Perceived Causes of Illness Among Infants and Young Children in Bangladesh: An Exploratory Qualitative Study
Abstract
1. Introduction
2. Materials and Methods
2.1. Conceptual Framework
2.2. Study Design and Sites
2.3. Data Collection
2.4. Data Analysis
2.5. Ethical Approval
3. Results
3.1. Participant and Household Characteristics
3.2. Perceived Causes of Child Illness
3.2.1. Individual Causes
Maternal Illness
Forgetfulness and Negligence Towards Care
Misperceptions and Knowledge Gaps
“I stopped the medicine after giving it for two days, and the cold problem reduced within three days. I stopped providing medicine as her condition got better, and I don’t like to continue medicine for long. I have a fear that medicine will create more body problems. I don’t take much medicine myself (take one medicine a day, not more than that), and believe that it will be good for the body to have less medicine. But, after stopping the medicine, my child’s cold turned into pneumonia.” IDI-11-Urban
“The child is fed formula milk, but they can’t digest it. Children get attacked by germs, bacteria, and others who don’t get their mother’s breast milk properly. If the child eats any dirt or germs and becomes sick. The child’s body didn’t fight against germs. The child quickly got infected and fell ill.” KII-01-Urban
3.2.2. Socio-Cultural Causes
Beliefs in Supernatural Power
“Traditional healer (kabiraj) said that his bowel movement problems were caused by the evil eye or negative energy, which had a negative influence on the house. He also gave an amulet for solving the problems.” IDI-07-Rural
“When my child was small, a young girl visited our home. The girl watched me feed my child, and even after being asked to leave, she continued to observe. Following this, the child’s condition worsened after the feeding, leading to diarrhea. There was a suspicion that the evil air might have played a role, and everyone said that something might be wrong with the girl. The household members believed that the girl’s presence might be connected to the child’s illness.” IDI-07-Rural
Power Dynamics and Decision-Making Power
“My child tends to smash rice on the floor and then eat. Grandmother doesn’t perceive that as a problem. Moreover, she (Grandmother) tends not to wash her hands before feeding the child. She doesn’t listen to me and says that she has raised many children for ages and doesn’t need advice. The child’s uncle also fed her food that was brought from outside (Shingara), even though I forbade him. And I told him that the child would get sick eating that food. Other family members do not hear my words (about child caring), though I am the mother. On top of this, I must maintain their (family members’) word about feeding the child. His uncle feeds the child juice twice a day; as a consequence, the child has started experiencing loose stools.” IDI-19-Urban
“My in-laws have differing opinions on child care. I visited a renowned doctor and sought medical advice from various sources, but my son’s condition didn’t improve; in fact, it was deteriorating. Due to these circumstances, they told me that I took my child to the doctor unnecessarily, which is why I am hesitant to seek immediate medical attention. However, if my child’s health condition worsens or if the illness proves to be serious, we will have to seek treatment for my child. As my in-laws had different opinions, we faced many challenges when seeking medical treatment.” IDI-14-Rural
Gender Roles and Responsibilities
“When I used too much water for domestic work and caught a cold, it might have affected him as well, also tends to get sick. Besides, I can’t always keep the child on my lap; he gets even frequently more fever if he has played on the ground.” IDI-03-Urban
Domestic Violence and Family Conflicts
Adolescent Marriage and Motherhood
“Many mothers, being too young and having married early, often lack the necessary knowledge and resources to provide adequate care for their children. These young, inexperienced mothers may not fully understand the details of child care, leading to practices that result in child malnourishment and health issues. Additionally, maternal mental health problems, anxiety, nutritional deficiencies, and lower levels of education further compound the challenges, making it even more difficult for these mothers to ensure their children’s well-being. As a consequence, the children, under the care of such vulnerable and inexperienced mothers, often suffer from malnutrition and various health problems due to the suboptimal caregiving they receive.”KII-01-Urban
