Knowledge, attitudes and practices (KAP) relating to avian influenza in urban and rural areas of China

Development and validation of a nomogram to predict medication risk based on a knowledge, attitude and practice (KAP) survey of residents in Shanxi Province, China

Objective

Unsafe medication practices and medication errors are a major cause of harm in healthcare systems around the world. This study aimed to explore the factors that influence the risk of medication and provide medication risk evaluation model for adults in Shanxi province, China.

Methods

The data was obtained from the provincial questionnaire from May to December 2022, relying on the random distribution of questionnaires and online questionnaires by four hospitals in Shanxi Province. Multiple linear regression analysis was used to explore the factors affecting the KAP score of residents. Univariate and multivariate logistic regression was used to determine the independent risk factors, and the nomogram was verified by receiver operating characteristic curve, calibration and decision curve analysis.

Results

A total of 3,388 questionnaires were collected, including 3,272 valid questionnaires. The average scores of drugs KAP were 63.2 ± 23.04, 33.05 ± 9.60, 23.67 ± 6.75 and 33.16 ± 10.87, respectively. On the evaluation criteria of the questionnaire, knowledge was scored "fair", attitude and practice were scored "good". Sex, monthly income, place of residence, insurance status, education level, and employment were regarded as independent risk factors for medication and a nomogram was established by them.

Conclusion

Males, low-income, and low-educated people are important factors affecting the risk of medication. The application of the model can help residents understand the risk of their own medication behavior and reduce the harm of medication.

Assessment of knowledge, attitude, and practice of dog owners to rabies disease in Kahama town council, Shinyanga region, Tanzania

BACKGROUND

Rabies is a fatal zoonotic disease of significant public health importance. Domestic dogs are the main reservoir and transmitter of this disease, particularly in developing countries. Community awareness about rabies is one of the key components of prevention. This study describes the knowledge, attitudes, and practices about rabies disease among dog owners at Kahama town council, Shinyanga Region, Tanzania.

METHODOLOGY

This was a cross sectional community-based study which was done in May 2021. Structured questionnaires were administered to collect the data among 422 dog owners. The information collected included demographic characteristics of the dog owners, as well as their knowledge, attitude and practice towards rabies. Data were analyzed using SPSS statistical software version 20.

RESULTS

Out of 422 respondents, 421 (99.76%) knew that rabies can be transmitted by dogs, 384 (91%) knew that rabies can be prevented by vaccination of dogs, 269 (63.74%) knew the symptoms and signs, and 379 (89.81%) believed that it was necessary to vaccinate all owned dogs, but 227 (53.79%) had not vaccinated their dogs. Education level (p = 0.006) and occupation (p = 0.002) were significantly associated with a positive attitude, whereby those with a higher level of education and farmers were more likely to have a positive attitude. Also there was statistically significant association between gender (p = 0.038), marital status (p < 0.001) occupation (p < 0.001), education level (p = 0.006) and the practices of the respondents in the community whereby majority of male, unmarried dog owner who are farmer with primary education level had lower practice score.

CONCLUSION

This study concludes that respondents had good knowledge, a relatively good attitude, and poor practice towards rabies prevention and control. Rabies awareness with an emphasis on the importance of vaccination as well as vaccination campaigns should, therefore, be intensified, especially among the least educated dog owners.

A cross-sectional survey of avian influenza knowledge among poultry farmworkers in Indonesia

Background

Avian influenza (AI) poses a serious threat to global public health, especially the highly pathogenic form. Awareness and protective behavior among the public, particularly the high-risk populations, are essential for prevention and control. This study aimed to ascertain the level of AI knowledge among Indonesia's poultry farmworkers.

Methods

This was a cross-sectional study conducted online. A predesigned standardized questionnaire, containing six demographic questions and 14 questions on AI knowledge, was used. The questionnaire was distributed via WhatsApp and email platforms. Volunteers (respondents) included 119 men and 81 women, aged 18-50 years, who work on poultry farms in Indonesia. Data were analyzed using the chi-squared and Fisher exact tests.

Results

The study's findings revealed that more than two-thirds (67.0%) of the respondents had heard about AI. Their primary sources of information were health workers (36.0%) and media, especially television (34.0%). The majority of the participants (91.3%) had good knowledge about AI as a contagious infection, transmissible from birds to other birds, animals, or humans. A total of 76.8% of the respondents believed that poultry workers and veterinarians were at high risk of contracting AI infection.

Conclusions

The study concluded that poultry workers had good knowledge about AI infection, transmission, and risk variables. Health workers and television were the main sources of information on AI. The level of AI knowledge was high among the respondents.

Knowledge, Attitudes and Practices of Parents and Pediatricians Regarding Antibiotic Use among Children: Differences in Relation to the Level of Education of the Parents in the Republic of Srpska Bosnia and Herzegovina

Antibiotics are often misused, especially for the treatment of upper respiratory tract infections (URTIs) in children, where their use is unnecessary and leads to antimicrobial resistance. This study sought to explore the knowledge, attitudes and practices (KAP) of parents and pediatricians on the use of antibiotics among children and whether the level of education of parents has an impact on their KAP. The research was carried out among 1459 parents of children under 6 years of age and among 18 pediatricians. Sixty percent of pediatricians (61.1%) were prescribed antibiotics daily in their practice. Most of the surveyed parents (98.4%) state that doctors are their main source of information when deciding on the use of antibiotics in the treatment of their children. Parents with a higher level of education use television less often as a source of information when making this decision compared to parents with a lower level of education (p = 0.039, i.e., p = 0.003). The majority of parents (80.7%) knew that Panklav (amoxicillin/clavulanic acid) is an antibiotic, while 52.5% identified Pancef (cefixime) as an antibiotic. Parents with a higher level of education correctly identified antibiotics significantly more often (p < 0.001). This study shows that in the Republic of Srpska, parents have adequate knowledge about antibiotics, especially those with a higher level of education, who show better KAP when it comes to antibiotic use.

Analyzing an Epidemic of Human Infections with Two Strains of Zoonotic Virus

Due to the existence and variation of various viruses, an epidemic in which different strains spread at the same time will occur. here, an avian–human epidemic model with two strain viruses are established and analyzed. Both theoretical and simulation results reveal that the mixed infections intensify the epidemic and the dynamics become more complex and sensitive. There are six equilibria. The trivial equilibrium point is a high-order singular point and will undergo the transcritical bifurcations to bifurcate three equilibria. The existence and stability of equilibria mainly depend on five thresholds. A bifurcation portrait for the existence and stability of equilibria is presented. Simulations suggest that the key control measure is to develop the identification technology to eliminate the poultry infected with a high pathogenic virus preferentially, then the infected poultry with a low pathogenic virus in the recruitment and on farms. Controlling contact between human and poultry can effectively restrain the epidemic and controlling contagions in poultry can avoid great infection in humans.

