Download Assessment of Knowledge and Concerns about Avian Influenza (AI

EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Ahmed et al
KNOWLEDGE AND CONCERNS ABOUT AVIAN INFLUENZA (AI)
AMONG WOMEN ATTENDING OUTPATIENT CLINICS OF BENI-SUEF
UNIVERSITY HOSPITAL
By
Neven A. Ahmad*, Safaa A.M. Kotb**,
Shokria A. Labeeb** and El-Morsy A.El-Morsy ***
*Technical Institute of Nursing, Departments of
**Community Health Nursing; Assiut Faculty of Nursing,
and ***Public Health & community Medicine, Beni–Suef Faculty of Medicine
ABSTRACT:
Introduction: The first known direct avian to human transmission of influenza a
(subtype H5N1) viruses was reported during an outbreak in Hong Kong in 1997.
Egypt is the 9thcountry to report laboratory confirmed human cases in the current
outbreak. Egypt is the 3rdcountry which has reported the largest number of human
cases of H5N1 infection (83 cases) after Indonesia and Vietnam, most of them were
women.
Aim of the study: Assess knowledge and concerns about AI among women attending
Out Patient Clinics of Beni- Suef University Hospital.
Methods: The descriptive study of sample comprised 600 women who were chosen
randomly, using a systemic random sampling technique. Data collection from the
target population was done by using personal interviewing questionnaire sheet. The
questionnaire included different parameters; age, residence, educational and
occupational statuses of women.
Results illustrates that (35.2%) of the studied sample didn't know signs and symptoms
of the disease on infected birds, (74.2%), of women correctly defined AI as an
infectious agent and (47.0%) known it caused by a virus, while (33.5% and 46.1%) of
them didn't know the seriousness of the disease on birds and human respectively. All
studied sample didn't wear gloves during slaughtering or cleaning process and didn't
use antiseptic solution for either cleaning tools or disinfecting area.
Conclusion: Generally, knowledge and concerns of the studied sample about disease
were low. Also, there is low knowledge regarding practice of women during and after
slaughtering process/dealing with sick/dead poultry appears. All studied sample let
their children in direct contact with poultry. All Studied sample have received
information on avian Influenza from Egyptian Television.
Recommendations: Effective health education programs should be implemented in
order to prepare the community to deal with this important threat.
KEYWORDS:
Outbreak
Avian
INTRODUCTION:
There is an increasing concern
worldwide about the highly infectious
strain of avian A (subtype H5N1) that
has recently caused outbreaks in more
than thirty countries. If human to
human transmission of Avian Influenza
Subtype H5N1.
(AI) becomes widespread, practices to
prevent and control the spread of the
virus in the health care setting become
critically important (Peiris et al, 2007).
There is a great diversity of
challenges encounter people handling
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EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
to AI. Although the virus spreads
among birds in the form of epidemic
and the appearance of human cases
with a high case fatality rate in Egypt
(27/83) (WHO c, 2009), still the
practice of domesticated poultry
present in a large number of houses
especially in the rural areas without
any precautions or applications of
protective measures. The main cause of
this situation is ignorance, lack of
knowledge among women. Economic
losses from AI have varied depending
on the strain of virus, species of bird
infected, number of farms involved,
control methods used, and the speed of
implementation of control or eradication
strategies
(Swayne
and
Halvorson, 2003).
Ahmed et al
chills, dry cough, headache, sore
throat, stuffy nose, lower respiratory
disease with breathlessness and signs
of pneumonia (in more serious cases
influenza causes pneumonia which can
be fatal particularly in young children
and the elderly). Patients with AI have
conjunctivitis, diarrhea (watery diarrhea without blood or inflammatory
changes appears to be more common
than in influenza), nausea, vomiting
(can be produced especially in
children), (abdominal, chest, pleuritic)
pain, bleeding from the nose and gums
has also been reported early in the
course of illness in some patients
(Tam, 2002 and Chotpitayasunondh et
al, 2005).
All age and sex groups contact
with diseased poultry are susceptible to
AI virus which most of the cases have
occurred among those exposed to
infected poultry (PHLD et al, 2006).
Workers in the poultry industry who
commonly have contact with sick or
dying poultry are at greater risk
because
handling
poultry
or
preparation of raw poultry meat and
products (Fatiregun and Saani, 2008).
The following groups are at increased
risk of complications from influenza;
persons older than 65 years, nursing
home
residents,
children
and
adolescents receiving long-term aspirin
therapy because of the risk of Reye’s
Syndrome and pregnant women
(Sandro, 2008). Complications are
otitis media, primary influenza pneumonia, secondary bacterial bronchitis,
encephalitis (rare) and worsening or
destabilization of pre existing diseases,
such as cardiac failure and diabetes
(CDC, 2007).
