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Field Trip Report

On-site Development and Pre-testing of Avian Influenza-related IEC materials Shwe Bo, Sagaing Division, Myanmar

7 – 13 May 2006

Background During an Avian Influenza Communication Working Group meeting on 20 April 2006 at UNICEF, the group agreed to the idea of forming a team to develop a range of communication materials related to avian influenza prevention on-site, in villages, together with community members. It was suggested that the group visit either Shwe Bo or Monywa (AI affected areas) and Pathein or Mawlamyein (non-affected areas). This report covers the first trip to Shwe Bo. The team was comprised of technical health, veterinarian and communication experts from the Ministry of Health, Ministry of Livestock and Fisheries, WHO, FAO, UNICEF, and complemented by a team of creative talent, including an artist, illustrator, graphic designer, script writer and photographer. Purpose of the Trip The purpose of the visit was to rapidly develop and pre-test prototype avian influenza-related information, education and communication (IEC) materials on-site. Location and Time Shwe Bo, Sagaing Division was selected as the site for the first trip. The team was equipped with a computer, laptop, printer, scanner and generator. During the week of 7 to 13 May 2006, the team visited and worked with commercial and backyard poultry farms, and families living in villages in Shwe Bo District. Methodology

1. Participatory Learning and Action (PLA)

2. Semi-structured interviews 3. Focus group discussions 4. Mobility mapping 5. Observations by using check

list (guidelines) Process

1. Data collection 2. Evaluating key findings 3. Identifying risk behaviours 4. Identifying desired behaviours 5. Identifying messages 6. Prioritizing key messages 7. Develop/producing prototype IEC materials on-site 8. Pre-testing

Villagers from May Gon village carrying out a mapping exercise

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Activities The team took the precaution of visiting a non-affected farm and village on the first day of the trip, and affected farms on the second day, so as to prevent the team’s possible carrying of the AI virus from affected areas to non-affected areas. Day 1: Monday, 8 May 2006 Morning: The team visited the KT commercial poultry farm in Shwe Bo, carried out mapping of the poultry farm, and held discussions with 30 small-scale poultry farmers. Semi-structured interviews were also conducted with some of the farm owners, as well as farm workers.

Afternoon: The team visited May Gon village, which is situated near Maha Nada Lake, where different types of migratory birds frequent from November to February each year. The team carried out mapping of the village tract, and held discussions with residents about practices involving the raising of chickens, ducks and pigs. The discussions revealed that different kinds of livestock are often kept together, and that chickens are often raised just under families’ living areas, without being properly fenced. Some residents raise fighting cocks, and cock-fighting is a common event in the community. The “Pocket Chart” method was also used to learn more about residents’ hygiene practices. At the end of the day, the team shared findings from the day, exchanged views, and evaluated the day’s activities and people’s responses. The team then planned for the next day’s activities on AI-affected areas, which included the development of a set of questionnaires to be used in villages. The team agreed to be sensitive to residents’ situation following recent AI outbreaks, and to try to ensure their questions don’t unnecessarily evoke painful experiences. Day 2: Tuesday, 9 May 2006 Morning: The team visited Zee Gone village, 28 miles north of Shwe Bo. In Zee Gone, three-quarters of all commercial and small-scale poultry farms were affected by recent outbreaks, and flocks were culled. For the purpose of the trip, commercial poultry farmers were divided into two categories – those from affected farms, and those from non-affected farms. Focus group discussions were conducted with farmers from affected farms, addressing a range of issues, including: (1) their opinions on what kind of preventive measures should be taken to prevent this kind of event; (2) how they reacted to the AI outbreak; (3) their views on information sharing, reporting systems