Knowledge, Attitude, and Practices Among the General Population During the Later Stage of the COVID-19 Pandemic in Malaysia: A Cross-Sectional Study

Purpose

Patients and Methods

Results

Conclusion

Knowledge, Attitudes, and Practices Concerning COVID-19 in Bangladesh: A Qualitative Study of Patients With Chronic Illnesses

The novel coronavirus disease (COVID-19) has posed a serious risk with pre-existing health conditions. This study was conducted to understand the knowledge, attitude, and practices concerning COVID-19 among patients with chronic illnesses in Bangladesh during the pandemic. The study was conducted in Khulna city of Bangladesh following a qualitative research design. We employed telephone interviews to collect data from 40 participants with four common pre-existing chronic illnesses (diabetes, hypertension, respiratory/asthma, and heart disease). Findings show that the majority of the participants had a moderate level of knowledge and an overall positive attitude regarding COVID-19 but appropriate safety practices were often ignored as the pandemic grows older. We also observed that the knowledge, attitude, and practice regarding COVID-19 varied based on age, marital status, education, social class, and rural/urban residence. We concluded that improving medical advice/support, promotion of awareness through mass media, strict monitoring of protective measures and subsidies from the government, and self-consciousness could be effective strategies to mitigate the transmission of the disease and reduce risks for patients with chronic illness in Bangladesh during the COVID-19 pandemic.

Dog ownership, demographics, owners' knowledge of rabies, and factors associated with canine rabies vaccination in urban and rural areas of Dedougou, Burkina Faso

Rabies is a prioritized zoonotic disease in Burkina Faso and is known as a major zoonotic disease with high public health importance. This investigation was conducted to assess community knowledge, dog ecology and demographics, and factors associated with dog vaccination against rabies in the urban and rural areas of Dedougou. Three hundred and sixteen (316) dog-owning households were surveyed in the rural and urban areas of Dedougou using a semi-structured questionnaire. Among participants, 55.7% lived in rural area, and 59.8% were farmers. Only 34.5% of participants had satisfactory knowledge of rabies. About 22% were aware of the required age of dogs’ primo vaccination against rabies while 55.7% knew the frequency of booster vaccination. Participants living in households with less than five persons were significantly more likely to be aware of rabies than those living in households with the higher number of persons (P<0.05). Participants who were aware of rabies were more likely to vaccinate their dogs compared to those who were not aware of rabies (P<0.05). In total, 2930 persons were recorded in visited households with 60.6% from rural area, and an average household size of 9.27 persons. Three hundred and thirty seven dogs were found in surveyed households’ and 54.9% were from rural area. In overall, a dog per human ratio of 1:8.7 was determinated. Regarding dog ownership practices, the majority of respondents reported that they provided their dogs with water (84.5%) and food (84.8%). This research reported supplementary data on dog ecology and rabies, which could be useful for rabies control planning in Burkina Faso.

Handwashing knowledge, attitudes, and practices during the COVID-19 pandemic in Saudi Arabia: A non-representative cross-sectional study

Handwashing (HW) with water and soap is one of the cheapest and most effective ways of protecting oneself and others against the coronavirus. Here, the HW knowledge, attitudes, and practices of Saudi adults were assessed during the COVID-19 pandemic using a cross-sectional study conducted between May 8 and June 8, 2020, during a partial lockdown period. A web-based validated questionnaire was distributed through different social media platforms, and the sociodemographic characteristics of the participants, seven items related to knowledge, four items related to attitudes, and thirteen items related to the practice of HW were assessed. A total of 1323 (51% male and 49% female) adults from all regions of Saudi Arabia responded to the questionnaire. The overall mean (± SD) was 5.13 (± 1.18) for knowledge of HW and COVID-19, 2.79 (± 0.77) for attitude toward HW, and 7.8 (± 2.56) for HW practice. A multiple linear regression analysis revealed factors associated with knowledge to be age and family income. Sex, educational level, family income, and HW knowledge were associated with negative and neutral attitude, whereas age, sex, family income, and HW knowledge were associated with practice. These results suggest that HW knowledge was strongly associated with positive attitudes toward HW and correct HW practice in Saudi adults during the COVID-19 lockdown.

Knowledge, Attitude, and Practice Regarding Zoonotic Risk in Wildlife Trade, Southern China

Current wildlife trade practices in China lead to significant interactions between humans and animals and drive the emergence of zoonotic diseases. The at-risk behaviors, knowledge, and attitudes that influence health-related behaviors in relation to animal contact and safety measures in the trade remain poorly understood. A self-administered questionnaire survey was conducted among 947 adult Internet users in three provinces in southern China to assess knowledge, perceived disease risks, at-risk behaviors, and the association of these factors with other demographic factors among the target population. Few of the participants possessed sufficient knowledge of zoonotic diseases. Although most participants were opposed to the use of wild animal resources, many reported keeping wild animals as pets (30.7%) and eating wild animals (30.5%). The majority of participants (76.3%) believed the disease transmission via wildlife trade, but few connected contact with animals to sickness (18.5%) and only slightly more than half sought post-exposure treatment (54.4%). These results reveal low levels of knowledge and perceived risk regarding disease emergence from the animal-human interactions in wildlife trade and uncover the gaps in knowledge and attitudes as key challenges to the development of health behavior change interventions pertaining to wildlife trade.

Informing influenza pandemic preparedness using commercial poultry farmer knowledge, attitudes, and practices (KAP) surrounding biosecurity and self-reported avian influenza outbreaks in Nepal

Avian influenza (AI) is a global health obstacle of critical concern as novel viruses are capable of initiating a pandemic. Recent spillover events of AI into human populations have occurred at human-poultry food system interfaces. As Nepal's poultry sector transitions to more intensified commercial production systems, it is important to examine the epidemiology of AI and the knowledge, attitudes and practices (KAP) of poultry sector workers. We conducted a cross-sectional KAP study utilizing a structured survey to interview 150 commercial poultry farmers in Chitwan District, Nepal. All commercial poultry farmers had knowledge of AI previous to the study and the majority farmers were able to identify farm-farm and poultry-human transmission mechanisms of AI. Farmers had more knowledge surrounding poultry AI symptoms as compared to human AI symptoms. Most farmers believe that AI is serious, contagious and a threat to everyone, yet only half believe it can be prevented. Individual-level personal protective equipment (PPE) uptake, such as facemask, glove and boot usage, on the enrolled farms was low and farm-level biosecurity practices varied greatly. Nine commercial poultry farms (6%) self-reported having an HPAI outbreak and 60 farms (40%) self-reported having an LPAI outbreak in the past 5 years. Layer farms had higher odds (OR: 5.4, 95% CI: 2.3–12.8) of self-reported LPAI as compared broiler farms. Poultry sector farmers face multiple obstacles when attempting to report AI to government authorities such as the fear of flock culling and the perceived lack of monetary compensation for culling. Our study provides updated KAP surrounding AI of farmers and self-reported AI farm-level epidemiology in Nepal's highest density commercial poultry production district. Commercial poultry farmers are fairly knowledgeable on AI, but do not take further protective practice efforts to implement their knowledge and prevent AI. Due to the potential role that human-poultry interfaces may play in AI emergence, it is critical to collaborate with the commercial poultry industry when planning and conducting AI pandemic preparedness mechanisms.

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Farmers had more knowledge surrounding poultry avian influenza symptoms as compared to human avian influenza symptoms.

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Farmer personal protective equipment (PPE) uptake, such as facemask, glove and boot usage, was low.

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6% of poultry farms self-reported having an HPAI outbreak and 40% self-reported having an LPAI outbreak in the past 5 years.

