HEALTH-ASIA: Bird Flu Awareness – No Preventive

By IPS Correspondents Reprint | | Print |

Sonny Inbaraj

KANCHANABURI, Thailand, Jan 21 2007 (IPS) - The upsurge in bird flu outbreaks in South-east Asia has raised a paradoxical question: does high community awareness of the disease, that at the start of the new year killed thousands of ducks and chickens in the region and five Indonesians, lead to behaviour change that could prevent the spread of the H5N1 virus globally?

Not necessarily, says new research into bird flu or avian influenza prevention in Cambodia, one of the virus’s past hot spots.

A paper – written by scientists from the Pasteur Institute in Phnom Penh, Cambodia, the London School of Hygiene and Tropical Medicine, and Cambodian and U.N. agencies – published in the January edition of the ‘Emerging Infectious Diseases’ edited by the U.S.-based Centres for Disease Control and Prevention is an eye-opener.

Cambodia recorded its first bird flu outbreaks caused by the H5N1 virus in poultry in 2004. It had four human cases in 2005 and two last year; all six victims died. International experts fear the H5N1 virus may mutate into a form that could spread easily between humans and potentially kill millions around the world.

The researchers surveyed 460 Cambodian villagers in two provinces judged to be at high risk for H5N1 flu.

Ninety-seven percent of the 269 households where the villagers lived kept chickens, while 39 percent also raised ducks. And 81 percent of the households had learned about avian flu and flu prevention from announcements on television; 78 percent had heard similar messages on the radio.

‘’Thirty-one percent of respondents were able to describe AI (avian influenza) symptoms in humans, and 72 percent believed that it is a fatal disease among poultry that can be transmitted to humans,’’ wrote the paper’s authors.

‘’Most respondents believed it is unsafe to touch sick or dead poultry with bare hands, eat wild birds, let children touch sick or dead birds with bare hands, and eat meat or eggs that are not fully cooked,’’ they added.

But large proportions of the villagers admitted doing things they had been cautioned against. Seventy-five percent acknowledged touching sick or dead poultry barehanded; 45 percent ate poultry that had died from illness; 33 percent ate wild birds; and 8 percent collected and ate dead wild birds.

In addition, the research revealed, though half of the participants agreed on the importance of reporting poultry deaths to authorities, many did not report – 41 percent because they did not know how, 31 percent because they had not done so in the past, and 18 percent because they believed it would hurt sales of their surviving birds.

‘’ General media reports about avian influenza through radio and television broadcasts appear to have been effective at reaching rural people. However, despite high awareness and widespread knowledge about AI and personal protection measures, most rural Cambodians still often practice at-risk poultry handling,’’ concluded the researchers.

While one might argue that Cambodia could be an isolated case, public health officials in Thailand and Indonesia however have expressed similar frustrations.

‘’Villagers know about bird flu and risky behaviour but many times we’ve found out that they’ve done dangerous things like eating sick or dead chickens,’’ Phrathom Khamhorm, a public health official at the Phanom Thuan sub-district health centre in Kanchanaburi province, 150 kilometres from the capital Bangkok, told IPS.

Three Thais died in Phanom Thuan from bird flu between 2004 and 2005. So far there have been 17 human deaths in Thailand.

‘’When questioned, these villagers said they knew about bird flu from television. When asked why they ate sick chickens, they said they saw their neighbours eat them and they didn’t fall ill,’’ said a frustrated Phrathom.

Thailand reported fresh H5N1 outbreaks in poultry in the past month. About 2,100 poultry were culled in the northern Thai province of Phitsanulok to control the spread of the H5N1, the Agricultural Ministry’s Avian Influenza Control Center said on Jan. 15.

Four family members in Phitsanulok are suspected to be infected with avian influenza after they ate a dead duck from their farm, Thai local media reported last week.

In Indonesia, too, similar frustration and anger have been expressed when a 14-year-old boy died from bird flu near the capital Jakarta on Jan. 9.

Rohana Manggala, the assistant for public welfare to the Jakarta governor, talking to IPS over the phone, said that instead of reporting or burning a dead duck, a resident threw it into a river in the densely populated Kalideres area of West Jakarta, where the 14-year-old boy resided.

‘’People still don’t understand how to deal with this disease despite the government’s public information campaign. Mind you, this area is near Jakarta where people watch TV all the time,’’ she said angrily.

On Saturday an Indonesian woman died of bird flu, raising the country’s death toll to 62 – the highest in the world. The woman’s death is the fifth human bird flu fatality in the country since Jan. 9. Before that, Indonesia had not recorded any cases for six weeks – a lull that led some Indonesian officials to say they were succeeding in beating the disease.

Initiated by the National Commission for Bird Flu Control and Influenza Pandemic Prevention, a nationwide campaign, ‘Beat Bird Flu’, was launched in September.

A communications officer from the United Nations Children’s Fund (UNICEF), Iwan Hasan, who was involved in an October survey to check on the efficacy of the campaign, told journalists in Jakarta it was too early to conclude that it had failed as it had only been underway for three months.

‘’Our survey shows that 97 percent of 508 respondents in Greater Jakarta and Garut in West Java are at least aware of the TV campaign,’’ he told reporters, adding that an AC Nielsen survey found that 120 million people had seen the TV advertisements.

‘’Behavioral change takes time,’’ he said, while pointing out that the survey had also recommended more direct approaches to poultry breeders.

But authors of the research paper published by the Centers for Disease Control argue that behavior change ‘’involves comprehensive and multidisciplinary intervention, which combines risk perception communication and feasible and practical recommendations, including economic considerations’’.

‘’We observed difficulties and frustrations among farmers whose flocks underwent culling after identification of H5N1 viruses in their flocks because compensation has not yet been approved by the government of Cambodia,’’ they concluded.

In Indonesia, the government’s move to cull poultry populations infected with H5N1 by just offering a paltry compensation of 1.50 U.S. dollars per chicken has angered the Association of Indonesian Poultry Farmers.

‘’Many traditional poultry farms will go out of business as a result of this mass culling,’’ said the association’s chairman M. Ali Abubakar said in Cirebon, West Java.

The culling policy with minimal compensation, he told the ‘Jakarta Post’, showed the government was trying to shift responsibility over the spread of bird flu from itself to the people. (