Flu viruses are constantly
changing, producing new strains and
varieties. Pandemics occur when a
virus emerges that is so different from
previously circulating strains that few,
if people have no immunity to it. This
allows the virus to spread widely and
rapidly, affecting many hundreds of
thousands of people. There are at least
15 types of AI divided to three main
groups of viruses. C virus only causes
mild problems in human, pigs and
dogs. B virus can cause more serious
illness and seasonal epidemics (widely
circulating in humans). However A
virus is more threat and have the
ability to cross the species barrier and
infect (human, ducks, chickens, birds),
animals as (pigs and horses) and
usually causes the most serious
epidemics (Hicks, 2007 and NIAID,
2008).
Most patients have initial
symptoms of high fever (typically a
temperature of more than 38°C) and
typically fever beings to decline on the
2nd or 3rd day of the illness. Influenzalike symptoms (sometimes it confuses
with the common cold), body aches,
Hand washing is the single
most effective way to reduce the
spread of virus that cause respiratory
disease. So, continuous hand washing
(use an alcohol based hand rub or wash
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EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
hands with soap and water) prevents
the spread of infection especially after
handling frozen or raw chicken or eggs
(WHO, 2005).
Ahmed et al
Data Collection Tool:
A semi-structured questionnaire it was
developed by the researchers based on
review of literature. The language of
structured interviewing questionnaire
was Arabic. Gathered information
concerning: personal data, age, marital
status, residence, level of education,
occupation and housing conditions,
women’s knowledge of various aspects
regarding preventive measures are used
during and after birds/eggs preparation
for consumption. Knowledge of
Women’s regarding their practice
during and after dealing with poultry.
And women’s concern about AI . The
time needed to fill out the sheet ranged
between 35-45 minutes.
Aim of the Study:
The aim of this study is to
assess knowledge and concerns about
AI among women attending Out
Patient Clinics of Beni-Suef University
Hospital
SUBJECTS AND METHODS:
The descriptive study; was
carried out by using systematic random
sampling technique to select the
studied sample from the women
attending the out patient clinics of
Beni-Suef University Hospital. The
study conducted in chest, internal
medical, surgical, Obstetric, and
pediatric outpatient clinics, which lies
in the entrance of Beni-Suef
Governorate. It provides free health
services for all rural and urban areas
where traffic is available. The work
system in the out patient clinics is one
shift from 8am to 2pm and serves
1200-1400 citizens daily. From the
previous years of hospital records and
statistics, it was found that about
40.000 women attended the out patient
clinics of the pervious mentions clinic
by using the Software Package for
Social Sciences (SPSS) version 16
program. , The sample size was
determined by the program to calculate
the sample size from the random
population, 600 women who were
chosen randomly from the previously
mentioned study settings. From those
accepted to participate in the study and
attended the selected settings during
the period of the study. The selected
population was distributed among
clinics as follows: Internal medical,
Surgical, Chest, Obstetric, Pediatric
(100, 90, 70, 140, 200) respectively.
Methods:
1- Administrative Design:
An official permission to
conduct the study was obtained by
submission of official letters issued
from the director of Beni-suef
University Hospital from Faculty of
Nursing-Assiut University. In addition,
a verbal consent was obtained from
each woman who participated in this
study.
2- Ethical Issues:
The purpose and nature of the
study was explained to the director of
the hospital to obtain his permission.
Oral informed consent was obtained
from all of the women who accept to
participate in the study after received
an explanation of the purposes of the
study. Confidentiality of obtained
information was completely ensured.
Women who agreed to participate in
the study were interviewed individually and privately by the researcher
to fill out the interview form. At the
end of the interviewing, the opportunity was given to women to ask
questions related to the most suitable
interventions about AI, and the
researcher provided a lot of explana-
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EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
tions and information about preventive
methods.
Ahmed et al
that known it infects birds, human and
animals. While (50.8%) reported that
virus infects birds and human only.
(43.1%) of the studied sample believes
that birds get infected from contacting
diseased birds. 13.0% of women
believes that AI can be transmitted
through air, on the other hand (35,
7%) didn't know the actual mode of
virus transmission among birds. 38.5%
reported that direct dealing with
infected remnant is one of mode for
transmutation. While (4.7%) of women
are sure that AI can be transmitted
from human to human in rare cases.
A pilot study has been carried
out on 10 % (60) of the total sample of
studied women and was excluded from
the study sample. To test the feasibility
and clarity of the study tools estimate
the time required for filling up the
forms and develop any modification if
needed.
The time needed to fill out the
sheet ranged between 35-45 minutes.
The number of women interviewed
every day ranged between 4-6 women.
Three days per week, 600 women in 10
months were studied from July 2007 to
April 2008.
Table (3) illustrates that
(35.2%) of the studied sample didn't
know signs and symptoms of the
disease on infected birds and (3.2%) of
women believes that there are "no
signs" in infected birds. 60.5% didn't
know the signs and symptoms of the
disease in infected human, while
(8.5%) believes that "no signs or
symptoms" in infected human.
