Effective communication: the key to efficient HPAI prevention and control

Transcription

1 010028_Journal_ :59 Pagina 143 DOI: /WPS Effective communication: the key to efficient HPAI prevention and control R.G. ALDERS* and B. BAGNOL International Rural Poultry Centre, KYEEMA Foundation, G.P.O. Box 3023, Brisbane, Qld 4001, Australia *Corresponding author: Currently working for the Emergency Centre for Transboundary Animal Disease (ECTAD) of the FAO, Bangkok, Thailand The current Highly Pathogenic Avian Influenza (HPAI) crisis, involving the H5N1 subtype, has developed quickly and has overwhelmed the human resource capacity of both international agencies and national governments in many affected countries. It has been recognized that the best way of preventing the emergence of a pandemic influenza virus of avian origin is to control the virus at source. The H5N1 subtype is now endemic in a number of countries and it has become clear that its control and eventual eradication will require a medium to long-term strategy involving multiple stakeholders. A common understanding of the problem and effective education and communication components are important elements of the control strategy. This paper reviews the challenges involved with the development of effective communication materials and methodologies for the wide range of partners involved in the prevention and control of HPAI, the communication lessons learnt to date and makes recommendations for improving the effectiveness and efficiency of communication activities in the future. Keywords: communication; education; highly pathogenic avian influenza Introduction The current Highly Pathogenic Avian Influenza (HPAI) crisis, involving the H5N1 subtype, has developed quickly and has overwhelmed the human resource capacity of both international agencies and national governments in many affected countries. It has been recognized that the best way of preventing the emergence of a pandemic influenza virus of avian origin is to control the virus at source (UNSIC, 2006). A commendable international effort coordinated by the United Nations has been mounted to assist countries currently battling to control the spread of HPAI. The H5N1 subtype is now endemic in a number of countries and it has become clear that World s Poultry Science Association 2007 World s Poultry Science Journal, Vol. 63, March 2007 Received for publication December 28, 2006 Accepted for publication December 29,

2 010028_Journal_ :59 Pagina 144 its control and eventual eradication will require a medium to long-term strategy involving multiple stakeholders. A common understanding of the problem and effective education and communication components are important elements of the control strategy. From 2003 to 2005, communication and technical activities were motivated by, and largely focused on, the potential for HPAI to cause a human influenza pandemic. Much of the communication activities focussed on the dissemination via TV and radio spots, posters and newspapers of key messages that highlighted the risk of poultry and poultry products to transmit the HPAI virus. Analyses of the direct and indirect impact of these communication activities on poultry farmers (both big and small), traders and consumers have concentrated on economics with fewer studies looking at knowledge levels and behaviour change outcomes. This paper reviews the challenges involved with the development of effective communication materials and methodologies for the wide range of partners involved in the prevention and control of HPAI, the communication lessons learnt to date and makes recommendations for improving the effectiveness and efficiency of communication activities in the future. Education and communication Education and communication (EC) materials dealing with disease prevention and control is especially challenging because of the wide range of perceptions about the origin of disease. Where communities have had limited access to formal education and are unfamiliar with the concept that disease is caused by pathogens, most conventional recommendations on disease prevention and control will be difficult to comprehend. For this reason, the education component is critically important to the overall success of the programme. Perceptions of the origin of livestock disease Example 1: The elders of the Alas Tehen village, Fatumea District of Timor-Leste, explained that prior to the arrival of the Indonesians, the area had been covered by a sacred teak forest. During the years of Indonesian rule, the forest had been cut down and the villagers moved from scattered homesteads to a central village where houses were very close to each other. The loss of the sacred forest made the spirits who dwelt in the forest angry and so they brought increased illness to all types of livestock. (Alders and Amaral, 2006). Example 2: In Caia District of Manica Province in Mozambique, a participant in a PRA exercise explained that if my neighbour has no chickens, he will look for a witch to bewitch my birds, through the use of drugs, out of malice... for my chickens to disappear... but, this is not too frequent. (Bagnol, 2006). The two situations presented in the box above illustrate the kind of interpretations that people may have concerning the origins of poultry disease. According to people s understanding of the cause/s of the disease/s (sometimes the same disease has different causes and different manifestations and may be named in different ways). The way that men and women understand disease, perceive risks and are prepared to change their behaviour may differ. The implication of any possible solution might impact differently men and women and/or people from different linguistic groups and/or social classes. Effective risk communication has proved a daunting task given the diverse situations in which the messages are required. Even within the same country, there can be significant socio-cultural diversity with respect to: 144 World s Poultry Science Journal, Vol. 63, March 2007

