Understanding the failure of a behavior change intervention to reduce risk behaviors for avian influenza transmission among backyard poultry raisers in rural Bangladesh: a focused ethnography

The Public Health Importance and Management of Infectious Poultry Diseases in Smallholder Systems in Africa

Poultry diseases pose major constraints on smallholder production in Africa, causing high flock mortality and economic hardship. Infectious diseases, especially viral diseases like Newcastle disease and highly pathogenic avian influenza (HPAI) and bacterial diseases, especially colibacillosis and salmonellosis, are responsible for most chicken losses, with downstream effects on human nutrition and health. Beyond production impacts, poultry diseases directly harm public health if zoonotic, can give rise to epidemics and pandemics, and facilitate antimicrobial resistance through treatment attempts. HPAI, campylobacteriosis, and salmonellosis are the priority zoonoses. Sustainable solutions for poultry health remain elusive despite recognition of the problem. This review summarises current knowledge on major poultry diseases in smallholder systems, their impacts, and options for prevention and control. We find biosecurity, vaccination, good husbandry, and disease-resistant breeds can reduce disease burden, but practical limitations exist in implementing these measures across smallholder systems. Treatment is often inefficient for viral diseases, and treatment for bacterial diseases risks antimicrobial resistance. Ethnoveterinary practices offer accessible alternatives but require more rigorous evaluation. Multisectoral collaboration and policies that reach smallholder poultry keepers are essential to alleviate disease constraints. Successful control will improve livelihoods, nutrition, and gender equity for millions of rural families. This review concludes that sustainable, scalable solutions for smallholder poultry disease control remain a critical unmet need in Africa.

Exploring the responses of smallscale poultry keepers to avian influenza regulations and guidance in the United Kingdom, with recommendations for improved biosecurity messaging

Understanding how smallscale ('backyard') poultry keepers interpret and respond to governmental directives designed to reduce the transmission of highly pathogenic avian influenza (HPAI) is of paramount importance in preparing for future HPAI outbreaks. Qualitative insights from open questions in an online survey conducted during the 2021-22 HPAI season (1,559 responses) shed light on smallscale poultry keepers' understanding of, and responses to, governmental directives to control HPAI exposure and onwards transmission. A follow-up participatory workshop (21 participants) explored the HPAI-related information sources used by smallscale poultry keepers, their trust in these sources, perceptions of HPAI-related risk, and interpretation of, opinions on and adherence to government regulations and communications regarding biosecurity and housing measures. This paper draws on a multi-scale behaviour change model to explore barriers to compliance with HPAI-related regulations. Insights from behaviour settings theory reveal how poultry-keeping settings and routines might be 'disrupted' and 're-configured' to improve long-term biosecurity and reduce the risk of HPAI exposure. The findings highlight the need for HPAI-related guidance that is tailored to smallscale poultry keepers. This guidance should include clear action points and simple, practical, affordable and sustainable suggestions for improving compliance with biosecurity measures.

Household Bird Ownership is Associated with Respiratory Illness among Young Children in Urban Bangladesh (CHoBI7 Program)

There is limited evidence on the association between animal ownership and respiratory illness among young children in low- and middle-income countries. In this study, we examined the association between animal ownership and respiratory illness among children younger than 5 years of age enrolled in a prospective cohort study in urban Bangladesh. This prospective cohort study enrolled 884 participants younger than 5 years of age in Dhaka, Bangladesh. At baseline, trained research assistants administered caregivers of children younger than 5 years of age a questionnaire on household animal ownership. Animal ownership was defined as owning chickens, birds other than chickens, cats, and dogs. Respiratory surveillance was conducted monthly for children based on caregiver-reported coughing, rapid breathing, and difficulty breathing in the past 2 weeks during the 12-month study period. At baseline, 48% of children (424 of 884) had reports of coughing, 5% (40 of 884) had difficulty breathing, 3% (25 of 884) had rapid breathing, and 49% (431 of 884) had reports of any of these three respiratory symptoms. Seventeen percent of children (151 of 884) resided in a household that owned an animal. Children residing in households reporting bird ownership had a significantly greater odds of coughing (odds ratio, 1.14; 95% CI, 1.02-1.28) and any of the three respiratory symptoms in the past 2 weeks (odds ratio, 1.14; 95% CI, 1.02-1.28). Household bird ownership was associated with respiratory illness in young children. These findings suggest that interventions aiming to reduce young children's exposure to domestic animals should extend to include birds other than chickens.

What influences people's responses to public health messages for managing risks and preventing infectious diseases? A rapid systematic review of the evidence and recommendations

BACKGROUND

Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond.

OBJECTIVE

To synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people's responses to messages.

DESIGN

A rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704.

DATA SOURCES

Electronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020.

STUDY SELECTION

All study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded.

SYNTHESIS

Due to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging.

RESULTS

Sixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility.

DISCUSSION

There are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics.