Data entry and statistical
analysis has been done by using
software package for social science
(SPSS) version (16), Data were
presented also by using descriptive
statistics as mean ± SD, frequencies
and percentages for qualitative
variables. Student t Test been used to
compare the different qualitative
variables. test of significance; P < 0.05
was considered significant.
Regarding the perception of the
studied sample on the seriousness of
the disease, (33.5% and 46.1%) of
them didn't know the seriousness of the
disease on birds and human respecttively. This table illustrates that (46.1%
and 74.3%) respectively didn't know
seasonal prevalence and places of
exposure the virus.
RESULTS:
Results show that the sociodemographic characteristics of the
studied sample, the majority of them
aged between 25:↓55 years with the
mean age 29.0 with ± SD (1.193).while
(53.0%) of rural areas. Regarding the
educational status, it was observed that
(41.8%) were illiterate, (10.5%) were
university education. Concerning the
marital status, the majority of them
(81.0%) were married. Table (1)
All studied sample didn't wear
gloves during slaughtering or cleaning
process and didn't use antiseptic
solution for either cleaning tools or
disinfecting area, or even hand
washing or washing eggs. 92.7% of
women didn't wash eggs and use them
directly. (61.5%) of the studied sample
taste poultry meat during cooking
process and (28.4%) sometimes taste.
(14.7% & 12.7%) of women respecttively are boiled eggs and birds until
complete solidification. Table (4)
Table (2) clear that (74.2%), of
women correctly defined AI as an
infectious agent and (47.0%) known it
caused by a virus and only (11.7%)
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EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Table (5) shows that only 4.2%
did not rise poultry at their home. On
the other hand all of the studied sample
reported that poultry breeding are
available in their residential area
.73.7% of the sample reported that
families are participating in rearing
poultry and all studied sample's stat
children contact to poultry either
through playing, feeding, collecting
eggs or cleaning cages. 67.5%, 54.6%
and 1.4% respectively reported that
they are mixing poultry together, raise
animals, cats and dogs with poultry.
Ahmed et al
measures are used during and after
dealing with poultry (51.7%).There
was a statistical significant association
between the total knowledge score
with age and education (Table 9).
The present study clear that
poor knowledge regarding preventive
measures are used during and after
birds/eggs preparation for consumption
among the studied sample (85.3%)
with no statistical significant deference
between total knowledge’s score
regarding preventive measures are used
during and after birds/eggs preparation
for consumption with personal data
(Table 10)
All of the studied women who
carry poultry did not wear special
clothes, mask and gloves when dealing
with poultry. 77.7%and 54.6% didn't
separate home appliances away from
poultry appliances and use the same
appliances for poultry and animals
together
respectively.
Regarding
preventive measures used after dealing
with domestic poultry. The majority of
the studied sample didn't wash their
face and didn't use antiseptic solution,
while (3.3%) didn't wash their hands
after dealing with poultry (Table 6).
Table (10) shows that 29.0%
didn't perceive seriousness of disease
while the rest didn't know what they
should do. Also, 49.4% of the studied
sample reported that human infection
occurs due to dealing with birds
without known precautions. It was
found that 53.2% and 38.3%
respectively didn't know the action in
case of suspect in infected human and
presence of confirmed human cases in
their residential areas. Only 5.3%
showed that they will report the
authority, upon encountering suspect
human case.
Table (7) shows that poor
knowledge regarding AI among the
studied sample (54.8%) with a
statistical significant difference between age and education with total
knowledge score among women
regarding AI
Regarding to the reaction of
women in case of the appearance of
sick or dead poultry in their residential
areas, only 1.7% would report it to the
authorities, while 19.2% didn't know
what they are do. No one reported that
they will bury it in a deep hole or pour
water and chlorine and put carcass in
the rubbish in sturdy bags. All the
respondents of this study confirm that
AI has a great impact on their income.
Tables (8) illustrate that Poor
concern among women regarding AI
(51.3%) with no statistical significant
deference regarding total concern’s
score of AI with personal data.
