Baseline Knowledge Attitudes Practices Survey of Animal Health Workers on Avian and Human Influenza

Transcription

1 Baseline Knowledge Attitudes Practices Survey of Animal Health Workers on Avian and Human Influenza Prepared by Nielsen Vietnam for Avian Influenza Behavior Change Communication (AI BCC) Academy for Educational Development Funded by United States Agency for International Development August 19, 2009

2 Contents Context Methodology and Sample Design Research Objectives Sampling Techniques Respondent Definition How Did We Collect Data Questionnaire Flow Detailed Findings

3 Context Methodology and Sample Design Research Objectives Sampling Techniques Respondent Definition How Did We Collect Data Questionnaire Flow Detailed Findings

4 Context Under the Provincial Program on Avian and Human Influenza (AHI) funded by USAID, AED s AI BCC project is implementing training, communication and research activities to improve understanding and practices of small commercial poultry farmers and animal health workers regarding AHI in The provincial package covers Ha Nam and Hung Yen in the north, Quang Tri in the center and Can Tho and Kien Giang in the south. AED is coordinating interventions with other USAID-partners i.e., FAO, WHO, Abt Associates. Majority of AED interventions at the commune level are in three provinces Ha Nam,, Quang Tri and Kien Giang. Through a competitive bidding process, Nielsen Vietnam was awarded a contract by AED to conduct a Knowledge- Attitudes-Practices (KAP) Survey of Animal Health Workers and Small Commercial (sector 3) Poultry Farmers to serve as baseline to monitor and assess training and other activities. This is the report on the Baseline Animal Health Worker survey

5 Business Needs Assessment Methodology and Sample Design Research Objectives Sampling Techniques Respondent Definition How Did We Collect Data Questionnaire Flow Detailed Findings

6 Research Objectives : To gather information on Knowledge, understanding and beliefs of animal health workers on AI, its symptoms, modes of transmission, preventive measures in poultry and actions to take when an AI outbreak occurs in farms and communities Knowledge, understanding and beliefs of animal health workers on transmission of AI to humans specifically symptoms of human H5N1 influenza and key preventive measures Practices of animal health workers regarding prevention, control and reporting of AI occurrence in their areas of coverage, if outbreaks have occurred; if outbreaks have not occurred, what practices they are doing and plan to do Knowledge of animal health workers on what actions to take if household members show symptoms of human H5N1 influenza Sources of information on the above matters and perceived credibility of those sources.

7 Research Design Sampling Techniques Purposive Sampling Geographic coverage: Ha Nam, Quang Tri, Kien Giang Fieldwork: Ha Nam started on June 01 and ended on June 10 Quang Tri started on May 24 and ended on June 02 Kien Giang started on May 24 and ended on June 05 Respondent Criteria Animal Health Worker (AHW) Licensed or non licensed Aware of Avian Influenza Sample Size Total sample size N=511 Ha Nam (N= 150 for AHW) Quang Tri (N= 165 for AHW) Kien Giang (N= 196 for AHW)

8 How Were Animal Health Workers Recruited? Overall, there are three levels of sampling for a sample design: Level 1 "Random Sampling ; Level 2 "Quota Sampling - Fixed Route and Level 3 "Quota Sampling - Open Route. In this study, we used Level 3 Purposive Random Sampling. Below describes step by step how animal health workers were recruited Step 1 At Provincial level, Group Leaders (GL) contacted the key contact people of the Veterinary Department of Ha Nam, Quang Tri and Kien Giang. Here, an introductory letter was issued for GL to be used in Districts Step 2 At District level, GL was provided with the key contact people of Communes Step 3 At Commune, interviewers are provided contact information of the animal health workers from head of villages.

9 Kim B ng TX. Phñ Lý Thanh Liª m Duy Tiª n B nh Lôc Lý Nh n Ha Nam Province Location: the south-west of the Red River delta Area: 850 square km Population: 837,662 Economy: mainly agriculture, forestry and aquaculture (making of one third of total provincial GPP) Other useful facts in 2008: Number of licensed veterinarians: 57 Number of licensed animal health workers: 827 No District Binh Luc#* (n=30) Duy Tien# (n=30) Ly Nhan# (n=30) Kim Bang# (n=40) Studied Communes Dong Du*; Binh Nghia; Dinh Xa; Trang An; Dinh Nghia; Trinh Xa Duy Minh*; Yen Bac; Duy Hai;Hoang Dong Nhan My; Nhan Thinh; Duc Ly; Dao Ly; Dong Ly; Nguyen Ly; Cong Ly Thanh Son; Lien Son; Khai Phong; Ba Sao Thuy Loi; Ngoc Son; Dong Hoa; Thi Son; Kim Binh 5 Thanh Liem# (n=40) Kien Khe; Thanh Ha; Thanh Tuyen; Thanh Binh; Lien Thuan; Thanh luu; Thanh Thuy; Liem Can; Liem Kiet; Thanh Tan # where fieldwork was conducted * where there was AI outbreak