3 010028_Journal_ :59 Pagina 145 literacy, culture/traditions, languages, perceptions of disease and disease control, priorities, and communication channels (Alders, 2006a). In general, the more socio-cultural diversity within a country, the more difficult it has been to communicate risk and adequately respond to outbreaks of HPAI. To ensure effective communication, the material must be: Clear presented in a form readily understood by the target group(s); Consistent provide the same basic information to all target groups in all material relating to a particular theme; and Credible and practical the information and recommendations make sense to the target groups and the recommendations can be implemented by the majority of the target group; Correct the information and recommendations are technically sound (Alders, 2006e). In general, the more diversity within a country, the more difficult it has been to communicate risk and adequately respond to outbreaks of HPAI (Table 1). In addition, the more resource-poor the community, the more difficult it has been to, not only prioritise the control of HPAI, but also to detect it in birds (Table 2). According to leading risk communicators it is important for messages to start where the audience starts (Sandman and Lanard, 2005) and given that the most vulnerable groups (i.e. resource-poor farmers, traders and communities) are the key target groups for much of the HPAI EC materials (GTZ, 2006), the messages need to reflect their situations. The majority of the HPAI EC material has made no mention of other killer diseases of poultry (Table 2). In many rural areas, for instance where Newcastle disease (ND), Fowl Cholera, IBD and Duck plague are endemic, farmers will be familiar with high mortality in poultry. With virulent strains of these diseases, birds may die without showing any clinical signs, just as with HPAI. The local names for these killer diseases are often descriptive and so these names could easily be applied to outbreaks of HPAI. To help poultry producers and traders understand that HPAI is a new and potentially more dangerous disease, a discussion of the similarities and differences between the key poultry diseases (and how they can be prevented or controlled) in any particular area would be beneficial. In addition to risk communication, agencies such as the FAO and OIE have responsibilities for the development of technical recommendations to support the implementation of technically sound and appropriate HPAI prevention and control activities by their national partners. The majority of available technical information focuses on recommendations suitable for intensive poultry production systems. Appropriate information for village poultry farmers is slowly being produced as understanding of extensive poultry production systems increases (Alders, 2006a). Refresher courses in poultry health for technical officers may be required where veterinary services are overwhelmed and staff with limited experience with poultry is coopted into the HPAI response programme (Freiji, 2006). The development of clear standard operating procedures, technical glossaries, technical manuals and occupational health and safety guidelines are required for all involved in HPAI prevention and control (Alders, 2006c; Alders and Pizzari, 2006). World s Poultry Science Journal, Vol. 63, March

4 010028_Journal_ :59 Pagina 146 Lessons learnt about message preparation and delivery THE IMPORTANCE OF INVOLVING ALL KEY STAKEHOLDERS Education and communication working groups are more effective when composed of representatives from commercial and family poultry farmer associations in addition to international organisations and the relevant national ministries. MESSAGES NEED TO BE CREDIBLE WITHIN THE CONTEXT OF THE SOCIAL, CULTURAL AND ECONOMIC REALITIES OF THE TARGET AUDIENCES Many of the technical recommendations concerning the prevention and control of HPAI were developed for use in the commercial poultry industry where birds are raised intensively. These recommendations need to be adapted for use in rural areas where village poultry are usually raised extensively. From a disease control point of view, the flock may be best viewed as a village flock rather than separate flocks belonging to individual households (P. Spradbrow, pers.comm.). In stable communities, community leaders are able to influence community members to behave in ways beneficial to the entire community (Bagnol, 2005). Unlike government livestock and extension officers, leaders and community animal health workers have a constant presence in their community and so can more easily encourage the practice of new improved techniques such as quarantining new birds for 1-2 weeks before releasing them to mix with the existing flock. To develop a culturally sensitive dialogue that will identify appropriate options for HPAI prevention and control, it is essential to consider people s knowledge and understanding (1) of the origin and (2) transmission of the disease from animals to animals, (3) from animals to humans, (4) from humans to humans, (5) their priorities in terms of livelihood strategies, (6) the gender dynamics of poultry raising activities and (7) risk awareness and reduction. In the short-term, it is possible to use analogies based on local beliefs to communicate recommendations in a way that can be more easily accepted by local communities. THE IMPORTANCE OF PRE-TESTING It is rarely possible to produce high quality EC material quickly. Even after pre-testing material, it is usually essential to revise it once feedback has been received from the field and impact monitoring performed (Figure 1). Pre-testing and monitoring require funds but Figure 1 Effective participatory communication is a continuous process (FAO, 2006). 146 World s Poultry Science Journal, Vol. 63, March 2007

