This study aimed to provide information on AI-related knowledge, attitudes, and practices among university students in Surabaya Indonesia. Human cases of avian influenza (H5N1) have resulted from contact between humans and infected backyard poultry . The frequency of disease occurrence in the avian population is also related to increased risk to humans .
In our study, 97.7% of participants had knowledge about avian influenza, which is comparable to a similar study already conducted in North Africa revealed that the people who kept backyard poultry breeders in rural Egypt's Fayoum Governorate had a high level of knowledge regarding AI . In a study conducted by Khan et al. (2008) on new arrival students' knowledge of avian influenza, 70% of the students stated that AI is a disease of viral etiology . In contrast, a study conducted in Thailand's Suphan Buri Province found that the majority of respondents had limited knowledge about AI [34, 35]. According to a study conducted in Europe found that a significant number of people lacked a detailed understanding of AI . The level of awareness in the current study was as high as expected because survey respondents were very acquainted with AI due to the high occurrence in the study area and appropriate information regarding the disease.
However, in our findings, 187 (62.3%) respondents had said that AI and swine influenza had a similarity in signs and symptoms. In an earlier study conducted in China by Gong et al. (2014) found that symptoms and transmission routes of avian influenza differed by area, with Hangzhou having the highest percentage of participants who were aware of AIV symptoms and transmission routes .
From the t-test, our study has indicated that respondents were awared with contagious infection of avian influenza from animal to human and poultry workers. Therefore, it is urgent to educate entire communities about the contagious infection of AIV specifically among the poultry workers that worked in different poultry sectors to decrease the incidence of avian influenza through different routes. As a first line of defense, the poultry industry and appropriate higher authorities should ensure that all poultry handlers wear protective gloves. To improve avian influenza awareness, vaccination of poultry would generate a unique opportunity to do so.
In our study, 61.3% of the respondents were females, and chi-square showed that females mostly knew about avian influenza transmission. 93% of the study participants correctly answered that AIV was transmitted from animal to human in contrast an earlier study finding conducted in Cambodia reveals most of the participants did not know about AIV transmission. In our finding 48.7% of the participants were revealed human to human transmission that is in contrast to an earlier study conducted in Cambodia where all participants were answered that avian influenza might be transmitted from human to human . According to a study conducted in Italy, the majority of respondents were aware of these modes of transmission .
Individuals in this survey had a mixed understanding that the disease can be transmitted by touching raw poultry, raw frozen poultry, and raw eggs. In terms of information about the vector of transmission, the majority of participants had sufficient knowledge that wild birds 273 (91 %) and poultry 269 (89.7 %) are the common vectors that assist in disease transmission. In our study, 83.7% respondents were undergraduates the chi-square test indicated-a significant correlation between the risk of AIV transmission knowledge to veterinarians and butchers with higher levels of education. These findings are similar to another study conducted earlier in Italy .
The third part of the analysis is about the respondents' attitudes. More than half of the participants (55%) were followed the precautionary measure like wearing of a surgical mask and while 73.3% of participants wash their hands before and after eating. The results of Chi-square showed a significant association between gender and wearing of surgical face masks and washing of hands. Similarly, earlier study results conducted in Cambodia showed that 166 (67.5%) felt hand washing, 229 (93.1%) said that wearing a mask is a good practice that can prevent themselves from HPAI . An earlier study in Malaysia found that more than half of respondents took positive steps in response to AI, which is similar to our results . In an earlier study conducted in China by Gong et al. 2014 specifically, 7061 (77.55%) participants believed eating cooked poultry, washing hands before and after eating, clean the other related items was safe from AI infection . Based on the intensity of documented practices, an earlier study conducted in Nepal revealed that handwashing with soap and water before and after eating has become the most common practice . In short, the selected students showed good knowledge, attitude, and practices concerning avian influenza and related risky practices. Avian influenza is still endemic in Indonesia, especially in Java. Veterinarians, Butchers and Poultry workers are at higher risk of AIV transmission and infection.
There were several limitations in the study that should be listed. First, we limited our research to a single district in East Java Province. Second, we only surveyed students, who may not be representative of East Java's population. Third, our sample size was small, which may adversely affect the results' validity and reliability. Despite these limitations, we believe our results would be useful to researchers and policymakers in the future.