WHO - World Health Organization Regional Office for The Western Pacific

08/14/2024 | News release | Archived content

Addressing the low risk perception of avian flu in Cambodia

Since early 2023, Cambodia has reported 15 human cases of avian influenza, five of which have been fatal. To combat this worrying trend, WHO and the Ministry of Health have designed proactive short- and medium-term communication strategies. Utilizing the Communication for Health (C4H) approach, these strategies aim to raise awareness of avian influenza risks among citizens and empower them to adopt preventive behaviours.

In Cambodia, poultry is an integral part of daily life, both in diet and livelihoods. Families often raise poultry in their backyards, relying on them for meat, eggs and additional income. Remarkably, 93% of poultry production in the country is under traditional backyard systems.1 Despite this prevalence, people's perception of avian influenza risks remains low, with limited knowledge about appropriate protective measures.

Avian influenza A(H5N1), or bird flu, is a viral disease that mainly affects birds, but can sometimes infect mammals, including humans, through close contact with infected poultry or contaminated environments. Human infections can range from mild to severe and may be fatal. Recent global media coverage has highlighted cases of avian influenza in dairy cows and farm workers in the USA, underlining the global nature of this threat.

The outbreak investigations identified that all human cases of avian influenza in Cambodia involved exposure to sick or dead backyard poultry, with increased infections occurring around festival periods when poultry slaughtering is more common.

A study2 conducted in 2023 in Prey Veng, a province with high poultry density, showed that 97.1% of adults reported burying dead poultry, while 22.6% admitted to cooking sick or dead poultry for their families. This discrepancy highlighted unidentified barriers preventing adherence to food safety advice.

Subsequently, to better understand these barriers, message testing was conducted and revealed that only 50% of participants had heard the advice not to touch or eat sick or dying birds when preparing food, and only 36.9% said they would follow it. This indicated an urgent need to address gaps in knowledge about protective measures during food preparation.

Targeted outreach to increase risk perception

In April 2024 during the Khmer New Year festival season, a pilot campaign was launched primarily on Facebook, Cambodia's most popular open social media platform. This campaign aimed to gather crucial baseline data and insights to refine future communication strategies for maximum impact.

The campaign messages were framed to be culturally relevant and simple, featuring a clear call to action and encouraging the audience to share messages with family and friends, who were identified as the primary source of knowledge (39%) in the Prey Veng study. Visuals were designed to reflect the festive and vibrant atmosphere of the Khmer New Year celebration.


An example of social media assets of the pilot campaign. The messages were simplified and made culturally relevant while the visuals matched the festive Khmer New Year atmosphere.
© WHO Cambodia

Working with Cambodia's Ministry of Health, WHO engaged long-standing partners, including the US Centers for Disease Control and Prevention (US CDC) and the Food and Agriculture Organization (FAO), to leverage synergies and maximize the impact of communication efforts.

The Ministry of Health also proactively distributed printed campaign posters, leaflets and stickers to pagodas, schools and households, in addition to health centers, in five high-risk provinces ahead of Khmer New Year, ensuring broad and effective outreach around the festival season.


Print posters were produced in addition to social media materials and distributed in high-risk provinces, specifically pagodas, health centers and communal areas in rural communities.
© WHO Cambodia

Results and lessons learned

The online campaign reached 8.8 million people (just over half the population of Cambodia) and garnered 1.2 million engagements.

However, despite its extensive reach and engagements, the rapid, short-term campaign has its limits, specifically in shifting behaviors. To create more meaningful impact, we conducted further desk research and a scoping visit to two villages to gain deeper insights into local attitudes and practices and design a more effect intervention. As a result, we found other risky behaviors, including the belief that freezing sick poultry after slaughtering will kill any viruses. These insights highlighted the need to better target audiences with tailored behavioural messages based on their barriers and motivators to change.

Applying these lessons, WHO, the Ministry of Health and partners are already refining the communication strategy and testing creative concepts to address behavioral barriers and promote adoption of preventive actions among target populations ahead of Cambodia's October to November festival season.

Stay informed about preventive measures against avian influenza:

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1 Birhanu, Mulugeta & Geremew, K & Woldegiorgiss, Wondmeneh & Alemu, Setegn & Kebede, Fasil & Ty, Chhay & Tum, Sothyra & Unger, Fred & Dessie, Tadelle. (2021). Poultry production, marketing and consumption in Cambodia: A review of literature,

2 Daraden Vang, Darapheak Chau, Kimim Vutha, Samnang Um. (2023). Knowledge, Attitudes, and Practices Related to Avian Influenza (H5N1) After the Outbreak in Rural, Cambodia, https://doi.org/10.1101/2023.09.25.23296059