PARTICIPATORY ACTION RESEARCH ON AVIAN INFLUENZA COMMUNICATION IN WEST AFRICA

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PARTICIPATORY ACTION RESEARCHON AVIAN
INFLUENZACOMMUNICATION IN WEST AFRICA
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BACKGROUND AND OBJECTIVES
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AVIAN INFLUENZA IN WESTERN AND CENTRAL AFRICA

• Between February 2006 and February 2007,
  outbreaks in birds were reported in
• Burkina Faso
• Cameroon
• Cote dIvoire
• Niger
• Nigeria
• In January 2007 confirmed human death in Nigeria

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OVERALL OBJECTIVE

• Developing communication/community mobilization
  interventions to reduce the negative impact of AI
  in three circumstances
• Continuing AI outbreaks
• Widespread AI
• Pandemic human influenza.
• For effective communication and mobilization
  interventions need to know
• The problem in context
• How communities identify problems and determine
  appropriate courses of actions

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SPECIFIC OBJECTIVES

• TO UNDERSTAND
• Perception of community members about AI
• Its potential impact on different aspects of
  their life
• Relationships between the spread of AI in the
  community and social, cultural and economic
  factors
• Communication resources that could be mobilized
  and feasible interventions that could be
  implemented using local resources

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APPROACH

• UNICEF partnered with AED to carry out
  community-based participatory action research
  (PAR).
• To capture diversity, three locations
• Burkina Faso
• Lagos State, Nigeria
• Kano State, Nigeria
• In each location, one urban/peri-urban and one
  more rural site

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WHAT IS PAR?
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PAR METHOD - PRINCIPLES

• Inclusion
• Participation
• Self determination

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PAR TOOLS

• Community mapping
• Transect walks
• Seasonal calendars
• Flow diagrams
• Bean heaps

Focus group discussions In-depth
interviews Matrix ranking Force-field
mapping Venn diagrams Causal flow mapping
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KEY ASPECTS OF PAR PROCESS

• Multiple tools
• Different aspects
• Different groups
• Men, Women, Youth
• Replicates
• ?Triangulation

• Ordered implementation
• Daily review and planning
• ? Refine research Qs
• ? Progress from general to specific

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PAR METHOD SCHEDULE
1 Team building Orientation training for community facilitators, exercises, and role plays
2 Community mapping (M,W,Y) Transect walk Feedback, data review, planning
3 Participants observation in the community Seasonal calendar (M,W,Y) Feedback, data review, planning
4 Focus group discussion Feedback, data review, planning
5 In-depth interview Bean quantification and Venn diagram (M,W,Y) Feedback, data review, planning
6 Causal flow diagramming, Preference matrix ranking, Story telling and force-field analysis (M,W,Y) Data review Prep for restitution
7 Restitution with community Presentations of the findings and the action plan Questions, comments and corrections
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BURKINA FASO FINDINGS
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BURKINA FASO PAR TEAM

• Dr Daniel Thieba, Team leader
• Dr Christophe Coulibaly, Field Coordinator
• M. Pierre Aimé Ouédraogo, Facilitator
• M. Luc Lankoande, Facilitator
• Mme Fatoumata Koné, Facilitator
• M. YANOGO Enoch Community facilitator, Gampela
• M. TONDE Abel, Community facilitator, Gampela
• M. BAKI Benoit Community facilitator, Ténado
• M. BAMOUNI Philippe Community facilitator, Ténado

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CHICKENS ARE EVERYWHERE
Chicken walking on force field analysis notes
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KNOWLEDGE ABOUT AI

• People know about AI
• People differentiate AI from other diseases such
  as Newcastle
• Specific local name for each site
• Noukoumtoaga large number of chicken deaths
  
• Kitjumanbeyolo the bad chicken disease

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ORIGIN AND CAUSES OF AI IN BIRDS

• Wind and dust
• Migrating and wild birds
• Introduction of foreign birds by traders and
  travelers
• Drinking contaminated water
• Backyard garbage disposal
• Eating dead birds

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MAIN USES OF BIRDS

• Commerce (monetary and barter)
• Religious and socio-cultural ceremonies
• Gifts
• Consumption

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POTENTIAL IMPACT 1

• On livelihood
• Lower family income for traders
• Lower access to health care and schooling
• On religious aspects of life
• Difficult/impossible to carry out
• Traditional ceremonies (Annual celebration of
  village founding father, prayers for rains,
  thanking ancestors)
• Rituals to mark all life milestones (engagement,
  marriage, death)
• Sacrifices for building a new house etc.