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Layer farms had higher odds of self-reported LPAI as compared broiler farms.

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Poultry farmers fear potential flock culling and lack of monetary compensation for culling when reporting avian influenza.

Cross-sectional study on the role of public awareness in preventing the spread of COVID-19 outbreak in India

BACKGROUND

WHO has recommended personal hygiene (respiratory hygiene, using face masks, washing hands with warm water and soap, use of alcohol-based hand sanitizers, avoid touching mouth, eyes & nose, cleanliness), social distancing and careful handling of purchased products as an effective preventive measure for COVID-19 disease. The growing pandemic of COVID-19 disease requires social distancing and personal hygiene measures to protect public health. But this message is not clear and well understood among people. The aim of this study is to determine the awareness, knowledge and attitude about COVID-19 and relate the behaviour of Indian society, especially when the country is restarting all its economic activities, after the complete lockdown.

METHOD

The present paper is based on an extensive survey among 21 406 adult participants of various sections of Indian society with different age groups between 18 and 80 years to introspect the level of public awareness with respect to cause, spread, prevention and treatment of disease caused by spread of COVID-19 viral outbreak, which will be automatically reflected in the societal behavioural response of rigorous precautionary measures.

CONCLUSIONS

There is a need to extend the knowledge base among individuals to enhance their active participation in the prevention mechanisms with respect to the spread of the pandemic. There is a need to elaborate the Indian socio-cultural aspects, so that society starts appreciating and voluntarily following social distancing. This should improve the adaptability of people with livelihood resilience to let them protect themselves not only from the present pandemic but also from all other unforeseen infections, and to provide care to patients.

Factors influencing chicken farmers' decisions to implement prevention and control measures to reduce avian influenza virus spread under endemic conditions

The ongoing circulation of Highly Pathogenic Avian Influenza (HPAI) H5N1 poses a threat to both poultry and public health. Adapting the constructs of the Health Belief Model (HBM) framework, we investigated perceptions of backyard, commercial broiler and layer chicken farmers to implement HPAI prevention and control measures in Bangladesh. Two cross-sectional studies were conducted in 2016 and 2017 on 144 backyard, 106 broiler and 113 layer chicken farms. Using Structural Equation Modelling, we modelled the direct and indirect effects on farmers' perceptions on taking HPAI prevention and control actions. Our results indicate that farmers of different chicken production systems have different decision-making processes. While perceived barriers to the implementation of prevention and control measures (e.g. wearing protective equipment when handling chickens) prevented both broiler and backyard farmers to adopt interventions, perceived benefits of measures (e.g. maintaining high biosecurity will reduce the risk of birds becoming sick) strongly influenced commercial farmers' decisions, but not backyard farmers' decisions. Information provided on HPAI through media, meetings or via information campaigns played an important role in farmers' decision-making in all production systems. Outcomes of this research can be used to tailor advice on HPAI control and prevention to different poultry farming groups by accounting for specific factors influencing their decision-making, instead of using one-size-fit-all communication approach.

Spatiotemporal Analysis of Influenza in China, 2005-2018

Influenza is a major cause of morbidity and mortality worldwide, as well as in China. Knowledge of the spatial and temporal characteristics of influenza is important in evaluating and developing disease control programs. This study aims to describe an accurate spatiotemporal pattern of influenza at the prefecture level and explore the risk factors associated with influenza incidence risk in mainland China from 2005 to 2018. The incidence data of influenza were obtained from the Chinese Notifiable Infectious Disease Reporting System (CNIDRS). The Besag York Mollié (BYM) model was extended to include temporal and space-time interaction terms. The parameters for this extended Bayesian spatiotemporal model were estimated through integrated nested Laplace approximations (INLA) using the package R-INLA in R. A total of 702,226 influenza cases were reported in mainland China in CNIDRS from 2005–2018. The yearly reported incidence rate of influenza increased 15.6 times over the study period, from 3.51 in 2005 to 55.09 in 2008 per 100,000 populations. The temporal term in the spatiotemporal model showed that much of the increase occurred during the last 3 years of the study period. The risk factor analysis showed that the decreased number of influenza vaccines for sale, the new update of the influenza surveillance protocol, the increase in the rate of influenza A (H1N1)pdm09 among all processed specimens from influenza-like illness (ILI) patients, and the increase in the latitude and longitude of geographic location were associated with an increase in the influenza incidence risk. After the adjusting for fixed covariate effects and time random effects, the map of the spatial structured term shows that high-risk areas clustered in the central part of China and the lowest-risk areas in the east and west. Large space-time variations in influenza have been found since 2009. In conclusion, an increasing trend of influenza was observed from 2005 to 2018. The insufficient flu vaccine supplements, the newly emerging influenza A (H1N1)pdm09 and expansion of influenza surveillance efforts might be the major causes of the dramatic changes in outbreak and spatio-temporal epidemic patterns. Clusters of prefectures with high relative risks of influenza were identified in the central part of China. Future research with more risk factors at both national and local levels is necessary to explain the changing spatiotemporal patterns of influenza in China.

Parents' self-directed practices towards the use of antibiotics for upper respiratory tract infections in Makkah, Saudi Arabia

Background

Excessive and inappropriate antimicrobial use in the community is one risk factor that can result in the spread of antimicrobial resistance. Upper respiratory tract infections are most frequently reported among children and mainly of viral origin and do not require antibiotics.

We have conducted Knowledge, Attitude and Perception (KAP) survey of parents to explore the parent’s knowledge, attitude & perception of Saudi parents.

Methods

A knowledge attitude perception questioner was adopted from a previous study conducted in Greece by Panagakou et al. Raosoft online sample size calculator calculated the sample size by adding the total estimated Makkah population of 5,979,719 with a response rate of 30%, 5% margin of error and 99% confidence interval. Based on the described criteria five hundred & fifty-eight was the required sample size of the study. Incomplete questioners were excluded from the statistical analysis. SPSS version 21 was used to analyse data and to produce descriptive statistics.

Results

Most of the mothers (95%) responded among parents. 67% had no health insurance to cover medications costs. Most of them (74%) were related to medium income level. Seventy per cent of the parents believed physicians as a source of information for judicious antibiotics use. Interestingly, only 8% were agreed that most of the upper respiratory tract infections are caused by viral reasons.

Majority of Saudi parents (53%) expect pediatricians to prescribe antimicrobials for their children for symptoms like a cough, nose discharge, sore throat and fever.

Moreover, most the parents had the poor knowledge to differentiate commonly used OTC medications for URTI and antibiotics like Augmentin (Co-amoxiclav), Ceclor (cefaclor) and Erythrocin (Erythromycin). While comparing males and female’s knowledge level, few males have identified Amoxil (Amoxicillin). Similarly, parents of age 20–30 years have good knowledge about the antibiotics.

Conclusions

Majority of Saudi parents believe in pediatricians and use antibiotics on physician’s advice. Most of them expect antibiotics from their physicians as a primary treatment for upper respiratory tract infections. There is need for more educational activities to parents by the pharmacists to prevent antibiotics overuse among children.

