Epidemiological risk factors of knowledge and preventive practice regarding avian influenza among poultry farmers and live bird traders in Ikorodu, Lagos State, Nigeria.

Avian Influenza (AI) is an infectious disease of birds caused by type A influenza virus. The disease has a pandemic risk leading to death or depopulation of millions of birds. This study determined the risk factors that predict adequate knowledge and good preventive practice measures towards AI, among poultry farmers and live bird traders in Ikorodu, Lagos State, South-western Nigeria. A descriptive cross sectional survey was conducted with questionnaire on socio- demographics, knowledge of definition, and transmission of avian influenza administered to 244 respondents at interview. Descriptive, Chi-square and logistic regression analysis were carried out to explore associations between demographic characteristics, knowledge and preventive practice scores. All levels of significance were set at p < 0.05. The total knowledge score computed on a 25-item scale revealed a mean total knowledge of 9.9 (SD ± 6.6). Respondents aged <20 years, live bird traders and those with no formal education had the poorest knowledge. The total preventive practice score regarding avian influenza on a 9-item scale revealed a mean of 5.3 (SD ± 2.1). Younger respondents, live bird traders; those with no tertiary education and those spent <24 months in their profession had the poorest preventive practice score. Logistic regression analysis showed that increasing education (p < 0.05) significantly predicted adequate knowledge of avian influenza and good preventive practice among respondents. Poultry farmers and live bird traders, specially those with no formal education, should be aware of the transmission, seriousness and preventive measures of AI that will be reflected in the prevention and control of the disease in Nigeria.

Introduction

The emergence of highly pathogenic avian influenza (HPAI), subtype H5N1 has led to increased global attention to the disease as the virus could potentially represent the source of the next human influenza pandemic [1]. Avian Influenza (AI) is an infectious disease of birds caused by type A influenza virus. In poultry, the virus causes distinctly different form of disease – one common and mild, the other rare and highly lethal. The mild form may be expressed only as ruffled feather, reduced egg production or mild effects on the respiratory system. The second and less common highly pathogenic form is characterized by sudden onset of severe disease, rapid contagion invading multiple organ and tissues and a mortality rate that can approach 100% in 48 h. The resulting massive, internal haemorrhage has earned it the lay name “chicken Ebola” [2]. The first outbreak within the poultry population in Africa was reported in Kaduna State, Nigeria, in February 2006 [3]. Since then, the disease has spread within the poultry population in most parts of the continent, which has resulted in the death or depopulation of millions of birds and up to US$5.4million paid in compensation in Nigeria alone [4]. A second outbreak of the disease was also reported in 18 out of 37 states of Nigeria involving both farms and live bird markets (LBM) in January 2015 [4]. In January 2017, the Nigerian Agriculture minister reported the avian influenza virus has invaded the Nigerian poultry in 26 states killing over 3.5 million birds and millions of Naira paid as compensation [5]. Also a recent study confirmed that 39.4% of the LBMs surveyed in Africa were infected with the virus [6].

Of all influenza viruses that circulate in birds, the H5N1 virus is of greatest concern for human health for two main reasons. First, the H5N1 virus has crossed the species barrier to infect humans and the second implication for human health of far greater concern is the risk of a pandemic [2]. The first human case of avian influenza was reported in Hong Kong in 1997 [7]. Since then there have been several alarming cases in humans. As of March 20, 2015, the WHO has reported 430 deaths in 16 countries attributable to H5N1, with a case fatality ratio of 55% [8]. In January 2007, there was a confirmed human death from H5N1 in Lagos, Nigeria where there was continuing sporadic outbreak [9].

In the past years a number of studies have been published investigating knowledge, attitudes, and practice (KAP) regarding avian influenza among target groups such as poultry workers and general population [10], [11], [12]. This area of investigation seems to be an important one because members of the public often misinterpret their risk of health problems [13]. In addition past studies have demonstrated that live poultry famers are high-risk groups in avian influenza virus transmission and LBMs play an important role in its spread from birds to humans [14], [15]. Moreover, LBMs have also been reported in previous studies to serve a central distributive function for the dissemination of the virus [6]. The virus can also persist in LBMs for several weeks [16] and thus these environments are suitable for viral re-assortment [4].

