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Vusirikala A, Yanshi, Robin C, Rowell S, Dabke G, Fox G, Bell J, Manuel R, Jenkins C, Love NK, McCarthy N, Sumilo D, Balasegaram S. Facilitators and barriers to implementing successful exclusion among children with shiga toxin-producing Escherichia coli: a qualitative analysis of public health case management records. BMC Public Health 2024; 24:2272. [PMID: 39169284 PMCID: PMC11340135 DOI: 10.1186/s12889-024-19580-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 07/24/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health concern as they can cause serious illness and outbreaks. In England, STEC incidence is highest among children and guidance recommends that children under six diagnosed with STEC are excluded from childcare until two consecutive stool cultures are negative. We aimed to describe the barriers and facilitators to implementing exclusion and the impact of exclusion policies on young children and their families. METHODS Individual level data was obtained from a wider study focusing on shedding duration among STEC cases aged < 6 years between March 2018 - March 2022. Data was extracted from England's public health case management system. The case management system includes notes on telephone conversations, email correspondence and meeting minutes relating to the case. Collected data consisted of free text in three forms: (1) quotes from parents, either direct or indirect, (2) direct quotes from the case record by health protection practitioners or environmental health officers, and (3) summaries by the data collector after reviewing the entire case record. We analysed free text comments linked to 136 cases using thematic analysis with a framework approach. RESULTS The median age of included cases was 3 years (IQR 1.5-5), with males accounting for 49%. Nine key themes were identified. Five themes focused on barriers to managing exclusion, including (i) financial losses, (ii) challenges with communication, engagement and collaboration, (iii) issues with sampling, processing, and results, (iv) adverse impact on children and their families and (v) conflicting exclusion advice. Four themes related to facilitators to exclusion, including (i) good communication with parents and childcare settings, (ii) support with childcare, (iii) improvements to sampling, testing, and reporting of results, and (iv) provision of supervised control measures. CONCLUSIONS Qualitative analysis of public health case records can provide evidence-based insights around complex health protection issues to inform public health guidelines. Our analysis highlights the importance of considering wider social and economic consequences of exclusion when developing policies and practices for the management of STEC in children.
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Affiliation(s)
- Amoolya Vusirikala
- UK Health Security Agency, London, England, UK.
- UK Field Epidemiology Training Programme, UK Health Security Agency, London, England, UK.
| | - Yanshi
- UK Health Security Agency, London, England, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, England, UK
| | | | - Sam Rowell
- UK Health Security Agency, London, England, UK
| | | | | | - Jade Bell
- UK Health Security Agency, London, England, UK
| | - Rohini Manuel
- UK Health Security Agency, London, England, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, England, UK
| | - Claire Jenkins
- UK Health Security Agency, London, England, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, England, UK
| | - Nicola K Love
- UK Health Security Agency, London, England, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, England, UK
| | - Noel McCarthy
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, England, UK
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Warwick Medical School, School of Medicine, Warwick, England, UK
| | - Dana Sumilo
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, England, UK
- Warwick Medical School, School of Medicine, Warwick, England, UK
| | - Sooria Balasegaram
- UK Health Security Agency, London, England, UK
- UK Field Epidemiology Training Programme, UK Health Security Agency, London, England, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, England, UK
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Buczkowska M, Chattaway MA, Jenkins C, Hungerford D, Katwa P, Kirkbride H, Hawker J. Linking epidemiological and genomic data in cases of enteric fever in England to inform clinical management and public health action. J Antimicrob Chemother 2024; 79:1811-1819. [PMID: 38873828 PMCID: PMC11290876 DOI: 10.1093/jac/dkae148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/18/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES To explore the feasibility of linking data from enhanced surveillance patient questionnaires from each enteric fever case in England with genome sequencing data, including antimicrobial resistance (AMR) profiles, from the corresponding isolate of typhoidal salmonellae. METHODS After linking data we interrogated the merged dataset and assessed the utility of passive surveillance data to match and monitor antimicrobial treatment regimens in enteric fever patients with the AMR profiles of the infectious agent. RESULTS A high proportion of cases were given antibiotics (n = 1230/1415; 86.9%); half of the cases stated the class of antibiotic they were given (n = 630/1239) and half were prescribed cephalosporins (n = 316/630). Reported treatment with a combination of antibiotics increased with symptom severity. Nearly half of isolates (n = 644/1415; 45.5%) had mutations conferring resistance to ciprofloxacin. Based on genome-derived AMR profiles, typhoidal salmonellae isolates inferred to be susceptible to the recommended first-line antimicrobials were twice as likely to be isolated from individuals residing in the least deprived areas compared with the most deprived (n = 26/169; 15.4% versus n = 32/442; 7.2%). CONCLUSIONS Due to the high proportion of missing data obtained from patient interviews, we recommend a more transparent and systematic approach to recording the antibiotic prescription details by healthcare professionals in primary and secondary care. A more robust approach to data capture at this point in the care pathway would enable us to audit inconsistencies in the prescribing algorithms across England and ensure equitable treatment across all sections of society. Integrating prescribing data with the genome-derived AMR profiles of the causative agent at the individual patient level provides an opportunity to monitor the impact of treatment on clinical outcomes, and to promote best practice in real time.
