UK flockdown: A survey of smallscale poultry keepers and their understanding of governmental guidance on highly pathogenic avian influenza (HPAI).

The scale of the current outbreak of highly pathogenic avian influenza (HPAI) due to the A/H5N1 virus in the United Kingdom is unprecedented. In addition to its economic impact on the commercial poultry sector, the disease has devastated wild bird colonies and represents a potential public health concern on account of its zoonotic potential. Although the implementation of biosecurity measures is paramount to reducing the spread of HPAI in domestic and commercial settings, little is known about the attitudes and perspectives of backyard poultry keepers, who often keep their flocks in close proximity to the public. A large nationwide survey of backyard poultry keepers was undertaken in December 2021-March 2022, contemporaneous with the enforcement of an Avian Influenza Prevention Zone (AIPZ) and additional housing measures in England, Scotland and Wales. The survey explored keepers' understanding of the clinical manifestations of HPAI, compliance with housing and biosecurity measures, attitudes towards obligatory culling on confirmation of HPAI in their flocks, and the potential use of vaccination to control HPAI. Summary statistical analysis of the closed question responses was supplemented with qualitative data analysis and corpus linguistic approaches to draw out key themes and salient patterns in responses to open text questions. Survey responses were received from 1559 small-scale poultry keepers across the United Kingdom. Awareness of the HPAI outbreak was very high (99.0%). The majority of respondents learned of it via social media (53%), with Defra (49.7%), British Hen Welfare Trust (33.8%) and the APHA (22.0%) identified as the principal sources of information. Analysis revealed that backyard keepers lacked knowledge of the clinical signs of avian influenza and legal requirements relating to compliance with biosecurity measures. Some respondents dismissed the seriousness of HPAI and were unwilling to comply with the measures in force. The issue of obligatory culling proved highly emotive, and some expressed a lack of trust in authorities. Most respondents (93.1%) indicated a willingness to pay for vaccination if the option was available. Communications on biosecurity measures that are relevant to large-scale industrial setups are inappropriate for backyard contexts. Understanding the barriers that backyard keepers face is essential if official agencies are to communicate biosecurity information effectively to such groups. Lack of trust in authorities is likely to make elimination of the virus in the UK difficult. We make recommendations for tailoring HPAI-related information for backyard contexts, to aid future HPAI control measures in the UK.

Veterinarians' knowledge and experience of avian influenza and perspectives on control measures in the UK.

BACKGROUND: The scale of the outbreak of highly pathogenic avian influenza (HPAI) in 2021-23 due to the influenza A/H5N1 virus is unprecedented. METHODS: An online survey was designed to explore veterinarians' experiences of and confidence in treating avian species, experiences of dealing with suspected HPAI and perspectives on control measures in the UK. The survey ran between December 2021 and March 2022. RESULTS: Survey responses were received from 26 veterinarians. Although veterinarians are well placed to communicate HPAI-related information and guidance, a lack of confidence around treating birds and dealing with suspected cases of HPAI represent key barriers for non-specialist practices, and this limits opportunities to educate clients. LIMITATIONS: This study presents the views of a small group of self-selected respondents and may over-represent veterinarians with existing interests in avian species and/or avian influenza and who engage with online fora. CONCLUSIONS: Improved training and resources designed to increase confidence with avian species, along with guidance on diagnosing and reporting notifiable diseases, are needed for first opinion practices. Governing bodies should clarify regulations on treating birds in veterinary practices when HPAI outbreak numbers are high.

Exploring the responses of smallscale poultry keepers to avian influenza regulations and guidance in the United Kingdom, with recommendations for improved biosecurity messaging.

Understanding how smallscale ('backyard') poultry keepers interpret and respond to governmental directives designed to reduce the transmission of highly pathogenic avian influenza (HPAI) is of paramount importance in preparing for future HPAI outbreaks. Qualitative insights from open questions in an online survey conducted during the 2021-22 HPAI season (1,559 responses) shed light on smallscale poultry keepers' understanding of, and responses to, governmental directives to control HPAI exposure and onwards transmission. A follow-up participatory workshop (21 participants) explored the HPAI-related information sources used by smallscale poultry keepers, their trust in these sources, perceptions of HPAI-related risk, and interpretation of, opinions on and adherence to government regulations and communications regarding biosecurity and housing measures. This paper draws on a multi-scale behaviour change model to explore barriers to compliance with HPAI-related regulations. Insights from behaviour settings theory reveal how poultry-keeping settings and routines might be 'disrupted' and 're-configured' to improve long-term biosecurity and reduce the risk of HPAI exposure. The findings highlight the need for HPAI-related guidance that is tailored to smallscale poultry keepers. This guidance should include clear action points and simple, practical, affordable and sustainable suggestions for improving compliance with biosecurity measures.

Domesticating cleaner cookstoves for improved respiratory health: Using approaches from the sanitation sector to explore the adoption and sustained use of improved cooking technologies in Nepal.

Drawing on village-based data from Nepal, this paper explores the transferability of the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to the clean cooking sector and its potential to elucidate how barriers to improved cookstove adoption and sustained use intersect at different scales. The paper also explores the potential of IBM-WASH, behaviour settings theory and domestication analysis to collectively inform effective behaviour change techniques and interventions that promote both adoption and sustained use of health-promoting technologies. Information on cookstove use in the community since 2012 enables valuable insights to be gained on how kitchen settings and associated cooking behaviour were re-configured as homes and stoves were re-built following the April 2015 earthquake. The methodological approach comprised of semi-structured interviews, focus group discussions, direct observation and household surveys. The findings indicated that the IBM-WASH framework translated well to the improved cookstove sector, capturing key influences on clean cooking transitions across the model's three dimensions (context, psychosocial and technology) at all five levels. Understandings gained from utilising IBM-WASH were enhanced - especially at the individual and habitual levels - by domestication analysis and settings theory which elucidated how different cooking technologies were incorporated (or not) within physical structures, everyday lives and routine behaviour. The paper concludes that this combination of approaches has potential applicability for initiatives seeking to promote improved environmental health at community-wide scales.

