title: Prevalent high-risk respiratory hygiene practices in urban and rural Bangladesh.
abstract: OBJECTIVE
  To identify existing respiratory hygiene risk practices, and guide the development of interventions for improving respiratory hygiene.
  
  
  METHODS
  We selected a convenience sample of 80 households and 20 schools in two densely populated communities in Bangladesh, one urban and one rural. We observed and recorded respiratory hygiene events with potential to spread viruses such as coughing, sneezing, spitting and nasal cleaning using a standardized assessment tool.
  
  
  RESULTS
  In 907 (81%) of 1122 observed events, households' participants coughed or sneezed into the air (i.e. uncovered), 119 (11%) into their hands and 83 (7%) into their clothing. Twenty-two per cent of women covered their coughs and sneezes compared to 13% of men (OR 2.6, 95% CI 1.6-4.3). Twenty-seven per cent of persons living in households with a reported monthly income of >72.6 US$ covered their coughs or sneezes compared to 13% of persons living in households with lower income (OR 3.2, 95% CI 1.6-6.2). In 956 (85%) of 1126 events, school participants coughed or sneezed into the air and 142 (13%) into their hands. Twenty-seven per cent of coughs/sneezes in rural schools were covered compared to 10% of coughs/sneezes in urban schools (OR 2.3, 95% CI 1.5-3.6). Hand washing was never observed after participants coughed or sneezed into their hands.
  
  
  CONCLUSIONS
  There is an urgent need to develop culturally appropriate, cost-effective and scalable interventions to improve respiratory hygiene practices and to assess their effectiveness in reducing respiratory pathogen transmission.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh. drsharifa@icddrb.org
authors.forename: S
authors.initials: S
authors.lastname: Nasreen
authors.forename: E
authors.initials: E
authors.lastname: Azziz-Baumgartner
authors.forename: E S
authors.initials: ES
authors.lastname: Gurley
authors.forename: P J
authors.initials: PJ
authors.lastname: Winch
authors.forename: L
authors.initials: L
authors.lastname: Unicomb
authors.forename: M A Y
authors.initials: MA
authors.lastname: Sharker
authors.forename: D
authors.initials: D
authors.lastname: Southern
authors.forename: S P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001459:Bangladesh; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000453:epidemiology; D005260:Female; D006235:Hand Disinfection; D015438:Health Behavior; D006801:Humans; D006920:Hygiene; D007223:Infant; D008297:Male; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000517:prevention & control*; D012309:Risk-Taking; D012424:Rural Population; D012912:Sneezing; D012959:Socioeconomic Factors; D014505:Urban Population; D055815:Young Adult