Academic journal article Journal of Health Population and Nutrition

A Qualitative Exploration of Social Contact Patterns Relevant to Airborne Infectious Diseases in Northwest Bangladesh

Academic journal article Journal of Health Population and Nutrition

A Qualitative Exploration of Social Contact Patterns Relevant to Airborne Infectious Diseases in Northwest Bangladesh

Article excerpt


The South Asian region has a high burden of infectious diseases. These diseases form a leading cause of morbidity and mortality and are responsible for 42% of all disability-adjusted life years (DALYs) in the region (1,2). Socioeconomic, environmental and behavioural factors contribute to the high prevalence of infectious diseases. The situation in the region is worsened by considerable poverty, prevailing inequities, poor health infrastructure, and inability to allocate resources for public health (3,4).

Some infectious diseases seem to be influenced more by the social environment than others. Leprosy and tuberculosis are examples of diseases in which the role of social determinants is well-recognized (5,6). Leprosy and tuberculosis are still endemic in the poorest countries of the world and, within these countries, especially in the poorest regions or urban slums (7,8). Although a causal relationship between poverty and these diseases is difficult to demonstrate, socioeconomic determinants have been suggested to be of major influence on the continuing transmission of these infectious diseases (6,9,10).

Interactions among people through social contacts play an essential role in the spread of infectious diseases, like tuberculosis and leprosy transmitted from person to person (11-14). Both diseases are caused by Mycobacteria that use an airborne route by small droplets as main mode of transmission while intensive or longstanding contacts with a patient are required (8,15). Determinants, like social, economic and cultural factors, are of influence on the number and variety of social contacts, and on the intensity and duration of these contacts. These aspects are important in the spread of infectious diseases (16,17).

In most Asian countries, only limited information is available on how people interact and which social contact patterns are important for the spread of infectious diseases. The understanding of specific social contact patterns in this region can be helpful to develop more effective control measures for infectious diseases. Bangladesh is one of the poverty-stricken countries in this region where limited information is available on social contacts and the way people interact while the burden of infectious diseases, including tuberculosis and leprosy, is high. In a recent nationwide survey (2007/2009), the prevalence of tuberculosis was 79 per 100,000 inhabitants but much higher rates were detected among the poor and uneducated population groups (18). Although the registered prevalence of leprosy in Bangladesh has been below 1.0 per 10,000 inhabitants over the last decade, a survey in northwest Bangladesh revealed 15.1 cases of previously-undiagnosed leprosy per 10,000 inhabitants in 2002/2003 (19).

The objective of this study was to explore social contact patterns in northwest Bangladesh in order to identify behavioural patterns that could facilitate spread of infectious diseases. We placed a special focus on contact patterns that are important for the spread of airborne diseases, such as tuberculosis and leprosy, in which the social environment plays an important role.


Study design

We used a qualitative method with focus group discussions to explore social contact patterns in northwest Bangladesh. This allowed us to elaborate on social contact patterns without predefined assumptions and to identify a broad range of ideas on the topic in a relatively short time.

Study area

The study was carried out in Nilphamari and Rangpur districts in northwest Bangladesh. In this predominantly rural area, which is one of the poorest parts of the country, leprosy and tuberculosis are endemic (20,21). We conducted focus group discussions in two villages and one urban ward. The locations were selected in collaboration with field staff of the Rural Health Program (RHP) of The Leprosy Mission International Bangladesh (TLMB), familiar with the region. …

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