Poor knowledge among women
regarding their practice and preventive
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EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Ahmed et al
Table (1): Distribution of the studied sample regarding to their personal
characteristics at outpatient clinics, Beni-Suef University Hospital,2008
No. (n=600)
Age (years):
1425354555+
Mean ± SD
Residence:
Urban
Rural
Educational Status:
Illiterate
Read & Write
Primary education
Preparatory education
Secondary education
University education
Marital Status:
Single
Married
Divorced
Widow
Occupation:
House wife
Employee
Interrupted work
%
79
13.2
158
26.3
168
28.0
132
22.0
63
10.5
29.0 ± 1.193
275
283
317
47.2
52.8
251
84
48
36
118
63
41.8
14.0
8.0
6.0
19.7
10.5
36
486
15
63
6.0
81.0
2.5
10.5
494
78
28
82.3
13.0
4.7
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Ahmed et al
Table (2): Knowledge of the studied sample regarding definition, nature and mode of
transmission of Avian Influenza at outpatient clinics, Beni-Suef University
Hospital, 2008
AI is infectious:
Yes
No
I don't know
AI is caused by a virus:
Yes
No
I don't know
AI infects (species susceptibility):
Birds, human and animals
Birds and human only
Birds only
Human only
I don't know
Transmission of the virus among birds
From the infected birds
Through air
From contaminated surfaces with the virus
I don't know
Transmission of the virus from birds to human
Direct dealing with infected birds
From contaminated surfaces with the virus
Eating infected poultry
Eating poultry (normal birds during outbreak)
Through air
Direct dealing with infected birds remnant
I don't know
Transmission of the virus from human to human:
Sure, in rare cases
Not Sure
I don't know
No
276
No.
(n=600)
%
445
41
114
74.2
6.8
19.0
282
16
302
47.0
2.7
50.3
70
305
153
29
43
11.7
50.8
25.5
4.8
7.2
259
78
49
214
43.1
13.0
8.2
35.7
226
63
33
26
21
231
0
37.7
10.5
5.5
4.3
3.5
38.5
0.0
28
118
454
0
4.7
19.7
75.6
0.0
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Ahmed et al
Table (3): Knowledge of the studied sample regarding signs, symptoms, perception
of seriousness of the disease in poultry, human, and places of exposure at
outpatient clinics, Beni-Suef University Hospital, 2008
Signs of the disease on infected birds:
No signs
Spinning and sudden death
Ruffled feathers
Reduced egg production
Head goes down
Secretion from nose and mouth
Looks weak
Don't eat
Cyanosis of comb and wattle
Swelling of the head
Diarrhea
I don't know
More than answer
Signs and symptoms of the disease on infected human
as ordinary flu:
Yes
No
I don't know
Seriousness of the disease on birds:
Not serious
Serious
I don't know
Seriousness of the disease on human:
Not serious
Serious
I don't know
Seasonal prevalence:
Seasonal
Not seasonal
I don't know
Places of exposure the virus:
Bird places (fresh markets slaughter, home slaughter,
poultry farms …)
I don't know
277
No. (n=600)
%
19
80
43
93
50
36
13
31
0
0
0
211
24
3.2
13.3
7.2
15.5
8.3
6.0
2.2
5.1
0.0
0.0
0.0
35.2
4.0
186
51
363
31.0
8.5
60.5
98
301
201
16.3
50.2
33.5
33
290
277
5.5
48.3
46.2
184
139
277
30.7
23.2
46.1
154
25.7
446
74.3
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Ahmed et al
Table (4): knowledge of women regarding preventive measures used during and after
preparation of birds and eggs for consumption at outpatient clinics, BeniSuef University Hospital, 2008
Wearing gloves when slaughtering or de-fathering birds:
No
Yes
Clean tools and area after processing birds by:
Water only
Water and soap
Water, soap and antiseptic solution
Wash your hands after slaughtering or processing birds
and washing eggs by:
Water only
Water and soap
Water, soap and antiseptic solution
Wash eggs:
Water, soap and antiseptic solution
No, directly use
With water only
Prepare eggs for consumption by:
Any way except boil
Boil or anyway (grill, fry boil consumed raw …)
Boil until complete solidification
Prepare birds for consumption by:
Any way except boil
Boil or anyway (grill, fry, boil, …)
Boil until complete solidification
Taste birds during cooking process:
Yes
Sometimes
No
278
No. (n=600)
%
600
0
100.0
0.0
24
576
0
4.0
96.0
0.0
52
548
0
8.7
91.3
0.0
0
556
44
0.0
92.7
7.3
45
467
88
7.5
77.8
14.7
114
410
76
19.0
68.3
12.7
369
171
60
61.5
28.5
10.0
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Ahmed et al
Table (5): Knowledge of the studied sample about breeding of poultry at outpatient
clinics, Beni-Suef University Hospital, 2008
Breeding poultry:
Yes
No
Is there any poultry raising clusters in your residential
area and / or street ‫٭‬:
Yes
No
Poultry rearing is your responsibility alone at home:
No, my family help me
Yes
Children in your family direct contact with poultry:
Yes (playing, feeding, collecting eggs, cleaning cages ….)