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POTENTIAL IMPACT 2

• On food security and nutrition
• Reduced consumption of chicken
• Reduced access to food
• Because of loss of income
• About 20 of income from poultry used to buy
  food
• On health
• Reduced access to health care because of loss of
  income
• Potential risk of human infection

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SOCIAL CULTURAL FACTORS AND THE SPREAD OF
AI

• Poultry movement
• Seasonal sales/barter of poultry
• Introduction of foreign poultry
• Poultry scavenging
• Contacts with wild birds
• Sick birds and reporting
• Small producers and sellers Less use of
  veterinarian specialists
• No reporting of sick birds
• Hygiene
• Body and hand washing after cleaning of chicken
  houses but not with soap (main motivation is
  odor)
• No special care after handling chicken droppings

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CHILDREN AND CHICKEN HOUSES IN BURKINA FASO

• Many people fear thieves
• so chicken houses are built with very small doors

• Only children 6-8 years old can get through the
  doors to clean the chicken houses
• Fear of thieves is the underlying factor for
  childrens exposure to infection

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FLEXIBILITY FOR CHANGE

• Possible alternatives to mitigate AI
  consequences
• Raising other animals as sources of income and
  food
• Gardening, vocational training for young people
• No alternative for religious, socio-cultural and
  traditional medicine
• Barriers and facilitating elements for AI
  mitigation
• Resources - All communities mentioned needing
  government/donor help

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EXISTING COMMUNICATION RESOURCES

• RELIABLE, TRUSTED AND EFFECTIVE SOURCES OF
  INFORMATION IN THE COMMUNITY
• Channel 1 Traditional network Village chief,
  neighborhood chief, village administrative
  delegate, traditional healers
• Channel 2 Poultry network Administrative
  chief, veterinarian, vaccinators, womens groups
• The two channels should work in close
  collaboration

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WIDESPREAD AI- RESPONSES

• Culling is an accepted measure
• Community surveillance
• Organize a local committee, provide adequate IEC,
  and ensure participation of administrative and
  technical authorities and community leaders
• Training of community volunteers for monitoring
  and reporting
• Bio-security measures suggested
• Bird separation (but not realistic)
• Movement control

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PANDEMIC AI - RESPONSES

• One site, with previous experience with
  meningitis, proposed
• Keep sick away from rest of community
• Banning public gatherings
• Other sites thought pandemic meant widespread
  infection of humans by birds, suggested banning
  poultry farming (not realistic)

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NIGERIA FINDINGS
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NIGERIA PAR TEAM

• Kano State
• Dr Umar Auwal Muhammed, team leader
• Mr Ilu Ismael, team coordinator
• Mrs Hajara Suleymane, facilitator
• Mr Aminu Suleymane, facilitator
• Mr Amino Abba, facilitator
• Community facilitators Jogana
• Mr Nazifi Ahmed
• Mr Farihat Ahmed
• Mrs Shamsuddeen A. Mohammed
• Community facilitators, Tarauni
• Mr Ado B. Dahiru
• Mr Abdurrazaq Harun
• Mrs Azumi Rufai

• Lagos State
• Ayodele Adeyoola Iroko, team coordinator
• Didos Olaoluwa, facilitator
• Leke Adeyemo, facilitator
• Bola Aladesuyi, facilitator
• Community facilitators Ajara Topa,
• Mrs. Sename Ogunjobi
• Mr. Kehinde Igesu
• Mrs. Sename Todonukun
• Community facilitators Iba
• Chief (Mrs) Phillips
• Mrs. Oseni,
• Mr. Tunde Ahotan

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KEY DIFFERENCES - NIGERIA AND BURKINA FASO

• PAR sites in Nigeria are more urban
• Lagos Ajara Topa and Iba
• Kano Limawa andTarauni
• Many people have small flocks of scavenging
  chickens
• But when asked, talk about commercial chickens
• Larger commercial sector than in Burkina Faso
• Includes backyard commercial poultry farmers
• Species of birds foreign breeds (Agric) and
  local breeds, both kept in cages