Map of a commercial poultry farm in Shwe Bo

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and other issues that they are facing; and (41) whether they were interested in restocking poultry. The team then engaged in a mapping exercise with those whose farms were not affected, identifying the location of some poultry farms in the area, and discussing their experiences following the AI outbreak, including the problems that they are facing due to restrictions placed on poultry products, social discrimination in their community, their response to the outbreak, preventative measures they are taking, and their assumptions about AI. Afternoon: The team visited Khin U, with the same approaches employed to ascertain residents’ and farmers’ knowledge, attitude and practices pertaining to poultry rearing. The team met with 21 small-scale poultry farm owners, including the Chairperson of the Livestock Federation (township level), whose farm was the first to be detected with avian flu in Khin U. Most of the farms located within a 3 kilometer radius of the outbreak site had their flocks immediately culled. Through discussions with those whose farms were not affected, it became apparent that many had misunderstandings about AI, with many confusing it with a serious and strong form of Newcastle Disease that normally occurs during this season. The team visited the most AI-affected communities in the area. The responses of the poultry farmers were objective, and they clearly understood the importance of the information sharing and reporting developments to relevant authorities. The discussions were productive, and the findings proved very useful in providing a foundation for the development of locally-appropriate IEC materials which the team aimed to produce. Day 3: Wednesday, 10 May 2006 Morning: The team visited Shar Daw village, and carried out mapping exercises as well as pocket chart method exercises to explore the dynamics of risky behaviours. Afternoon: The team interviewed two chicken vendors and two egg sellers about their awareness of AI, with a focus on potentially risky behaviours. Those who were interviewed demonstrated good existing knowledge of AI. Based on the exercises described above, that evening the team began the process of identifying risk behaviours and based on the inputs provided by farmers and community members, compiled a comprehensive mobility map of the poultry farmers, breeders, local veterinarians, chicken dealers, chicken feed sellers, chicken disposal buyers, drug stores, and staff from LBVD, the township development council and Livestock Federation. Day 4: Thursday, 11 May 2006 The team identified desired behaviours based on the risk behaviours that were identified, and came up with ten major messages consistent with these desired behaviors. Five key messages were then prioritized, and detailed discussions were held about target audiences, media channels, illustration, layout design and the wording of messages. Pursuant to the outcomes of these discussions, that evening the group began producing a range of draft prototype IEC materials.

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Day 5: Friday, 12 May 2006 Morning: The team continued working on the layout and design of posters and other IEC materials. This was limited due to time constraints. Afternoon: The team field-tested four prototype posters with residents of Oo-yin-daw village, and workers from a commercial poultry farm near Shwe Bo. Overall, the messages communicated in the IEC materials were well understood by community members and farmers.

Posters and other IEC materials were pre-tested with community members

Day 6: Saturday, 13 May 2006 On the way back to Mandalay, the team met with some quail farm owners, and carried out additional mapping exercises to understand their current and risk behaviours, knowledge on AI, and practices. The pocket chart method was also used to identify how people handle sick/dead quails. The team visited one quail farm in Amarapura. Conclusion The team randomly visited some affected areas during the trip. Non-affected areas will also be visited in the third week of May 2006 in a different area of Myanmar to identify a more complete set of behavioural patterns of poultry farmers, so as to produce more effective and appropriate IEC materials to prevent transmission of Avian Influenza.

ANNEXES Annex 1: Itinerary Annex 2: Participants List Annex 3: Pre-prepared Questionnaires Annex 4: Findings on current knowledge, attitude and practices

of poultry farmers and villagers Annex 5: Ten Key Messages Annex 6: Pocket Chart Results Annex 7: Draft Prototype Posters

One of the team members explaining the illustrations on the pocket charts

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Annex 1: Itinerary

Sunday 7 May 2006 Morning Yangon to Mandalay by air Afternoon Mandalay to Shwe Bo by car

