Cultural Persistence of Tahnik Practice (Use of Honey) Despite Infant Botulism Risk: A Community-Based Study in Pakistan.

Abstract

Purpose: Infant botulism is an uncommon but serious condition arising from honey containing spores of Clostridium botulinum. Despite this well-understood risk, practices like tahnik, where honey or dates are fed to newborns, continue as customs in many cultures. Understanding these traditions is important for informing global public health strategies. This study aimed to determine maternal awareness about infant botulism, investigate the prevalence of tahnik, and recognize factors affecting its practice in a Muslim community.

Design: Descriptive cross-sectional survey.

Methods: A total of 419 mothers of infants aged 12 months or younger were recruited into this descriptive cross-sectional survey through a questionnaire in Karachi, Pakistan. Maternal awareness of infant botulism, prevalence of tahnik practice, and factors affecting tahnik practice were assessed.

Findings: A total of 94.75% of subjects had never heard of botulism, and none linked it with C. botulinum. Despite risks, 54.42% did not view honey as harmful, and 61.6% practiced tahnik. Lower education, larger families, and rental housing were linked to higher tahnik rates, while higher education showed an inverse effect. Conclusions: Lack of awareness about infant botulism and strong cultural adherence to tahnik highlight the need for culturally sensitive public health initiatives.

Clinical relevance: Honey poses a proven risk for infant botulism, yet cultural practices such as tahnik remain widespread, especially in many Muslim communities, highlighting a critical gap between medical advice and traditional beliefs.