EZBET SIDI OMAR, Egypt: When Attia Abdel-Hamid Hassan notices the chickens or ducks that he keeps at home in Egypt s Nile Delta starting to wobble on their feet, he puts them in a sack and drowns them in an irrigation canal. His neighbors, afraid of catching the deadly bird flu virus that has so far killed 13 Egyptians, do the same. That is how residents in the red-brick farming hamlet of Ezbet Sidi Omar, 40 km north of Cairo, are trying to protect themselves from avian influenza in Egypt, which has the largest number of confirmed human cases outside of Asia. Health officials say the cultural practice of keeping birds at home, often in secret, is aiding the spread of bird flu in the most populous Arab country, where 24 people have contracted the disease since it emerged in Egyptian poultry a year ago. A week ago I had 10 sick chickens and I threw them in the water. When I see they are jelly-like, I know they are sick, said Hassan, a 36-year-old driver who estimates he has drowned 200 chickens and 100 ducks since bird flu arrived in Egypt. He suspects the birds were infected with the virus. But, like his neighbors, he has no way of knowing for sure because the birds were never tested. Egypt has barred city dwellers from keeping poultry at home, but the practice remains widespread in the countryside where five million families depend on poultry as a main source of income and nutrition. On a recent afternoon in Ezbet Sidi Omar, a single white chicken flitted back and forth on a straw-strewn packed dirt path that is one of the village s main arteries. Down a side alley, a handful of chickens pecked the ground in a vacant lot. But hundreds more birds were out of sight on rooftops, while others are kept in village homes in poorly ventilated dim rooms that reek of feathers, stale chicken feed and bird excrement. Like many rural Egyptians who are often distrustful of the government, the villagers have largely ignored advice to keep birds out of the house, to wear masks and gloves when handling live poultry, or to report sick or dead birds to authorities. Most of those who have fallen ill with bird flu in Egypt, where the disease is considered endemic, contracted the virus after coming into contact with household birds like those in Ezbet Sidi Omar, health officials say. By contrast, just two Egyptians are believed to have contracted the disease from poultry farms, and both of those were in the early days of the outbreak. Egypt has kept the disease largely under control in poultry farms, where birds are routinely vaccinated, even as it has been unable to contain bird flu in backyard flocks of the rural poor. At Egypt s premier chicken hatchery, which produces 400,000 chicks daily, workers hose off entering trucks with disinfectant and employees shower before entering the plant, where the air is filtered and pressurized to keep disease out. Inside, workers wear coveralls, sterile caps and masks, and dip their wading boots in a disinfectant bath each time they enter a room where eggs or chicks are kept. Since bird flu appeared in Egypt, workers have started manually inoculating day-old chicks, born from disinfected eggs laid by vaccinated birds, after plant management determined that automated vaccination could miss some chicks. The company, which previously exported chicks to Gulf and African countries, lost 86 million Egyptian pounds ($15 million) in the six months after bird flu appeared in Egypt. We have increased our precautions, although we had a system before, said Wadi Hatcheries manager Mahmoud El-Adawy, adding that he too feared household birds. Before, we were afraid of this place. Now, we are worried about what is outside. Egypt has been unable to enforce in the countryside the same strictures that have kept bird flu largely at bay in farms and hatcheries, and officials say illicit trade in live, unvaccinated birds has continued. Parliament is working on a bill to regulate movement of live poultry between provinces and to bar the slaughter of birds outside of state slaughterhouses, the government says. Egypt has offered to vaccinate household birds for free, and workers going from house to house have inoculated 45 million of an estimated 100-200 million household birds, according to Saber Abdel Aziz Galal, a bird specialist at the agriculture ministry. But vaccination teams face resistance from villagers who sometimes hide birds over fears the teams are planning a cull or that the shots themselves may be harmful, Galal said. Among the rural poor, some Egyptians have denied keeping birds at home even after family members fall ill, which has led to often fatal delays in diagnosing the disease. Villagers in Ezbet Sidi Omar say their flocks were culled last year after four people in the same province contracted bird flu, including two who died. Villagers complain that promised compensation for the birds they lost never came. But birds have slowly crept back into village houses in recent months, although they are mostly kept out of sight from visitors. Some villagers say they would like to get rid of their birds but already live a hand-to-mouth existence and could not eat protein without the eggs and meat the birds provide. We are, of course, afraid for the children, said Hassan, who lives with 33 members of his extended family. But we are peasants. It would be hard to get rid of the birds because life is so expensive.