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COMMUNITY CLASSIFICATION OF POULTRY FARMING
Free range/ scavenging 1 20 chicken raised for family consumption
Small scale commercial Backyard poultry 20 50 chicken raised for family and for sale
Large scale (Backyard) 500 or more chicken raised for business. (predominantly foreign birds)
Semi-Commercial 1,000 or more chicken raised for business.
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PERCEPTION OF CAUSES AND ORIGINS

• RECURRING THEME EXTERNAL SOURCE
• Birds migrating from Asia and South Africa
• Deliberately introduced by western countries
• Rumors about the rich wanting to take the
  poultry business away from the middle and low
  income earners
• Rumors about the government encouraging the
  minority (rich people) to take over poultry
  business

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RELEVANT SOCIAL AND CULTURAL FACTORS

• Ownership
• No restriction on ownership or rearing of chicken
  
• Husbands endorsements are needed when chickens
  are to be given out or consumed in a household
• Cultural rites
• Chickens are perceived as protective wall for
  household members against evil spirit
  manipulation e.g. sickness, death and other evil
  occurrences
• Not clear how widespread this belief is

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PERCEPTION OF THE IMPACT OF AI

• Direct impact of AI on livelihood
• Massive death of birds falling poultry price
• Loss of money by poultry farmers
• Loss of jobs by poultry workers
• Direct impact of AI on religious/social rites
• If all chickens die, there may be no substitute
  for rites belief that the gods accept only
  chicken blood
• Belief that family protection is threatened
• Indirect impact on food security
• Fear of human infection and death prompted
  educated and rich people to shift to beef and
  fish which increased in price

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ACTIONS TAKEN TO PREVENT SPREAD AND REDUCE IMPACT
OF AI

• Avoiding infection
• Most individuals stopped eating poultry and eggs
• Buried dead and affected birds
• Protecting livelihood
• Traditional remedies at the onset of the epidemic
  as well as offering prayers
• Awareness campaign to encourage people to eat
  chicken implemented by POFAN (Nigerian Farmers
  Poultry Association)

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BARRIERS TO CHANGING PRACTICES

• Custom of letting chickens roam free
• Consumption of chickens that die or slaughter and
  consumption of infected chickens is an accepted
  practice in some communities
• For some, monetary incentive to buy cheaply (near
  outbreaks), sell elsewhere
• Lack of infrastructure (dumpsite, water)

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MOTIVATORS FOR CHANGING PRACTICES

• Protecting livelihoods/sources of income
• Ritual/ceremonial uses of chickens
• Health

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VIEWS ON COMPENSATION

• Views of authorities and communities differ
• Authorities compensation was a token for
  chickens that were culled
• Communities compensation should be
• 1) equivalent to the pre-outbreak price
• 2) paid both for culled chickens and those that
  died during the outbreak

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WIDESPREAD AI

• Communities expressed fear and concern about
• Loss of investment
• Loss of jobs
• Proposed solutions
• Sensitization and education of community
• Community surveillance and reporting
• Culling with support from local government
  authorities (full compensation)

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WIDESPREAD AI

• Almost impossible to imagine
• gods will not allow this
• Actions communities could take
• Take family members for vaccinations
• Reduce movement of people to the barest minimum
• Educate children and adults on the dangers of the
  infection
• Quarantine
• Pray

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EXISTING COMMUNICATION RESOURCES

• Source of information
• Radio, TV, word of mouth, public gatherings,
  posters and booklets
• Reliable and trusted sources
• Radio, traditional and religious leaders
• Veterinarians and health workers

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IMPLICATIONS FOR THE CONTENT OF COMMUNICATIONS
INTERVENTIONS
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KEY BEHAVIORAL INTERVENTIONS

• Key behavioral interventions for AI risk
  reduction recommended by WHO/FAO/UNICEF in March
  2006
• Report
• Separate
• Wash
• Cook
• PAR showed that not all are feasible for
  communities because key enabling factors are
  absent

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REPORT BARRIERS AND RECOMMENDATIONS

• Lack of recognition of AI (Nigeria)
• No longer a problem
• Lack of a surveillance system and
  confused/delayed response to reports or positive
  samples
• Advocacy for better response
• Mistrust of authorities
• Advocacy for improved/continuing transparency
• Problems with compensation
• Advocacy for a well-thought-out, fair and timely
  policy
• As part of the process, dialogue with farmers to
  establish a policy

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SEPARATEBARRIERS AND RECOMMENDATIONS

