title: Lay perceptions of kala-azar, mosquitoes and bed nets in Bihar, India.
abstract: OBJECTIVE
  To describe the lay perception of kala-azar (KA) in an endemic area of Muzaffarpur District, Bihar, India: local names, symptoms, affected persons, perceived severity and modes of transmission, as well as perceived mosquito nuisance, modes of protection and use of bed nets.
  
  
  METHODS
  We held 16 focus group discussions (FGD) in eight remote villages with altogether 157 participants in March 2008. Separate FGDs were held according to gender, socio-economic status (SES) and with key informants.
  
  
  RESULTS
  Kala-azar is most commonly named pilahi. Poor people were said to be the most affected. Knowledge about symptoms was satisfactory. Fever and prolonged fever were the most stated symptoms. KA was perceived as a life-threatening disease with a heavy economic burden. Mosquito bites were perceived as the main mode of transmission but in lower socio-economic groups, non-vector-related explanations were also provided. The main modes of protection from mosquitoes mentioned were the use of fumes and bed nets. Season was the strongest factor influencing the use of bed nets and non-affordability for not owning them.
  
  
  CONCLUSIONS
  Although the sand fly is not recognised as the vector, the relatively good awareness of disease transmission by mosquitoes and the nuisance caused by their high density might be an entry point for adopting preventive measures to protect from mosquito bite and thereby indirectly preventing from KA. Educational campaigns targeted to the poorer segments of society are needed to enhance knowledge about KA, its mode of transmission, risks of getting infected and to increase bed net use.
authors.affiliation: Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. rnmishra_prem@rediffmail.com
authors.forename: Rabindra N
authors.initials: RN
authors.lastname: Mishra
authors.forename: S P
authors.initials: SP
authors.lastname: Singh
authors.forename: Veerle
authors.initials: V
authors.lastname: Vanlerberghe
authors.forename: Shyam
authors.initials: S
authors.lastname: Sundar
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.forename: Pierre
authors.initials: P
authors.lastname: Lefèvre
mesh_terms: D000328:Adult; D000818:Animals; D009033:Culicidae; D019353:Endemic Diseases; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D007303:Insect Vectors; D007898:Leishmaniasis, Visceral / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D008297:Male; D057147:Mosquito Nets / Q000706:statistics & numerical data* / Q000600:supply & distribution; D012621:Seasons; D012923:Social Class