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Affiliation(s)
- Matylda Buczkowska
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Gastrointestinal Bacteria Refence Unit, United Kingdom Health Security Agency (UKHSA), London NW9 5HT, UK
| | - Marie A Chattaway
- Gastrointestinal Bacteria Refence Unit, United Kingdom Health Security Agency (UKHSA), London NW9 5HT, UK
| | - Claire Jenkins
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Gastrointestinal Bacteria Refence Unit, United Kingdom Health Security Agency (UKHSA), London NW9 5HT, UK
| | - Daniel Hungerford
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Parisha Katwa
- Travel Health and International Health Regulations Team, UK Health Security Agency, London, UK
| | - Hilary Kirkbride
- Travel Health and International Health Regulations Team, UK Health Security Agency, London, UK
| | - Jeremy Hawker
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology Service, UK Health Security Agency, Birmingham, UK
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Murrell L, Clough H, Gibb R, Zhang X, Green M, Chattaway M, Buchan I, Barr B, Hungerford D. Understanding the impact funding cuts on Environmental and regulatory services and gastrointestinal infections: a longitudinal ecological study. NIHR OPEN RESEARCH 2024; 3:41. [PMID: 39139278 PMCID: PMC11320035 DOI: 10.3310/nihropenres.13426.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 08/15/2024]
Abstract
Background Gastrointestinal (GI) infections result in 17 million cases annually, with foodborne illness costing the National Health Service (NHS) £60m per year. The burden of GI infection is unequally distributed, with greater impact in more socioeconomically disadvantaged groups and areas. Local authorities (LA) provide vital services that protect public health and wellbeing. The impact of funding cuts to local services and their effect on public health is an area of concern. Environmental and regulatory (ER) services are responsible for roles such as food safety and infectious disease control. This study aims to understand the impact of local funding cuts on ER and GI infection outcomes. Methods We will conduct an ecological longitudinal study in England from 2010-2019 at the LA level to examine how changes in ER expenditure overtime have impacted ER and GI infection outcomes. Data will be gathered on food hygiene enforcement, food hygiene compliance levels, GI infection hospitalisation, NHS 111 calls relating to GI infection symptoms, GI infection pathogen data, deprivation, and population density. Measures will be aggregated to LA level and statistical analysis will be carried out. Ethics and dissemination University of Liverpool Ethics committee have confirmed ethical approval will not be required. All data will be aggregated and anonymised, therefore only data sharing agreements will be required. Findings will be disseminated to the stakeholder group in addition to outputs through conferences and publications. These findings will help understand impact of key services on public health and should inform government and public health policy and strategy.