10 Quang Tri Province Location: North Central Vietnam Area: 4,760 square km Population: 625,800 Other useful facts in 2008: Number of licensed veterinarians: 50 Number of licensed animal health workers: 543 No District Gio Linh*# (n=45) Trieu Phong*# (n=30) Vinh Linh# (n=30) Cam Lo# (n=30) Studied communes Gio My*; Trung Son*; Gio Thanh*; Gio Phong; Trung Hai Trieu Trung*; Trieu Do; Trieu Trach; Trieu Son Vinh Thuy; Vinh Hoa; Vinh Long; Vinh Son Cam Thanh; Cam Tuyen; Cam Hieu 5 Dong Ha# (n=30) Dong Luong 6 Hai Lang# (n=15) Hai Thanh; Hai Truong # where fieldwork was conducted * where there was AI outbreak

11 Phó Quèc Kiª n H i TX. Hµ Tiª n Kiªn L- ng Hßn Êt An Minh An Biªn Ch u Thµnh T n HiÖp VÜnh ThuËn Gß Quao Giång GiÒng TX. R¹ch Gi Kien Giang Province Location: Mekong delta of Southern Vietnam Area: 6299 square km Population: 1,634,043 Other useful facts in 2008: Number of licensed veterinarians: 17 Number of licensed animal health workers: 370 No District Go Quao#* (n=30) Tan Hiep#* (n=30) An Bien# (n=30) Giong Gieng# (n=30) Chau Thanh# (n=35) Studied communes Vinh Tuy*; Thoi Quan; Dinh Hoa; Dinh An Tan Hiep A*; Tan Thanh; Tan An;Tan Hoi; Tan Hiep B; Thanh Dong 3; Thanh Tri Ham Yen*; Dong Thai; Dong Yen; Hung Yen; An Bien; Thu 3 Town; Tay Yen; Tay Yen A; Nam Thai; Nam Thai A Ngoc Truc; Giong Gieng Town; Long Thanh; Ngoc Thanh; Da Ban Thach Minh Luong; Mong Tho; Mong Tho B; Mong Tho A; Minh Hoa; Thanh L?c; Gi?c Tu?ng; Vinh Hoà Hi?p; Vinh Hoà Phu; Bình An Hon Dat# (n=23) Son Kien; Nam Thai Son; Binh Giang; Binh Son; Hon Dat Town; Lin Huynh; My Hiep son; My Lam; My Phuoc; My Thai; My Thuan; Son Binh; Tho Son; Soc Son Town 6 Kien Luong# (n=18) Duong Hoa; Kien Binh; Vinh Dieu; Vinh Phu; Kien Luong Town; Binh An; Binh Tri; Phu My; Hoa Dien; Phu Loi; Tan Khanh Hoa # where fieldwork was conducted * where there was AI outbreak

12 Questionnaire Flow Screening questions (Q2-Q5) Awareness Of Avian Influenza (Q6-Q7) Past Training On Avian Influenza (Q8-Q17) Knowledge Of Avian Influenza Among Poultry (Q18-Q22) Prevention And Control Of Avian Influenza Among Poultry (Q23- Q62) Knowledge of Avian Influenza To Humans (Q63-Q75) Sources of Avian Influenza Awareness (Q76ab) Media Habits (Q77-Q82ab) Demographics (Q83-Q88) 32 OPEN ENDED QUESTIONS, 56 CLOSED ENDED QUESTIONS

13 Business Needs Assessment Methodology and Sample Design Research Objectives Sampling Techniques Respondent Definition How Did We Collect Data Questionnaire Flow Detailed Findings

14 1.Avian Influenza Awareness

15 7 out of 10 AWH are males, 65% of them belong to class EF. Most of them are from ages 36 and above and have varied education levels. More than 80% have received AI training. Profile Of Animal Health Workers Gender Male 72% Attending AI training Trained 86% Female 28% None Trained 14% 25 and below 9% Primary and Elementary school 26% % High school 24% Age % Education Diploma/ Vocational training 12% 46 and above 45% College 34% AB 0% Bachelor degree 4% SEC CD 34% Raise Poultry Raising poultry 63% EF 65% Non-raising poultry 37%

16 All AHWs are aware of Avian Influenza in overall and the top three knowledge of AI are related to the transmission of AI, an infectious caused by H5N1 virus and cause fatal disease to humans. Have you heard of Avian Influenza? Is transmissible to humans Is an infectious disease caused by H5N1 virus in the air What do you know about AI? Cause fatal disease to humans A disease that can cause massive death 45% 39% 56% 100% Yes Has strong spread Avian flu is a very dangerous infectious disease among poultry H5N1 disease is originated from poultry Is transmissible among poultry Easily cause a fatality to poultry Easily transmit to humans through respiration H5N1 causes a heavy damage to the economy Has no cure yet/can only vaccinations for prevention for this disease 27% 23% 19% 19% 13% 10% 10% Source: Q6. Have you heard of Avian Influenza? (Close-end) Source: Q7. What you know about AI? (Open-end)

