Acute respiratory infections in rural Bangladesh: cultural understandings, practices and the role of mothers and community health volunteers.

Qualitative data collected from 63 older and younger mothers revealed that almost all recognized pneumonia and all described mild and severe signs and symptoms to explain incidences of pneumonia. Respiratory illnesses were attributed to humoral imbalances, supernatural causes and "negligent" mothers. Home care practices involved drinking specially prepared juices, massaging the child with oil and avoiding "cooling" foods. Traditional and allopathic care was sought depending on the perceived severity of the illness. The role of the family was important in decision-making. Rural mothers were relieved and satisfied to be able to quickly access low-cost medicines from Bangladesh Rural Advancement Committee (BRAC) health volunteers, who clearly influence health care practices. In-depth interviews and focus group discussions with 23 health volunteers showed that 22 were able to correctly identify breathing rates and their association with pneumonia. All had knowledge of acute respiratory infections (ARI) and were able to list a range of signs and symptoms. Some health volunteers complained of operational constraints with monitoring and technical equipment. Nevertheless, the programme has strong links with grassroots volunteers and community people, making it a successful intervention.