Baseline KAP Study

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<p>CARE INTERNATIONAL IN VIETNAM</p> <p>AVIAN INFLUENZA LOCAL RISK REDUCTION PROJECT</p> <p>BASELINE KAP STUDY</p> <p>August 2006</p> <p>Disclaimer: The views expressed herein are those of CARE Viet Nam and do not necessarily reflect the official position of the Australian Government, the Australian Agency for International Development (AusAID) or any other Party.</p> <p>Table of ContentsCARE INTERNATIONAL IN vIETNAM.................................................................0 Disclaimer: The views expressed herein are those of CARE Viet Nam and do not necessarily reflect the official position of the Australian Government, the Australian Agency for International Development (AusAID) or any other Party.Table of Contents....................................................................................0 Table of Contents .............................................................................................1 Introduction.......................................................................................................2 Avian influenza in Vietnam .............................................................................2 CAREs STOP AI program .............................................................................2 Aim..................................................................................................................3 Methods ............................................................................................................3 1. Study population.........................................................................................3 2. Data collection ............................................................................................4 3. Statistical analysis ......................................................................................4 Results..............................................................................................................4 1. Part 1: General information ........................................................................4 Attitudes towards AI.........................................................................................5 2.1. Part 2A: Knowledge of AI transmission and symptoms in poultry ..........6 21.1.1 Question 10: Transmission routes among poultry..........................6 2.1.2 Question 11: Symptoms of AI in chickens .........................................7 2.1.3 Question 12: Symptoms of AI in ducks...............................................7 2.2 Part 2B: Knowledge of AI transmission and symptoms in humans .........7 2.2.1 Question 13: Transmission of AI in humans......................................7 2.2.2 Question 14: Symptoms of AI in humans...........................................8 3. Part 3: Knowledge of AI practices ..............................................................8 3. Part 3: Knowledge of AI practices ..............................................................9 3.1 Question 14: Prevention methods against AI for family ......................9 3.2 Question 15: Protection methods for AI when slaughtering poultry ..9 3.3 Question 16: Protection methods for AI when cooking poultry ........10 3.4 Question 17: Prevention methods against AI for poultry ..................11 3.5 Question 18: What do you do when you suspect AI in your poultry? ..........................................................................................................................11 3.6 Question 19 and 20: Reporting suspect AI .........................................12 3.7 Question 21: Vaccination of poultry......................................................13 4. Part 4: Direct Observation ........................................................................13 Conclusion......................................................................................................14 Annexes..........................................................................................................16 Annex1. Study Protocol for KAP ..................................................................17 Methods ...............................................................................................................17 Study population.................................................................................................17 Data collection ....................................................................................................17 Statistical analysis..............................................................................................18 Timeline ...............................................................................................................18 Annex 2. KAP Tools .....................................................................................20</p> <p>1</p> <p>IntroductionAvian influenza in Vietnam The H5N1 avian influenza virus (AI) is a particularly virulent poultry disease that has caused billions of dollars of livestock losses in Asia and is now considered endemic in Vietnam. It is a zoonotic disease that has already caused deaths in humans, and threatens to mutate into a human infection with potential consequences larger than the scale of the 1918 influenza pandemic. Direct losses from the 2003-2004 outbreaks in Vietnam resulted in 44 million birds either dying or being destroyed. Vietnam has been ground zero for human cases of avian influenza, reporting the highest number of human AI infections in any country by a substantial margin until just recently. Vietnam has experienced 93 cases resulting in 42 deaths as of 11 August 2006. Almost all the human cases to date have had presumed contact with infected birds. The most important exposures have been from handling sick or dead birds, although limited human-to-human transmission through close contact with infected relatives has recently been confirmed in Indonesia. The nature of the threat to humans persists so long as birds and other animals continue to be infected with highly pathogenic AI. The effective management and control of AI is critical not only for the livelihoods and food security of the rural poor in Vietnam, but because of the potential of the virus to mutate and become capable of human-to-human transmission. CAREs STOP AI program CARE in Vietnam has been working with communities since 2004 to address the major gap in AI awareness, prevention, and outreach support and, based on considerable experience, has developed a successful AI model to be replicated and expanded to the most vulnerable communities. CARE couples Behaviour Change Communication (BCC) with creative new approaches to develop the IEC messaging through both formal and informal community structures. CAREs model encourages partnership and a multi-sectoral approach to community mobilization for understanding of and response to AI. CARE initially conducted a Knowledge, Attitude and Practice survey in December 2004- January 2005 in Long An, An Giang, Binh Dinh and Son La provinces to obtain an in-depth understanding of mainly small-scale rural farmers knowledge, attitude and practices (KAP) on poultry rearing in order to inform health education in regards to AI. Using the results from this report, CARE developed the STOP-AI program (Strengthening Training, Outreach and Prevention services for the ongoing Avian Influenza response), which was funded by NZAID and implemented in four districts in Binh Dinh and Long An Provinces, between May 2005 and February 2006. An independent evaluation of