Knowledge , Attitude and Practices related to AI among poultry workers of Bangladesh

Background Bangladesh is a high risk country for an influenza pandemic because of its dense human population, expansion of backyard poultry with minimum biosecurity and endemic avian influenza (H5N1 infection) in poultry sector.1 In March 22, 2007 Bangladesh faced the first localized outbreak of highly pathogenic avian influenza (H5N1, HPAI) among poultry .2 Of the affected 20 backyard farms, 14 were situated in 7 northern districts.2 The outbreaks peaked on March 26, 2007, when 11 affected farms in 3 districts—Dhaka, Gazipur, and Narayangogj .2 Again the outbreak peaked in 2008, with 226 reported between January and March but decreasing trend in incidence continued up to 2009. 2 Second outbreak has been reported on 25 March 2010 3 when 297 cases found in commercial farms and 53 in backyard poultry.3 Total 6 human cases were reported in Bangladesh.1 First cases of AI (avian influenza) recognized in 2008 while 2nd and 3rd cases were reported in 2011.1 Rest of the three cases were reported in 2012.Last two cases had


Knowledge, Attitude and Practices related to AI among poultry workers of Bangladesh
Hossain SM 1 , Eusufzai SZ 2 , Elahi MM 3 , Jamayet NB 4 Background Bangladesh is a high risk country for an influenza pandemic because of its dense human population, expansion of backyard poultry with minimum biosecurity and endemic avian influenza (H5N1 infection) in poultry sector. 1 In March 22, 2007 Bangladesh faced the first localized outbreak of highly pathogenic avian influenza (H5N1, HPAI) among poultry . 2 Of the affected 20 backyard farms, 14 were situated in 7 northern districts.2 The outbreaks peaked on March 26, 2007, when 11 affected farms in 3 districts-Dhaka, Gazipur, and Narayangogj . 2 Again the outbreak peaked in 2008, with 226 reported between January and March but decreasing trend in incidence continued up to 2009. 2 Second outbreak has been reported on 25 March 2010 3 when 297 cases found in commercial farms and 53 in backyard poultry.3 Total 6 human cases were reported in Bangladesh. 1 First cases of AI (avian influenza) recognized in 2008 while 2nd and 3rd cases were reported in 2011. 1 Rest of the three cases were reported in 2012.Last two cases had recovered.1 It can be said that decreasing trend in incidence of the past three years is continuing.Several investigation found that primary source of infection was backyard chickens which belongs to the subclade 2.2 of the Qinghai lineage 4 that might be closely related to viruses isolated from Afghanistan, Mongolia,and Russia 4 but in Bangladesh this disease has been recorded in ducks, pigeons and non-migratory wild birds (mostly crows) as well.About 21 species of migratory birds capable of carrying the virus visit the country annually every winter.So it was also assumed that the virus might have entered Bangladesh through migratory birds .5-7 Although several projects have been implemented in Bangladesh with financial support of FAO, World Bank, ADB mostly for strengthening disease surveillance, AI virus elimination and communication campaigns remain firmly entrenched. 1 Three major constrains identified that inhibit progress towards AI virus elimination effort which encompass the structure of the poultry industry, the quality of Veterinary and poultry production service along with the level of commitment by all sectors.3 Hence, AI in Bangladesh remains a significant threat to avian health and welfare, public health, agricultural productivity, economics and livelihoods of the poorest farmers.Therefore, this study aimed to find out the knowledge, attitude and preventive practices of avian influenza among the poultry workers in the Keraniganj, Tejgaon & Dhamrai from Dhaka district and Harirampur, Shibalaya & Sadar from Manikganj district.

Methodology:
The study, which took place between January to April 2012 was based on a cross-sectional survey design.Face-to-face interviews with the help of a pretested, modified questionnaire were conducted with 120 poultry workers from Keraniganj, Tejgaon & Dhamrai upazila of Dhaka district and Harirampur, Shibalaya & Sadar upazila of Manikganj, Bangladesh.This district was chosen because AI was peaked in time of first outbreak.2 but no actual cases of H5N1 had appeared in this area at the time of the study.As the study has been done in a small area so the outcomes might not represent the situation of the country as a whole.Prior to the interviews verbal informed consent was obtained from participants.Prior to study, ethical approval was taken from local ethical committee.

Questionnaire:
The interview was based a pretested ,modified questionnaire divided into four different parts was used to collect the information.
First, second, third and fourth parts containing Socio-demographic information, Knowledge related information, Attitude related information and Practice related information respectively.Socio-demographic information Socio-demographic information was collected for age, gender, school education and occupational status (owner of poultry farm versus paid employee).Knowledge related information Knowledge about avian influenza was assessed by asking whether cases of avian influenza among poultry had appeared in Bangladesh (yes/no).Perceptions of professional risk were measured by a question asking about whether particular professional groups such as poultry workers, butchers or health workers were at risk for contracting avian influenza (yes/no).Then participants were asked for the route of transmission of avian influenza, by flies, Mosquito, Saliva, Sexual intercourse, Placenta, Blood transmission and Birds.Again knowledge about prevention of avian influenza was assessed by asking whether avian influenza can be prevented by Hand washing after poultry care, eating well cooked meat and eggs, Read prevention related articles, Use of PPE (Personal Protective Equipment) during poultry care.Further, participants were asked from which sources they had obtained information about avian influenza, among them electronic media, religious leader, counseling through GO/NGO, Miking, and training to the poultry worker.For each behavior correctly identified one point was assigned.

