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EID: Knowledge, Attitudes, and Practices regarding Avian Influenza (H5N1), Afghanistan

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  • EID: Knowledge, Attitudes, and Practices regarding Avian Influenza (H5N1), Afghanistan

    DOI: 10.3201/eid1409.071382 -
    Suggested citation for this article: Leslie T, Billaud J, Mofleh J, Mustafa L, Yingst S. - Knowledge, attitudes, and practices regarding avian influenza (H5N1), Afghanistan. Emerg Infect Dis. 2008 Sep; [Epub ahead of print]

    Knowledge, Attitudes, and Practices regarding Avian Influenza (H5N1), Afghanistan

    Toby Leslie, Julie Billaud, Jawad Mofleh, Lais Mustafa, and Sam Yingst
    Author affiliations: Ministry of Public Health, Kabul, Afghanistan (T. Leslie, J. Mofleh, L. Mustafa); US Naval Medical Research Unit 3, Cairo, Egypt (T. Leslie, S. Yingst); London School of Hygiene and Tropical Medicine, London, United Kingdom (T. Leslie); Sayara Media Communication, Kabul (J. Billaud); and United Nations Food and Agriculture Organization, Kabul (S. Yingst)

    From February through April 2007, avian influenza (H5N1) was confirmed in poultry in 4 of 34 Afghan provinces.

    A survey conducted in 2 affected and 3 unaffected provinces found that greater knowledge about reducing exposure was associated with higher socioeconomic status, residence in affected provinces, and not owning backyard poultry.

    Human cases of avian influenza (H5N1) have resulted from contact between humans and infected backyard poultry (


    Risk to humans is also related to frequency of disease occurrence
    in the avian population (5).

    Recently, human-to-human transmission has been reported in the
    neighboring Northwest Frontier Province of Pakistan (2).

    Knowledge of disease is therefore a key factor in reducing exposure and enhancing reporting.

    Overall knowledge was low, although in provinces exposed to intensive IEC campaigns, KAP scores of the population were higher.

    This finding indicated that campaigns had some success in increasing awareness.

    The level of concern generated by the campaign, government response, media reports, and proximity to the outbreak are all likely to contribute to this association.

    Despite this encouraging evidence, level of knowledge was far higher among persons with higher socioeconomic status.

    This finding contrasts with frequency of poultry ownership.

    Exposure risk is therefore likely to be considerably higher among lower
    socioeconomic groups.

    Our results can be broadly generalized to the population, although we did not have access to unsafe districts (most of the districts in southern and eastern Afghanistan).

    This limitation may introduce selection bias, which would underestimate the effect of socioeconomic status because those living in inaccessible areas likely have a lower status than persons in accessible areas.

    Preintervention and postintervention surveys would provide a more robust measure of effectiveness. In the immediacy of an outbreak, this was unfeasible and would have been unethical.

    Although there are limitations to the study design in concluding intervention effectiveness, the results provide evidence to support further intensive campaigns as a response to influenza outbreaks in poultry.

    Several reports have examined KAPs and behavior related to avian influenza (H5N1) (6?9). Similar to the finding in the Lao People?s Democratic Republic (6), our study suggests that conventional education and behavior change messages have a limited effect in populations with
    highest exposure.

    Efforts to ensure that IEC messages are suitable for lower socioeconomic
    groups should be adopted, specifically by improving the knowledge of community leaders, designing messages in a suitable format for the poor and illiterate, and ensuring that the most accessible channels are used.

    Messages should carefully balance the risk for human disease
    against potential nutritional and economic consequences of high population concern (e.g., food scares).

    Successfully promoting behavior change is a lengthy process and requires frequent reinforcement. The acuteness of avian influenza (H5N1) outbreaks requires a concerted effort to enhance knowledge and change behavior among those most at risk in low-income countries.