Effects of seasonality on access to improved water in Benue State, Nigeria.

Many people switch sources of drinking water and sanitation between seasons, yet such shifts are not reflected in the reporting of access to improved water and sanitation services by the Joint Monitoring Programme (JMP). Drawing on quantitative and qualitative data collected from urban and rural sites in dry and rainy seasons in Benue state, Nigeria, this study highlights the importance of seasonal variations in water access and quality. Water testing showed that water sources had higher levels of contamination with coliforms, nitrate and chloride in the dry season than the wet season. The contamination of water from these pollutants is above WHO standards and believed to come mainly from pit latrines. Semi-structured interviews revealed that many people who use improved water and sanitation facilities in the rainy season sometimes switch to poorer quality unimproved sources in the dry season. Travel times for collecting water as well as waiting times also significantly increased in the dry season. It is recommended that this important seasonality element is factored into JMP data collection and reporting.

Which Biomass Stove(s) Capable of Reducing Household Air Pollution Are Available to the Poorest Communities Globally?

Globally, household and ambient air pollution (HAAP) leads to approximately seven million premature deaths per year. One of the main sources of household air pollution (HAP) is the traditional stove. So-called improved cookstoves (ICS) do not reduce emissions to levels that benefit health, but the poorest communities are unlikely to have access to cleaner cooking in the medium term. Therefore, ICS are being promoted as an intermediate step. This paper summarises the current evidence on the ICS available to the global poorest, utilising data from the Clean Cookstoves Catalog and systematic review evidence from the field. The cheapest stoves offer little reduction in HAP. Only one ICS, available at US$5 or less, (the canarumwe) minimally reduced pollutants based on ISO testing standards and no studies included in the systematic reviews reported tested this stove in the field. We recommend field testing all ICS as standard, and clear information on stove characteristics, sustainability, safety, emissions efficiency, in-field performance, affordability, availability in different settings, and the ability of the stove to meet community cooking needs. In addition, ICS should be promoted alongside a suite of measures, including improved ventilation and facilities to dry wood, to further reduce the pollutant levels.

Seasonality in faecal contamination of drinking water sources in the Jirapa and Kassena-Nankana Municipalities of Ghana.

This paper examines seasonal variations in faecal contamination of drinking water sources in the Jirapa and Kassena-Nankana Municipalities of Ghana. Data collection involved a survey of 568 households, testing of faecal coliform concentrations in drinking water source samples (141 in the rainy season, 128 in the dry season), in-depth interviews with key water stakeholders, and field observation to identify sources of faecal contamination. From the water quality testing, faecal coliforms were detected in all source types, including 'treated' pipe-borne water. Contamination was significantly higher in the rainy season than in the dry season (P < 0.05) with 51.8% of water samples in the rainy season and 27.3% in the dry season failing to meet the World Health Organisation and Ghana Standard Authority guideline on faecal coliform concentrations in drinking water sources. The proportion of population at risk of faecal contamination in the rainy season was 41.5% compared to 33.1% in the dry season. We argue that in Ghana and Sub-Saharan Africa at large, water surveillance agencies risk underestimating population exposed to faecal contamination through drinking water sources if monitoring is only done in the dry season. To avoid this, we recommend seasonal monitoring of faecal concentration in drinking water sources. However, in periods of limited resources, monitoring is most appropriate in the rainy season when the risk of contamination is high.

Toilet training: what can the cookstove sector learn from improved sanitation promotion?

Within the domain of public health, commonalities exist between the sanitation and cookstove sectors. Despite these commonalities and the grounds established for cross-learning between both sectors, however, there has not been much evidence of knowledge exchange across them to date. Our paper frames this as a missed opportunity for the cookstove sector, given the capacity for user-centred innovation and multi-scale approaches demonstrated in the sanitation sector. The paper highlights points of convergence and divergence in the approaches used in both sectors, with particular focus on behaviour change approaches that go beyond the level of the individual. The analysis highlights the importance of the enabling environment, community-focused approaches and locally specific contextual factors in promoting behavioural change in the sanitation sector. Our paper makes a case for the application of such approaches to cookstove interventions, especially in light of their ability to drive sustained change by matching demand-side motivations with supply-side opportunities. Abbreviation: DALY: Disability-adjusted life year; CHC: Community Health Club; CLTS: Community-Led Total Sanitation; HAP: Household air pollution; BM-WASH: Integrated Behavioural Model for Water, Sanitation and Hygiene; ICS: Improved cookstove; LPG: Liquefied petroleum gas; NBA: Nirmal Bharat Abhiyan; NGO: Non:governmental organisation; OD: Open defecation; ODF: Open defecation free; HAST: Participatory Hygiene and Sanitation Transformation; RANAS: Risks, Attitudes, Norms, Abilities and Self-regulation RCT: Randomised controlled trial; (Sani) FOAM: Focus, Opportunity, Ability and Motivation; SBM: Swachh Bharat Mission; TSC: Total Sanitation Campaign; WASH: Water, Sanitation and Hygiene.