Adequacy of public health communications on H7N9 and MERS in Singapore: insights from a community based cross-sectional study

Background

Singapore remains vulnerable to worldwide epidemics due to high air traffic with other countries This study aims to measure the public’s awareness of the Middle East Respiratory Syndrome (MERS) and Avian Influenza A (H7N9), identify population groups who are uninformed or misinformed about the diseases, understand their choice of outbreak information source, and assess the effectiveness of communication channels in Singapore.

Methods

A cross-sectional study, comprising of face-to-face interviews, was conducted between June and December 2013 to assess the public’s awareness and knowledge of MERS and H7N9, including their choice of information source. Respondents were randomly selected and recruited from 3 existing cohort studies. An opportunistic sampling approach was also used to recruit new participants or members in the same household through referrals from existing participants.

Results

Out of 2969 participants, 53.2% and 79.4% were not aware of H7N9 and MERS respectively. Participants who were older and better educated were most likely to hear about the diseases. The mean total knowledge score was 9.2 (S.D ± 2.3) out of 20, and 5.9 (S.D ± 1.2) out of 10 for H7N9 and MERS respectively. Participants who were Chinese, more educated and older had better knowledge of the diseases. Television and radio were the primary sources of outbreak information regardless of socio-demographic factors.

Conclusion

Heightening education of infectious outbreaks through appropriate media to the young and less educated could increase awareness.

Knowledge, attitudes and practices related to the influenza virus and vaccine among older adults in Eastern China

BACKGROUND

This study aims to assess the association between socio-demographic and health characteristics of older adults in Eastern China and knowledge, attitudes, and practices (KAP) about the influenza virus and vaccine.

METHODS

A prospective cohort of 1506 older adults (aged ≥60 years) was enrolled from November to December 2015 in Jiangsu Province. We examined the association between demographics, health and functional status, and cognitive impairment at enrollment with awareness of influenza virus and vaccine and KAP items focused on five Health Belief Model domains. At a 12-month follow-up interview we assessed change in awareness and readiness to be vaccinated.

RESULTS

One in five older adults was aware of the influenza virus (21%) or vaccine (20%); even fewer reported having at least "a little" knowledge of the virus and vaccine (7% and 4%, respectively); less than 1% reported ever receiving an influenza vaccine. Retirement, higher education and income, and normal cognitive status were consistently associated with both awareness and knowledge of influenza virus. The odds of having at least "a little" knowledge of the vaccine was 2.9-fold (95% CI = 1.6-5.3) higher among older adults with at least some secondary schooling. Among the 108 with knowledge of the virus, 55% said they "worry about getting the flu this season." Among the 73 with knowledge of the vaccine, 92% believed the vaccine was at least somewhat effective and less than half (43%) thought that influenza vaccination was safe. At a 12-month follow-up interview, 33% (442/1333) increased from no knowledge to at least "a little".

CONCLUSIONS

If and when influenza vaccines become widely available to older adults in China, our results indicate that influenza vaccination campaigns with basic information on the virus and vaccine could be beneficial for all older adults, especially those with less education and/or more cognitive impairment.

Knowledge, Attitudes, and Practices Associated with Brucellosis in Livestock Owners in Jordan

We evaluated livestock owners' knowledge, attitudes, and practices regarding brucellosis in Jordan. A questionnaire was administered and biological samples were examined to verify the serological status of animals. Seroprevalence estimates indicated that 18.1% (95% CI: 11-25.3) of cattle herds and 34.3% (95% CI: 28.4-40.4) of small ruminant flocks were seropositive. The results showed that 100% of the interviewed livestock keepers were aware of brucellosis: 87% indicated a high risk of infection if unpasteurized milk is consumed and 75% indicated a high risk if unpasteurized dairy products are consumed. Awareness of the risk of infection through direct contact with fetal membranes or via physical contact with infected livestock is considerably lower, 19% and 13%, respectively. These knowledge gaps manifest in a high frequency of high-risk practices such as assisting in animal parturition (62%), disposing aborted fetuses without protective gloves (71.2%) or masks (65%), and not boiling milk before preparation of dairy products (60%). When brucellosis is suspected, basic hygiene practices are often disregarded and suspect animals are freely traded. Public health education should be enhanced as the disease is likely to remain endemic in the ruminant reservoir as long as a suitable compensation program is not established and trust on available vaccines is regained.

Parental knowledge, attitudes and practices regarding antibiotic use for acute upper respiratory tract infections in children: a cross-sectional study in Palestine

BACKGROUND

In primary health care centres, upper respiratory tract infections (URTIs) in children are commonly encountered by physicians. Viruses cause most URTIs, but parents' attitudes often represent an important reason for antibiotic abuse, which leads to the development and spread of antimicrobial resistance. The goal of this study was to examine parents' knowledge, attitudes, and practices (KAP) about antibiotic use for children with URTIs in Palestine.

METHODS

A cross-sectional study was performed in primary health care centres in Nablus city from 1 June to 31 October 2012. A questionnaire was developed and administered to determine parents' KAP regarding antibiotic use for their children with URTIs.

RESULTS

Three hundred and eighty-five parents completed the questionnaire. A total of 79.7% of the parents were attentive to the truth that antibiotic misuse is responsible for bacterial resistance. Only 18.9% of parents thought that antibiotics did not have any harmful side effects. Fifty nine per cent of parents did not agree that URTIs are mostly viral in origin and are self-limited. Almost 73% of parents choose antibiotics as a treatment for URTIs, while earache (68%) and fever (64%) were the most common reasons for which parents expected antibiotics. However, more than 38% of the parents never asked the paediatrician to prescribe antibiotics, and only 6% congratulated their paediatricians for not prescribing antibiotics.

CONCLUSIONS

Although there is a trusted relationship between parents and paediatricians, Palestinian parents have insufficient knowledge related to antibiotic use for URTIs in children, which results in inappropriate attitudes and practices. Educational interventions for both parents and physicians will reduce unnecessary antibiotic use and resistance.

Changing risk awareness and personal protection measures for low to high pathogenic avian influenza in live-poultry markets in Taiwan, 2007 to 2012

Background

Outbreaks of low and high pathogenic avian influenza (LPAI, HPAI) H5N2 in chickens have occurred in Taiwan since 2003 and 2012, respectively. Fully understanding the different awareness, attitudes and protective behaviors adopted by workers in live-poultry markets (LPMWs) and local community residents (CRs) to face the challenges of LPAI and HPAI is very important to minimize viral adaptations to human populations.

Methods

A structural questionnaire containing information on respondents’ occupation, personal risk awareness, attitudes toward different policies, and preventative measures was administered. The two-stage survey (before and after HPAI H5N2 outbreaks) was conducted from 2007 to 2012, including: (1) 430 LPMWs and 418 CRs at LPMs from different geographical areas of Taiwan after the government announced outbreaks of LPAI H5N2 during 2007–2009, and (2) 73 LPMWs and 152 CRs at two LPMs in central Taiwan after the HPAI H5N2 outbreaks in 2012. The chi-squared test and logistic regression were applied for univariate and multivariate analyses, respectively.