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Affiliation(s)
- Lauren Murrell
- Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, National Institute for Health and Care Research, Liverpool, England, L69 7BE, UK
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, England, UK
| | - Helen Clough
- Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, National Institute for Health and Care Research, Liverpool, England, L69 7BE, UK
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, England, UK
| | - Roger Gibb
- Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, National Institute for Health and Care Research, Liverpool, England, L69 7BE, UK
| | - Xingna Zhang
- Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, National Institute for Health and Care Research, Liverpool, England, L69 7BE, UK
- Department of Public Health, Policy & Systems, University of Liverpool, Institute of Population Health, Liverpool, L69 3GF, UK
| | - Mark Green
- Department of Geography and Planning, School of Environmental Sciences, University of Liverpool, Liverpool, L69 3GF, UK
| | - Marie Chattaway
- Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, National Institute for Health and Care Research, Liverpool, England, L69 7BE, UK
- United Kingdom Health Security Agency (UKHSA), London, NW9 5EQ, UK
| | - Iain Buchan
- Department of Public Health, Policy & Systems, University of Liverpool, Institute of Population Health, Liverpool, L69 3GF, UK
| | - Benjamin Barr
- Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, National Institute for Health and Care Research, Liverpool, England, L69 7BE, UK
- Department of Public Health, Policy & Systems, University of Liverpool, Institute of Population Health, Liverpool, L69 3GF, UK
| | - Daniel Hungerford
- Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, National Institute for Health and Care Research, Liverpool, England, L69 7BE, UK
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, England, UK
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Socioeconomic and ethnic inequalities in incidence and severity of enteric fever in England 2015-2019: analysis of a national enhanced surveillance system. Epidemiol Infect 2023; 151:e29. [PMID: 36722253 PMCID: PMC9990404 DOI: 10.1017/s0950268822001959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
There is limited research on whether inequalities exist among individuals from different ethnicities and deprivation status among enteric fever cases. The aim of the study was to investigate the association between the enteric fever incidence rates, ethnicity and deprivation for enteric fever cases in England. Additionally, it was assessed if ethnicity and deprivation were associated with symptom severity, hospital admission and absence from school/work using logistic regression models. Incidence rates were higher in the two most deprived index of multiple deprivation quintiles and those of Pakistani ethnicity (9.89, 95% CI 9.08-10.75) followed by Indian (7.81, 95% CI 7.18-8.49) and Bangladeshi (5.68, 95% CI 4.74-6.76) groups: the incidence rate in the White group was 0.07 (95% CI 0.06-0.08). Individuals representing Pakistani (3.00, 95% CI 1.66-5.43), Indian (2.05, 95% CI 1.18-3.54) and Other/Other Asian (3.51, 95% CI 1.52-8.14) ethnicities had significantly higher odds of hospital admission than individuals representing White (British/Other) ethnicity, although all three groups had statistically significantly lower symptom severity scores. Our results show that there are significant ethnic and socioeconomic inequalities in enteric fever incidence that should inform prevention and treatment strategies. Targeted, community-specific public health interventions are needed to impact on overall burden.
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Rotheram S, Cooper J, Barr B, Whitehead M. Linking pathogens, people and places: Using geo-ethnography to understand place-based, socio-economic inequalities in gastrointestinal infections in the UK. Health Place 2022; 74:102741. [PMID: 35114615 DOI: 10.1016/j.healthplace.2022.102741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
This ethnographic study in two socio-economically contrasting areas employed geo-ethnography, underpinned by a relational approach, to understand inequalities in gastrointestinal infections in families with young children. In our 'relatively disadvantaged' area, gastrointestinal infections spread to multiple households within a small radius, whereas in our 'relatively advantaged' area, illness was confined to one household or dispersed long distances. These differences were shaped by historical, social and economic contrasts in: housing; social networks and childcare arrangements; employment and household income. Our findings show how linking places, pathogens and people helps us understand inequalities in gastrointestinal infections and may be pertinent to other infectious diseases such as COVID-19.
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Affiliation(s)
- Suzanne Rotheram
- National Institute of Health Research Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, United Kingdom; Department of Public Health, Policy and Systems, The University of Liverpool, Whelan Building, Liverpool, L68 3GB, United Kingdom.
| | - Jessie Cooper
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, Myddelton Street Building, London, EC1R 1UW, United Kingdom.
| | - Ben Barr
- National Institute of Health Research Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, United Kingdom; Department of Public Health, Policy and Systems, The University of Liverpool, Whelan Building, Liverpool, L68 3GB, United Kingdom.
| | - Margaret Whitehead
- National Institute of Health Research Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, United Kingdom; Department of Public Health, Policy and Systems, The University of Liverpool, Whelan Building, Liverpool, L68 3GB, United Kingdom.
