Understanding community perceptions, social norms and current practice related to respiratory infection in Bangladesh during 2009: a qualitative formative study

BMC Public Health

Peter J Winch²  Stephen P Luby³  Eduardo Azziz-Baumgartner³  Mohammad A Kadir¹  Shaila Arman¹  Emily S Gurley¹  Dorothy Southern¹  Leanne Unicomb¹  Sharifa Nasreen¹  Fosiul A Nizame¹ 

[1] International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh;Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA, USA

关键词: Respiratory hygiene;    Sneezing;    Coughing;    Influenza;    Pandemic;    Non-pharmaceutical intervention;   

Others  :  1164035
DOI  :  10.1186/1471-2458-11-901

 received in 2011-07-20, accepted in 2011-12-04,  发布年份 2011

【 摘 要 】

Background

Respiratory infections are the leading cause of childhood deaths in Bangladesh. Promoting respiratory hygiene may reduce infection transmission. This formative research explored community perceptions about respiratory infections.

Methods

We conducted 34 in-depth interviews and 16 focus group discussions with community members and school children to explore respiratory hygiene related perceptions, practices, and social norms in an urban and a rural setting. We conducted unstructured observations on respiratory hygiene practices in public markets.

Results

Informants were not familiar with the term "respiratory infection"; most named diseases that had no relation to respiratory dysfunction. Informants reported that their community identified a number of 'good behaviors' related to respiratory hygiene, but they also noted, and we observed, that very few people practiced these. All informants cited hot/cold weather changes or using cold water as causes for catching cold. They associated transmission of respiratory infections with close contact with a sick person's breath, cough droplets, or spit; sharing a sick person's utensils and food. Informants suggested that avoiding such contact was the most effective method to prevent respiratory infection. Although informants perceived that handwashing after coughing or sneezing might prevent illness, they felt this was not typically feasible or practical.

Conclusion

Community perceptions of respiratory infections include both concerns with imbalances between hot and cold, and with person-to-person transmission. Many people were aware of measures that could prevent respiratory infection, but did not practice them. Interventions that leverage community understanding of person-to-person transmission and that encourage the practice of their identified 'good behaviors' related to respiratory hygiene may reduce respiratory disease transmission.

【 授权许可】

   
2011 Nizame et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]CDC: Cover your Cough. Seasonal flu; 2007. [http://www.cdc.gov/flu/protect/covercough.htm] webciteCenters for Disease Control and Prevention, Atlanta, GA, USA; (Accessed 25/5/2009)
• [2]Barker J, Stevens D, Bloomfield SF: Spread and prevention of some common viral infections in community facilities and domestic homes. J Appl Microbiol 2001, 91(1):7-21.
• [3]Tellier R: Review of aerosol transmission of influenza A virus. Emerg Infect Dis 2006, 12(11):1657-1662.
• [4]WHO: Influenza (Seasonal). [http://www.who.int/mediacentre/factsheets/fs211/en/] webciteWorld Health Organization, Geneva, Switzerland; (Retrieved June 10, 2009)
• [5]Hall CB: Respiratory syncytial virus and parainfluenza virus. N Engl J Med 2001, 344(25):1917-1928.
• [6]CDC: Respiratory Hygiene/Cough Etiquette in Healthcare Settings. Seasonal flu; 2003. [http://www.cdc.gov/flu/professionals/infectionControl/resphygiene.htm] webciteCenters for Disease Control and Prevention, Atlanta, GA, USA; (Accessed 11/06/2009)
• [7]Arifeen SE, Akhter T, Chowdhury HR, Rahman KM, Chowdhury EK, NurulAlam , Haque DME, Baqui AH: Causes of death in children under five years of age. Bangladesh Demographic and Health Survey 2004. Nat Inst Population Res Train(NIPORT)125-133.
• [8]World Health Organization Writing Group (WHO): Non-pharmaceutical interventions for pandemic influenza, national and community measures. Emerg Infect Dis 2006, 12(1):88-94.
• [9]Nasreen S, Azziz-Baumgartner E, Gurley ES, Winch PJ, Unicomb L, Sharker MA, Southern D, Luby SP: Prevalent high-risk respiratory hygiene practices in urban and rural Bangladesh. Trop Med Int Health 2010, 15(6):762-771.
• [10]Rashid SF, Hadi A, Afsana K, Begum SA: Acute respiratory infections in rural Bangladesh: cultural understandings, practices and the role of mothers and community health volunteers. Trop Med Int Health 2001, 6(4):249-255.
• [11]Hussain R, Lobo MA, Inam B, Khan A, Qureshi AF, Marsh D: Pneumonia perceptions and management: an ethnographic study in urban squatter settlements of Karachi, Pakistan. Soc Sci Med 1997, 45(7):991-1004.
• [12]Grace J: The treatment of infants and young children suffering respiratory tract infection and diarrhoeal disease in a rural community in Southeast Indonesia. Soc Sci Med 1998, 46(10):1291-1302.
• [13]Chand AD, Bhattacharyya K: The Marathi "taskonomy" of respiratory illnesses in children. Med Anthropol 1994, 15(4):395-408.
• [14]Fishbein M: The role of theory in HIV prevention. AIDS Care 2000, 12(3):273-278.
• [15]Panter-Brick C, Clarke SE, Lomas H, Pinder M, Lindsay SW: Culturally compelling strategies for behaviour change: a social ecology model and case study in malaria prevention. Soc Sci Med 2006, 62(11):2810-2825.
• [16]Manderson L: Roasting, smoking and dieting in response to birth: malay confinement in cross-cultural perspective. Soc Sci Med B 1981, 15(4):509-520.
• [17]Stewart MK, Parker B, Chakraborty J, Begum H: Acute respiratory infections (ARI) in rural Bangladesh: perceptions and practices. Med Anthropol 1994, 15(4):377-394.
• [18]McNee A, Khan N, Dawson S, Gunsalam J, Tallo VL, Manderson L, Riley I: Responding to cough: Boholano illness classification and resort to care in response to childhood ARI. Soc Sci Med 1995, 40(9):1279-1289.
• [19]Gove S, Pelto GH: Focused ethnographic studies in the WHO Programme for the Control of Acute Respiratory Infections. Med Anthropol 1994, 15(4):409-424.
• [20]Kresno S, Harrison GG, Sutrisna B, Reingold A: Acute respiratory illnesses in children under five years in Indramayu, west Java, Indonesia: a rapid ethnographic assessment. Med Anthropol 1994, 15(4):425-434.
• [21]Nichter M: Acute respiratory illness: popular health culture and mother's knowledge in the Philippines. Med Anthropol 1994, 15(4):353-375.
• [22]Ottewill R, Wall A: Item 2 models of health and health care. Manag Your enterprise 2004, 11-17.