17 More than 80% of AHW have attended an AI training recently and the key organizer is Sub-DAH. Have you ever attended AI training before? Who organized the AI training? Sub-DAH 74% 14% Vietnam Poultry Association 15% 86% Local vet centre 4% Food and agriculture organisation/fao 3% Yes No Department of animal health of Vietnam 1% Vietnam Veterinary Association 1% Source: Q8. if you ever attended a training about Avian Influenza before? (Close-end) Q11. Who organized the training? (Close-end)

18 78% say that the most recent AI training attended was about prevention methods to H5N1 and the training was held 1-5 months ago. What were the training about? Those Who Attended AI Training (n=439) When did it happen? Those Who Attended AI Training (n=439) Prevention methods to H5N1 Symptoms/ signs/ ways to recognize H5N1 among poultry 25% 78% 1 month ago 35% Vaccination skills/ knowledge 14% Communication about the Avian Flu awareness 10% 2-5 months ago 26% Consequences/impacts of the disease 9% Causes of the disease 7% Skills to deal with the areas with H5N1 outbreaks Communicate local community that H5N1 is a dangerous virus 7% 6% 6-12 months ago 16% Source: Q12. What was the training about? (Open-end) Source: Q9. When was the last time attending the most recent AI training? (Close-end)

19 Only 29%of AHW attended another AI training and Sub-DAH is also the key organizer for this training. Aside from the most recent AI training, did you attend any other AI training? Who are the organizers? Who Said Attended Another AI Training (n=129) Sub-DAH 79% Vietnam Poultry Association 9% 71% 29% Women union of province/district 3% Local vet centre 3% Association of local farmers 2% Yes No Agricultural extension centre 2% Source: Q13. Aside from the most recent AI training, did you attend any other training on AI? (Close-end) Source: Q16. Who organized this training? (Close-end)

20 The contents of the other AI training AHWs attended focus on prevention and symptoms and the training was conducted over one year ago. What was the training about? Those Who Attended Another AI Training (n=129) When did it happen? Those Who Attended Another AI Training (n=129) Prevention methods to H5N1 72% Trainings on symptoms/signs/ways to recognize H5N1 among poultry 22% 1 month ago 7% Vaccination skills/knowledge 15% Skills to deal with the areas with H5N1 outbreaks Communicate local community that H5N1 is a dangerous virus 9% 8% 2-5 months ago 22% Ways to clean breeding facilities Consequences/impacts of the disease 8% 7% 6-12 months ago 24% Ways to raise poultry 5% Communication about the Avian Flu awareness 4% Over 1 year 47% Disinfection methods 4% Source: Q17. What was the training about (Open-end) Source: Q14. When did it happen (Close-end)

21 2. Knowledge of Avian Influenza among Poultry

22 Overall, most of AHW know all birds can get AI. Key reasons for poultry to get AI are related to birds migration and transporting poultry from place to place. Which birds can get AI? What cause poultry to get AI? All birds 85% Birds' migration can transmit the disease to other poultry Transport the poultry from the infected place to this place 41% 21% Chickens 15% Do not clean the breeding facilities often or clean enough Poultry drink water that carries the disease 13% 12% Ducks 15% Unexpected change in weather Poultry do not have vaccinations Due to the unclean raising environment 12% 8% 8% Geese 5% Let poultry run free in fields Eat foods that carry the disease 7% 6% Turkey Wild bird 5% 2% Contact other sick poultry Through the feces/respiration of birds Wet condition/place make the poultry weak hence the disease easily attracks Buy a sick breeding poultry Buy uncertified/unknown poultry 6% 5% 5% 4% 4% Local people throw dead poultry negligently 4% Source: Q18. Which birds can get AI (Close-end) Source: Q19 What cause poultry/bird to get AI (Open-end)

23 Symptoms recognized in Chicken and Ducks are similar. Very few AHWs mentioned sudden massive death as one of the common symptoms of AI. What are the symptoms that show CHICKEN get AI? What are the symptoms that show DUCK get AI? Sluggish/sick chicken 59% Sluggish/sick chicken 51% Crest/skin/mouth/tongue becomes black and blue 49% Suffers from in appetence 26% Suffers from in appetence 30% Feather is ruffled up/lost 21% Redden the skin areas without hair/at legs Salivates at mouth/nose 29% 28% Redden the skin areas without hair/at legs Mass death among poultry Convulsive/go around 20% 18% 17% Feather is ruffled up/lost 26% Salivates at mouth/nose 14% Feces are white/green/light red/liquid 20% Lose balance in movement 14% Mass death among poultry 15% Feces are white/green/light red/liquid 14% High fever 15% High fever 12% Source: Q20/Q21 Sign/symptom on duck/chicken that have got AI (Open-end)

24 80% of AHWs say ducks can be infected without showing any symptoms. Can ducks be infected with AI even without showing any symptoms? 20% 80% Yes No Source: Q22 Can ducks be infected with AI even without showing any symptoms (Close-end)

