Impact of Educational Intervention Concerning Awareness and Behaviors Relating to Avian Influenza (H5N1) in a High-Risk Population in Vietnam Toshie Manabe 1 *, Pham Thi Phuong Thuy 2 , Vu Van Can 5 , Jin Takasaki 1 , Dinh Thi Thanh Huyen 2 , Nguyen Thi My Chau 4 , Takuro Shimbo 3 , Bui Thi Thu Ha 5 , Shinyu Izumi 1 , Tran Thuy Hanh 4 , Ngo Quy Chau 4 , Koichiro Kudo 1 1 Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan, 2 NCGM-BMH Medical Collaboration Center, Hanoi, Vietnam, 3 Research Institute, National Center for Global Health and Medicine, Tokyo, Japan, 4 Bach Mai Hospital, Hanoi, Vietnam, 5 Health Department of Ninh Binh Province, Ninh Binh City, Vietnam Abstract Background: Early initiation of treatment is essential for treatment of avian influenza A/H5N1 viral infection in humans, as the disease can lead to rapid development of severe pneumonia which can result in death. Contact with infected poultry is known to be a significant risk factor for contraction of H5N1 infection. However, handling and encountering poultry are a part of most peoples’ daily lives, especially in rural communities in Vietnam where epidemic outbreaks among poultry have been continuously reported. Enhancing proper knowledge relating to H5N1 and to the importance of early initiation of treatment are crucial. The aim of this study was to develop an effective educational program to enhance awareness of H5N1 and motivate people to access to health care earlier when H5N1 infection is suspected or likely. Methodology and Principal Findings: A study was conducted in two agricultural communities (intervention and control groups) in the Ninh Binh province in Vietnam, where epidemic outbreaks of avian influenza have recently occurred in birds. A unique educational intervention was developed and provided to the intervention group, and no intervention was provided to the control group. A knowledge, attitude and practice (KAP) survey was conducted in both groups with a face- to-face interview by trained local healthcare workers at time points before and after the educational intervention. KAP scores were compared between the different time points and between the groups. How educational intervention influenced awareness relating to H5N1 and accessibility of healthcare in the population was analyzed. The study indicated an increased awareness of H5N1 and increased reliance on local health care workers. Conclusions: The novel educational program which was developed for this study impacted awareness of H5N1, and resulted in more people seeking early access to healthcare, and also resulted in earlier medical intervention for patients with H5N1 avian influenza infection in Vietnam. Citation: Manabe T, Thuy PTP, Can VV, Takasaki J, Huyen DTT, et al. (2011) Impact of Educational Intervention Concerning Awareness and Behaviors Relating to Avian Influenza (H5N1) in a High-Risk Population in Vietnam. PLoS ONE 6(8): e23711. doi:10.1371/journal.pone.0023711 Editor: Malcolm Gracie Semple, University of Liverpool, United Kingdom Received February 21, 2011; Accepted July 22, 2011; Published August 22, 2011 Copyright: ß 2011 Manabe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was supported by the Japan Initiative for Global Research Network on Infectious Diseases from the Ministry of Education, Culture, Sports, Science and Technology of Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: manabe@dcc.go.jp Introduction Human infections with the highly pathogenic avian influenza A (H5N1) virus have been reported since November 2003 by countries in South-east Asia. The fatality rate is about 58% [1]. H5N1 infection can cause rapid development of severe pneumonia and can lead to acute respiratory distress syndrome [2]. Most cases of avian influenza in humans have resulted from contact with infected poultry, which is a significant H5N1 risk factor [3]. However, backyard poultry are common in rural communities in northern Vietnam, and epidemic outbreaks among poultry and non-domesticated birds have been continuously reported [4]. It is crucial for residents who live in high- risk areas to have a good understanding of why they should seek healthcare early once they experience symptoms. The aim of the present study was to assess impact factors that can help raise awareness of H5N1 infection in order to develop an effective educational program to follow the strategy of treatment for H5N1 infection in humans, which includes early diagnoses and early medical intervention. Materials and Methods Study Sites The study was performed in two communities: Yen Son and Ninh Hoa communes in the Ninh Binh province in Vietnam. The communes are physically separated and the populations attend geographically different venues and gathering. Ninh Binh province is located about 100 km south from Hanoi and has heavy traffic of PLoS ONE | www.plosone.org 1 August 2011 | Volume 6 | Issue 8 | e23711