Monday 8 May 2006 Morning Visit Commercial Poultry Farm in Shwe Bo and meet with

farm workers and small scale poultry farm owners Afternoon Visit May Gon Village and meet with backyard poultry

farmers and villagers Tuesday 9 May 2006 Morning Visit Zee Gone Village and meet with workers from affected

and non-affected farms Afternoon Visit Khin U and meet with small scale poultry farm owners Wednesday 10 May 2006 Morning Visit Shar Daw Village and meet with villagers Afternoon Interview with chicken vendors and egg sellers in Shwe Bo Group discussion on findings Thursday 11 May 2006 Morning Identify ten key messages Afternoon Development of prototype posters Friday 12 May 2006 Morning Development of prototype posters Afternoon Field-test prototype posters with villagers from Oo-yin-daw

village and commercial poultry farm workers from Shwe Bo Saturday 13 May 2006 Morning Shwe Bo to Amarapura by car Meet with quail farm owners and visit a quail farm Afternoon Mandalay to Yangon by air

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Annex 2: Participants list

1. U L Tu Ming Gawng Deputy Director Livestock Breeding and Veteriarary Department Ministry of Livestock and Fisheries 2. U Sian Za Nang Assistant Director Central Health Education Bureau Ministry of Health 3. U Aung Naing San

Writer/Song composer 4. U Win Naing IEC/Design Consultant 5. U Myo Thame Photographer 6. Dr. Ye Tun Win AI Focal Point, FAO 7. Dr. Myo Paing

National Professional Officer, WHO

8. U Aye Win Assistant Project Officer, UNICEF 9. Daw Aye Aye Than Assistant Communication Officer, UNICEF 10. Daw Khin Moe Moe Aung Communication Assistant, UNICEF 11. U Thant Zin IT Assistant, UNICEF 12. U Kyaw Zwa Information Assistant, UNICEF

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Annex 3: Pre-prepared Questionnaires

Bio-Security Bio-Safety

1. How do you raise your poultry? Do you

keep them fenced or let them roam free?

2. Any case of died or sick chickens in

your farm? 3. How do you know if/when your chickens

get sick? 4. What do you usually do with dead/sick

chickens? Eat them or give them to others?

5. What will you do if you face massive

death of birds in your farm? 6. Do you always allow outsiders/visitors

to enter your farm? (Do you normally restrict the entries into your farm?)

7. Do you spray disinfectant/ calcium

hydroxide at the entrance of your farm? 8. Can other birds such as doves, pigeons

and sparrows enter the fowl house? What kind of action do you take to prevent that?

9. How do you use cages and containers

that carry birds? Do you wash them after every use? What do you wash them with? What kind of containers do you use?

10. How can you identify that your birds are

infected by avian influenza? 11. Do you raise chickens, ducks and pigs

together in the same area?

1. Is your farm house close to your

home? 2. Do you wash your hands :

• After handling chickens • After handling eggs • Before preparing to cook

3. Do the chicken dealers/vendors buy

sick birds? What do you do with the sick birds if they are not bought?

4. What do you do with chicken

faeces? 5. Do you raise fighting cocks? Is there

any cock fighting in the villages? If yes, how often?

6. What do you do if your family

members get sick? 7. How do you clean eggs before

selling out? Do you sell cracked eggs too?

8. Do you eat chicken now? How do

you cook it? If not, why don’t you eat it?

9. How do you handle with chicken

waste, feathers, intestines and other remains? Do you sell/ give away/dispose them? If disposed, where is the disposal place?

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Annex 4: Findings on current knowledge, attitude and practices of poultry farmers and villagers

Knowledge • The disease is only a seasonal influenza that annually occurs to the poultry • Sick chickens suffer from a strong strain of new castle disease • AI is not a contagious disease • AI cannot be transmitted from poultry to human by consuming chicken • Village chickens are the main source or the carrier of the disease • Eating undercooked eggs is not dangerous • AI cannot be prevented • Repeatedly using egg containers, feed bags and other types of materials to

carry the poultry is not a risky habit • Farmers mention their lack of knowledge and financial capability to build

systematic poultry houses • Lack of knowledge and accurate information on AI Attitude • Commercial and small scale poultry farmers are willing to report unusual

cases of sick/dead poultry in their farms • Backyard poultry farmers and villagers denied any unusual sick/death of

their native chicken in many months • Some commercial farmers do not want to disclose the news of poultry