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de Gier B, Houben-van Herten M, Uiters E, Hahné SJM. Educational differences in acute infectious diseases in the Netherlands: results from a nationwide health survey. Eur J Public Health 2021; 30:270-275. [PMID: 31981359 DOI: 10.1093/eurpub/ckz230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is unclear to what extent socioeconomic inequalities exist in common infectious diseases in high-income countries. We aimed to explore educational differences in five common acute infectious diseases in adults in the Netherlands. METHODS As part of a year-round repeated cross-sectional health survey, adults aged 25 and older were asked if they had experienced acute upper or lower respiratory tract infections, acute otitis media, urinary tract infections or gastro-enteritis in the two previous months. If so, participants were asked whether they had consulted their general practitioner and if they had been unable to perform their normal daily activities. These outcomes were analyzed per highest attained level of education. RESULTS Data of 18 629 survey respondents were used in the analyses. People with a low educational level had lower odds of upper respiratory tract infections (OR 0.88, 95% CI 0.81-0.95), but higher odds of lower respiratory tract infections (OR 1.57, 95% CI 1.16-2.11). After adjustment for several covariates, the differences in upper respiratory tract infections remained statistically significant (aOR 0.84, 95% CI 0.77-0.91). The educational differences in lower respiratory tract infections were mitigated by adjusting for chronic diseases and health behaviours. For all infectious diseases, the likelihood of general practitioner consultation was highest for the lower educated group. Inability to work or perform normal daily activities due to an infectious disease was similar across all levels of education. CONCLUSION This study shows that educational differences in incidence and care seeking behaviours exist for common acute infectious diseases in the Netherlands.
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Affiliation(s)
- Brechje de Gier
- Department for Early Warning and Surveillance, Centre for Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Ellen Uiters
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Susan J M Hahné
- Department for Early Warning and Surveillance, Centre for Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Rotheram S, Cooper J, Barr B, Whitehead M. How are inequalities generated in the management and consequences of gastrointestinal infections in the UK? An ethnographic study. Soc Sci Med 2021; 282:114131. [PMID: 34174579 PMCID: PMC8287589 DOI: 10.1016/j.socscimed.2021.114131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 05/27/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
Gastrointestinal infections are an important global public health issue. In the UK, one in four people experience a gastrointestinal infection each year and epidemiological research highlights inequalities in the burden of disease. Specifically, poorer children are at greater risk of infection and the consequences of illness, such as symptom severity and time off work/school, are greater for less privileged groups of all ages. Gastrointestinal infections are, however, largely ‘hidden’ within the home and little is known about the lived experience and practices surrounding these illnesses, how they vary across contrasting socioeconomic contexts, or how inequalities in the disease burden across socioeconomic groups might come about. This paper presents data from an ethnographic study which illuminate how socioeconomic inequalities in the physical and material management and consequences of gastrointestinal infections are generated in families with young children. The study shows how the ‘work’ needed to manage gastrointestinal infections is more laborious for people living in more ‘disadvantaged’ conditions, exacerbated by: more overcrowded homes with fewer washing and toilet facilities; inflexible employment; low household incomes; and higher likelihood of co-morbidities which can be made worse by having a gastrointestinal infection. Our findings call into question the current approach to prevention of gastrointestinal infections which tend to focus almost exclusively on individual behaviours, which are not adapted to reflect differences in socioeconomic context. Public health agencies should also consider how wider social, economic and policy contexts shape inequalities in the management and consequences of illness. Our findings are also pertinent to the COVID-19 pandemic response in the UK. They highlight how research and policy approaches to acute infectious diseases need to take into consideration the differing lived experiences of contrasting households if they wish to address (and avoid exacerbating) inequalities in the future. First ethnographic study to examine UK socioeconomic inequalities in GI infections. GI infections create a huge amount of labour for all families with young children. Co-morbidities, poorer living conditions and low income increase GI infection labour. Low paid, insecure, inflexible work exacerbates material consequences of infection. GI infection policy should look beyond behavioural advice to address inequalities.
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Affiliation(s)
- Suzanne Rotheram
- National Institute of Health Research Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Waterhouse Building (2nd Floor, Block F), 1-5 Brownlow Street, Liverpool, L69 3GL, United Kingdom; Department of Public Health, Policy and Systems, The University of Liverpool, Whelan Building, Liverpool, L68 3GB, United Kingdom.
| | - Jessie Cooper
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, Myddelton Street Building, London, EC1R 1UW, United Kingdom.
| | - Ben Barr
- National Institute of Health Research Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Waterhouse Building (2nd Floor, Block F), 1-5 Brownlow Street, Liverpool, L69 3GL, United Kingdom; Department of Public Health, Policy and Systems, The University of Liverpool, Whelan Building, Liverpool, L68 3GB, United Kingdom.
| | - Margaret Whitehead
- National Institute of Health Research Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Waterhouse Building (2nd Floor, Block F), 1-5 Brownlow Street, Liverpool, L69 3GL, United Kingdom; Department of Public Health, Policy and Systems, The University of Liverpool, Whelan Building, Liverpool, L68 3GB, United Kingdom.