No
Mixed poultry types population:
Yes
No, separated
One type only
Pet animal and poultry are present together at the same
place:
Yes
No, separated
No pet animals at all
Raise cats or dogs with poultry:
Yes
No, separated
No pet cats or dogs at all
279
No=600
%
575
25
95.8
4.2
600
0
100.0
0.0
424
151
73.7
26.3
575
0
100.0
0.0
388
71
116
67.5
12.3
20.2
314
178
83
54.6
31.0
14.4
8
15
552
1.4
2.6
96.0
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Ahmed et al
Table (6): Knowledge of the studied sample about protective measures followed
during and after dealing with poultry at outpatient clinics, Beni-Suef
University Hospital, 2008
Separate home appliances away from poultry
appliances:
No
Yes
Wear special clothes, mask, gloves when dealing with
poultry:
No
Yes
Use the same instruments for poultry and animals:
Yes
No
No other animals are present
Wash your hands, face and legs after dealing with
poultry:
No, wash my hands only
No
Sometimes wash my hands only
Clean your hands with:
No clean
Water
With water and soap
With water, soap and antiseptic solution
280
No. =575
%
447
128
77.7
22.3
575
0
100.0
0.0
314
178
83
54.6
31.0
14.4
510
19
46
88.7
3.3
8.0
19
90
466
0
3.3
15.7
81.0
0.0
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Ahmed et al
Table (7): Total knowledge's score among women regarding Avian Influenza by
personal data at outpatient clinics, Beni-Suef University Hospital, 2008
Poor
Knowledge
No.
%
Age (years):
1442
53.2
2585
53.8
3581
48.2
4576
57.6
55+
45
71.4
Residence:
Rural
169
53.3
Urban
160
56.5
Educational Status:
Illiterate
152
60.6
Read & Write
51
60.7
Primary education
20
41.7
Preparatory education
15
41.7
Secondary education
53
44.9
University education
38
60.3
Occupation:
House wife
269
54.5
Employee
44
56.4
Interrupted work
16
57.1
329
54.8
Total
* Statistical significant difference; P < 0.05.
281
Good
Knowledge
No.
%
37
73
87
56
18
46.8
46.2
51.8
42.4
28.6
148
123
46.7
43.5
99
33
28
21
65
25
39.4
39.3
58.3
58.3
55.1
39.7
225
34
12
271
45.5
43.6
42.9
45.2
X2
P-value
10.536
0.032*
0.628
0.428
15.826
0.007*
0.167
0.920
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Ahmed et al
Table (8): Total Concern's score among women regarding Avian Influenza by
personal data at outpatient clinics, Beni-Suef University Hospital, 2008
Age (years):
1425354555+
Residence:
Rural
Urban
Educational Status:
Illiterate
Read & Write
Primary education
Preparatory education
Secondary education
University education
Occupation:
House wife
Employee
Interrupted work
Total
Poor
Concern
No.
%
Good
Concern
No.
%
37
92
85
60
34
46.8
58.2
50.6
45.5
54.0
42
66
83
72
29
53.2
41.8
49.4
54.5
46.0
164
144
51.7
50.9
153
139
48.3
49.1
131
40
19
17
62
39
52.2
47.6
39.6
47.2
52.5
61.9
120
44
29
19
56
24
47.8
52.4
60.4
52.8
47.5
38.1
249
47
12
308
50.4
60.3
42.9
51.3
245
31
16
292
49.6
39.7
57.1
48.7
282
X2
P-value
5.684
0.224
0.043
0.835
6.321
0.276
3.462
0.177
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Ahmed et al
Table (9): Total knowledge's score among women regarding their practice of
preventive measures used during and after dealing with poultry by personal
data at outpatient clinics, Beni-Suef University Hospital, 2008
Poor
knowledge
No.
%
Age (years):
1443
59.7
2576
50.3
3585
51.8
4570
54.3
55+
23
39.0
Residence:
Rural
166
54.2
Urban
131
48.7
Educational Status:
Illiterate
117
47.6
Read & write
47
57.3
Primary education
26
57.8
Preparatory education
23
67.6
Secondary education
62
57.9
University education
22
36.1
Occupation:
House wife
256
53.8
Employee
29
40.3
Interrupted work
12
44.4
297
51.7
Total
‫ ٭‬No of studied sample are breeding poultry=575
* Statistical significant difference
283
Good
knowledge
No.