3.2.3. Economic Causes
Parents’ Low and Irregular Income
“Suppose we need 500 Taka today to buy the necessities, but only have 300 Taka, it creates a shortfall of 200 Taka. This shortage forces us to adjust our expenses and manage within the available 300 Taka. However, this constraint can lead to compromises in nutrition, as we may end up purchasing less nutritious food. If we had the full 500 Taka and could provide better nutrition for our child, I believe that nutrition would not have been compromised, and the child wouldn’t be sick.”GD-01-Urban
“When I asked the child’s mother, how does your child get sick? Then the mother replied that I work in garments, and the child’s father stayed at home and looked after our child. But I can’t take proper care of the child. Besides, the child’s father is a male, and can’t be taken care of properly as I(mother) can. But I don’t have any option. I have to work for my family.” KII-01-Urban
Food and Medicine Price Hike
Commercial Food Marketing and Selling Strategies
“Children often cry for chips and chocolates because they saw them hanging in front of nearby shops. Although we don’t prefer to give them, we unwillingly provide these snacks. Later, the child didn’t want to eat anything and complained of stomach pain, which eventually turned into diarrhea.”IDI-04-Urban
Contaminated and Low-Quality Food Consumption
3.2.4. Environmental Causes
Poor Household Environment and Waste Management
“We shared the yard (communal space) with neighbors, and the neighbors left dirty items scattered around the environment. For this reason, the child touches the dirty things and experiences loose motions.” IDI-20-Urban
Extreme Heat Waves
Air Pollution Exposure
“I used to take her outside every Friday for fresh air and weather, but the outside environment didn’t suit my child; she started nagging, crying, and getting cold due to the dirt. I took her to Gulistan Park in the afternoon when she was 4 months old. Also, the weather was hot, the outside environment was full of dirty things, and the place was crowded (She doesn’t like crowded places, she started crying and saw many people). After coming from there, she got a fever.” IDI-11-Urban
Environmental Contamination of Water Supplies
“My child suffered from diarrhea due to having too much dirt in the supplied water in our area. To solve this problem, I placed a scarf in the tap’s mouth as a makeshift filter. I removed a significant amount of dirt from the scarf after two days of using that scarf. But the other renters disapproved of using a scarf in the tap’s mouth. In response, my mother-in-law provided a clean scarf, but they also disapproved of using it. Consequently, both my child and I continuously remained ill due to drinking water with dirt.” IDI-19-Urban
Perceived Interconnected Causes of Illness
4. Discussion
5. Strengths and Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
GD | Group discussion |
icddr,b | International Centre for Diarrhoeal Disease Research, Bangladesh |
IDIs | In-depth interviews |
KIIs | Key informant interviews |
LMICs | Low- and middle-income countries |
SARS | Severe acute respiratory syndrome |
WASH | Water, Sanitation and Hygiene |
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ID | Children Characteristics | Caregivers/Mothers Characteristics | Households Characteristics | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | Sex | Religion | Illness Since Birth | Caregiver | Age | Education Status | No of Children | Employment Status | Family Type | Earning Person | Income Source | Decision Maker | |
IDI-01 | 8 months | Girl | Islam | Diarrhea, | Mother | 19 Years | Nine | One | Housewife | Extended | Father | Salesman in a clothing store | Father and mother-in-law |
IDI-02 | 9 months | Girl | Islam | Jaundice, diarrhea, pneumonia | Mother | 21 Years | Primary | One | Housewife | Extended | Father | Auto driver | Father |
