Paradoxical risk perception and behaviours related to Avian Flu outbreak and education campaign, Laos

<p>Abstract</p> <p>Background</p> <p>In Laos, small backyard poultry systems predominate (90%). The first lethal human cases of highly pathogenic avian influenza (HPAI) occurred in 2007. Few studies have addressed the impact of outbreaks and education campaigns on a smallholder producer system. We evaluated awareness and behaviours related to educational campaigns and the 2007 HPAI outbreaks.</p> <p>Methods</p> <p>During a national 2-stage cross-sectional randomised survey we interviewed 1098 households using a pre-tested questionnaire in five provinces representative of the Southern to Northern strata of Laos. We used multivariate analysis (Stata, version 8; Stata Corporation, College Station, TX, USA) to analyse factors affecting recollection of HPAI educational messages, awareness of HPAI, and behaviour change.</p> <p>Results</p> <p>Of the 1098 participants, 303 (27.6%) received training on HPAI. The level of awareness was similar to that in 2006. The urban population considered risk to be decreased, yet unsafe behaviours persisted or increased. This contrasted with an increase in awareness and safe behaviour practices in rural areas.</p> <p>Reported behaviour changes in rural areas included higher rates of cessation of poultry consumption and dead poultry burial when compared to 2006. No participants reported poultry deaths to the authorities. Overall, 70% could recall an educational message but the content and accuracy differed widely depending on training exposure. Washing hands and other hygiene advice, messages given during the HPAI educational campaign, were not recalled. Trained persons were able to recall only one message while untrained participants recalled a broader range of messages. Factors associated with an awareness of a threat of AI in Laos were: having received HPAI training, literacy level, access to TV, recent information, living in rural areas.</p> <p>Conclusion</p> <p>We report a paradoxical relationship between unsafe behaviours and risk perception in urban areas, as well as exposure to HPAI training and message misinterpretation. Future educational campaigns need to be tailored to specific target populations and farming styles, for example, small holder farms as compared to commercial farms. Special attention must be given to varying risk perceptions and the risk of misinterpretation of key messages, economic hardship, and real life consequences of reporting.</p

Breast-Milk Substitutes: A New Old-Threat for Breastfeeding Policy in Developing Countries. A Case Study in a Traditionally High Breastfeeding Country

Background: Developing countries with traditionally breastfeeding are now experiencing the increasing pressure of formula milk marketing. This may endanger lives and undermine the efforts of national policies in achieving the objectives of the Millennium Development Goals. We examined the use of, and factors for use, of all available breast-milk substitutes (BMS) in a country with a traditionally high rate of breastfeeding. Methods: Randomised multi-stage sampling surveys in 90 villages in 12/17 provinces in Laos. Participants: 1057 mothers with infants under 24 months of age. Tools: 50-query questionnaire and a poster of 22 BMS (8 canned or powdered milk; 6 non-dairy; 6 formulas; 2 non-formulas). Outcome measures included: prevalence of use and age of starting BMS in relation to socio-demographic characteristics and information sources, by univariate and multivariate analyses

Knowledge of and feeding BMS to infants less than 6 months in Laos^£.

<p>*Mean age and 95% confidence interval,</p>£<p>knows at least one BMS in the category.</p><p>The following questions were asked: Did you give this product to your baby? If yes, How old was your child when you started giving this product to her/him (month).</p

Main reasons for giving BMS to infants before 6 months of age among users.

£<p>The following question was asked: Why do you feed your baby this product?</p><p>*Of 207 users before 6 months, 203 users ‘responses available.</p><p>**Rich with vitamins, similar to rice, good for children.</p><p>***1.4% of 1057 mothers reported that they could not breastfeed.</p

Main source of information on breast milk substitute (BMS).

£<p>The following questions were asked: How did you hear about these products? (many answers possible), if the answer was TV: Which channels?</p>££<p>The following question was asked: Which of the above mentioned sources of information do you trust the most for your family?</p

Factors associated with the use of BMS before 6 months of age in Laos (multivariate analysis).

<p>95% Confidence Interval.</p

Map of study site.

<p>Map of study site.</p

Top five BMS used before the age of 6 months for infants in Laos.

<p>*One US$ = 8,000 kip. Mean prices reported by mothers, ^£ How long does one can or box last or box.</p><p>**Main component: Skimmed milk powder (36,5%), full cream milk powder (21,9%,) vegetable fat mix (12,6%), sucrose 7,7%, Maltodextrin 6,7%, honey 5,5%, lactose 3,2%, oligo-fructose (2,6%), butter oil (1,3%), vitamins and minerals premix (0,9%), soya lecithin (0,3%), fish oil (0,1%).</p

Main socio-economic characteristics of mothers in 12 provinces of Laos.

<p>*mean (95% confidence interval);</p><p>**This classification is used to roughly describe ethnic groups belonging to lowlands, midlands and highlands though people may have migrated since then from their original residency.</p>£<p>834 (78.9%) reported an occupation: 73 (6.9%) civil servants, 60 (5.7%) shop keepers, 18 (1.7%) workers, 16 (1.5%) other occupations.</p>££<p>At list one visit.</p>£££<p>In US dollars: US = 8000 Lao kip.</p