Attitude related information
Attitudes towards Concern authority of legal notification were assessed by first describing about Local political member, Rapid response team member, UN organization and then asking whether respondents agreed with or disagreed with about these notifications.Afterwards another item asked about habitual actions taken when sick or dead poultry was found on the farm they do, inform rapid response team (Yes/No) Practice related information Finally, study participants were asked for use of hand washing solution after dealing with poultry, only running water, water and soap, anti bacterial solution and liquid hand wash.They were also asked for using the following personal protective equipments while dealing with poultry, Gloves, musk, gloves and musk together and gowns.Training regarding avian influenza prevention was also assessed by asking them (yes/no) Descriptive statistics and chi-square test were done to explore associations between demographic characteristics, knowledge and preventive practice scores.All levels of significance were set at p < 0.05 Result: Current study reveled that nearly one third of the respondents were belonged to age group 26-30 years (39.17%)where as more than one fourth belong to 31-35 years (32.5%) with the mean age 32.18±6.65 years.Majority of the respondents were male (70%).More than half of the respondents having educational qualification were higher secondary pass (55%)while about one third are completed secondary education(34.17%)and only nine point seven percent were found to be illiterate.Nearly two thirds (80%) were owners of poultry farms, the others (20%) were employed workers.Knowledge related information Among the study respondents most of them 90.83% knew that cases of avian influenza among poultry had appeared in Bangladesh (Table 1) More than half (68.33 )of the respondents said that poultry workers are more vulnerable group to devel-op avian influenza while one third of the respondents reported butchers are more vulnerable and rest of them said health workers .(Table 2) More than half of the respondents (65%) identified that avian influenza can transmit by bird.Nearly one third of the study respondents (34.17%) replied that hand washing after poultry care, less that one third of the respondents (31.67%) said by using PPE (Personal Protective Equipment) during poultry care ,more than twenty percent said by Eating well cooked meat and eggs and rest of them (11.67%) said by reading prevention related articles can prevent that transmission of avian influenza.(Table 3) When knowledge about the source of information regarding avian influenza assessed by multiple responses among the respondents it was found that most number (63.21%) said by counseling through GO/NGO by health worker , half of them (49.67%)By electronic media whereas more that one third (38.44%) said by training to the poultry worker and rest of them (34.23%) said by community leader they got information.

Attitude related information:
When attitude towards proper authority of legal notification of avian influenza were assessed it was found that almost half of the respondents (48.7%)Most of the participant said that they informed Rapid Response Team (RRT) for management of sick or dead poultry.(Table 4) Practice related information When hand washing practice among the respondents after dealing with poultry assessed it was found that more than half of the respondents (65.83%) washed their hands always while less than one third (22.5%) practiced sometimes and remaining of them (11.67%)never washed.Among those washed their hand majority (71.7%) washed their hand with soap and water, less than one third (25.47%) used water only and very few (2%) used liquid hand wash.(Table 5) While assessing use of PPE(Personal Protective Equipment) more than half of the respondents (57.5)reported about using PPE.Among them less than half (43.5%) and one third (36.67%) responded as using gloves only, musk only while rest of them said gloves and musk together (4% ) (Table 6) Study findings showed that majority of them (76.67%) received training regarding avian influenza prevention.Association found between Socio demographic variable (Age) and Knowledge on preventing avian influenza among the respondents whereas p-value= 0.001 Discussion: The higher knowledge could also be due to several projects have been implemented in Bangladesh with financial support of FAO, World Bank, ADB mostly for strengthening disease surveillance, AI virus elimination and communication campaigns.1 The current study illustrated that more than half of the respondents agreed that poultry workers are more vulnerable group to develop avian influenza whereas a study conducted in Nepal.8 This study revealed that more than half (68.33 )of the respondents agreed that poultry workers are more vulnerable group which are different from a study Table no 5

Conclusion and Recommendation:
Current study reveals moderate knowledge, practice and positive attitude among the poultry workers of Bangladesh.Knowledge of personal protective equipment (PPE) varies considerably among the participants.Hand washing is considered to be one the most effective protective measures to prevent contracting avian influenza.Hand washing practice was not adequate among them that needed to be enhanced.The current protection practice against contacting AI revealed to be inadequate.None of the responded could mention the optimum measures of protection for AI.Beyond large-scale mass education campaigns, awareness creating to the poultry workers future efforts should focus more strongly on target-group-specific information and practical trainings to enhance protective behaviors.Besides this, social marketing of protective equipment should be increased.Rapid reporting of infection, prompt and adequate response, and community support for disease control activities require a high level of public awareness and knowledge about AI and the various issues involved and a commitment to comply with control policies and actions.At the regional and national levels, partnerships should be established along with appropriate government bodies (including ministries of agriculture), the media, NGOs and the private sector need to work together to roll out communication campaigns adapted to local conditions and priorities.

Table no 1 :
Hossain SM, Eusufzai SZ, Elahi MM, Jamayet NB 28 Distribution of respondent by knowledge about cases of avian influenza among poultry had appeared in Bangladesh (n=120)

:
Distribution of respondent by use of hand washing solution after dealing with poultry (n=106)