Most people are not knowledgeable about AI and the dangers it’s likely to pose, rather they perceive such outbreak as an opportunity for them to eat cheap poultry (being disposed of). In a knowledge, attitude and practice (KAP) study conducted in adult population in Italy, it revealed that only 33.5% of respondents correctly identified the modes of transmission of avian influenza [13]. There is a need to identify the factors that will improve uptake of control strategies by high risk groups. This study therefore seeks to determine the predictors of knowledge and practice of preventive measures regarding avian influenza among live bird traders and poultry farmers in Ikorodu Local Government Area (LGA) of Lagos State, Nigeria.

Materials and methods

Study location and design

A Descriptive cross sectional survey was conducted in Ikorodu LGA, Lagos State, Nigeria among commercial poultry farmers and live bird traders. Ikorodu LGA (Fig. 1) is one of the administrative divisions of Lagos State. It lays approximately between latitude 6°36′ N and longitude 3°30′ E. Lagos state has a population of approximately 341 poultry farms [17]. Ikorodu local government has one of the largest concentrations of these farms and markets in Lagos state, thus it was selected as the study location. The investigators included the author and two avian influenza desk officers located in Ikorodu LGA who identified the poultry farmers and live bird traders within 3 community development areas (CDA) in Ikorodu LGA. Poultry farmers in Ikorodu North and Imota community development areas; and live bird markets in Ikorodu Central were surveyed for this study (Fig. 2, Fig. 3, Fig. 4). A structured questionnaire modified from a previous KAP study carried out in Italy was used in this survey [11]. The respondents were interviewed confidentially on demographic, knowledge of definition, knowledge of transmission and preventive practices regarding avian influenza. The response choices for all knowledge questions were on a three-point Likert-type scale using “yes”, “No”, “do not know” whilst those of preventive measures were “always”, “often”, “sometimes”, “rarely” and “never”. The questionnaires were back translated to the local language, which is Yoruba. All the poultry workers and live bird traders identified in the area that agreed to participate were recruited into the study. A response rate of 91% (244 respondents) was achieved and was included in the analysis.

Fig. 1

Above: Map of Nigeria showing Lagos State, Below: Map of Lagos State showing Ikorodu Local Government Area (The study location).Map constructed by Nusirat Elelu using QGIS® software.

Fig. 2

Large-scale poultry farm in Ikorodu North Farm Settlement (Odogunyan), Ikorodu, Lagos state Nigeria. Source: Nusirat Elelu, 2009.

Fig. 3

Backyard poultry house in Imota farm settlement, Ikorodu, Lagos State Nigeria. Source: Nusirat Elelu, 2009.

Fig. 4

Ejina Live bird market in Ikorodu Central, Lagos State Nigeria. Source: Nusirat Elelu, 2009.

Statistical analyses

Data collected were entered into Microsoft Excel® (Microsoft Redmond, USA) for data cleanup and collation. They were then analyzed using descriptive statistics such as frequencies and percentages on key indicators. To determine the measure of knowledge and preventive practice measures of respondents on AI, a scoring system was used by addition of scores from the variables pertaining to these items. Knowledge regarding avian influenza was scored on a 25-item scale while total preventive practice score was scored on a 9-item scale. A correct response attracted a score of 1, while an incorrect response attracted a score of 0. The mean knowledge and preventive score was computed in which adequate knowledge/good preventive practice was then categorized using the mean as cutoff. Respondents with scores above the mean while inadequate knowledge/poor preventive practice scores were those with scores below the mean. Data were then exported into SPSS software version 16.0 (SPSS Inc., Chicago, IL, USA) to carry out Chi-square tests or Fisher’s exact tests in order to explore associations between demographic variables, knowledge scores and preventive practice scores. Variables that were significant from the bivariate analysis was further subjected to logistic regression analysis using forward stepwise method to identify possible predictors of knowledge and preventive practice regarding avian influenza. These predictors from the analysis were compared to past studies from literatures from other parts of the world. All levels of significance were set at p < 0.05.