%
29
75
79
59
36
40.3
49.7
48.2
45.7
61.0
140
138
45.8
51.3
129
35
19
11
45
39
52.4
42.7
42.2
32.4
42.1
63.9
220
43
15
278
46.2
59.7
55.6
48.3
X2
P-value
6.130
0.190
1.765
0.184
14.492
0.013*
5.156
0.076
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Ahmed et al
Table (10): Total knowledge's score among women regarding preventive measures
used during and after birds/eggs preparation for consumption by personal
data at outpatient clinics, Beni-Suef University Hospital, 2008
Age (years):
1425354555+
Residence:
Rural
Urban
Educational Status:
Illiterate
Read & Write
Primary education
Preparatory education
Secondary education
University education
Occupation:
House wife
Employee
Interrupted work
Total
Poor
Knowledge
No
%
Good
Knowledge
No
%
70
141
134
115
52
88.6
89.2
79.8
87.1
82.5
9
17
34
17
11
11.4
10.8
20.2
12.9
17.5
267
245
84.2
86.6
50
38
15.8
13.4
206
75
42
31
99
59
82.1
89.3
87.5
86.1
83.9
93.7
45
9
6
5
19
4
17.9
10.7
12.5
13.9
16.1
6.3
417
71
24
512
84.4
91.0
85.7
85.3
77
7
4
88
15.6
9.0
14.3
14.7
284
X2
-value
7.501
0.112
0.657
0.418
7.056
0.217
2.357
0.308
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Ahmed et al
Table (11): Behavioral reaction of women after Avian Influenza notification and
presence of infected human cases in their residential area at outpatient
clinics, Beni-Suef University Hospital, 2008
Your reaction after appearance of the disease
Felt panic, but I know nothing to do
I followed some precautions as hand washing
No thing
I followed strict precautions
Expectation of human infection due to
Dealing with birds without the known precautions
I don't know
Your reaction when suspect in infected human case in the
vicinity
I don't do any thing, avoid him only
Convince patient to treat himself
Report authorities
I don't know
Your reaction when there are infected human cases in the
vicinity
I don't do any thing, avoid him only
Avoid eating birds and its products
Stopping dealing with both birds and human
I don't know
AI affect the family income
Yes
No
Your reaction when appeared sick or dead poultry in your
residential area:
No thing and continuing raising‫٭‬
Hide away my birds from responsible agencies‫٭‬
Dispose of my birds alive in street‫٭‬
Slaughter my birds and get rid of them in canal‫٭‬
Slaughter my birds and get rid of them in trash‫٭‬
Slaughter my birds and eat them‫٭‬
Bury the carcass of bird in a deep hole
Pour water and chlorine and put carcass in the rubbish in sturdy
bags
No thing
Report it to authorities
I don't know
(‫ )٭‬Studied sample who are breeding poultry (No=575).
285
No=600
%
304
122
174
0
50.7
20.3
29.0
0
297
303
49.4
50.6
205
44
32
319
34.2
7.3
5.3
53.2
124
66
180
230
20.7
11.0
30.0
38.3
600
0
100.0
0.0
64
152
113
15
46
75
0
0
10.7
25.4
18.8
2.5
7.7
12.5
0.0
0.0
9
10
116
1.5
1.7
19.2
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Ahmed et al
very restricted manner (Hien, et al,
2004, Ungchusak et al, 2005, Hayden
and Shindo, 2008, Yang et al, 2007,
Fatiregun and Saani, 2008, WHO,
2008, Elisa and Caroline, 2008).
Although there is no strong evidence
for human-to-human transmission of
H5N1, in Egypt more than one case in
the same family was detected. H5N1
clusters involving highly probable
human-to human transmission have
been documented in China, Thailand,
Vietnam, Indonesia, and Pakistan
(Nicoll, 2008).
DISCUSSION:
In the meantime, the probable
risk of a pandemic human influenza
strain emerging from co-infection of
human influenza by H5N1 virus
(Ferguson et al, 2004) continues to
exist where the potential global public
health impact could be catastrophic.
Modern travel and transportation links
would distribute a new humantransmissible
influenza
strain
worldwide within days and overwhelm
most healthcare systems within weeks.
Preventing such event is a vital public
health enterprise (Fielding et al, 2005).
According to the present study
around half of the studied women
reported that the disease is serious in
birds and human while, those who
didn't perceive the seriousness of
disease on birds and human more than
third and little number of them didn't
agree that the disease is serious in birds
and human respectively . The findings
of this study agree with (MOHP et al,
2006) who found that 38% said that the
disease was risky, 12.5% reported that
disease has no effect at human health
as it is a disease of birds only. Gomez,
2006 observed that 64.0% of people
reported that the disease is serious,
15.0% disagreed and saying that
influenza is not a serious disease and
21.0% had no opinion. Also, UNICEF,
2006 found that 88.9% reported that
the disease is very serious and 5.6%
didn't perceive the seriousness of
human infection. On the other hand,
more than half of poultry workers
believed that AI is a serious but
preventable disease (Abbate, 2006,
Fatiregun and Saani, 2008).
Knowledge of the disease is a
key factor and a significant role in
reducing exposure to the virus and
enhancing
health,
it
provides
knowledge about signs, symptoms,
modes of transmission and preventive
measures which enables individuals to
identify illness & seek care early.
Knowledge of health risk behaviors
that contribute to the spread of disease
may influence infected individuals to
modify their behavior & thus assist in
prevention of the spread of disease
(Lundy and Jans, 2001).
The present study found that the
majority of the sample was married,
aged between 25:↓55 years and more
than half of them from rural areas.