5 010028_Journal_ :59 Pagina 147 the cost is minimal compared to the production of large quantities of EC material and the negative impact that inaccurate or misleading information can have in the field. Another complicating issue is the diverse situations (e.g. differences in education, literacy levels, traditions, languages, background, environment and accessibility) in which the material must be used. For example, in Timor-Leste, Avian Influenza was translated as Gripe Manu in Tetum (where Gripe comes from the Portuguese word for flu or sickness and manu means chicken or poultry ), the major local language and the language used in awareness raising messages across the nation. Unfortunately, the term Gripe Manu was already used in the districts of Suai and Aileu to refer to Newcastle disease (Alders, 2006d; Table 3). This problem with translation was identified during a participatory planning exercise and government materials subsequently referred to Avian Influenza as Gripe das Aves. The preparation of illustrations for use with low-literate audiences requires considerable attention given the audiences lack of familiarity with interpreting two dimensional images. Earlier work on the control of Newcastle disease (ND) in village chickens confirmed the importance of conducting pre-tests with separate groups of women and men (Bagnol 2000; Figure 2). When pretesting images in the ND control flip chart was conducted by a social anthropologist with rural poultry farmers, a small percentage of male farmers noted that the bird had diarrhoea (Figure 2A). None of the female poultry farmers noted that the bird was sick with diarrhoea but, rather, gave more attention to trying to identify what the item was on the right hand side of the picture (the item was a coconut husk added by the artist to balance the image). The women farmers did not think that the chicken was sick because its head was upright. The revised version of the image (Figure 2B) showed the bird with its head down and the coconut removed. PATH (2002) have noted that pictures with detailed, busy backgrounds make it difficult for low-literate audiences to understand the main message and so recommend that background detail be removed. THE NEED FOR CLEAR, SCIENTIFICALLY-SOUND TECHNICAL PROCEDURES APPROPRIATE FOR DIFFERENT SITUATIONS Technical control procedures commonly available tend to emphasise the use of commercial products. For example, disinfectants are recommended to decontaminate (A) (B) Figure 2 Image (A) was designed by a committee in Maputo, the capital city of Mozambique, and was to illustrate a chicken with diarrhoea. Image (B) was designed in collaboration with female village chicken farmers and effectively communicated the message to the target audience. World s Poultry Science Journal, Vol. 63, March

6 010028_Journal_ :59 Pagina 148 equipment and properties as quickly as possible so that commercial production can be resumed as quickly as possible. Where commercial products or the funds to purchase them are not available, it would be advisable to provide information on less expensive options such as: Resting premises and equipment the AI virus outside a host inactivates with the passage of time: the higher the ambient temperature, the faster the rate of inactivation; Boiling the AI virus is quickly inactivated at temperatures above 70ºC. Items such as metal equipment and clothes can be decontaminated by boiling water; Burning small chicken houses, wooden cages and such items can be quickly decontaminated by burning; Composting will decontaminate carcasses and litter; and Wood ash studies have found that wood ash has an average ph of 10.4 (range ; Risse and Harris, 1999) which would inactivate the AI virus. Wood ash could be used as a substitute for agricultural lime. THE NEED FOR BALANCED, INFORMATIVE MESSAGES THAT DO NOT CREATE PANIC Food safety messages concerning the importance of cooking poultry and poultry products well have not always been clear. Initial recommendations focussed on the need to cook poultry and poultry productions such that it reached a temperature of 70ºC and not to eat runny eggs. Given the difficulties with measuring temperatures, recommendations were changed to emphasise the need to ensure that no pink areas remained in poultry meat. Runny would be better written as firm or solid as literal translations of runny caused problems in many instances (Alders, 2006a). At times media reports have caused unnecessary panic with large decreases in poultry consumption even in countries unaffected by HPAI. Building ongoing links with journalists and providing them with scientifically sound information can greatly improve the quality of media reports. COMPENSATION POST CULLING REQUIRES GOOD COMMUNICATION An electronic consultation on compensation and HPAI found that effective communication was essential to obtain farmers cooperation (Hancock, 2006). The same consultation found that compensation messages, the whole compensation system and other control activities need to be considered as integral components of the overall control strategy. Hancock (2006) stated that a disconnect between control and compensation messages, both in terms of principles communicated and in terms of personnel involved and timing of actual activities, increased the risk of reduced cooperation. DIFFERENT METHODOLOGIES ARE REQUIRED FOR DIFFERENT CIRCUMSTANCES Providing education and communication materials to remote rural communities requires different methodologies to reaching urban and peri-urban target audiences with ready access to TV and radio. Even with the same target audience, different methodologies may be required for different messages. For instance, technical officers are likely to accept the introduction of a new disease control procedure or pharmaceutical product simply by receiving written information from a source they consider reliable. However, the adoption of gender-sensitive participatory approaches to communication by these same technical officers generally requires practical training sessions and field experience prior to 148 World s Poultry Science Journal, Vol. 63, March 2007