IDI-03 | 24 months | Boy | Islam | Cold, Fever | Mother | 19 Years | Nine | Two | Housewife | Extended | Father | Construction worker | Father |
IDI-04 | 5 months 10 days | Boy | Hindu | Jaundice, pneumonia, convulsions | Mother | 27 years | Honors 3rd year | Two | Housewife | Nuclear | Father | Car Driver | Father mother both |
IDI-05 | 17 months | Boy | Islam | Diarrhea, Fever | Grandmother | 50 years | One | Sweeper and maid | Extended | Father, grandmother, grandfather | Swiping | Grandmother | |
IDI-06 | 9 months | Boy | Islam | Persistent fever, SAM, Diarrhoea | Mother | 21 Years | Class nine | Two | Housewife | Extended | Father | Clerk | Father |
IDI-07 | 5 months 19 days | Boy | Islam | Urinary infection, diarrhea, SAM | Mother | 26 Years | Class 8 | Two | Housewife | Extended | Father | Immigrant | Grandfather, Grandmother |
IDI-08 | 8 Months 21 Days | Girl | Islam | Fever, diarrhea, SAM | Mother | 22 years | HSC | Three | Housewife | Extended | Grandfather, Uncle | Tea stall | Father, grandfather |
IDI-09 | 8 months | Boy | Islam | Dysentery, Fever, diarrhea, MAM | Mother | 17 Years | Class 8 | One | Housewife | Nuclear | Father | Factory worker | Father |
IDI-10 | 6 months 25 days | Boy | Islam | Fever, cold, MAM, and defecation | Mother | 24 Years | Class 10 | Two | Housewife | Nuclear | Father | Day laborer | Father |
IDI-11 | 6 months 13 days | Girl | Islam | Diarrhea, fever, SAM | Mother | 19 years | SSC passed | One | Housewife | Extended | Father, Uncles | Delivery man in Malaysia | Grandfather |
IDI-12 | 11 months | Girl | Islam | Diarrhea, Fever, MAM | Mother, | 17 years | Class five | One | Housewife | Extended | Father | Garments worker | Father, Grandfather, Grandmother |
IDI-13 | 7 months | Boy | Islam | Fever, Diarrhea, Rubella, SAM | Mother | 21 years | Class five | One | Housewife | Extended | Maternal uncles | Garments worker | Grandmother, Mother |
IDI-14 | 23 months | Boy | Islam | Fever, diarrhea | Mother | 25 years | Class five | Two | Housewife | Extended | Father | Construction worker | In-law |
IDI-15 | 21 months | Boy | Islam | Fever, hernia, SAM | Mother | 30 years | One | Housewife | Nuclear | Father | Rickshaw driver | Father, mother | |
IDI-16 | 10 months 18 days | Girl | Islam | Diarrhea & SAM | Mother | 20 years | Class 8 passed | Three | Housewife | Extended | Father | Business (sweet shop) | Father |
IDI-17 | 14 months | Girl | Islam | SAM, diarrhea, | Mother | 35 years | Class 9 pass | Three | Housewife | Nuclear | Father | Guard | Father |
IDI-18 | 8 months | Boy | Islam | Pneumonia, diarrhea, rubeola, and hernia | Mother | 35 years | Illiterate | Five | Working as a cook | Nuclear | Mother | Cooking | Mother |
IDI-19 | 7 months | Girl | Islam | Pneumonia, cold, and diarrhea, SAM | Mother | 19 years | Primary education | One | Worker | Nuclear | Mother | Works in a vest factory | Mother |
IDI-20 | 20 months old | Girl | Islam | Diarrhea, MAM | Mother | 20 years | Class 6 | One | Housewife | Nuclear | Father | CNG driver | Father |
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Uddin, M.F.; Sumi, A.-U.-H.; Saha, A.; Latif, M.B.; Jamaludin, S.S.S.; Alam, N.H.; Chisti, M.J. Perceived Causes of Illness Among Infants and Young Children in Bangladesh: An Exploratory Qualitative Study. Healthcare 2025, 13, 2627. https://doi.org/10.3390/healthcare13202627
Uddin MF, Sumi A-U-H, Saha A, Latif MB, Jamaludin SSS, Alam NH, Chisti MJ. Perceived Causes of Illness Among Infants and Young Children in Bangladesh: An Exploratory Qualitative Study. Healthcare. 2025; 13(20):2627. https://doi.org/10.3390/healthcare13202627
Chicago/Turabian StyleUddin, Md. Fakhar, Asma-Ul-Husna Sumi, Akash Saha, Mubassira Binte Latif, Shariffah Suraya Syed Jamaludin, Nur Haque Alam, and Mohammod Jobayer Chisti. 2025. "Perceived Causes of Illness Among Infants and Young Children in Bangladesh: An Exploratory Qualitative Study" Healthcare 13, no. 20: 2627. https://doi.org/10.3390/healthcare13202627
APA StyleUddin, M. F., Sumi, A.-U.-H., Saha, A., Latif, M. B., Jamaludin, S. S. S., Alam, N. H., & Chisti, M. J. (2025). Perceived Causes of Illness Among Infants and Young Children in Bangladesh: An Exploratory Qualitative Study. Healthcare, 13(20), 2627. https://doi.org/10.3390/healthcare13202627