25 3. Prevention and Control of Avian Influenza among Poultry

26 Majority AHWs consider AI is very serious. Key reasons for considering AI very serious/serious is related to fatality and incurability of H5N1. How serious the AI is? Why do you think AI is serious? All Animal Health Workers (n=507) Fatal disease to humans/quick death among humans if do not have timely cure Is transmissible to humans 52% 70% 6% 1% Heavy damages to the economy 44% Cause massive death among poultry Speedy transmission 25% 20% 93% Very serious (5.0) Serious (4.0) Neutral (3.0) Not serious (2.0) Not very serious (1.0) Affect the public health Not cure for humans yet It is an infectious virus Cause death among poultry Wide spread Cause disease among poultry Transmit to other animals 6% 5% 5% 4% 3% 3% 2% Source: Q23 How serious is avian influenza (Close-end) Source: Q24 Why do you think AI is serious (Open-end)

27 According to AHW, actions which are farmers can take to prevent AI in poultry are Vaccination, Regular Cleaning and Disinfection. What can be done by farmers to prevent AI from occurring in poultry? Timely/periodic vaccination Clean the breeding facilities regularly 67% 59% Disinfect the breeding facilities Spray lime around the breeding cage/holes for burying dead poultry Do not allow poultry run freely Keep flocks separately/separate sick poultry from the flock Raise certified and known poultry/assured breed Wear glove, mask, protection clothes when contacting poultry Protect the cage carefully/closed cage/open cage with fence Do not allow people to contact dead/sick poultry Do not prepare/eat sick/dead poultry Report to animal health centre 9% 9% 6% 6% 5% 4% 3% 2% 2% 34% Source: Q25 What can be done by farmers to prevent AI from occurring in poultry (Open-end)

28 According to AHWs, if farmers find sick poultry in their farm, the first thing farmers should do is report to the nearest vet (74%) then keep flock separately from the sick poultry (51%). What should be done by farmers if they find sick poultry in their farm? Report to the nearest vet 74% Keep flocks separately/separate sick poultry from the flock Report to a local authority 24% 51% Disinfect the breeding facilities Do not prepare/eat sick/dead poultry Timely/periodic vaccination Do not transport, sell, buy sick poultry Strictly monitor flocks of poultry to prevent disease in time Do not allow people to contact dead/sick poultry Clean the breeding facilities regularly Spray lime around the breeding cage/holes for burying dead poultry Destroy immediately after the poultry is dead 7% 5% 5% 4% 4% 3% 3% 2% 2% Source: Q26. What should be done by farmers if they find sick poultry in their farms (Open-end)

29 AHWs say that farmers should Report to the nearest vet (69%) if they find dead poultry in their farm followed by Bury dead poultry (37%). What should be done by farmers if they find dead poultry in their farm? Report to the nearest vet 69% Bury dead poultry/put the dead poultry into a nylon pack and bury it deeply Destroy immediately after the poultry is dead Report to a local authority Disinfect the breeding facilities Spray lime around the breeding cage/holes for burying dead poultry Keep flocks separately/separate sick poultry from the flock Do not allow people to contact dead/sick poultry Do not transport, sell, buy sick poultry Do not prepare/eat sick/dead poultry Clean the breeding facilities regularly Do not throw the dead poultry negligently 37% 26% 23% 19% 14% 11% 7% 7% 6% 5% 4% Source: Q27. What should be done by farmers if they find dead poultry in their farms (Open-end)

30 When receiving a report of sick poultry from a farmer, the first action AHWs will do is Come to identify the reason causing the death of the poultry (63%). What should AHW do if they receive a report of sick poultry from farmer? Come to identify the reason causing the sick of the poultry and if it is caused by H5N1 Separate the sick poultry from the flock/communicate people not to let their poultry to contact with the infected poultry Report to animal health centre Quickly come to the place reported with the H5N1 outbreak Report to everyone about the place with the outbreak and localize that place Test the sample to check if there is H5N1 or not Keep track of each poultry to give medicine Directly spray chemicals to disinfect the farm with other people Follow guideline Report to local government Burn the dead poultry (put into the nylon pack) Report to superior/specialized organizations 28% 18% 18% 15% 12% 10% 9% 8% 7% 5% 5% 63% Source: Q28. What should you, as an animal health worker, do if you receive a report of sick birds from a farmer (Open-end)

31 If AHW receives a report of dead poultry from a farmer, AHWs will Burn the dead poultry (39%) and/or Come to identify the reason causing death of poultry (37%). What should AHW do if they receive a report of dead poultry from farmer? Burn the dead poultry (put into the nylon pack) Come to identify the reason causing the death of the poultry and if it is caused by H5N1 Dig holes to bury poultry/ dig hole to bury poultry placed in a nylon pack Report to animal health centre Test the sample to check if there is H5N1 or not Quickly come to the place reported with the H5N1 outbreak Report to everyone about the place with the outbreak and localize that place Directly spray chemicals to disinfect the farm with other people Distribute the lime around the cage/ buried hole Follow guideline Report to local government Separate the sick poultry from the flock/communicate people not to let their poultry to contact with the infected poultry 39% 37% 25% 20% 19% 17% 15% 14% 13% 13% 10% 9% Source Q29. What should you, as an animal health worker do if you receive a report of dead birds from a farmer (Open-end)

