Acute respiratory infections (ARI) in rural Bangladesh: perceptions and practices.

Acute Respiratory Infections (ARI) are a major cause of death in children under five in rural Bangladesh. A popular strategy for lowering ARI mortality in such settings includes detecting and managing pneumonia in children at the community level. The success of programs using this approach requires a well-trained community-based cadre of health workers and the appropriate utilization of services provided. Determinants of health care seeking behavior are clearly of interest in this regard. A qualitative study was conducted in Matlab, Bangladesh to describe community perceptions of signs and symptoms of ARI, case management behavior, and constraints to service utilization. Mothers recognized pneumonia and thought it to be caused by "exposure to cold." They were able to identify labored breathing, chest retractions, lethargy, and inability to feed as signs of severe disease needing treatment outside the home. Nevertheless, similar illnesses were sometimes believed to be due to attack by evil influences. In these cases, spiritual healers were sought and allopathic treatment was avoided or delayed. The mothers' observance of purdah and "proper" behavior were reported to play a role in prevention of child death from disease. Implications of this belief and its impact on service utilization are discussed. Suggestions for program managers are made in addition to recommendations for further research.