Awareness not enough to combat bird flu
http://www.atimes.com/atimes/Southeast_Asia/IA23Ae01.html
By Sonny Inbaraj
KANCHANBURI, Thailand - The upsurge in bird-flu outbreaks in Southeast Asia has raised a paradoxical question: Does high community awareness about the cause and handling of the potentially fatal disease lead to behavioral change that could prevent the global spread of the H5N1 virus?
Not necessarily, says new research into avian-influenza prevention in Cambodia, one of the deadly virus's prior hot spots. A recent paper by scientists from the Pasteur Institute in Phnom Penh, the London School of Hygiene and Tropical Medicine, and
Cambodian and United Nations agencies published in the January edition of Emerging Infectious Diseases and edited by the US-based Centers for Disease Control and Prevention paints a worrying statistical portrait.
Cambodia recorded its first bird-flu outbreaks in poultry in 2004. It recorded 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, sparking a possible global pandemic.
The researchers surveyed 460 Cambodian villagers across two provinces judged to be at high risk. Of that sample, 97% of the 269 households kept chickens, while 39% also raised ducks. And 81% of the households had learned about avian flu and its prevention from announcements on television, while 78% had heard similar radio messages.
''Thirty-one percent of respondents were able to describe avian-influenza symptoms in humans, and 72% 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.''
But large proportions of the villagers admitted to behavior that they had been cautioned against. Seventy-five percent acknowledged touching sick or dead poultry barehanded; 45% ate poultry that had died from unknown illness; 33% ate wild birds; and 8% 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 - 41% because they did not know how, 31% because they had not done so in the past, and 18% 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 [avian influenza] and personal protection measures, most rural Cambodians still often practice at-risk poultry handling,'' concluded the researchers.
Bad health habits
It could be argued that Cambodia is an isolated case, but public-health officials in Thailand and Indonesia have recently expressed similar frustrations.
''Villagers know about bird flu and risky behavior, but many times we've found that they've done dangerous things like eating sick or dead chickens,'' said Phrathom Khamhorm, a public-health official at the Phanom Thuan sub-district health center in Kanchanaburi province, 150 kilometers from Bangkok.
Three Thais died in Phanom Thuan from bird flu between 2004 and 2005, and so far Thailand has recorded 17 human deaths from the disease. ''When questioned, these villagers said they knew about bird flu from television. When asked why they ate sick chickens, they said they saw their neighbors eat them and they didn't fall ill,'' said Phrathom.
After nearly one year without any new outbreaks in fowl, Thailand has in recent weeks reported new cases of H5N1, including four potential fowl-to-human transmissions.
About 2,100 poultry were recently culled in the northern Thai province of Phitsanulok to contain the disease's spread, the Agricultural Ministry's Avian Influenza Control Center said on January 15. Four family members in Phitsanulok are suspected to be infected with avian influenza after they consumed an infected dead duck from their farm, Thai media reported last week.
An Indonesian woman died of avian influenza over the weekend, raising the Southeast Asian country's human death toll from bird flu to 62 - the highest in the world. The woman's death is the fifth human bird-flu fatality in the country since January 9.
Before that, Indonesia had not recorded any cases for six weeks - long enough to lull some officials into believing they were succeeding in containing the disease.
Rohana Manggala, the assistant for public welfare to the governor of Jakarta, said in a telephone interview that instead of reporting or burning a dead duck, a 14-year-old boy threw it into a river in the densely populated Kalideres area of West Jakarta, where he 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.
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 under way for three months.
''Our survey shows that 97% 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 ACNielsen survey found that 120 million people had seen the TV advertisements.
''Behavioral change takes time,'' Hasan said, pointing out that the survey had also recommended more direct approaches to poultry breeders.
Authors of the research paper published by the Centers for Disease Control argue that behavioral change ''involves comprehensive and multi-disciplinary 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 birds because compensation has not yet been approved by the government of Cambodia,'' they concluded.
In Indonesia, meanwhile, the government's paltry US$1.50 compensation for culling infected fowl has raised hackles with the Association of Indonesian Poultry Farmers. ''Many traditional poultry farms will go out of business as a result of this mass culling,'' the association's chairman, M Ali Abubakar, said in Cirebon, West Java.
The scant compensation, he told the English-language Jakarta Post newspaper, showed that the government was trying to shift responsibility for the spread of bird flu from the state to the people.
(Inter Press Service)