32 Majority of AHWs think an AI outbreak will not likely happen in their commune because poultry are vaccinated. The minority who say AI will likely happen cite the habit of letting poultry run freely, migration and not having proper vaccination as reasons. How likely do you think that there will be an AI outbreak in your commune? Very likely not happen (1.0) Likely not happen (2.0) Slightly not happen (3.0) Neutral (4.0) 11% 35% 17% Reasons AI Unlikely to happen (n=481) Follow full vaccination: 50% Always prevent strictly: 14% Local people here have a good awareness of Avian Flu: 9% People keep their breeding facilities cleaned: 9% People carry out properly the communication activities: 6% Slightly happen (5.0) 6% 2% Likely happen (6.0) Very likely happen (7.0) 25% 4% Reasons AI likely to happen (n=158) Raising habit to let poultry run freely: 6% Can not control the number of birds migrated from other places: 5% Poultry does not have proper vaccination: 5% Total (n=511) Q31 (Close-end) Q32: Open-ended

33 All AHWs say they are doing something to prevent poultry in their area from getting AI. Communicating to people to continue full vaccination is the main action (72%) followed by telling people not to neglect cleaning of breeding facilities (34%). As an AHW, are you doing anything to prevent poultry not getting H5N1 in your areas? Q33 Yes 100% 0% No What are you doing? Communicate people to continue vaccinations 100% Do not neglect with the cleaning of breeding facilities Follow guideline Communicate people to buy breeding animal with the clear origin and quarantined Directly spray chemicals to disinfect the farm with other people Instruct people about the methods to prevent H5N1 Communicate people to not transport, sell sick poultry Request people to wear glove, mask, protection clothes when contacting poultry Communicate people to be aware of the danger of the epidemic disease Do not slaughter/eat sick/dead poultry Communicate people to wash their hands with clean water and soap before and after contacting poultry Distribute the lime around the cage/ buried hole 5% 4% 4% 4% 3% 3% 15% 13% 13% 11% 34% 72% Source: Q34. What are you doing to prevent poultry in your areas from getting avian influenza even if there is no outbreak (Open-end)

34 Other actions by AHWs to prevent poultry in their area are related to hygiene and communication like washing hands with soap and water. Apart from that, what else are you doing? Wash hand with clean water and soap BEFORE AND AFTER contacting with poultry Communicate farmers/others not buy or sell poultry that has been sick or dead Communicate to farmers to only buy breeders from certified or known sources Communicate farmers/others to keep poultry in a protected environment (enclosed building/ fenced area) Immediately report of sick or dead poultry to veterinary officials and local authorities Communicate farmers/others avoid contacting with sick and dead poultry Communicate to farmers to wear mask and gloves when handling poultry Communicate farmers/others to keep all poultry brought to the farm separate from other poultry for at least 2 weeks Communicate to farmers to clean and disinfect their farm regularly Communicate farmers/others to control entries into the farm (do not let middleman enter the farmyard, keep visitors away from poultry etc Communicate farmers/others to vaccinate poultry against AI 71% 70% 67% 66% 63% 61% 59% 58% 54% 54% 40% Source: Q35. Apart from that, what else are you doing to prevent poultry in you commune from getting AI H5N1 even if there is no outbreak (Close-end)

35 All AHWS report they are doing something to inform farmers in their area on what to do if there is an AI outbreak. 25% of AHWs say that they request farmers to report immediately to vet centre when they have an AI outbreak in poultry. Are you doing anything to inform farmers on what to do if there is AI outbreak? What are you doing? All Animal Health Worker (n=511) Request farmer to report veterinary centers immediately when finding out H5N1 among their poultry Request farmer use PPE when contacting poultry 25% 22% 100% Yes Communicate people to keep their breeding facilities clean Advise them not to eat/slaughter sick/dead poultry Communicate people not to transport chicken/ducks to the area with the H5N1 outbreak Limit contacting sick/dead poultry (including children) Regularly spray disinfections chemicals Before and after contacting poultry, wash hands with clean water/soap Guide/directly meet people to guide people about H5N1 prevention Communicate farmer to disinfect their farm Through a loud speaker of the commune Temporarily keep the poultry separately during the outbreak 18% 14% 12% 11% 9% 9% 8% 7% 6% 6% Source: Q36. Are you doing anything to inform farmers in your area on what to do if there is an AI outbreak (Close-end) Source: Q37. As an animal health worker, what are you doing to inform farmers on what to do if there is an AI H5N1 outbreak (Open-end)