Intensification of fragility: Poultry production and distribution in Bangladesh and its implications for disease risk

Poultry production is a valuable source of nutritious food and income and is considered a crucial part of global development. This is especially important for countries such as Bangladesh where levels of hunger and childhood stunting remain high. However, in many low- and middle-income countries poultry production remains dominated by small to medium scale enterprises operating with poor farm biosecurity associated with poultry and zoonotic disease risks. We aimed to characterize the structure of poultry production in Bangladesh in order to identify the underlying structural factors and resulting practices which create risk environments for emergence, persistence and transmission of infectious diseases. Using the concept of a production and distribution network (PDN), we conducted a review of the literature, 27 in-depth interviews with key-informants and stakeholders, and 20 structured interviews with poultry distributors to map the ways which poultry are raised, distributed and marketed in Bangladesh. Findings indicate that the PDN can be considered in the context of four major sub-networks, based on the types of chickens; broadly indigenous, cross-bred, exotic broiler, and layer chickens. These sub-networks do not exist in isolation; their transactional nodes - actors and sites - are dynamic and numerous interactions occur within and between the PDN. Our findings suggest that the growth in small and medium scale poultry enterprises is conducted within 'fragile' enterprises by inexperienced and poorly supported producers, many of whom lack capacity for the level of system upgrading needed to mitigate disease risk. Efforts could be taken to address the structural underlying factors identified, such as the poor bargaining power of producers and lack of access to independent credit and indemnity schemes, as a way to reduce the fragility of the PDN and increase its resilience to disease threats. This knowledge on the PDN structure and function provide the essential basis to better study the generation, mitigation and consequences of disease risks associated to livestock, including the analysis of potential hotspots for disease emergence and transmission.

Understanding the Motivation of Western Java Smallholder Broiler Farmers to Uptake Measures Against Highly Pathogenic Avian Influenza (HPAI)

Understanding broiler farmers' intention toward highly pathogenic avian influenza (HPAI) control is important to design successful HPAI control programs. We used Theory of Planned Behavior (TPB) to identify factors (i.e., attitude, subjective norm, and perceived behavioral control) associated with the intentions of Western-Java small-scale broiler farmers toward implementing cleaning and disinfection (C&D), vaccination, reporting, and stamping-out without or with 50% compensation. For this, 203 Western-Java farmers were interviewed. The majority of the farmers had a positive intention to implement C&D (89%), reporting (88%), and vaccination (80%). A lower number had a positive intention to join stamping-out both with 50% compensation (67%) and without any compensation (53%). Farmers had a more positive attitude and subjective norm, but lower perceived behavioral control toward one or more of the intentions to implement measures. Attitude was positively associated with intentions to implement C&D and vaccination. Subjective norm of veterinarians of integrated companies was positively associated with intentions to implement vaccination. Perceived behavioral control (i.e., money and time) was positively associated with intentions to implement C&D, vaccination, and stamping-out without any compensation. Results suggest that farmers are in favor of implementing preventive measures (i.e., C&D and vaccination) on HPAI control over facing the consequences of control measures (i.e., stamping-out), and HPAI control programs should primarily focus on incentivizing farmers complemented by programs aiming to improve farmers' attitude. Thus, policy should be emphasized to preventive measures rather than control measures. Financial incentive-based instruments (e.g., price and performance bonus) can be used to increase the intention of farmers to implement C&D and vaccination. Trained vaccinators might help to save the time needed to vaccinate the entire flock can increase the intention of farmers to vaccinate their chickens. Also, informational instruments (e.g., education and communication) can be used to change and to improve the attitude of farmers to implement both measures.

Controlling Avian Influenza Virus in Bangladesh: Challenges and Recommendations

Avian influenza virus (AIV) remains a huge challenge for poultry production with negative repercussions for micro- and macro-economy and public health in Bangladesh. High (HP) H5N1 and low pathogenicity (LP) H9N2 AIV are currently endemic in poultry, and both have been reported to infect humans sporadically. Multiple virus introductions of different clades of HPAIV H5N1, reassorted genotypes, and on-going diversification of LPAIV H9N2 create a highly volatile virological environment which potentially implicates increased virulence, adaptation to new host species, and subsequent zoonotic transmission. Allotropy of poultry rearing systems and supply chains further increase the risk of virus spreading, which leads to human exposure and fosters the emergence of new potentially pre-pandemic virus strains. Here, we review the epidemiology, focusing on (i) risk factors for virus spreading, (ii) viral genetic evolution, and (iii) options for AIV control in Bangladesh. It is concluded that improved control strategies would profit from the integration of various intervention tools, including effective vaccination, enhanced biosecurity practice, and improved awareness of producers and traders, although widespread household poultry rearing significantly interferes with any such strategies. Nevertheless, continuous surveillance associated with rapid diagnosis and thorough virus characterization is the basis of such strategies.

The Effectiveness of Traditional Media (Leaflet and Poster) to Promote Health in a Community Setting in the Digital Era: A Systematic Review

Introduction: The use of health promotion media in the digital era, such as e-health and m-health, is increasing. However, traditional health promotion media, such as posters and leaflets, are still used. This review aimed to identify the effectiveness of the use of traditional health promotion media (leaflets and posters) in a community setting in the digital era.Methods: The data was gathered using the following steps: (1) determining the topic, (2) determining the keyword chain, (3) looking for the relevant literature in the database and (4) analyzing the article. The search using a predetermined keyword chain in Scopus, Science Direct and Sage Journals produced 208 publications.Results: After applying the inclusion and exclusion criteria, 16 publications were selected for review.Conclusion: Traditional health promotion media such as leaflets and posters are still useful in the current digital era, especially for adult respondents. This form of media will be more effective when combined with other media such as videos, telephone interactions, games and others.

