Since the first human outbreak of the highly pandemic avian influenza (HPAI) H5N1 subtype in Hong Kong in 1997 [1, 2], surveillance efforts to detect the H5N1-subtype virus in birds have increased. A risk factor of contracting the virus is by handling infected poultry and poultry products . Between December 2003 and April 2007, an unprecedented epizootic of HPAI virus affected poultry and wild birds in over 50 countries on 3 continents . In Africa, the H5N1 virus first appeared in Nigeria, followed by Egypt in 2006, and then spread rapidly to poultry farms in other African countries [5, 6]. There has been limited spread of H5N1 from human to human, but military populations are especially susceptible to rapid spread of respiratory pathogens such as influenza . In many developing countries, military personnel live in barracks in close proximity to poultry populations. These militaries have risk factors for both the transmission of zoonotic diseases and conditions favorable for rapid human to human spread, making them important groups for avian influenza surveillance and prevention efforts. The possibility of emergence of pandemic avian influenza in the military population that may be called upon to play a significant role in the pandemic response, presents a major public health challenge and biosecurity threat. The establishment of H5N1 in domestic poultry, unregulated trade of potentially infected poultry, and high-risk farming practices continue to put some African countries at high risk . This increasing risk to the African region has highlighted the importance of African pandemic preparedness plans and their potential shortcomings .
As a result, interviews on knowledge and attitudes of poultry workers and educational interventions for health workers have been conducted. Studies in Europe and Asia have shown that risk perception in relation to avian influenza was high [10, 11]. In a similar study in Oyo state, Nigeria, farm workers were knowledgeable about AI and its associated risks, poor poultry handling practices were observed .
In 2005, a pandemic preparedness plan for Ghana was drafted and approved to clearly define the actions and resources necessary to build the capacity in the country to adequately prepare for and respond to the threat of pandemic avian influenza by strengthening existing structures and their capabilities . A year later the first avian influenza outbreak in Ghana occurred on April 14, 2007 at Kakasunanka near Tema, where 12,811 birds died and 23,327 were culled. The second outbreak occurred in Sunyani on May 11, 2007 with 210 deaths and 2,671 birds culled. Then on June 13, 2007, another outbreak occurred in Aflao where 350 birds died and 1,357 were culled [14, 15]. All the outbreaks were close to military barracks. No human case was recorded in any of the 3 outbreaks.
Following the outbreaks in Ghana, there have been two simulation exercises with all stakeholders including the Ghana Police Service, Customs Excise and Preventive Services, Ghana Prisons Services, National Disaster Management Organization (NADMO), and the Ministry of Health (MOH), but not the Ghana Armed Forces (GAF).
The recent pandemic of novel influenza A/H1N1 2009 virus clearly illustrates the unpredictable nature of pathogens that require dynamic and evolving public health strategies for surveillance, disease management and mitigation. Militaries are called upon for pandemic response and leaders require the knowledge, skills, and experience to address the evolving nature of threats to public health. Educating military professionals to understand, monitor, respond to, control and prevent emerging infections is essential for the GAF. The GAF has the mission of providing security and protection to the citizens, and stability during times of crisis, such as pandemics. The presence of individual and commercial poultry farms in military barracks and the deployment of Ghanaian troops for international peacekeeping operations put troops and families at increased risk. A recent bird census in all garrisons of the GAF found 7,424 birds being kept in or near the garrisons, with fowl constituting 5,990 (81%) of all birds; followed by ducks and turkeys at 8% and 6%, respectively. To date, there are limited data on the knowledge, attitudes and practices of troops handling or living near these birds which may influence the potential for avian influenza transmission to humans. A public health campaign on avian influenza was implemented which included education of GAF troops who may own or handle poultry. Veterinarians also carried out AI surveillance by sampling domesticated birds in the military barracks.