36 Other actions by AHWs are mostly communication activities as described as below. Apart from that, what else are you doing if there is an outbreak? Communicate to farmers to wash hands with clean water and soap before and after contacting with poultry Communicate with farmers to immediately report sick or dead poultry to vet or village head Communicate with farmers not to transport any poultry from outbreak area Communicate with farmers to use mask and gloves when handling any poultry Communicate farmers/others avoid contacting with sick and dead poultry Communicate with farmers not to eat sick or dead poultry Communicate farmers/others that if people had contact with poultry and have fever to immediately go to their local health center or hospital Communicate farmers/others not buy or sell poultry that has been sick or dead Communicate with farmers to clean and disinfect their farm Communicate farmers/others eat only thoroughly cooked poultry and poultry products (no pink meat or runny eggs) Communicate farmers/others to control entries into the farm (do not let middleman enter the farmyard, keep visitors away from poultry etc 75% 72% 70% 66% 62% 60% 59% 57% 57% 57% 50% Source: Q38. Apart from that, what else are you doing to inform farmers on what to do if there is an AI outbreak (Close-end)

37 Almost all AHWs claim to give vaccination to poultry in their area. Most AHW gave vaccination within last month. Have you given vaccination to poultry in your area? When was the last time you gave vaccinations? Those who gave vaccinations (n=506) Last week 14% 1% Last two week 23% 99% Last three week 16% Last month 15% Yes No Before last month 27% Source: Q40. Have you given vaccinations to poultry in your area (Close-end) Source: Q41. When was the last time you gave vaccinations (Close-end)

38 93% AHW say ducks require 2 vaccinations. 77% AHW say days is the days apart the first and second vaccination. Most of AHW claim giving vaccination to ducks from 15 days or older. How many vaccinations do DUCK require? How many days apart should the first and second vaccination be given? Those who ans Code 2 to 3 in Q43 (n=502) 1-14 days 4% 5% 2% days 15% days 77% 93% Over 30 days 5% First Vaccination To Ducks One Two More than two Q43. How many vaccinations do ducks require (Close-end) 1-14 days: 4% 15-27: 15% days: 77% Over 30 days: 5% Source: Q44. How many days apart should the first and second vaccinations be given (Close-end) Source: Q45. When should the first vaccination for ducks be given (Close-end)

39 84% of AHWS say that vaccination is not harmful to young ducks. Of the 16% AHWS who say that vaccination is harmful to young ducks, 53% claim that young ducks can get side effects from vaccinations. Is vaccination harmful to young duck? Why do you think vaccination harmful to your duck? Those who ans Code 2 to 3 in Q43 (n=83) Young duck can get side effect from vaccination such as light fever, quit eating 53% Immune system of young ducks is weak and vaccination is strong hence this can cause fatal harm to young duck 20% 84% 16% Vaccination for weak young duck will only weaken them 13% Cause the duck grow slowly 12% Cause slow growth in the young ducks' feather 11% Yes No Some young ducks can not stand the chemicals in the vaccination 8% Affect the wings of the ducks 1% Q46. Is vaccination harmful to young ducks (Close-end) Source: Q47. Why do you think that vaccination harmful to young ducks (Open-end)

40 Nearly all AHWs say they wear something when handling poultry. 97% say they wear mask and gloves when handling poultry. Of those who wear mask and gloves, 65% say they wear them always. Do you wear anything to protect yourself when handling with poultry? What do you wear? Those who claimed to wear (n=507) Mask 3% 1% Glove and Mask 97% 99% How frequently do you wear Glove & Mask? Those who claimed to wear Glove & Mask (n=493) Yes No Always 65% Often 34% Sometimes 1% Q48. do you wear anything to protect yourself when handling poultry (Close-end) Q49. What do you wear (Close-end) Q50R3. How often do you wear-mask and gloves (Close-end)

41 All AHWs say they wash hands with soap and clean water when handling poultry. 61% of AHWS report that they always wash before and after handling poultry while 21% say they always wash after handling poultry. Do you wash your hands with soap and water when handling poultry? How often do you wash your hands? Always before and after handling poultry 61% Always after handling poultry 21% 100% Often before and after handling poultry 8% Often after handling poultry 6% Yes No Sometimes before and after handling poultry 1% Always before handling poultry 1% Sometimes after handling poultry 1% Q51. As an animal health worker, do you wash your hands with soap and water when handling poultry (Close-end) Source Q52. How often do you wash your hands with soap and water when handling poultry (Close-end)

42 87% of AHWs who always wash hands before and after handling poultry say the reason is to prevent transmitting disease to poultry. 63% AHWs report changing clothes frequently after handling poultry. Why do you wash your hands? Those who claimed always wash hands (n=312) How Often Do You Change Your Clothes After Handling Poultry? Prevent transmitting germs to poultry/prevent transmitting the disease from poultry 87% Every time 14% Protect myself 30% Frequently 63% Kill germs 12% Sometimes 13% I also have germs on my hands before contacting poultry 2% Rarely 9% Avoid feeling of dirt 1% Never 1% Source: Q53R1. Why do you wash your hands with soap and water when handling poultry (Open-end) Source Q54. How often do you change your clothes after handling poultry (Close-end)

