El Zanaty and Associates

July 2007

This 117-page report details the purpose and results of a community survey carried out to provide information on avian influenza (AI)-related knowledge, attitudes, and practices (KAP) in Egypt. The United Nations Children's Fund (UNICEF) requested that this survey be conducted in order to guide the planning process for, and implementation of, a multi-disciplinary national, society-wide intervention that draws on communication strategies to achieve behaviour change among the Egyptian public related to avian flu. It short, the research showed that the public has gained important, critical knowledge about bird flu due to the health communication interventions undertaken to date, but there still remain a number of areas that require continued attention in the coming phase of the programme.

This communication initiative is being developed in response to the fact that, on February 17 2006, the government of Egypt announced the incidence of Highly Pathogenic Avian Influenza (H5N1) in domestic poultry. One month later, the first death case occurred; since then, the virus has been reported in 19 governorates in Egypt. As of April 2007, 34 human cases had been confirmed, including 14 deaths.

In collecting the baseline data that is presented in this report, evaluators focused, specifically, on an especially vulnerable group - females who are 15 years or older and are engaged in breeding birds, buying, slaughtering, or cooking birds. The goal was to assess this group's awareness and knowledge of transmission of AI, carriers, and preventive measures. Evaluators also sought to establish a quantitative technique to understand attitudes and practices of the most at-risk groups related to poultry breeding, cooking, buying, and slaughtering. In addition, the survey was designed to provide data on vulnerable groups' perceptions related to various parties' roles in combating the disease. The acquisition of accurate and segregated data, it is thought, could be used for audience segmentation or for developing appropriate mass media or interpersonal communication policies related to bird flu in Egypt.

In order to ensure a comprehensive countrywide coverage, 12 governorates were selected for the survey out of the 21 governorates. In total, 3,291 households and 4,009 eligible respondents were interviewed. Following a description of characteristics of individual respondents, the report shares findings about health hygiene practices such as handwashing. For instance, the majority of respondents wash their hands with water and soap 4 times or more per day, but differentials were found by urban-rural residence, and by educational level.

Questions were asked to assess respondents' media habits in general, and exposure to health (not AI-specific) hygiene media messages in particular. To cite one finding about general habits, 93% of respondents reported watching television regularly or occasionally, whereas 28% reported listening to the radio, and (among literate people) only 35% reported reading a newspaper/magazine at least occasionally. Particular health-related media messages to which respondents had been exposed in the 12 months preceding the survey are outlined here. For instance, slightly more than one-quarter of respondents were exposed to any messages about handwashing from different sources; the majority of them received the message via TV.

Respondents were also asked about exposure to any TV spot/programme, radio advertisements/programmes, printed media, or community meetings that focused on avian flu; for each media channel, respondents were asked what they learned from the message. Approximately 9 in 10 respondents reported exposure to AI messages through any source, with exposure by far the highest through TV. The percentages of respondents who received messages about AI from other sources are low: radio spots were mentioned by only 5%, and newspapers/magazines by only 12%. Messages learned, as reported by the majority of respondents are: how to handle birds during slaughtering and cooking (58%), how to protect oneself from AI (54%), how to identify an infected bird (49%), and what is AI (44%).

Specific details about respondents' AI-related knowledge are shared here. Here are a few selected findings from these sections of the report:

• Knowledge of AI transmission to humans from birds is universal (99%) across all background characteristics.
• 92% of respondents mentioned that they know symptoms of AI among birds, and 80% know the symptoms of AI in humans.
• The majority of respondents (92%) reported knowing modes of transmission of the virus.
• Virtually all respondents reported that they know a protective behaviour to avoid getting infected with AI (96%); yet only 37% mentioned handwashing regularly with water and soap as a preventive behaviour.
• Two-thirds of respondents reported that they have heard about the AI vaccine. (Clear
  variation was observed in knowledge by place of residence, education, and wealth
  quintiles). The majority of respondents either reported that they have heard about the AI vaccine from the television (52%) or relatives/friends (51%).
• Respondents were asked about their knowledge of infected cases, and if so, their source of information, the number of infected cases, and their behaviour after the knowledge about the infected cases. Overall, 30% had heard about any infected cases with AI among birds in their governorate; the main sources of knowledge were
  friends/neighbours (63%) and television (39%), with clear differentials between regions.

Attitudes and practices related to such categories as breeding birds at home, buying birds, slaughtering and cleaning birds, and dealing with birds and eggs for cooking are outlined here, based on survey findings. Here are a selected few:

• The percentage of home breeders who wear protective clothing when handling
  birds is very low; however, the majority of home breeders (90%) wash their hands with water and soap after handling birds, and virtually all of them do so immediately.
• Among respondents who slaughter birds, only 4% wear something in their hands (i.e.
  gloves or plastic bags), and just 1% cover their face. The levels of those who appropriately dispose of bird waste after slaughter were found to be low. Almost all respondents who slaughter birds (97%) reported washing their hands with water and soap after slaughtering or defeathering birds and immediately after slaughtering.
• Nine out of every ten respondents reported that they wash their hands with water and soap after handling birds and eggs for cooking.
• Only 16% of respondents reported that they would notify the authorities if they found dead birds in the street.

Among the communication-related findings in the final section of the report, "Perceived Parties' Role in Eradicating the AI Outbreak": Ninety-four percent of respondents mentioned that mass media should increase media messages related to awareness, and 12% mentioned that it should follow up with news of the disease. Also, three-quarters of respondents mentioned that non-governmental organisations (NGOS) should continue practicing their role in increasing awareness about the virus.

To request a copy of the full document, please see contact details, below.