Exploring community awareness and perspectives on zoonotic disease in Nepal: a qualitative study.

BACKGROUND: Qualitative research focused on Nepalese community perspectives on zoonotic disease is lacking. We aimed to characterise the contextual factors and mechanisms driving awareness of risk and prevention of zoonotic diseases in selected communities in Nepal. METHODS: We conducted 39 semi-structured individual interviews in six communities, and five focus groups with 34 participants. Ten participated in photovoice. Twenty healthcare professionals and policymakers were interviewed, 14 representing human health and six representing animal health. We analysed data thematically. FINDINGS: We generated two major themes: disease awareness, and beliefs and behaviours. Participants were aware of diseases that they had directly experienced or that they perceived might affect their family or livelihood. This was especially true of rabies. Information on disease was usually spread informally. Use of traditional medicine was widespread: some participants saw this behaviour as anachronistic, with others seeing it as pragmatic, as accessing traditional healers is often easier than visiting health posts. Consuming bushmeat was seen as something 'others' did, although some suggested bushmeat was medicinal and others distinguished between 'clean' and 'dirty' rodents. Hygiene practices were perceived as necessary to remove dirt but seldom linked explicitly to illness. Religious beliefs were presented as a reason for not harming rodents. CONCLUSION: Working with communities is essential to understanding complex behaviours that might increase disease risk, especially in communities that lack resources to mitigate these threats. Specific implications for policymakers are the importance of ensuring the healthcare system is inclusive of different groups needing its services, and that differing beliefs are considered when designing services.