deaths among their competitors/neighbours • Farmers want to get necessary information as soon as possible • Regarding the symptoms of AI, only 2 out of 7 symptoms are matched in

sick/dead chickens. Therefore they assume that it was not AI. • Farmers those whose farms were stamped out are being discriminated by

the community at teashops, clinics, barber shops, etc., Practices • In visited commercial farms, good hygiene system is practiced – regular

cleaning of the floors, feed bins, masks/gloves are used to collect eggs • After AI outbreak, entries of outsiders into the farm are restricted • Disinfectants are sprayed on the farms every other day • Eggs unsold are buried in a pit • Chicken faeces are kept in distant corner of the compound before selling

them to farmers who use them as natural fertilizer • Separate sandals are used in the poultry farms • Do not wash hands after handling chickens and chicken related materials • Regularly consume sick/dead native chickens • Cracked eggs are eaten by the family, given to neighbours or workers, fed

to pet cats • People from affected areas and neighbouring areas still do not consume

chicken and egg • Chicken, ducks and pigs are raised together in villages • Villagers live closely with poultry • Children play with native chickens

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• Chicken faeces are widely used in agriculture as natural fertilizer and frequently used as feed in commercial fish ponds in the area

• Cock fighting is very common in villages and it was found that the care for fighting cock is very intimate

Possible Reasons of Transmission • Through chicken, human and vehicles coming from infected areas • Frequent visits of poultry dealers onto the farms • From wild birds, native birds and mice • Using contaminated cages to sell out chickens at the end of lay stage. • Exchange of feedbags at the feed stores • Smell from the chicken farm houses • Through the air • Genetic causes • Dealing poultry at rail stations • Social encounters of chicken dealers at places like tea shops, billiard

centres, etc. Preferred media to receive timely AI information • MRTV/Myawaddy channels between 7 pm and 8 pm • Pamphlets • Manual including layout of a standard farmhouse, feeding systems, hygiene

practices, new/good breeds to raise, etc. • Posters

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Annex 5: Ten K

ey Messages

Sr. N

o. R

isk Behaviour/ C

urrent behaviour

Desired B

ehaviour B

arriers to Change

Messages

Target Audience

Proposed Media

Channels

1. Lack of aw

areness on AI

transmission

Misconception

Have know

ledge on AI

transmission

Lack of education Lack of inform

ation Lack of financial resources

Mode of Transm

ission (anim

al to animal transm

ission) Those w

ho are exposed to livestock especially poultry farm

ers

Poster; P

amphlet

Flipchart; Interpersonal com

munication (IP

C)

2. H

andle and consume chicken

products with unsafe practices

Handle, prepare and

consume poultry safely

Lack of knowledge

Habits

Low risk perception

Safe to eat

General public

Poster

Ratio/TV

spots IP

C

3. S

tay closely with poultry

No fencing/free range

Avoid staying with poultry

Lack of financial resources H

abits

Avoid staying with chicken

(bio-safety; Anim

al to human

transmission)

Poultry farm

ers B

ackyard poultry farmers

Cartoon w

all-sheet IP

C

4. H

andling poultry and utensils w

ithout washing hands

Alw

ays wash hands after

handling chicken and chicken related products and utensils

Lack of hygiene practices Lack of know

ledge

Alw

ays wash hands w

ith running w

ater and soap after handling chicken and chicken related products and utensils

General public

Print m

aterials TV

/radio spots IP

C

5. H

iding current situation by •

eating sick/dead chickens; •

selling them at low

price; •

giving them aw

ay; •

disposing of unsafely and burying them

Report sick/dead poultry to

authorities imm

ediately D

o not want to let the

neighbours know

Lack of knowledge

Neglect risk factors

Sick and dead chickens are

dangerous. Inform/ report

authorities imm

ediately.