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McGarrol S, Kaley A, Eastham R, Whitehead M, Limmer M. Disgusting disruptions: Capturing the everyday experience and burden of managing gastrointestinal infections in the home. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:284-293. [PMID: 32656872 DOI: 10.1111/hsc.13091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/18/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
Gastrointestinal (GI) infections exert a significant public health burden in the United Kingdom and the numbers of episodes are increasing. Younger children are considered particularly vulnerable to infection, and can experience 2-3 GI infections episodes per year, with consequences being more severe for more disadvantaged children, who are much more likely to be admitted to hospital. Few qualitative studies have explored the lived experience of GI infection in the community in the UK. The aim of the study reported here was to contribute to addressing this evidence gap, by examining the consequences of GI infection for 'normal' family life. Eighteen mothers with young children who had recently experienced a gastrointestinal infection were recruited from two socioeconomically contrasting neighbourhoods in North West of England. The findings demonstrated that GI infections were particularly disruptive: experienced as disgusting, laborious and stressful and significantly impacted normal family routines. Women felt burdened by the heavy physical and emotional demands of caring for a GI infection, resulting in feelings of isolation and insufficient support in their caring role from male partners. Tensions also arose from interactions with external community organisations, particularly in complying with their regulations on infection which often undermined caregivers knowledge and expertise of what was best for their children. This study challenges assumptions that managing GI infections in the home is unproblematic and experienced by caregivers as a 'minor ailment.' Infection control measures need to incorporate insights gleaned from the day-to-day realities of caring for sick children in the community.
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Affiliation(s)
- Sarah McGarrol
- Department of Public Health, Policy and Systems, NIHR Health Protection Research Unit in Gastrointestinal Infection, Farr Institute @ The Health eResearch Centre, University of Liverpool, Liverpool, UK
| | - Alex Kaley
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
| | - Rachael Eastham
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, The Quadrangle, Liverpool, UK
| | - Mark Limmer
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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Hadakshi RK, Patel DM, Patel MV, Patel MM, Patel PJ, Patel MV, Yadav KS, Mahadeviya HJ, Gajjar RA, Patel PN, Patel HD. Association between socioeconomic status and influenza-like illness: A study from Western part of India. J Family Med Prim Care 2020; 9:4587-4591. [PMID: 33209768 PMCID: PMC7652122 DOI: 10.4103/jfmpc.jfmpc_856_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives: Health status is associated with socioeconomic status (SES) of the individuals. The aim of this study was to identify any link between the SES and influenza-like illness (ILI). Materials and Methods: This observational case-control study was done on 18–70 years old patients presented with ILI (cases) at tertiary care hospital of western India. Controls were selected from demographically matched elective surgery patients except the SES. SES was evaluated as per the Modified B G Prasad 2017 scale and participants were further classified in lower SES (per capita income <2000 INR) and non-lower SES groups. Results: 810 cases and 830 controls were compared. Many cases were from lower SES, had poor hand hygiene, and were using soil, mud, ash (SMA) for hand cleaning as compared to the control. Among the cases significant numbers were from lower SES (543/810[67%], P < 0.02), many were alcoholics, smokers, had poor hand hygiene, were using SMA for hand cleaning, and had preexisting chronic obstructive pulmonary disease (COPD), while few were having diabetes in the lower SES group as compared to the non-lower SES group. ILI was more common among lower SES class in unadjusted analysis (odds ratio [OR] 1.58, 95% CI 0.89–2.76) and the results were significant even after the adjustment of covariates (OR 1.62, 95% CI, 0.94–2.85). Conclusion: Lower SES people were 2.8 times more prone to ILI as compared to the age- and sex-matched control in western part of India.
