title: Understanding community perceptions, social norms and current practice related to respiratory infection in Bangladesh during 2009: a qualitative formative study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh. fosiul@icddrb.org
authors.forename: Fosiul A
authors.initials: FA
authors.lastname: Nizame
authors.forename: Sharifa
authors.initials: S
authors.lastname: Nasreen
authors.forename: Leanne
authors.initials: L
authors.lastname: Unicomb
authors.forename: Dorothy
authors.initials: D
authors.lastname: Southern
authors.forename: Emily S
authors.initials: ES
authors.lastname: Gurley
authors.forename: Shaila
authors.initials: S
authors.lastname: Arman
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Kadir
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D012424:Rural Population; D012927:Social Control, Informal; D055815:Young Adult