General public

Com

mercial/ sm

all scale poultry and backyard poultry farm

ers

Print m

aterials IP

C

6. R

aising chickens, ducks and pigs together

Separately raising poultry

by getting them fenced/

caged/ housed

Lack of space H

abits Lack of know

ledge

Don’t raise chickens, ducks and

pigs together B

ackyard poultry farmers

Print m

aterials TV

/radio spots IP

C

7. C

ock fighting is comm

on in the com

munity

Lack of hand washing at the

critical times

Living with poultry

Avoid extreme exposure to

fight cocks W

ashing hands after handling poultry, poultry related products and utensils P

laying with chickens

Habits

Lack of knowledge

Prevent anim

al to human

transmission

- Fighting cocks - H

and washing

- Avoid staying w

ith poultry - A

void playing with poultry

Backyard poultry farm

ers Fam

ily mem

bers especially children

Print m

aterials TV

/radio spots IP

C

8. S

taying closely with poultry

Keeping old and new

stocks together S

easonal migrations of the w

ild birds

Avoid living together with

poultry S

eparate new stocks

Habits

Lack of space Lack of financial resources Lack of know

ledge that w

ild birds can bring in virus

Separate poultry from

1. living areas 2. new

stocks for 2 weeks

3. wild birds

4. different species

Backyard poultry farm

ers C

omm

ercial poultry farm

ers C

hildren

Print m

aterials TV

/radio spots IP

C

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Sr. N

o. R

isk Behaviour/ C

urrent behaviour

Desired B

ehaviour B

arriers to Change

Messages

Target Audience

Proposed Media

Channels

Mixing different species in the

same area

Children playing w

ith domestic

poultry

Keep poultry houses

sheltered R

aise different species separately K

eep children away from

poultry

Treating domestic poultry

as children’s pets

5. children

9. N

o or little knowledge of Avian

Influenza

Lack of information

What is Avian Influenza?

G

eneral public C

omm

ercial/ Sm

all scale/ backyard poultry farm

ers

Print m

aterials TV

/radio spots IP

C

10.

C

lean clothes, footwear, vehicle,

motor cycle, bicycle, cage,

chicken feed container

Com

mercial poultry

farmers

Those who have contact

with livestock

Print m

aterials TV

/radio spots IP

C

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Annex 6: Pocket Chart Results (A)

Place : May Gun village, Shwe Bo Township Date : 08 May 2006 Participants : Chicken backyard farmers 13 Participants Purpose : To see how people clean themselves after handling chickens

Washing hands While taking bath

After using latrine

After cooking chicken

After processing

chicken

After giving away

chicken

After disposing of chicken

After feeding chicken

Participants (13) (male 1; female 12) 12 9 11 11 3 4 6

(B)

Place : Shar Daw Village, Shwe Bo township Date : 10 May 2006 Participants : Backyard Poultry farmers 9 men / 7 women (total 16 participants) Purpose : To see how people clean themselves after handling sick/dead chickens

Washing hands

While taking bath

After using latrine

After cooking chicken

After processing

chicken

After giving away

chicken

After disposing of chicken

After feeding chicken

After collecting

eggs

Male (9) 6 12 9 3 1 1 - 1 Female (7) 7 4 3 6 1 - 1 1 Total 16 13 16 12 9 2 1 1 2 (C)

Place : Township LBVD office, Amarapura, Mandalay Division Date : 13 May 2006 Participants : Quail small scale farmers from Amarapura 5 men / 2 women Purpose : To see how people handle sick/dead chickens

How people handle sick/dead chickens

Give away Eat Sell Dispose Bury Inform authorities

Male (5) 1 1 - 1 4 1

Female (2) - - - 3 1 -

Total (7) 1 1 - 4 5 1

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Annex 7: Draft Prototype Posters

Safe to Eat

Modes of Transmission

Separate poultry from:

1. living areas; 2. new stocks for 2 weeks; 3. wild birds; 4. different species; 5. children

Sick/dead chickens are dangerous.

Inform/report authorities immediately.

Note: The above posters are the very first drafts developed on-site during the trip. All posters have been pre-tested in communities, with feedback on messages and on illustrations. This feedback has not yet been incorporated.