Results

Before HPAI-H5N2 outbreaks, higher educated respondents demonstrated greater risk awareness and concerns regarding AI. However, LPM-workers protected themselves less from AI viruses (AIVs) and had lower acceptance of human or avian influenza vaccines. Most importantly, the participants who opposed (versus agreed with) the policy on banning live-poultry slaughtering at LPMs reported lower awareness of government prevention and control policies [Odds Ratio (OR): 0.76, 95 % Confidence Interval (CI): 0.56–1.01] or practiced preventive measures (OR: 0.42, 95 % CI: 0.25–0.70).

After HPAI-H5N2 outbreaks, the risk awareness about AI in central Taiwan significantly increased [LPAI to HPAI LPMWs: 34.6 to 65.6 %, p < 0.05; CRs: 44.0 to 76.5 %, p < 0.05] and LPMWs’ belief in the effectiveness of vaccination to prevent human or avian influenza virus infection strikingly decreased (92.3 to 68.5 %, p < 0.05).

Conclusions

Risk awareness depends on high or low pathogenicity of AIVs, working in LPMs, levels of education, age, and proximity to the sites of severe AI outbreaks. Regardless of novel LPAI or HPAI virus reassortants that pose public health risks, prompt and clear risk communication focusing on both correct information about AIVs and the most appropriate preventive measures are important for effective prevention of human infection.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-015-0987-8) contains supplementary material, which is available to authorized users.

Global dynamics of avian influenza epidemic models with psychological effect

Cross-sectional surveys conducted in Thailand and China after the outbreaks of the avian influenza A H5N1 and H7N9 viruses show a high degree of awareness of human avian influenza in both urban and rural populations, a higher level of proper hygienic practice among urban residents, and in particular a dramatically reduced number of visits to live markets in urban population after the influenza A H7N9 outbreak in China in 2013. In this paper, taking into account the psychological effect toward avian influenza in the human population, a bird-to-human transmission model in which the avian population exhibits saturation effect is constructed. The dynamical behavior of the model is studied by using the basic reproduction number. The results demonstrate that the saturation effect within avian population and the psychological effect in human population cannot change the stability of equilibria but can affect the number of infected humans if the disease is prevalent. Numerical simulations are given to support the theoretical results and sensitivity analyses of the basic reproduction number in terms of model parameters that are performed to seek for effective control measures for avian influenza.

Collective resistance to HPAI H5N1 surveillance in the Thai cockfighting community: Insights from a social anthropology study

Farmers may organize themselves to collectively manage risks such as animal diseases. Our study shows some evidence of such organization among fighting cock owners in Thailand. Fighting cocks were specifically targeted by HPAI (Highly Pathogenic Avian Influenza) H5N1 surveillance and control measures in Thailand because they were thought to pose a high risk of spreading diseases. In this work, we used a social-anthropological approach to gain an inside view of the issues associated with HPAI H5N1 surveillance in the cockfighting community in Thailand. Based on a qualitative analysis of data collected through in-depth interviews and observation of cockfighters' practices, we found that fighting cock owners share a sense of belonging to the same community based on a common culture, values, interests, practices, and internal rules, including rules to manage poultry diseases. During the HPAI H5N1 outbreaks, these rules may have contributed to mitigating the potential risk associated with the intense movements of fighting cocks inside the country. Nevertheless, this community, despite the high awareness and know-how of its members regarding poultry diseases, has shown a strong reluctance to comply with HPAI surveillance programs. We suggest that this reluctance is due to important gaps between the logic and rationales underlying surveillance and those associated with cockfighting activities. Our study highlights the need for multi and trans-disciplinary research involving the social sciences to analyze interactions between stakeholders and the collective actions implemented by communities to face risks.

Knowledge, Attitudes, and Practices Regarding Avian Influenza A (H7N9) Among Mobile Phone Users: A Survey in Zhejiang Province, China

BACKGROUND

Understanding people's knowledge, attitudes, and practices (KAP) regarding a new infectious disease is crucial to the prevention and control of it. Human infection with avian influenza A (H7N9) was first identified on March 31, 2013 in China. Out of the total number of 134 cases confirmed from March to September 2013 in China, Zhejiang Province saw the greatest number (46 cases).

OBJECTIVE

This study employed a mobile Internet survey to assess KAP regarding H7N9 among mobile phone users in Zhejiang Province. This study intended to examine KAP by region and the association between sociodemographic variables and KAP.

METHODS

An anonymous questionnaire was designed by Zhejiang Provincial Center for Disease Control and Prevention (CDC). A cross-sectional survey was executed through a mobile Internet application platform of China Unicom in 5 regions in Zhejiang Province. Stratified and clustered sampling methods were applied and mobile phone users were invited to participate in the study voluntarily.

RESULTS

A total of 9582 eligible mobile phone users participated in the survey with a response rate of 1.92% (9582/5,000,000). A total of 9105 valid responses (95.02%) were included for statistical analysis. Generally, more than three-quarters of the participants had some basic knowledge of H7N9 and held the attitude recommended by the Zhejiang CDC toward eating cooked poultry (77.55%, 7061/9105) and visiting a hospital at the occurrence of symptoms (78.51%, 7148/9105). Approximately half of the participants worried about contracting H7N9, and took preventive practices recommended by the Zhejiang CDC. But only 14.29% (1301/9105) of participants kept eating cooked poultry as usual. Although worry about H7N9 infection did not differ by region, Hangzhou saw the largest proportion of participants with knowledge of H7N9, which was probably because Hangzhou had the greatest number of H7N9 cases. KAP varied by some sociodemographic variables. Female participants were more likely to know about symptoms of H7N9 (OR 1.32, 95% CI 1.08-1.61), to worry about contracting it (OR 1.15, 95% CI 1.04-1.27), and to report their lives being influenced by it (OR 1.27, 95% CI 1.15-1.41). They were also more likely to take the recommended precautions. Male participants and younger participants were less likely to comply with advocated protective practices.

CONCLUSIONS

The results suggest that health education should be customized depending on sociodemographic variables to achieve more effective behavioral outcomes.

Knowledge, attitudes and practices (KAP) about rabies prevention and control: a community survey in Tanzania

Background

Despite being entirely preventable, canine rabies still kills 55,000 people/year in developing countries. Information about local beliefs and practices can identify knowledge gaps that may affect prevention practices and lead to unnecessary deaths.

Methodology/Principal Findings

We investigated knowledge, attitudes and practices related to rabies and its prevention and control amongst a cross-section of households (n = 5,141) in urban and rural areas of central, southern and northern Tanzania. Over 17% of respondents owned domestic dogs (average of 2.3 dogs/household),>95% had heard about rabies, and>80% knew that rabies is transmitted through dog bites. People who (1) had greater education, (2) originated from areas with a history of rabies interventions, (3) had experienced exposure by a suspect rabid animal, (4) were male and (5) owned dogs were more likely to have greater knowledge about the disease. Around 80% of respondents would seek hospital treatment after a suspect bite, but only 5% were aware of the need for prompt wound cleansing after a bite. Although>65% of respondents knew of dog vaccination as a means to control rabies, only 51% vaccinated their dogs. Determinants of dog vaccination included (1) being a male-headed household, (2) presence of children, (3) low economic status, (4) residing in urban areas, (5) owning livestock, (6) originating from areas with rabies interventions and (7) having purchased a dog. The majority of dog-owning respondents were willing to contribute no more than US$0.31 towards veterinary services.