A Decade of Avian Influenza in Bangladesh: Where Are We Now?

Highly pathogenic avian influenza (HPAI) has been a public health threat in Bangladesh since the first reported outbreak in poultry in 2007. The country has undertaken numerous efforts to detect, track, and combat avian influenza viruses (AIVs). The predominant genotype of the H5N1 viruses is clade 2.3.2.1a. The persistent changing of clades of the circulating H5N1 strains suggests probable mutations that might have been occurring over time. Surveillance has provided evidence that the virus has persistently prevailed in all sectors and caused discontinuous infections. The presence of AIV in live bird markets has been detected persistently. Weak biosecurity in the poultry sector is linked with resource limitation, low risk perception, and short-term sporadic interventions. Controlling avian influenza necessitates a concerted multi-sector ‘One Health’ approach that includes the government and key stakeholders.

Risk and Response to Biological Catastrophe in Lower Income Countries

Natural and intentional biological risks threaten human civilization, both through direct human fatality as well as follow-on effects from a collapse of the just-in-time delivery system that provides food, energy and critical supplies to communities globally. Human beings have multiple innate cognitive biases that systematically impair careful consideration of these risks. Residents of low-income countries, especially those who live in rural areas and are less dependent upon global trade, may be the most resilient communities to catastrophic risks, but low-income countries also present a heightened risk for biological catastrophe. Hotspots for the emergence of new zoonotic diseases are predominantly located in low-income countries. Crowded, poorly supplied healthcare facilities in low-income countries provide an optimal environment for new pathogens to transmit to a next host and adapt for more efficient person-to-person transmission. Strategies to address these risks include overcoming our natural biases and recognizing the importance of these risks, avoiding an over-reliance on developing specific biological countermeasures, developing generalized social and behavioral responses and investing in resilience.

Where backyard poultry raisers seek care for sick poultry: implications for avian influenza prevention in Bangladesh

BACKGROUND

In Bangladesh, backyard poultry raisers lack awareness of avian influenza and infrequently follow government recommendations for its prevention. Identifying where poultry raisers seek care for their ill poultry might help the government better plan how to disseminate avian influenza prevention and control recommendations.

METHODS

In order to identify where backyard poultry raisers seek care for their ill poultry, we conducted in-depth and informal interviews: 70 with backyard poultry raisers and six with local poultry healthcare providers in two villages, and five with government veterinary professionals at the sub-district and union levels in two districts during June-August 2009.

RESULTS

Most (86% [60/70]) raisers sought care for their backyard poultry locally, 14% used home remedies only and none sought care from government veterinary professionals. The local poultry care providers provided advice and medications (n = 6). Four local care providers had shops in the village market where raisers sought healthcare for their poultry and the remaining two visited rural households to provide poultry healthcare services. Five of the six local care providers did not have formal training in veterinary medicine. Local care providers either did not know about avian influenza or considered avian influenza to be a disease common among commercial but not backyard poultry. The government professionals had degrees in veterinary medicine and experience with avian influenza and its prevention. They had their offices at the sub-district or union level and lacked staffing to reach the backyard raisers at the village level.

CONCLUSIONS

The local poultry care providers provided front line healthcare to backyard poultry in villages and were a potential source of information for the rural raisers. Integration of these local poultry care providers in the government's avian influenza control programs is a potentially useful approach to increase poultry raisers' and local poultry care providers' awareness about avian influenza.

Biosecurity Conditions in Small Commercial Chicken Farms, Bangladesh 2011-2012

In Bangladesh, highly pathogenic avian influenza H5N1 is endemic in poultry. This study aimed to understand the biosecurity conditions and farmers' perception of avian influenza biosecurity in Bangladeshi small commercial chicken farms. During 2011-2012, we conducted observations, in-depth interviews and group discussions with poultry farmers in 16 farms and in-depth interviews with seven local feed vendors from two districts. None of the farms were completely segregated from people, backyard poultry, other animals, households, other poultry farms or large trees. Wild birds and rodents accessed the farms for poultry feed. Farmers usually did not allow the buyers to bring egg trays inside their sheds. Spraying disinfectant in the shed and removing feces were the only regular cleaning and disinfection activities observed. All farmers sold or used untreated feces as fish feed or fertilizer. Farmers were more concerned about Newcastle disease and infectious bursal disease than about avian influenza. Farmers' understanding about biosecurity and avian influenza was influenced by local vendors. While we seldom observed flock segregation, some farmers used measures that involved additional cost or effort to protect their flocks. These farmers could be motivated by interventions to protect their investment from diseases they consider harmful. Future interventions could explore the feasibility and effectiveness of low-cost alternative biosecurity measures.