Results

Knowledge score analysis regarding avian influenza

The total knowledge score computed in this study regarding avian influenza on a 25-item scale revealed a mean knowledge score of 9.9 (SD ± 6.6). Respondents with knowledge score above 9.9 were classified as having adequate knowledge while respondents with scores below the mean were classified as having inadequate knowledge. About 60.0% of respondents had adequate total mean knowledge scores. Table 1 below shows the knowledge scores of respondents based in different demographic variables. Greater knowledge was recorded in older respondents, female, poultry farmers and respondents with tertiary education.

Table 1

Total knowledge score of avian influenza among 244 respondents in Ikorodu, Lagos State, Nigeria.

Variables	Adequate knowledge N (%)	Inadequate knowledge N (%)	Total N (%)	Mean score	Chi-square value	p-value
Age (Years)
<20	6(2.5%)	24(9.8%)	30(12.3%)	4.5
20–29	48(19.7%)	36(14.8%)	84(34.4%)	9.7
30–39	30(12.3%)	17(7.0%)	47(19.3%)	11.2	30.236	0.0001
40–49	31(12.7%)	8(3.3%)	39(16.0%)	11.7
50–59	20(8.2%)	6(2.5%)	26(10.7%)	11.2
>60	12(4.9%)	6(2.5%)	18(7.4%)	10.4
Sex
Male	85(34.8%)	56(23.0%)	141(57.8%)	9.4	0.0001	0.989
Female	62(25.4%)	41(16.8%)	103(42.2%)	10.4
Marital Status
Married	87(35.7%)	50(20.5%)	137(56.1%)	10.1
Single/Widow	58(23.8%)	47(19.3%)	105(43.0%)	9.4	3.026	0.22
Divorced	2(0.8%)	0(0%)	2(0.8%)	16.0
Occupation
Live Bird Trader	6(2.5%)	33(13.5%)	39(16.0%)	4.9	39.006	0.0001
Poultry Farmer	141(57.8%)	64(26.2%)	205(84.0%)	10.8
Highest Education
No Formal	4(1.6%)	34(13.9%)	38(15.6%)	1.4
Primary	0(0%)	6(2.5%)	6(2.5%)	4.3	92.511	0.0001
Secondary	43(17.6%)	45(18.4%)	88(36.1%)	8.5
Tertiary	100(41.0%)	12(4.9%)	112(45.9%)	14.1
CDA
Ikorodu North	94(38.5%)	66(27.0%)	160(65.6%)	9.9
Ikorodu Central	10(4.1%)	31(12.7%)	41(16.8%)	6.0	50.532	0.0001
Imota	43(17.6%)	0(0%)	43(17.6%)	13.4
Length of profession
1–11 months	8(3.3%)	2(0.8%)	10(4.1%)	13.8
12–23 months	8(3.3%)	14(5.7%)	22(9.0%)	9.2	8.362	0.039
24–35 months	10(4.1%)	10(4.1%)	20(8.2%)	9.6
>36 months	121(49.6%)	71(29.1%)	192(78.7%)	9.8

Field survey, 2009. p < 0.05.

Further logistic regression analyses of knowledge score showed that increasing education (p < 0.05) was significantly associated with good knowledge score.

Preventive practice score analysis regarding avian influenza

The total preventive practice score regarding avian influenza on a 9-item scale revealed a mean score of 5.3 (SD ± 2.1). Respondents with total preventive scores above the 5.3 were classified as having good preventive practice regarding avian influenza while respondents below the mean were categorized as having poor practice scores. Sixty-eight percent (68.0%) of all respondents had good practice scores. Table 2 shows the total preventive practice score of respondents based in different groups.

Table 2

Total preventive practice score of avian influenza among 244 poultry workers in Ikorodu, Lagos State, Nigeria.