43 82% of AHWs say they do something before entering a farm. Of these, 80% report washing hands with soap and water, 52% report washing shoes or slippers with soap and water. Did you do anything before entering farmer s poultry? What did you do before entering a poultry farm? Those Who Did Some AI Preventions (Code 1 In Q55) 18% Wash hands with soap and water before entering farm 80% 82% Wash shoes or slippers with soap and water before entering farm 52% Yes No Wash bicycle or motorbike tires before entering farm 17% Source: Q55. Before entering someone's poultry farmer, do you do anything to ensure that the poultry in the farm are protected from AI virus from outside (Close-end) Source Q56. What do you do before you enter a poultry farm (Close-end)

44 34% claim to know what is a PPE (Thiết Bị Bảo Hộ Cá Nhân). Of these, 75% say that PPE is mask and/or gloves. Do you know what a PPE is? What is PPE? Those Who Were Aware Of PPE (n=173) Mask 75% 66% 34% Glove Boot/shoe 75% 48% Protective clothes 34% Hat 19% Glass 18% Yes No Is a tool to protect humans infected 12% Raincoat 8% Blue Shirt 8% Source: Q57. Do you know what a Personal Protective Equipment (PPE) is (Close-end) Source: Q58. What is PPE (Open-end)

45 85% of those who know PPEs say it is easy to access. Dong Ha vet centre and sub vet department are two key places to access PPE. 85% of those received training on PPE. Where To Easily Access PPE Those Who Ans Easily Access PPE (n=147) Do you access to a PPE easily? Those Who Were Aware Of PPE (n=173) Dong Ha veterinary center Sub veterinary department 31% 20% 15% Animal health worker comes to distribute District/commune people committee 17% 10% Buy from the local market 9% Local medical centre 8% 85% Yes No Have you been trained on how to use PPE? Those Who Ans Easily Access PPE (n=147) 15% Source: Q59. Do you have easy access to a PPE? (Close-end) Source: Q60. Where can you easily get one? (Open-end) Source: Q61. Have you been trained on how to put it on and use a PPE? (Close-end) Yes 85% No

46 4. Avian Influenza Prevention and Control Among Humans

47 85% of AHWs say they can recognize signs of AI in humans. Causes for humans to get AI are eating sick poultry and contact with infected poultry. 92% of AHWs say high fever is the key symptom of a human with AI. What cause human to get AI? Those Who Were Aware Of AI (n=433) Eat sick poultry 52% Can you always realize when human get AI? Transmits H5N1 to humans when contacting poultry Do not wear PPE when contacting poultry 38% 35% 14% 1% Eat unwell-cooked poultry Through respiration when contacting sick poultry 6% 15% Q63. Open-ended 85% What are sign and symptom of AI among human? Those Who Were Aware Of AI (n=433) Yes No DK High fever Difficult breathing 55% 92% Cough 36% Stiff breast 27% Tired 25% Source: Q62. Can you always realize when humans get AI (Close-end) Headache/lose balance 21% Q64. Open-ended

48 91% of AHWS say that if they think someone has AI, the person should be brought immediately to health center. What should you do if you think someone get AI? Bring immediately to health center 91% Inform community health worker 58% Bring immediately to doctor/hospital 53% Keep patients separated 3% Get medicine from pharmacy/medicine shop 3% Source: Q65a,b. If you think someone has AI, what should you do? (Close-end)

49 24% of AHWS report having had an AI outbreak in their commune; of these, 86% say that the outbreak happened in the commune more than a year ago. Have there been any outbreak of AI in this commune? How long did it happen? Those who said yes (n=120) 1% 2-6 months ago 8% 75% 24% 6 months to 1 year 6% Yes No DK More than one year ago 86% Source: Q66a,b. Have there been any outbreak of AI in this commune? (Close-end) Source: Q67b. How long did that happen in your commune (Close-end)

50 12% of AHWs report having had an AI outbreak in their village; of these, 95% say the outbreak happened in the village more than a year ago. Have there been any outbreak of AI in this village? How long did it happen? Those who said yes (n=60) 12% 2-6 months ago 2% 88% 6 months to 1 year 3% More than one year ago 95% Yes No Source: Q66a,b. Have there been any outbreak of AI in this village? (Close-end) Source: Q67a. How long did that happen in your village (Close-end)

51 16% of AHWs say they face some difficulties which prevent them from doing their work effectively. Of these, 52% say the difficulty is low awareness of local people resulting in non-cooperation in vaccination while 21% say little allowance. Do you confront any problem that prevent you from doing your work effectively? What are the problems? Those Who Said Yes (n=84) Low awareness from the local people hence they do not cooperate in vaccination as they are afraid that vaccination has negative impact on their poultry 52% 84% 16% Little allowance Roads to farms are quite far and not good conditions 21% 12% They are not aware of the consequence of the epidemic disease 10% Yes No Vaccination to wild ducks is very hard 8% People do not report sick flock of poultry because they are afraid that their poultry will be culled 7% Source: Q68. As AHW, do you confront any problems that prevent you from doing your work effectively? (Close-end) Source: Q69. what are these problems? (Open-end)