Conclusions/Significance

We identified important knowledge gaps related to, and factors influencing the prevention and control of rabies in Tanzania. Increasing knowledge regarding wound washing, seeking post-exposure prophylaxis and the need to vaccinate dogs are likely to result in more effective prevention of rabies; however, greater engagement of the veterinary and medical sectors is also needed to ensure the availability of preventative services.

Rabies remains a major public health problem in Africa and Asia, although means to control and prevent the disease are available through mass dog vaccination and provision of post-exposure prophylaxis to people exposed to bites by suspect rabid animals. Here we report the results of an extensive community survey on knowledge, attitudes and practices related to rabies control and prevention, covering rural and urban settings in central, northern and southern Tanzania. Our results showed that the majority of people across Tanzania had heard about rabies and knew that it is transmitted by dog bites, but most lacked comprehensive knowledge about key practices, such as the need for wound cleansing, which could prevent unnecessary deaths from the disease. In other circumstances, knowledge (for example, about the need to vaccinate dogs to control rabies) did not reflect good practice. In order to address the knowledge gaps identified by this study, there is a need for interventions aimed at increasing awareness, focusing on simple messages and targeting the community as a whole. This information could be channelled through media, community meetings and professionals including community leaders, health workers, teachers, livestock officers and clinicians.

Community knowledge and experience of mosquitoes and personal prevention and control practices in Lhasa, Tibet

Since 2009, great public attention has been paid in Lhasa City (Tibet, China) to mosquito bites and accompanying inflammatory complications. However, the potential contribution of knowledge levels, experiences, disease control and preventive practices (KEP) towards mosquitoes has not received much attention. To investigate community KEP concerning mosquitoes in Lhasa, a cross-sectional survey was undertaken in four sub-districts of urban Lhasa in 2012. Questionnaires were designed to collect information regarding socio-demographics and KEP concerning the harmful effects of mosquitoes on participants. The scoring for KEP was developed after consultation of literature. A total of 591 eligible questionnaires were examined. The majority of respondents were female (61.8%) with a mean age of 46 years. Nearly all of the respondents were of Tibetan nationality (97.4%) and living in registered native households (92.7%), who have less than primary school education. The averages of overall score, knowledge score, experience score, and practice score were 9.23, 4.53, 1.80, 2.90, respectively. The registered household with the highest overall score, knowledge score and practice score was non-native. Female subjects with monthly incomes between 1000 and 3000 RMB had higher experience scores. The correlation analysis revealed that significant positive linear correlations existed between knowledge and experience, knowledge and practices, and experience and practices towards mosquitoes. Past experiences with mosquitoes can result in a better knowledge of effective mosquito control practices in the present and the future. Though the average of overall scores related to mosquitoes is high among the participants in Lhasa, however, the knowledge about the ecological habits of mosquitoes should be strengthened. The findings in this study may help to develop strategies and measures of mosquito and mosquito-borne diseases in the future, not only in Lhasa, but also in similar altitude, latitude and longitude regions worldwide.

Brief literature review for the WHO global influenza research agenda--highly pathogenic avian influenza H5N1 risk in humans

Highly pathogenic avian influenza A H5N1 viruses remain a significant health threat to humans given the continued rare occurrence of human cases with a high case fatality rate. This brief literature review summarizes available evidence of risk factors for H5N1 infection in humans and updates a recent systematic review published in early 2011. Several epidemiologic studies have been published to evaluate the risk factors for H5N1 infection in humans, including contact with poultry and poultry products and non-poultry-related contact such as from H5N1-contaminated water. While most H5N1 cases are attributed to exposure to sick poultry, it is unclear how many may be due to human-to-human transmission. The collective results of published literature suggest that transmission risk of H5N1 from poultry to humans may be highest among individuals who may have been in contact with the highest potential concentrations of virus shed by poultry. This suggests that there may be a threshold of virus concentration needed for effective transmission and that circulating H5N1 strains have not yet mutated to transmit readily from either poultry to human or from human to human. However, the mode of potential transmission can be quite varied throughout different countries and by study with exposures ranging from visiting a wet market, preparing infected poultry for consumption, to swimming or bathing in ponds frequented by poultry. Several important data gaps remain in the understanding of the epidemiology of H5N1 in humans and limit our ability to interpret the results of the available H5N1 seroepidemiologic studies.

A community-based education trial to improve backyard poultry biosecurity in rural Cambodia

The emergence and spread of Highly Pathogenic Avian Influenza H5N1 has caused substantial poultry-related economic losses and public health concerns in relation to a potential pandemic. While biosecurity measures for commercial poultry industry are of the highest standards, these measures are difficult to implement and often unaffordable for backyard poultry farming, particularly in tropical and low-income settings. We designed a feasible biosecurity intervention to improve flock hygiene in Cambodia, - based on community hygiene, cleaning of poultry flock areas and human and poultry movement control. We conducted a cluster randomized and controlled intervention trial in 18 villages in Takeo province to evaluate improvements in biosecurity-related knowledge and practices. The intervention relied on community involvement and community education using special information dissemination tools. We trained village teams (VT) to assist villagers in implementing the intervention using a cascade training approach, in which a few individuals were trained, who in turn trained a larger group of people. During the 14 month follow up, we conducted observational and interview-based surveys (baseline vs. final surveys, VT supervision visits, monitoring surveys) to assess VTs' motivation, intervention messages dissemination and the implementation of recommended measures. Most of villagers (95%, confidence interval: 87.8-100.0%) in intervention villages received general information about how to raise poultry. Farmers in intervention villages reported to have made more changes (≥1 biosecurity related practice during the study period) compared with that of control villages (70.0% (260/372) vs. 22.6% (85/377), p value<0.01). When observing biosecurity-related practices in intervention villages, overall scores increased significantly (p<0.05). Practices such as use of quarantine cages for new and sick birds, limitation of people movement in backyards and waste management reached high scores during the 15-months period within five of the nine intervention villages. Cascade training managed to reach out to almost all villagers and significantly influence changes in biosecurity practices in the community. However, further follow-ups are needed to assess whether practices-related changes persist over a longer period of time.

Knowledge, beliefs and preventive behaviors regarding Influenza A in students: a test of the health belief model

BACKGROUND

The higher prevalence rate of influenza A among adolescence emphasizes the importance of preventative strategies among this age group of population. The aim of this study was to evaluate the preventive behaviors of high school students regarding type A influenza, in Shahrekord, Iran.

MATERIALS AND METHODS

In this cross-sectional study, 313 high school students were enrolled. Preventive behaviors of influenza A was evaluated by components of the Health Belief Model (HBM), using a questionnaire which its reliability was verified through a pilot study (alpha score 0.8). Data analysis was done by descriptive statistics, independent t-test and Pearson correlation coefficient.

FINDINGS

Mean age of the students was 16.31 years. Knowledge, perceived severity and perceived barriers were in the modest level among the students. The highest scores were related to perceived susceptibility (75.4%) and perceived benefit (55.6%). Mass media was the main source of their information regarding influenza A.

CONCLUSION

Considering the findings of this study and the relation between HBM components and the preventive behaviors of students, it seems that using HBM could be useful in improving preventive behaviors of influenza A among the studied population.