Illiterate women represented more than
third. Only (13%) of women were
employees while the majority of
studied sample were housewives.
Insufficient general information
was found on modes of transmission,
signs/symptoms and seriousness of the
diseases on infected birds/human.
Three quarter of the studied sample
didn't know if the virus is transmitted
from human to human while (4.7%)
reported that the virus transmitted
between humans occurred in rare
cases. No doubt that H5N1 human to
human transmission was observed in
Little attention was paid for
hygiene
and
basic
preventive
measures, considerable number of the
studied sample believe that incidence
of human infection which result from
dealing with birds without knowing
any
precautions
may
create
286
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
opportunities for further and extensive
exposure to potentially contaminated
parts of poultry, which pose a
significant risk of infection. In Egypt, a
large number of confirmed human
cases acquired infection during the
dealing, slaughtering and subsequent
handling of diseased or dead birds
(Hayden and Shindo, 2008). This
finding coincides with the results of the
present study. El-Hawari, 2009,
through NAMRU-3 stated that Egypt is
the most country infected with AI
outside of Asia, despite control
measures. It pointed out that among the
63 confirmed cases recorded in Egypt
between March 2006 and March 2009,
there were 23 serious infections. The
report used the term "epidemic curve"
when it addressed the evolution of the
disease in Egypt, where the number
jumped from 12 cases in the first
quarter of 2006 to 18 cases in this year
alone. It ranked Egypt the third in the
global infection rate with
14%
infection rates as registered by W .H.
O in March. Indonesia is ranked first
with 34% and Vietnam second with
26%.
higher percentage
females than males.
Ahmed et al
of
concerning
The study revealed that all
women let their kids deal freely with
birds (playing, feeding, collecting
eggs, and cleaning cages….), a large
number of households keep domestic
birds inside their houses and
backyards. These birds often mingle
freely with wild birds that enter inside
and share outdoor areas where children
play, creating extensive opportunities
for human exposure to H5N1. These
findings consist with Sowth et al, 2007
study. El-Hawari, 2009 study though
NAMRU-3 which was conducted in
Egypt revealed that infections have
increased among Egyptian's children
less than 5 years of age and females
between 10 and 39 years, pointing out
that female infection reached 60%, a
rate that is much greater than the
global rates which agree with these
findings.
The present study showed that
(95.8%) of the studied sample breeding
poultry, more than half mixed poultry
types, and breeding poultry at the same
time in the same place and pet animals
as raise cats or dogs with poultry ,this
situation plays a crucial role and
increased the probability of virus
mutation and evolution of new virus
strains. This finding is similar with that
reported by (Rimmelzwaan et al, 2006
and Thiry et al, 2007).
Regarding the reaction of
women after appearance of the disease,
no one reported that they followed
strict precautions and more than half of
women felt panic but they know
nothing to do and there was no reaction
regarding the appearance of the disease
for more than one quarter of them. The
current study agree with the study of
Sonja et al, 2005, who cleared that
many persons who have heard about
AI,
their
behavior
remained
unchanged, and only 29.3% of
respondents modified their behavior
regarding the handling of birds and
poultry products (Fatiregun and Saani,
2008). While Al-Shehri etal, 2006 they
found that the majority of participants
feared that they or their family member
would get avian flu (78.0%) with a
Poor knowledge scores about
AI were attributed to more than half of
sample with statistical significant
differences in the knowledge regarding
age and education of women, while
there are no statistically significant
differences regarding residence and
occupation of women with their
knowledge. This is agreement with
results of (Toby et al, 2008,
Mohammad et al, 2008) they found a
287
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
relatively low level of knowledge
about AI in their studies, while Abbate,
2006 observe that knowledge was
greater in persons with more education
On the other hand,. Al-Shehri, 2006,
found no statistical
significant
difference in knowledge between
participants regarding age.
The transmission and infection of
H5N1 is a concern due to the global
spread of H5N1 that constitutes a
pandemic threat. There was poor
concern regarding AI among half of
the studied sample, with no statistical
significance
differences
between
concern of women regarding AI and
their age, residence, education and
occupation.
Ahmed et al
All studied sample have
received their information about AI
from the Egyptian's television, which
constitutes the most attractive, trustful
media and represents the first popular
media for the different socio-economic
Egyptian peoples and the only source
for health information and news about
the outbreak of AI virus. These finding
agree with (UNICEF, 2006, MOHP et
al, 2006, Fatiregun and Saani, 2008,
Mohammad et al, 2008) who named
TV as the most preferred source of
population information's about AI.
CONCLUSION:
The present study concluded
that the there is lack of knowledge and
concern among women; about AI. The
unacceptable behaviors regarding
dealing with sick/dead poultry that
may lead to great environmental and
water pollution and exposure of
children to direct contact with poultry,
never used the preventive measures
during and after dealing with poultry or
during and after bird slaughtering is a
greet risky behavior.