Variables	Good Practice N (%)	Poor Practice N (%)	Mean score	Chi-square value	p-value
Age (Years)
<20	20(8.2%)	10(4.1%)	4.5
20–29	54(22.1%)	30(12.3%)	5.0
30–39	37(15.2%)	10(4.1%)	5.9	9.085	0.106
40–49	23(9.4%)	16(6.6%)	5.1
50–59	22(9.0%)	4(1.6%)	6.3
>60	10(4.1%)	8(3.3%)	4.8
Sex
Male	107(43.9%)	34(13.9%)	5.8	9.473	0.002
Female	59(24.2%)	44(18.0%)	5.3
Marital Status
Married	99(40.6%)	38(15.6%)	5.6
Single/Widow	67(27.5%)	38(15.6%)	4.8	6.254	0.044
Divorced	0(0%)	2(0.8%)	4.0
Occupation
Live Bird Trader	25(10.2%)	14(5.7%)	4.6	0.33	0.566
Poultry Farmer	141(57.8%)	64(26.2%)	5.4
Highest education
No Formal	34(13.9%)	4(1.6%)	4.7
Primary	4(1.6%)	2(0.8%)	4.3	15.992	0.001
Secondary	48(19.7%)	40(16.4%)	4.5
Tertiary	80(32.8%)	32(13.1%)	5.8
CDA
Ikorodu North	96(39.3%)	64(26.2%)	4.8
Ikorodu Central	27(11.1%)	14(5.7%)	4.7	25.041	0.0001
Imota	43(17.6%)	0(0%)	7.4
Length of profession
1–11 months	6(2.5%)	4(1.6%)	4.6
12–23 months	8(3.3%)	14(5.7%)	4.2	15.153	0.002
24–35 months	18(7.4%)	2(0.8%)	6.0
>36 months	134(54.9%)	58(23.8%)	5.4

Logistic regression analyses of preventive practice score showed that increasing education (p < 0.05) significantly predicted good preventive practice among the respondents.

Discussion

This study aimed to provide information on knowledge and preventive practice measures related to avian influenza among poultry traders and live bird traders in Ikorodu LGA. We found that live bird traders who are high-risk group have inadequate knowledge and poor preventive practice towards avian influenza. Past studies reported low level of preventive practice and attributed it to low perceived threat by respondents [14]. However, this inadequate knowledge is of concern because of the fact that studies have identified direct exposure to infected poultry as the primary risk factor in transmission of avian influenza virus to human [15]. These are high-risk groups based on the nature of their profession, which involves direct contact with poultry and poultry products. Hence public health campaign strategies should involve education on transmission related risk to population involved in poultry business. This could encourage uptakes of adequate protective measures in the course of poultry handling thereby improving public health campaign. For example, a KAP study carried out in Vietnam showed that knowledge of risk of eating sick/dead birds and perception of the threat of avian influenza H5N1 was a factor that motivated respondents to seek healthcare [18]. In addition, a past study suggested that conventional education and behavioural change messages for prevention have limited effect on population at high risk of AI [19]. There is therefore need to explore other approaches such as the active involvement of high risk groups in formulating control strategies. The FAO had previously suggested involving poultry sector stakeholders in a participatory process to ensure those who will implement preventive measures understand the benefits of doing so [20]. Also this study shows that older respondents and those spent longer time in the profession have significantly higher preventive practice scores and are more likely to adopt preventive measures. Hence, older poultry workers could be trained as key informants or advocators who would educate other members of the groups in the risk of the disease both to them and their families. They may be more likely to accept intervention if received from members they identify with. These key informants or advocators could also be healthcare leaders from local health facilities who are trusted by residents as was practiced in Vietnam [21]. The importance of community members’ involvement is further supported by a study carried out on community preparedness for AI in Indonesia, which revealed that 55% of respondents learnt about preventive measures from their villages, as attempts to disseminate information via leaflets and brochures were ineffective and went largely unread [22].

On the other hand, poultry farmers had a significantly higher mean total knowledge score compared to live bird traders (p < 0.05). This may be due to the fact that they are breeders and are involved in the health management of poultry and are likely to be familiar with poultry diseases [23].

Education was a significant predictor of knowledge and practices of prevention of avian influenza among respondents. This is not surprising as past studies have shown similar results [13], [24]. The level of education has been previously shown to improve knowledge scores regarding avian influenza [11].

Conclusions

With the recent resurgence of avian influenza in Nigeria, there is still a need for improved and sustained control strategy to prevent outbreak in the poultry sub sector. Poultry farmers and live bird traders, specially those with no formal education, should be aware of the transmission, seriousness and preventive measures of AI that will be reflected in the prevention and control of the disease in Nigeria.

Competing interests

The author declares no competing interests.