Awareness not enough to combat bird
flu 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.
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