• Most difficult set of behaviors to change because
  of the custom of letting birds roam free
• Contributing factors
• Cost of caging materials
• Cost of feeding caged birds (biggest impediment)
• Belief that commercial birds can be source of
  infection
• Possible undesirable consequence greater
  exposure of children to feces (cleaning cages)
• Not much scope for communication intervention
  need to address underlying factors

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SEPARATEBARRIERS THAT CAN BE ADDRESSED

• Temporary quarantine
• Most feasible to initiate (because temporary)
  quarantine of new stock for 2 weeks before
  introducing to flock
• Communication should focus on
• Information about transmission of infection
• Modeling how to do it

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SEPARATEBARRIERS THAT CAN BE ADDRESSED

• Disposing of dead birds
• Food insecurity is the key factor underlying
  consumption of dead birds
• Long-term response Advocacy
• In the short term, address the problem of
  slaughtering and eating potentially infected
  birds
• Focus on safe practices for slaughter and food
  preparation

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WASHBARRIERS AND RECOMMENDATIONS

• Not using soap
• Possibly related to price, but also just habit
• Motivation for washing (with water)
• Smell
• Bad feel of hands
• Build on this in communication
• Emphasize how hands smell better after washing
  with soap and encourge people to wash often
• Not thinking handling birds is contaminating
• Information problem (communication solution)

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COOKBARRIERS AND RECOMMENDATIONS

• Main situations when undercooked meat is
  consumed
• Children cooking
• As part of rituals
• In both cases, problem seems to be simply
  impatience
• Focus communication efforts on children and
  traditional practitioners

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AUDIENCES

• Complex ownership/management issues
• Related to decision making
• Also implications for who gets compensation
• Issue of equity for women
• Ritual importance of chickens
• Need to involve traditional healers
• Differing organization of poultry production in
  Burkina Faso and Nigeria
• Much large commercial sector in Nigeria
• Commercial farmers may need different messages

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MOTIVATION

• Variety of motivating factors identified
• Health/mortality risks, especially for children
• Livelihood and specific uses for chicken income
  (school fees, health costs, buy other food)
• Lack of substitutes for ritual/social uses of
  chicken
• Existing fear of thieves affects childrens
  exposure to risk (through design of coops)
• Belief in chickens as protective barrier may
  affect willingness to cull

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MESSAGE CONTENT

• Existing information, including both true and
  false
• Not a blank slate
• Many rumors
• Different views about source of AI
• Biomedical AND supernatural explanations
• Conspiracy explanations
• Gap between communicated and perceived risk
• Most people who eat dead birds have no bad
  consequences
• Seasonality of poultry movement of risk

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IMPLICATIONS FOR COMMUNICATIONS CHANNELS AND
CHANNEL MIX
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MIX OF CHANNELS

• Mass media was used to convey information to
  public
• Needed to be supplemented with interpersonal
  channels for communities to act
• Nigeria Professional Poultry Farmers
  Association roving theater
• Burkina Faso Traditional village leaders and
  traditional healers
• Recommendation best to use mix of channels

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OPTIMAL INTERPERSONAL CHANNELS

• Local leaders and traditional healers for
  backyard poultry farmers and the general public
• Veterinarians and experienced farmers for
  semi-commercial and commercial farmers
• Religious leaders of all types and local
  authorities to discuss and prepare for widespread
  AI and human pandemic

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THE FUTURE OF PAR
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ADDED VALUE OF PAR

• Richer, wider understanding of issue than
  obtained using conventional formative research
  approaches because the results are
  contextualized/grounded
• Stimulates communities to assess what they might
  do themselves
• Involving professionals as local facilitators
  improves community professional dialogue
• Some results meaningful across many topics (e.g.,
  key motivators, trusted sources, existing
  networks)

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RECOMMENDATIONS

• Implement at scale to capture national diversity
• Apply to other health topics
• Investigate possibility of training community
  agents to use an abbreviated PAR process to
  initiate dialogue with communities

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APPLYING PAR AT SCALE
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POSSIBLE BOTTLENECKS

• Cost (time/money)
• Build on existing PAR network(s)
• Managed through a core local institution/group
• Able to rapidly mobilize local teams
• Mainstream across health/development
  interventions
• Advocate for PAR among key stakeholders
• Technical expertise
• Build on existing PAR network(s)
• Toolkit
• Coaching/mentoring by core local
  institution/group