the STOP-AI project was favourable, and concluded that the project effectively contributed to raising the awareness of Avian Influenza for small-scale poultry producers in Binh Dinh and Long An provinces. Further funding from McDonalds in early 2006 allowed CARE to expand the program to four districts in Hai Phong, Bac Ninh, Dong Thap and An Giang provinces (STOP-AI2). This project has been conducted in 64 communes and is2</p> <p>due for completion in September 2006. In June 2006 AusAID also provided funding to expand STOP-AI2 in four different districts in these same four provinces (referred to as Local Risk Reduction project (LRR) from now on). This phase will reach an additional 32 communes. One of the additional components of the STOP-AI2 program is to conduct a knowledge, attitude and practices (KAP) survey of households in all four provinces at the beginning and towards the end of the project cycle in order to evaluate the effectiveness of the program. Aim To conduct a baseline knowledge, attitude and practices (KAP) survey of households in Hai Phong, Dong Thap, Bac Ninh and An Giang before conducting CAREs Local Risk Reduction project in these provinces.</p> <p>MethodsThe study design is a cross-sectional survey, administered at the beginning of the project cycle. The same survey will be administered towards the end of the project cycle and compared to the results of this baseline. This report includes the baseline survey results only. 1. Study population The baseline study was conducted in one commune in each of the four provinces of the LRR project Hai Phong, Bac Ninh, An Giang and Dong Thap. The participating communes were randomly selected from the eight communes in each province that will be involved in the LRR project. The total number of households to be interviewed in each commune was 100. For each of the selected communes, information was gathered about the structure of the commune and this was used to determine the selection method of households for that commune. In Bach Ninh, the selected commune was Tam Giang, which consists of five villages. Each of these villages had a different number of hamlets (streets), and these were divided to allow for twenty interviews from each village as follows: 1. Hamlet 1 5 interviews in all 4 sub villages 2. Hamlet 2 4 interviews in all 5 sub villages 3. Hamlet 3 10 interviews in all 2 sub villages 4. Hamlet 4 4 interviews in all 5 sub villages 5. Hamlet 5 5 interviews in all 4 sub villages In Hai Phong, the selected commune was Lai Xuan, which consists of four villages. Each of these villages has twelve hamlets and five of these were randomly selected. Five interviews were conducted in each hamlet to give the total of 100 interviews (554). For these two provinces, the first house in each hamlet was selected, followed by every fifth house until all interviews were completed. In Dong Thap, the selected commune was My Ngai, which consists of three villages. As there were five interviewers to conduct twenty interviews each, forty interviews were conducted in the two large villages and twenty in the smaller village. As there are 740 households in the village, every seventh house was3</p> <p>selected for interview. In An Giang, the selected commune was My Hoa Hung, which consists of 106 groups of houses. One house per group was interviewed. 2. Data collection Data was collected through a knowledge, attitude and practice (KAP) questionnaire. The questionnaire was developed during a CARE AI team meeting whereby the team brainstormed all the AI prevention messages that form the basis of the LRR project, under the three headings of knowledge, attitude and practice. From these the most important twelve were chosen for inclusion in the questionnaire. The questions were then based on previous KAP studies conducted in Vietnam by CARE and the Academy of Educational Development (AED), with new questions developed where necessary. The questions were either of yes/no format or open, with the interviewers selecting responses from a list provided in the questionnaire and recording those not on the list as other. These other responses were then recoded. The questionnaire is attached in Appendix 1. Five interviewers were recruited in each province from the Provincial Womens Union (PWU) and the District Womens Union (DWU). A CARE staff member conducted training in each province which included working through each question and receiving feedback from the interviewers. The interviewers then took turns interviewing each other for practice. Each interviewer was responsible for conducting 20 interviews. The head of the household or an adult member was interviewed. The interviewer also made some direct observations as indicated in the questionnaire. Once all interviews were completed they were sent to the team leader in each province for checking and any missing data was re-collected. The forms were then sent to CARE. 3. Statistical analysis All data was entered into an Access database designed for this survey. The data was then exported and analysed in Stata where basic frequencies were calculated. Tables and graphs were then developed in Excel.</p> <p>Results1. Part 1: General information 67.2% (n=267) of respondents were female and most were aged between 30 and 59 (Figure 1). Male respondents were mostly aged over 40. Most respondents (74.3%) were of middle income, this proportion ranged from 57% in Bac Ninh to 88% in Hai Phong. Bac Ninh had the highest proportion of rich respondents, at 38% and Dong Thap had the highest proportion of poor and very poor respondents, at 12% (Figure 2).</p> <p>4</p> <p>Figure 1: Age and sex distribution of participants 50 40 Percent 30 20 10 0 10-19 20-29 30-39 40-49 50-59 Age group 60+</p> <p>Figure 2: Economic status of participants by province</p> <p>Male</p> <p>FemalePercent</p> <p>100 80 60 40 20 0 An Giang Bac Ninh Don ThapRich</p> <p>Hai PhongUnspecified</p> <p>Poor</p> <p>Middle income</p> <p>71.5% (n=276) of participants reported raising poultry at their home. This ranged from 37.6% in An Giang to 92.9% in Bac Ninh. For those respondents that reported raising poultry, the numbers that they raise are shown in Table 1. The most common size of poultry farm was 10-99.Table 1: Number of poultry raised by participants No. of poultry Frequency Less than 10 62 10-99 166 100-999 42 More than 1,000 6 Total 276 Percent 22.5 60.1 15.2 2.2 100.0</p> <p>One respondent (0.3%) reported having a previous human case of AI in their household; 7.1% (n=27) reported having a previous case of AI in their poultry. 24 of these 27 reported still raising poultry at their home. 96.5% of participants (n=386) had heard of AI. The 14 people that hadnt were all from Hai Phong province. These 14 were excluded from the analysis making total sample size 386.</p> <p>Attitudes towards AI 59.6% (n=229) of participants reported that they thought AI would occur again in Vietnam, 22.7% (n=87) reported they didnt think AI would occur again and 17.7% (n=68) answered Dont know. 77.1% (n=296) reported that they thought it was possible to prevent AI from spreading; 7.0% (n=27) thought it was not possible and 15.9% (n=61) answered Dont know. Seven participants (1.8%) reported having attended an AI community event sponsored by CARE, 81.5% reported they hadnt and 16.7% (n=64) answered Dont know. Of those that reported raising poultry (n=276), half (48.2%) believed that it is very unlikely that their poultry will be infected with AI (Figure 3). A tenth (9.8%) reported thinking it is very likely that their poultry...</p>