7 010028_Journal_ :59 Pagina 149 acceptance. Recommendations and conclusions To guarantee the effective prevention and control of HPAI it is essential that communication activities are built into HPAI strategies to ensure clarity and consistency across the breadth of the programme. The development, testing, monitoring and revision of communication activities require professional assistance, time and adequate funding. Education and communication working groups at the national level should involve representatives of key stakeholders groups including the commercial and family poultry sectors. The current HPAI prevention and control programme provides an opportunity to strengthen the communication capacity of animal health services such that livestock and zoonotic diseases in general will be better controlled. Providing people with access to education and communication programmes and materials that equip them with appropriate life skills (such as understanding the components and importance of good hygiene and good animal husbandry) will enable them to both respond more effectively to the current HPAI epidemic and to reduce the opportunities for new diseases to emerge and spread. Acknowledgements Thanks go to our colleagues at the Food and Agriculture Organisation of the United Nations (FAO), the International Livestock Research Institute and the International Rural Poultry Centre of the KYEEMA Foundation for their collaboration on HPAI communication issues. Thanks also go to the veterinarians, extensionists, researchers, traders and farmers in many parts of the world who have given freely of their time and expertise over the years. Financial support provided by Japanese Official Development Assistance, the Asian Development Bank and the US Agency for International Development for the FAO s HPAI prevention and control programme, under which the both authors have been employed as consultants, is gratefully acknowledged. References ALDERS, R. (2006a) Education and communication challenges and gaps in HPAI control. In: Avian Influenza Rapid Appraisal and Pro-Poor Livelihoods Agenda Consultation Preliminary Assessment of Lessons Learned (A. Omore et al., Eds.). International Livestock Research Institute, Nairobi, Kenya. ALDERS, R. (2006b) Highly Pathogenic Avian Influenza: establishing a learning system to capture and enhance knowledge of pitfalls and best practices in controlling outbreaks of zoonotic diseases. Presentation at the ALive Research Proposal Development Workshop, 4-6 July 2006, Nairobi, Kenya. ALDERS, R. (2006c) Prevention and control of HPAI in Lao PDR. Consultancy report to ECTAD FAO, April 2006, Bangkok, Thailand. ALDERS, R. (2006d) Prevention and control of HPAI in SE Asia. Consultancy report to ECTAD FAO, October 2006, Bangkok, Thailand. ALDERS, R. (2006e) Thoughts on information, education and communication material available on the prevention and control of HPAI. Discussion paper ECTAD FAO, November 2006, Bangkok, Thailand. ALDERS, R. and AMARAL, A. (2006) Poultry production in Timor-Leste. Rural Poultry enewsletter, 8th Edition, pp 8-9; ALDERS, R. and PIZZARI, M. (2006) Effective communication: the foundation of efficient prevention and control of HPAI. Paper presented at the Second HPAI Japanese Trust Fund Joint Steering Committee Meeting, December 2006, Bangkok, Thailand. World s Poultry Science Journal, Vol. 63, March