Factors affecting repeated influenza vaccination among older people in Taiwan

OBJECTIVE

This study identifies factors that influence repeated influenza vaccination among people aged 65 years and older in Taiwan.

METHODS

Data of this retrospective cohort study were drawn from the 2005 National Health Interview Survey and the 2005-2007 National Health Insurance claims data; a sample of 1384 older people was analyzed. The pattern of repeated influenza vaccination was divided into 3 groups: unvaccinated all 3 years, vaccinated 1-2 times over 3 years, and vaccinated all 3 years. Multinomial logistic regression analyses were performed.

RESULTS

Only 20.6% of older people were vaccinated all 3 years. Those 70-74 years of age (odds ratio [OR]=1.81), living in rural areas (OR=2.47), having one (OR=2.07) or more (OR=2.41) chronic conditions, frequent outpatient visits (OR=1.48), and undergoing preventive health examinations (OR=2.22) were more likely to have repeated vaccinations. However, those with difficulties performing one or more activities of daily living (ADL difficulty) (OR=0.41) and seeking care from alternative medicine (OR=0.48) were less likely to undergo regular vaccinations.

CONCLUSION

The repeated influenza vaccination rates in our Taiwan sample were far from optimal. Factors identified in this analysis may help to improving influenza vaccination programs.

Knowledge, attitudes, practices and emotional reactions among residents of avian influenza (H5N1) hit communities in Vietnam

BACKGROUND

Awareness of individuals' knowledge and predicting their behavior and emotional reactions is crucial when evaluating clinical preparedness for influenza pandemics with a highly pathogenic virus. Knowledge, attitude, and practice (KAP) relating to avian influenza (H5N1) virus infection among residents in communities where H5N1 patients occurred in Vietnam has not been reported.

METHODS AND PRINCIPAL FINDINGS

Face-to-face interviews including KAP survey were conducted in Bac Kan province, located in the northeast mountainous region of Vietnam. Participants were residents who lived in a community where H5N1 cases have ever been reported (event group, n = 322) or one where cases have not been reported (non-event group, n = 221). Data on emotional reactions of participants and healthcare-seeking behavior after the event in neighboring areas were collected as well as information on demographics and environmental measures, information sources, and KAP regarding H5N1. These data were compared between two groups. Higher environmental risk of H5N1 and improper poultry-handling behaviors were identified in the event group. At the time of the event, over 50% of the event group sought healthcare for flu-like symptoms or because they were scared. Awareness of the event influenced KAP scores. Healthcare-seeking behavior and attention to H5N1 poultry outbreaks diminished in the event group as time passed after the outbreak compared with the non-event group. Factors that motivated participants to seek healthcare sooner were knowledge of early access to healthcare and the risk of eating sick/dead poultry, and perception of the threat of H5N1.

CONCLUSIONS

Awareness of H5N1 patients in neighboring areas can provoke panic in residents and influence their healthcare-seeking behavior. Periodic education to share experiences on the occurrence of H5N1 patients and provide accurate information may help prevent panic and infection and reduce mortality. Local conditions should be taken into account when emphasizing the need for early access to healthcare.

Knowledge, attitudes and practices towards avian influenza A (H5N1) among Cambodian women: a cross-sectional study

OBJECTIVE

To measure highly pathogenic avian influenza (HPAI)-related knowledge, attitudes, and practices (KAPs) among Cambodian women.

METHODS

This cross-sectional study selected 246 married women aged between 18-55 years who had backyard poultry and lived at least one year in the areas of the survey through multi-stage cluster sampling. An average score of correct answers was generated to evaluate respondents' knowledge (Good/Poor), attitudes (Positive/Negative), and practices (Good/Bad).

RESULTS

We reported that about half of the respondents had good knowledge and good practices and four-fifth of them had positive attitudes towards HPAI. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through a logistic regression model to explore contributing factors that raise their KAP levels. Most of the sources were significant in increasing knowledge of the respondent, like television (OR=1.6, 95%CI=1.0-2.7), radio (OR=2.5, 95%CI=1.3-4.9), leaflets/booklets (OR=2.1, 95%CI=1.2-3.9), school students (OR=18.4, 95%CI=2.4-142.9), village health volunteers (OR=4.5, 95%CI=2.2-10.9) etc. Factors such as television (OR=3.7, 95%CI=2.1-6.4), leaflets/booklets (OR=2.6, 95%CI=1.4-5.1), and public health staff (OR=2.2, 95%CI=1.2-4.1) had similar influence on practices. Although, we found similar effect on raising the attitudes of the responded, it was not significant.

CONCLUSIONS

We report a satisfactory level of positive attitudes, and moderate level of knowledge and practices related to HPAI among Cambodian women. Raising KAPs through television, radio and other medias may be more efficient than using usual information, education and communication materials to prevent HPAI.

Local poultry biosecurity risks to highly pathogenic avian influenza in Kaduna State, Nigeria

The study appraised local poultry biosecurity risks to highly pathogenic avian influenza by assessing farmers' knowledge, beliefs and poultry practices using a standard questionnaire. Farmers' knowledge on transmission and prevention was high but low on disease recognition. Radio was ineffective at informing Islamic educated farmers. Extensive knowledge on transmission and protection did not result in behavioural change as farmers engaged in risky practices of selling, eating or medicating infected poultry and not reporting poultry death. Islamic educated farmers do not believe highly pathogenic avian influenza is a serious and preventable disease. Women are more likely to self medicate when experiencing influenza-like illness. Audio-visual aids would improve avian influenza recognition while involvement of community leaders would enhance disease reporting. Outbreak of highly pathogenic avian influenza in local poultry in Nigeria would follow a similar pattern in Southeast Asia if the risk perception among farmers is not urgently articulated.

Interspecies interactions and potential Influenza A virus risk in small swine farms in Peru

Background

The recent avian influenza epidemic in Asia and the H1N1 pandemic demonstrated that influenza A viruses pose a threat to global public health. The animal origins of the viruses confirmed the potential for interspecies transmission. Swine are hypothesized to be prime "mixing vessels" due to the dual receptivity of their trachea to human and avian strains. Additionally, avian and human influenza viruses have previously been isolated in swine. Therefore, understanding interspecies contact on smallholder swine farms and its potential role in the transmission of pathogens such as influenza virus is very important.

Methods

This qualitative study aimed to determine swine-associated interspecies contacts in two coastal areas of Peru. Direct observations were conducted at both small-scale confined and low-investment swine farms (n = 36) and in open areas where swine freely range during the day (n = 4). Interviews were also conducted with key stakeholders in swine farming.

Results

In both locations, the intermingling of swine and domestic birds was common. An unexpected contact with avian species was that swine were fed poultry mortality in 6/20 of the farms in Chancay. Human-swine contacts were common, with a higher frequency on the confined farms. Mixed farming of swine with chickens or ducks was observed in 36% of all farms. Human-avian interactions were less frequent overall. Use of adequate biosecurity and hygiene practices by farmers was suboptimal at both locations.

