats species by using standard images of species recorded from each study site . observed insectivorous bats included nycteris spp .
ruber , h. gigas , and h. abae ( hipposideridae ) ; observed fruit bats included hypsignathus monstrosus , rousettus aegyptiacus , and eidolon helvum ( pteropodidae ) .
these bat species are known to carry coronaviruses ( particularly hipposideridae bats ) ( 11 ) ; hantaviruses ( particularly nycteridae bats ) ( 12 ) ; paramyxoviruses , including henipavirus ( 13 ) ; and filoviruses ( 14 ) .
trading of roasted and fried bats was widely observed in market places ( figure 2 , panel c , and figure 1 , panel d ) .
initial information about the supply routes of bat meat obtained from hunters and members of the indigenous community led to investigation of the bat meat trade at the main market in techiman .
information gathered from traders showed that the supply route of bat meat extends far beyond the brong ahafo region to other regions in ghana and neighboring countries ( figure 1 ) .
some places mentioned by the traders as sources of bat meat include towns and villages in the ashanti region . some of these were duamo ( 3 km from kwamang ) , adobomam , kyekyebon , kumawu , deduako , agogo , and the zoological gardens in kumasi , where migratory e. helvum bats roost seasonally ( 13 ) .
other areas were in techiman , nkoranza , tanoso , and tuobodom in the brong ahafo region ; afram plains and akuapem in the eastern region , and accra in the greater accra region .
some supplies came from the northern region and beyond the borders of ghana from cte divoire .
of the 1,274 respondents , 581 ( 45.6% ) reported having consumed bats . among these ,
257 ( 44.2% ) respondents were from buoyem , 141 ( 24.2% ) from forikrom , and 183 ( 31.5% ) from kwamang ( technical appendix table 1 ) .
of the 581 respondents who ate bat meat , 237 ( 40.8% ) obtained bats from caves , 123 ( 21.1% ) caught bats on farms with bat roosts , 114 ( 19.6 ) bought bats from community markets , and 60 ( 10.3% ) bought bats from restaurants as part of meals served .
big bats ,  suggesting that most were fruit bats ( pteropodidae ) . to identify the factors associated with bat consumption , we compared determinant variables for the 581 respondents who consumed bats and the 690 who did not ( technical appendix table 2 ) .
bat meat was eaten by a significantly higher percentage of men than women ( p<0.001 ) and a significantly higher proportion of farmers than those with other occupations ( p<0.001 ) . to determine the variables that significantly influenced the consumption of bat meat
the odds of consuming bat meat were higher for men ( odds ratio  2.47 ; 95% ci  1.933.17 ) than for women and for respondents > 25 years of age ( odds ratio  4.14 ; 95% ci  2.915.89 ) than for those < 25 years of age ( technical appendix table 3 ) . a second multivariate analysis , conducted to determine factors that predict visitation of bat caves , indicated that older age and male sex were significantly associated with visitation of bat caves ( technical appendix ) .
the association between cave visitation and bat consumption was significant (   =  75.6 ; p<0.001 ) ; odds of eating bat meat were twice as high among respondents who visited bat caves ( odds ratio 2.74 ) than among those who did not .
the deliberate entry into bat caves represents a prevalent behavior that could be influenced by community - level education in the aftermath of the ongoing outbreak of ebola virus disease in west africa .
further research will be necessary for understanding belief systems and developing acceptable guidance for rural communities exposed to bats because of traditional and spiritual reasons .
processing of bat meat in ghana ; factors associated with consumption of bat meat ; and predictors of bat meat consumption and bat cave visitation .
 because some bats host viruses with zoonotic potential , we investigated human  
 bat interactions in rural ghana during 20112012 . 
 nearly half ( 46.6% ) of respondents regularly visited bat caves ; 37.4% had been bitten , scratched , or exposed to bat urine ; and 45.6% ate bat meat . 
 human  bat interactions in rural ghana are frequent and diverse . 
The Study
Conclusions
None