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Avian Influenza in Egyptian Slum Settlements- An Action Plan February 9, 2009

Posted by Nora in Environmental Health, Global Health, Prevention.
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This is a continuation of the post “Avian Influenza in Egyptian Slum Settlements- The Epidemiology”.

Given the frequency of avian influenza cases in Egypt, and the settlement dwellers evident predisposition to contract, and possibly induce a global avian influenza pandemic; environmental, occupational, and policy changes must be made. Unfortunately, several issues will confront a health professional attempting to communicate risks to this particular population.According to Dr. Fahmy the first and foremost of these is

“The Egyptian squatter’s lack of trust in others, and thus his/her tendency to live in a highly individualistic environment”.

This is an obstacle in facilitating cooperation with the government and even other settlers. The Egyptian government and health officials are currently grappling with several problems; according to Dr. Meliegy, in their attempt to curtail the spread of avian flu, they have issued

“blanket orders to cull all birds within a 1km vicinity of avian flu infected poultry. These orders, along with communication as to the risks of avian flu; have merely driven poultry farming underground. Many of the inhabitants of “Manshiet Nasser” rely on poultry as a source of income. Currently, these culling orders come with no guarantee of compensation and the schemes available have been described as mismanaged and ineffective”.

According to Dr. Fahmy, due to previous dealings with government officials, in which squatters are made countless unfulfilled promises, from apartments to electricity in return for a vote; squatters harbor a definite mistrust of governmental promises . In my personal dealings with the members of this community, health communications tended to be well received if coupled with the promise of the reduction of diarrheal diseases or cholera, both of which are endemic in the community.  Health messages were best accepted if propagated by a community leader, and if the community members felt empowered. Community members often expressed the need to meet his/ her daily survival needs rather than anticipating and planning for a pandemic. An effective health communication message would have to account for their economic situation as well as aim to improve their general health, for example initiating interventions reducing the incidence of cholera as well as avian flu.  According to Dr. Masuda, in a similar community in Navrongo, Ghana, a dramatic increase in family planning and child immunization was seen by engaging traditional leaders and communities in planning and delivering health services.
In order to design an effective risk communication strategy, Dr. Masuda’s study  indicates that paying particular attention to the cultural and social demographics of the particular area is critical. The financial situation of those involved must be taken into account  and finally the community must feel empowered.

From an epidemiological perspective, we may implement several practical solutions in order to ameliorate the close living quarters and lack of ventilation. These include vaccination of poultry breeders and associated family members, hand washing practices, the use of personal protective equipment including masks if a pandemic should arise,  and respiratory hygiene (covering of the mouth with coughing or sneezing). In terms of environmental and occupational health, the rapid culling of the entire poultry population in the event of an infection would be ideal, personal protective equipment should be utilized in this event. The proper disposal of carcasses and the disinfection of  the yard or the home where the poultry was bred are a necessary to ensure the efficacy of the mass culling.

In terms of preventing water contamination, proper hand washing practices and other hygienic behavior would be useful; this may include the distribution of soap, as according to USAID only 12% of households have soap near the public latrine.  According to USAID, households with both water and sewer facilities are approximately three times more likely to have soap at or near the latrine, thus the inclusion of infrastructure in this settlement would promote good hygiene practices . If the creation of  an infrastructure is impossible, water contamination may also be prevented by the storage of water in containers with a cover and a spout.

According to Dr. Meliegy,water containers with a cover and a spout show a 69% reduction in fecal coliform levels as compared to water containers without covers. This reduction would also result in the reduction of diarrheal disease, and by the same token a decline in H5N1 transmission. Furthermore, in terms of health communication issues; devising a particular strategy tailored to the culture of mistrust present in this community and the economic necessities of its survival is paramount. This involves the application of the Dr. Masuda’s Social Amplification of Risk Framework;  or the determination of the social, cultural and individual response structures that shape public perception of risk.  Finally, according to Dr. Mahfouz, it is vital to develop local case studies in order to identify community leaders as well as attempt produce health behavior messages sensitive to local identity and issues.

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