Conclusions

Close human-animal interaction, frequent interspecies contacts and suboptimal biosecurity and hygiene practices pose significant risks of interspecies influenza virus transmission. Farmers in small-scale swine production systems constitute a high-risk population and need to be recognized as key in preventing interspecies pathogen transfer. A two-pronged prevention approach, which offers educational activities for swine farmers about sound hygiene and biosecurity practices and guidelines and education for poultry farmers about alternative approaches for processing poultry mortality, is recommended. Virological and serological surveillance for influenza viruses will also be critical for these human and animal populations.

Protocol for a national, mixed-methods knowledge, attitudes and practices survey on non-communicable diseases

Background

Mongolia is undergoing rapid epidemiological transition with increasing urbanisation and economic development. The lifestyle and health of Mongolians are changing as a result, shown by the 2005 and 2009 STEPS surveys (World Health Organization's STEPwise Approach to Chronic Disease Risk Factor Surveillance) that described a growing burden of Non-Communicable Diseases and injuries (NCDs).

This study aimed to assess, describe and explore the knowledge, attitudes and practices of the Mongolian adult population around NCDs in order to better understand the drivers and therefore develop more appropriate solutions to this growing disease burden. In addition, it aimed to provide data for the evaluation of current public health programs and to assist in building effective, evidence-based health policy.

Methods/design

This national survey consisted of both quantitative and qualitative methods. A quantitative household-based questionnaire was conducted using a nationally representative sample of 3854 rural and urban households. Participants were selected using a multi-stage cluster sampling technique in 42 regions across Mongolia, including rural and urban sites. Permanent residents of sampled households were eligible for recruitment, if aged between 15-64 years. This quantitative arm was then complemented and triangulated with a qualitative component: twelve focus group discussions focusing on diet, exercise and alcohol consumption. Discussions took place in six sites across the country, facilitated by local, trained health workers. These six sites were chosen to reflect major Mongolian cultural and social groups.

Discussion

KAP surveys are well represented in the literature, but studies that aim to explore the knowledge, attitudes and practices of a population around NCDs remain scarce. This is despite the growing number of national epidemiological surveys, such as STEPS, which aim to quantify the burden of these diseases but do not explore the level of population-based awareness, understanding, risk-perception and possible motivation for change. Therefore this paper will contribute to building a knowledge base of NCD KAP survey methodology for future use in epidemiology and research worldwide.

Impact of educational intervention concerning awareness and behaviors relating to avian influenza (H5N1) in a high-risk population in Vietnam

BACKGROUND

Early initiation of treatment is essential for treatment of avian influenza A/H5N1 viral infection in humans, as the disease can lead to rapid development of severe pneumonia which can result in death. Contact with infected poultry is known to be a significant risk factor for contraction of H5N1 infection. However, handling and encountering poultry are a part of most peoples' daily lives, especially in rural communities in Vietnam where epidemic outbreaks among poultry have been continuously reported. Enhancing proper knowledge relating to H5N1 and to the importance of early initiation of treatment are crucial. The aim of this study was to develop an effective educational program to enhance awareness of H5N1 and motivate people to access to health care earlier when H5N1 infection is suspected or likely.

METHODOLOGY AND PRINCIPAL FINDINGS

A study was conducted in two agricultural communities (intervention and control groups) in the Ninh Binh province in Vietnam, where epidemic outbreaks of avian influenza have recently occurred in birds. A unique educational intervention was developed and provided to the intervention group, and no intervention was provided to the control group. A knowledge, attitude and practice (KAP) survey was conducted in both groups with a face-to-face interview by trained local healthcare workers at time points before and after the educational intervention. KAP scores were compared between the different time points and between the groups. How educational intervention influenced awareness relating to H5N1 and accessibility of healthcare in the population was analyzed. The study indicated an increased awareness of H5N1 and increased reliance on local health care workers.

CONCLUSIONS

The novel educational program which was developed for this study impacted awareness of H5N1, and resulted in more people seeking early access to healthcare, and also resulted in earlier medical intervention for patients with H5N1 avian influenza infection in Vietnam.

Descriptive study on parents' knowledge, attitudes and practices on antibiotic use and misuse in children with upper respiratory tract infections in Cyprus

Upper respiratory tract infections (URTIs) are common in children and represent a significant cause of antibiotic abuse which contributes to the development of antibiotic resistance. A survey was conducted in Cyprus in 2006 to assess parents’ and pediatricians’ Knowledge, Attitude and Practices (KAP) concerning the role of antibiotics in children with URTIs. A school-based stratified geographic clustering sampling was used and a pre-tested KAP questionnaire was distributed. A different questionnaire was distributed to paediatricians. Demographic factors associated with antibiotic misuse were identified by backward logistic regression analysis. The parental overall response rate was 69.3%. Parents (N = 1,462) follow pediatricians advice and rarely administer antibiotics acquired over the counter. Although a third expects an antibiotic prescription for URTI symptoms, most deny pressuring their doctors. Low parental education was the most important independent risk factor positively related to antibiotic misuse (OR = 2.88, 95%CI 2.02 to 4.12, p < 0.001). Pediatricians (N = 33) denied prescribing antibiotics after parental pressure but admit that parents ask for antibiotics and believe they expect antibiotic prescriptions even when not needed. In conclusion, Cypriotic parents trust their primary care providers. Although it appears that antibiotic misuse is not driven by parental pressure, the pediatricians’ view differs.

Brucella spp. infection in large ruminants in an endemic area of Egypt: cross-sectional study investigating seroprevalence, risk factors and livestock owner's knowledge, attitudes and practices (KAPs)

Background

Brucellosis is regarded as one of the major zoonotic infections worldwide. It was first reported in Egypt in 1939 and is now endemic, the predominate species of Brucella in cattle and buffalo in Egypt is B. melitensis. The aim of the study was to estimate seroprevalence of Brucella spp. in cattle and buffalo reared in households in an Egyptian village, identify risk factors for animals testing seropositive and to assess the knowledge, attitudes and practices (KAPs) of livestock owners with regards to brucellosis.

Methods

A cross-sectional study was carried out in a village in Menufiya Governorate of Egypt. In June and July 2009, 107 households were selected using systematic sample and all lactating cattle and buffalo present in the household were sampled and tested for antibodies against Brucella spp. In addition, a questionnaire collecting information on potential risk factors for Brucella spp. infection in cattle and buffalo was administered to the household member responsible for rearing the livestock. Between December 2009 and February 2010 households were revisited and a second questionnaire regarding KAPs associated with brucellosis was administered.

Results

True individual and household seroprevalence were estimated to be 11.0% (95% CI: 3.06% to 18.4%) and 15.5% (95% CI: 6.61% to 24.7%), respectively. Cattle and buffalo kept in a household with sheep and goats had 6.32 (95% CI: 1.44 to 27.9) times the odds of testing seropositive for Brucella spp., compared to cattle and buffalo that were not. Most participants in the study stated that livestock owners assist in the parturition of ruminants without wearing gloves and that some farmers sell animals which they suspect are Brucella infected to butchers or at market. Many participants made their livestock's milk into cheese and other dairy products without pasteurising it.

Conclusions

Brucellosis was endemic at high levels, in the current study. Although livestock owners had good general knowledge of brucellosis, they still appeared to participate in high-risk behaviours, which may contribute to the high seroprevalence in the area. Veterinarians, public health authorities and other community leaders need to collaborate to control the disease in animals and to manage the risk of human exposure.