Respiratory infections are prevalent and pose a constant threat to society, and facemasks are one of the proven preventative measures against transmission. In several randomized control trials (RCTs), epidemiologists have found that masking up at the community level can significantly reduce the transmission of COVID-19 (Brooks & Butler, 2021). Before the COVID19 pandemic, very few people were familiar with the use of facemasks in Bangladesh; it was deemed to be a tool mainly used for professional needs, by doctors, patients, factory workers for example.
But since COVID19 hit the country, wearing a mask has been turning into an essential ‘new-normal’ for us. Different government and non-governmental development organizations and even political parties and local politicians have been working hard to promote and distribute masks in Bangladesh in an attempt to reduce the transmission of COVID 19. From our recent study on BRAC’s ‘Community Fort for Resisting COVID-19 (CFRC) in Bangladesh’ project, we have observed that such initiatives to normalize masking up face several barriers and limitations in the normalization process of masking up at ground level. We would shed light on some points categorizing the behavioural notion towards mask using at individual and, to some extent, at the community level.
People used masks during the lockdowns partly out of fear of infection and partly due to institutional and administrative rules. Their fear of the infection is also influenced by the strictness of the lockdown and the statistics on infection and death rates. As a result, most people feel the importance of mask use during a lockdown or when infection and death rates are increasing. But another study found that people cannot always relate the macro situation to their individual and local experiences. To grasp the gravity of the crisis, people often cross-check the community-level infection and death rates with the national-level daily updates and, based on their assessment, consider practising COVID 19 health measures, including wearing a mask.
Apart from this, during our fieldwork in September ’21, we observed that usually the individuals follow the community’s mask-wearing practice, not unusual for public behavioural practice. Many people wear facemasks only when people around them do. The respondents—a seasonal migrant from northwest Bangladesh who migrated to the port city of Chattogram before the outbreak of delta variant—informed that he worked as a casual construction labourer before the migration and that he used to wear a facemask like all the other labourers around him. He said,
“I wear a mask when I find my surrounding people with facemasks. When everybody complies with mask-wearing, being without a mask seems foolish”.
But when he went back home, he found a mask free atmosphere in his village, and so he stopped wearing it.
Similarly, people are still using masks inside many organizations where the authorities have made it compulsory. We observed that school and college students complied with mask-wearing as their institutions restricted mask free entry after the reopening in 2021. Another respondent who is an agent banker said,
“My mother usually wears a niqab (veil), but when she visits a doctor she wears a mask. Otherwise, the doctor won’t serve her. The doctor had put a ‘no mask, no service’ sign on his door.”
To ensure mass masking, many stakeholders have been distributing masks during social and cultural functions and even political campaigns. People expect the organizers to distribute masks to the masses regardless of the nature of a program. Even at an individual level, we found that many people gifted masks to their distant family members and close ones. Nowadays, to the community people, getting masks from different social and political sources has become a common practice. Certainly, mask distribution has motivated people to use masks and reduced their economic burden. However, the mask distribution may not be effective, even if people use them, because of quality concerns.
Most individuals and organizers buy masks from their local markets. But the quality of the locally produced masks is often questionable, and according to the community people, several seasonal mask producers seemed to market low-quality masks. Since the World Health Organization (WHO) declared Coronavirus a pandemic, authorities have urged the public to wear masks but did not specify the importance of “quality masks”. Thus, many people did not know that they needed to wear high-quality masks. Even when they did, they simply could not afford it, a dispensary owner said,
“Since the better-quality masks are expensive, we cannot keep them. I will not get customers. Nobody is going to buy them. So there’s no point in bringing masks from good companies. That’s why I only bring the mask from local companies.”
So, even though people complained that those masks smelled bad and were uncomfortable to wear, they still bought those masks as they needed them in hospitals, offices, banks and educational institutions.
The most common problem of a low-quality is the lack of an additional layer, preventing effective filtration. Some masks smell bad, and thus cannot be worn for too long. For these reasons, mask use is rare in local communities, increasing their exposure to airborne infections during epidemics (Sin, Shin wei et al, 2014).
This problem has somehow been reduced in some places, especially in the 35 districts where BRAC’s CFRC project was implemented. In those areas, BRAC had distributed masks to the community people, especially those who were unwilling to use the mask, could not afford masks, women, and persons with disabilities. BRAC had distributed both cloth masks and procedure masks which had been tested from government-affiliated labs. They used several channels so that they could cover at least 70 % of the population in those 35 districts. Some of the old users asked for more masks during the distribution, and those who hadn’t used the mask before were also persuaded of its quality. Regardless of whether they had ever used the mask, community members believed it to be better because of the BRAC brand value. We observed that people were happy with the quality of the masks distributed by BRAC. According to a user,
“I have used a BRAC mask. Its quality is better than the masks available on the market. I have also washed it twice and still, it feels like a new mask. Moreover, I felt so special because no one had ever given us a customized mask and at such a larger scale. The hotspot mobilizer (the grassroots volunteer of the project) is on my friend list; I have seen his pictures. They distributed masks in several unions.”
Furthermore, BRAC field staff promoted masks, informed people about COVID-19 hygiene practices, and provided information regarding vaccinations, in addition to identifying suspected cases and providing telemedicine when necessary. They included local influential people and leaders, community groups, and community clinics to carry out the grassroots activities of CFRC to build resilience against COVID19. According to a user,
“I didn’t use a mask when the infection rate was higher but now, I use it regularly. Some people mock me for using it after the pandemic. But after meeting the BRAC hotspot mobilizer, I understood the importance of masking and its benefits. Even if the virus is controlled, I think I am going to use it as long as I can. Because it protects me from the dust and pollution.”
Because of the high quality of masks, awareness creation, and community mobilization, those who hadn’t worn masks earlier were now using them, and this experience prompted them to continue using them. BRAC’s attempt to use the NORM[1] model has shown a positive impact on the community.
The fieldwork and engagement with the local people helped us to understand the community’s perception regarding the mask. It revealed that the fear of the virus is hardly a sufficient condition for compliance; communities and authorities play an important role in an individual’s mask practice. But lack of knowledge about the necessity of and high price and availability of high-quality masks are major barriers to mask use.
As scientists and epidemiologists cannot predict how this virus will manifest in the future, it is important to examine the quality of masks available in the market, to improve them, and to encourage people to do the same. This can play a critical role in containing the ongoing omicron variant.
Reference:
- Brooks, J. T., & Butler, J. C. (2021). Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2. JAMA, 325(10), 998–999. https://doi.org/10.1001/jama.2021.1505
- Sim, S. W., Moey, K. S., & Tan, N. C. (2014). The use of facemasks to prevent respiratory infection: a literature review in the context of the Health Belief Model. Singapore medical journal, 55(3), 160–167. https://doi.org/10.11622/smedj.2014037
- Tanvir,S., Afrin, S., Saha, S., Ghosh, D & Kamruzzaman, MD.(2021). Qualitative Exploration The End User Context of BCC Materials on COVID-19 Guidelines and Handwashing, BIGD, BRAC University. https://bigd.bracu.ac.bd/publications/qualitative-exploration-the-end-user-context-of-bcc-materials-on-covid-19-guidelines-and-handwashing/
[1] NORM model – no-cost free mask distribution door-to-door, offering information on mask-wearing via video and brochures, reinforcement in-person and in public, and modelling and endorsement by trusted leaders;
Dhanista Chakma is a Research Associate and Tanvir Shatil is a Senior Research Associate at BRAC Institute of Governance and Development (BIGD), BRAC University.