8 010028_Journal_ :59 Pagina 150 BAGNOL, B. (2006) Improvement of village chicken production: a PRA study. Report to IRPC/KYEEMA Foundation and FAO Mozambique (component of project GCP/MOZ/079/BEL), October BAGNOL, B. (2006) Bicycles, boots, T-shirts and percentage over payment for vaccination: What role for community leaders? Paper presented at the International Conference on Opportunities for village chickens to assist with poverty alleviation with special emphasis on the sustainable control of Newcastle disease hosted by the AusAID Southern Africa Newcastle Disease Control Project in collaboration with the FAO, 5-7 October 2005, Dar es Salaam, Tanzania. BAGNOL, B. (2000) Investigação acerca do controle da doença de Newcastle das galinhas do sector familiar. Australian Centre for International Agricultural Research and the Mozambican National Veterinary Research Institute, January 2000, Maputo, Mozambique. FAO (2006) Guidelines on Communication for Rural Development: a brief for development planners and project formulators. (3 of 11) Accessed 7/12/2006. FREIJI, M. (2006) Avian Influenza Perspectives and Communication Issues from the Commercial/Private Poultry Sector. Paper presented at the World Congress on Communication for Development, 27 October 2006, Rome, Italy. GTZ (2006) Policies against hunger V: Food Security and Poultry Production How to cope with Avian Influenza. International Workshop hosted by the Federal Ministry of Food, Agriculture and Consumer Protection and GTZ, Berlin, Germany October, Accessed 28/12/2006. HANCOCK, J. (2006) Report on an electronic consultation on compensation and HPAI. ECTAD Socioeconomic Group, 18 October 2006, FAO, Rome, Italy. PATH (2002) Developing materials on HIV/AIDS/STIs for low-literate audiences. Program for Appropriate Technology in Health, December 2002, Washington DC, USA. RISSE, M. and HARRIS, G. (1999) Best management practices for wood ash used as an agricultural soil amendment. Soil acidity and liming internet inservice training. Cooperative Extension Service, the University of Georgia College of Agricultural and Environmental Sciences. bestwoodash.html Accessed 14/08/2006. SANDMAN, P.M. and LANARD, J. (2005) Bird flu: communicating the risk. Perspectives in Health 10(2): 2-9. UNSIC (2006) Avian and human pandemic influenza: consolidated action plan for contributions of the UN system. UN System Influenza Coordinator, UN Development Group, 3 July 2006, New York, USA. 150 World s Poultry Science Journal, Vol. 63, March 2007

9 010028_Journal_ :59 Pagina 151 Table 1 Comparison of factors at the country level that may influence the efficiency with which HPAI can be controlled (adapted from Alders, 2006b). Criteria Countries where HPAI was Countries where HPAI control was quickly controlled difficult % of households Low most poultry produced High many households raise small raising poultry on large commercial farms poultry flocks; commercial farms also present Farmer - poultry Strong Poor health service links Farmer perceptions Aware of the role of infectious Traditional disease often understood of disease agents to be caused by supernatural phenomena Literacy rate High Low to medium Annual poultry Low High mortality % medium, Low most poultry produced Medium small-scale commercial intensive farms on very large commercial poultry units commonplace (200-2,000 birds) farms Table 2 Differential diagnosis for HPAI (adapted from Alders, 2006e). Clinical signs Intensive production Extensive production Other diseases causing Newcastle disease Newcastle disease sudden high mortality Infectious laryngotracheitis Acute fowl cholera Infectious bursal disease Duck plague (Duck Virus (Gumboro disease) Enteritis) Acute fowl cholera Acute poisonings Duck plague (Duck Virus Enteritis) Acute poisonings Other diseases causing Acute/chronic fowl cholera and Acute/chronic fowl cholera and swelling of combs and other septicaemic diseases other septicaemic diseases wattles Bacterial cellulitis of the comb Bacterial cellulitis of the comb and wattles and wattles Table 3 Information collected from District Livestock Workers in Timor-Leste in September 2006 (Alders 2006d). Liquiça Ainaro Baucau Suai Dili Oecusse Ermera Aileu Same Bobonaro Manatuto Local name for Lacar No local Pesti Gripe Manu Men Isfani Rai Is Gripe manu Pesti Lakar / rai is Pesti manu Newcastle disease name manu manu mpeu manu World s Poultry Science Journal, Vol. 63, March