Community preparedness for highly pathogenic Avian influenza on Bali and Lombok, Indonesia

INTRODUCTION

The Asia-Pacific region is the likeliest location for the next significant outbreak of highly pathogenic avian influenza (HPAI). Indonesia has experienced HPAI H5N1 outbreaks in poultry and humans each year since 2003 and has had the highest case fatality rate for human cases. The purposes of this study were to capture the knowledge of avian influenza and of poultry-raising practices in two regions of Indonesia and to evaluate the impact and extent of activities undertaken to 2010 through the National Strategic Plan for Avian Influenza Control at the village level.

METHODS

A combination of quantitative and qualitative methods was used to investigate the multiple influences on behaviours, decisions and actions taken by poultry-raising households, and by villages and communities, regarding the threat of HPAI. Between June 2010 and May 2011 a structured survey of 400 households was conducted on Lombok and of 402 on Bali, inviting Sector 3 (small-scale independent commercial poultry farms) and Sector 4 (village household) poultry raisers to participate. Focus groups and in-depth interviews were convened with key stakeholders, including livestock and animal health and public health officials, community leaders and villagers.

RESULTS

From the focus group and in-depth interviews, it appears that the flow of information through the national HPAI control program has been efficient at the top levels (from national to provincial, then to districts and subdistricts). However, these findings show that effective transmission of information from subdistrict to rural village level and from village leaders to community members has been limited. The degree of community preparedness for HPAI on Bali and Lombok appears minimal. Knowledge of government activities was more extensive at Bali sites, while only limited government programs and activities occurred at the village level on Lombok. Activities conducted by government agencies from provincial to village level were limited in scope and need to be further developed to ensure safe poultry-handling practices and biosecurity measures. On both Bali and Lombok, community respondents knew the signs and symptoms of sick birds but did not differentiate well between HPAI and other bird diseases. On both islands, more than 60% of respondents were reluctant to report sudden deaths of poultry. The lack of a government compensation program for destroyed flocks contributed to this unwillingness to report.

CONCLUSIONS

While the Indonesian government's planning efforts for HPAI are commendable, the plan has not been effective, as it depends on the cooperative actions of people with small rural farms who have not been consulted in the development of the plan, have not been adequately instructed on the nature of the plan, and perceive no benefits to themselves from prevention efforts. Context-appropriate mechanisms for communicating zoonotic risk and options for risk mitigation that do not result in net loss to poor households are also needed.

Financial aspects of the provision of care to AIDS patients at Hartford Hospital

Data on the provision of care to persons with AIDS at Hartford Hospital are presented for the years 1988 and 1989. Approximately 2% of the total operating loss from uncompensated care at the hospital was due to patients with AIDS during both of those years. While the hospital continues to show a net surplus of revenues over expenses, the operating loss incurred by the hospital for the provision of care to hospitalized case-definition AIDS patients increased by 88.1% between 1988 and 1989.