Half of the studied sample had
poor knowledge regarding their
practice and preventive measures are
used during and after dealing with
poultry. There were no statistical
significant differences regarding their
age, residence and occupation, except
their education were statistical
significance differences among the
studied sample.
RECOMMENDATIONS:
1. Providing
of
comprehensive
effective and coordinated information about AI and necessary
precautions to avoid spreading the
virus among poultry and humans.
2. Strengthening health education and
communication targeting communities at risk (women are the main
target in family and community);
this communication strategy will
deliver messages informed by
improved understanding of disease,
human behavior and risk of
acquiring H5NI infection.
3. Production and dissemination of
guidelines and health promotion
and information materials to promote barrier preventive measures
The present study revealed that
poor knowledge regarding preventive
measures are used during and after
birds/
eggs
preparation
for
consumption. The vast majority among
the studied sample, that leads to fault
practices help in the spread of infection
among poultry and existence of high
risk of human infection, with a
statistically significant differences in
age, education and occupation of the
studied women. A real risk for further
human cases still existed since most
human cases in Egypt were recoded in
either children or women who handle
birds through direct contact or
slaughtering and dealing with diseased
birds (Hayden and Shindo, 2008).
288
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
with subsequent reduction of the
risk of human transmission and
establish an early warning system.
Develop information materials for
required behaviors among high-risk
population groups.
4. MOHP should increasing message
on AI to different types of media
especially. Local TV channels,
work places, universities, schools,
clubs, rural and urban areas
through integrated AI campaign
and community outreach workers.
Increase broadcast and prints
materials (consumer fliers, Q&A
booklets, magazine inserts, fact
sheets, posters, …) as well as
community outreach activities.
Ahmed et al
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‫‪EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009‬‬
‫الملخص العربي‬
‫تم اكتشاف أول حالة إلنتقال مرض إنفلووناا اليووور لسننوان نو حو و المورض يوي‬
‫م ونة هونج كونج ام ‪1997‬م‪ .‬وتعتبر مصر حالوا ً تانع أقيار العالم يي حاالت وي اإلننان‬
‫حاالت وي اإلننان‬
‫المؤك ة‪ .‬وكذلك تع ثال أقيار العالم بع أن ونونوا ويوتنام من حو‬
‫الحاالت حوالي ‪ 83‬حالةحتى ام ‪2008‬م وكان معظمهم من النو ات‪.‬‬
‫حو بلغ‬
‫تهدف هذه الدراسة إلي تقووم م ى المعريوة واالهتماموات ون مورض إنفلووناا اليووور‬
‫بون النو ات المتر ات لوي العووا ات الخارةووة بمنتشوفي بنوي نوووف الةوامعي وام ‪2008‬م‬
‫و قو كانووت هووذا ال رانووة وصووفوة لقيووا موون النووو ات واشووتملت لووي ‪ 600‬نووو ة تووم اختوووارهن‬
‫بيروقووة شووواموة منت ظمووة‪ .‬وتووم ةمووع البوانووات وون يرووول المقابلووة الشخصوووة وموول انووتمارة‬
‫خاصة بذلك‪.‬‬
‫ولقددد فسددارن الجتد اآل يد ا تد ‪ %35.2 :‬موون النووو ات ال وعوورين مظوواهر و المووات‬
‫المرض يي اليوور المصابة‪ ،‬وأن ‪ %74.2‬من النوو ات ريووا مورض أنفلووناا اليووور لوي‬
‫أنه مرض مع ي‪ ،‬وأن ‪ %74‬وعريون أن نبب المرض هو الفوروس بونما ‪ %33.5‬و‪%46.1‬‬
‫لي التوالي ال وعريون م ي خيورة المرض لسننان واليوور‪ .‬وأن كل النو ات يوي ال رانوة‬
‫ال ورت ون قفاا للو ون أثنا ذبح وتنظوف اليوور وال ونتخ مون أوضا ً أي أنوا من الميهرات‬
‫يي تنظوف األ وات وتيهور المكان‪.‬‬
‫والخالصة‪ :‬أن معلومات واهتمامات النوو ات كانوت قلولوة وكوذلك ممارنوتهن أثنوا ذبوح‬
‫وتنظوف ا ليووور وأثنوا التعامول موع اليووور التوي وبو و لوهوا المورض أو الموتوة‪ ،‬وكوذلك كلهون‬
‫و ن أيفالهن وتعاملون مباشرة مع اليوور‪ ،‬وكلهن كانوا وتلقون معلوماتهم ن مرض أنفلووناا‬
‫اليوور من خالل التلفاوون المصري‪ .‬وفوصن الدراسة‪ :‬بتنفوذ برنامج تثقوف صوحي يعوال مون‬
‫أةل إ ا ومشاركة المةتمع تةاا هذا الخير ال اهم‪.‬‬
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