52 AHWS recommend actions to solve these problems as below : What should be done? Those Who Said Yes (n=84) Explain and communicate with the farmers about the danger of the epidemic disease for the community 39% Request for more allowance to assist communication Communicate people that vaccination is not harmful to poultry Provide the transport (e.g. boats, etc) Communicate people through training Try to persuade by my words Request superior to handle cases Need the support from local government Persuade people about the importance of vaccination in prevention of the epidemic disease Improve the road conditions for easier commuting Training on epidemiology Training on how to handle when there is AI outbreak 23% 11% 7% 6% 6% 6% 6% 5% 5% 2% 2% Source: Q70. What do you think can be done to help in solving these problems? (Open-end)

53 Of things which will help them in improving their work, AHWs cite training on epidemiology (55%), regular meetings with vet (50%), training on culling and outbreak response (50%), among others. What should be done to help you improving your work on AI prevention? Training on epidemiology Regular meetings with vet Training on culling and outbreak response Study visits Training on communication Training on surveillance Communication materials like poster/leaflet Regular meetings with other animal health workers Supervision from vet Uniform/badge/ID 55% 50% 50% 45% 43% 42% 39% 32% 25% 21% Source: Q71. As AHW, what will help you in improving your work on ai prevention and control? (Close-end)

54 76% of AHWs report using visual aids in their work. Aids include vaccination flyers (74%), leaflets (70%) and duck leaflets (69%). All AHWS find them useful in their AI communication. Many AHWs were able to show these materials. Are you using visual aids for AI communicating? What are the materials? Those Who Said Yes (n=387) Vaccination flyer 74% 24% AI prevention leaflet Duck leaflet 70% 69% 76% Hat Bag Duck vaccination poster 34% 27% 41% Yes No Q72. (Close-end) Do you find these materials useful? Those Who Said Yes (n=387) Boots 5% Can I see these materials? Those Who Said Yes (n=387) Q73a (Close-end) 100% Duck leaflet Vaccination flyer AI prevention leaflet Hat Bag 51% 43% 39% 27% 24% Q74. (Close-end) Yes Duck vaccination poster Raincoat 11% 4% Q73b (Close-end)

55 Key sources of AI information for AHWs are television (99%), followed by vet and AI training (73%), loudspeaker (67%), radio (61%). AHWS think television is the most reliable source of AI information followed by AI training. Where did you get AI information? Television Vet AI training that I attended Loudspeaker Radio Newspaper/magazine Neighbor 61% 53% 50% 73% 73% 67% 99% Which source do you consider your most reliable source? Television AI training that I attended Dept of Animal Health (DAH) or Ministry of Agriculture and Rural Development (MARD) Vet 11% 8% 27% 49% People Committee Leaflets 48% 46% People Committee 2% Friends/relatives 45% Radio 1% Dept of Animal Health (DAH) or Ministry of Agriculture and Rural Development (MARD) Billboards/posters 41% 27% Leaflets 1% Agricultural extension worker 24% Loudspeaker 1% Q76a. Open-ended Source: Q76B. Which one do you consider your single most reliable source of information on AI? (Close-end)

56 5. Media Habits

57 AHW watched TV 1-3 hours a day, whilst they listened to the radio rarely, read newspaper one or two times a week and rarely read magazine. How frequently do you read Magazine? How frequently do you watch TV? Everyday 2 More than 4 hours/day 14 One or two times/week hours/day 23 One to two times/month hours/day 32 Rarely hours/day 30 Never 12 Less than 1 hour/day 1 How frequently do you read Newspaper? How frequently do you listen to Radio? More than 3 times/day 17 Everyday 16 One or two times/week 45 One or two times/week 26 Rarely 37 Rarely 41 Never 2 Never 17 Source: Q77/Q78/Q79/Q81.

58 VTV3 and VTV1 are the most often TV channels whilst FM is the most often radio channel. Most Often Radio Channel Those who listen to radio (n=422) Most Often Tivi Channel All Animal Health Worker (n=511) Radio station of VN FM Radio station of VN AM Radio station of HCM people Kien Giang radio station VTV 3 VTV 1 Kien Giang TV Quang Tri TV Ha Nam radio station 3 VTV 2 3 Can Tho radio station 3 Can Tho TV (HCMC/CT) 2 Occasional Radio Channel Those who listen to radio (n=422) Occasional Tivi Channel All Animal Health Worker (n=511) Radio station of VN FM 53 VTV 3 60 Radio station of VN AM 30 VTV 1 54 Ha Noi radio station 19 Kien Giang TV 51 Can Tho radio station 16 Quang Tri TV 28 Ha Nam radio station Radio station of HCM people VTV 2 Can Tho TV (HCMC/CT) Source: Q80/Q82.

59 Thank You