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Affiliation(s)
| | - Dhruvkumar M Patel
- Department of Medicine, Zydus Medical College and Hospital, Dahod, India
| | | | - Maitri M Patel
- Department of Community Medicine, GCS Medical College and Hospital, Ahmedabad, India
| | | | - Maurvi V Patel
- Department of Medicine, B. J. Medical College, Ahmedabad, India
| | - Krishnat S Yadav
- Department of Biochemistry, Zydus Medical College and Hospital, Dahod, India
| | | | - Ritesh A Gajjar
- Department of Medicine, B. J. Medical College, Ahmedabad, India
| | - Prathana N Patel
- Department of Community Medicine, Surat Municipal Medical College, Surat, Gujarat, India
| | - Harsh D Patel
- Department of Community Medicine, Surat Municipal Medical College, Surat, Gujarat, India
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Risk factors associated with outbreaks of seasonal infectious disease in school settings, England, UK. Epidemiol Infect 2020; 148:e287. [PMID: 33203492 PMCID: PMC7770374 DOI: 10.1017/s0950268820002824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Children are important transmitters of infection. Within schools they encounter large numbers of contacts and infections can spread easily causing outbreaks. However, not all schools are affected equally. We conducted a retrospective analysis of school outbreaks to identify factors associated with the risk of gastroenteritis, influenza, rash or other outbreaks. Data on reported school outbreaks in England were obtained from Public Health England and linked with data from the Department for Education and the Office for Standards in Education, Children's Services and Skills (Ofsted). Primary and all-through schools were found to be at increased risk of outbreaks, compared with secondary schools (odds ratio (OR) 5.82, 95% confidence interval (CI) 4.50–7.58 and OR 4.66, 95% CI 3.27–6.61, respectively). School size was also significantly associated with the risk of outbreaks, with higher odds associated with larger schools. Attack rates were higher in gastroenteritis and influenza outbreaks, with lower attack rates associated with rashes (relative risk 0.17, 95% CI 0.15–0.20). Deprivation and Ofsted rating were not associated with either outbreak occurrence or the subsequent attack rate. This study identifies primary and all-through schools as key settings for health protection interventions. Public health teams need to work closely with these schools to encourage early identification and reporting of outbreaks.
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Rose TC, Adams NL, Whitehead M, Wickham S, O'Brien SJ, Hawker J, Taylor-Robinson DC, Violato M, Barr B. Neighbourhood unemployment and other socio-demographic predictors of emergency hospitalisation for infectious intestinal disease in England: A longitudinal ecological study. J Infect 2020; 81:736-742. [PMID: 32888980 PMCID: PMC7649336 DOI: 10.1016/j.jinf.2020.08.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/22/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Abstract
We examined trends in infectious intestinal disease (IID) hospitalisations in England. Overall IID admission rates for children and older adults declined between 2012 & 2017. Increasing unemployment was associated with increasing IID admission rates. Healthcare access, underlying morbidity and ethnicity were also associated with IID rates. Policies should address inequalities in emergency IID hospitalisations.
Background Previous studies have observed that infectious intestinal disease (IID) related hospital admissions are higher in more deprived neighbourhoods. These studies have mainly focused on paediatric populations and are cross-sectional in nature. This study examines recent trends in emergency IID admission rates, and uses longitudinal methods to investigate the effects of unemployment (as a time varying measure of neighbourhood deprivation) and other socio-demographic characteristics on IID admissions for adults and children in England. Methods A longitudinal ecological analysis was performed using Hospital Episode Statistics on emergency hospitalisations for IID, collected over the time period 2012–17 across England. Analysis was conducted at the neighbourhood (Lower-layer Super Output Area) level for three age groups (0–14; 15–64; 65+ years). Mixed-effect Poisson regression models were used to assess the relationship between trends in neighbourhood unemployment and emergency IID admission rates, whilst controlling for measures of primary and secondary care access, underlying morbidity and the ethnic composition of each neighbourhood. Results From 2012–17, declining trends in emergency IID admission rates were observed for children and older adults overall, while rates increased for some sub-groups in the population. Each 1 percentage point increase in unemployment was associated with a 6.3, 2.4 and 4% increase in the rate of IID admissions per year for children [IRR=1.06, 95%CI 1.06–1.07], adults [IRR=1.02, 95%CI 1.02–1.03] and older adults [IRR=1.04, 95%CI 1.036–1.043], respectively. Increases in poor primary care access, the percentage of people from a Pakistani ethnic background, and the prevalence of long-term health problems, in a neighbourhood, were also associated with increases in IID admission rates. Conclusions Increasing trends in neighbourhood deprivation, as measured by unemployment, were associated with increases in emergency IID admission rates for children and adults in England, despite controlling for measures of healthcare access, underlying morbidity and ethnicity. Research is needed to improve understanding of the mechanisms that explain these inequalities, so that effective policies can be developed to reduce the higher emergency IID admission rates experienced by more disadvantaged communities.
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Affiliation(s)
- Tanith C Rose
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK.
| | - Natalie L Adams
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Sophie Wickham
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Sarah J O'Brien
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Hawker
- National Infection Service, Public Health England, Birmingham, UK
| | - David C Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Mara Violato
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Benjamin Barr
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
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12
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Rotheram S, Cooper J, Ronzi S, Barr B, Whitehead M. What is the qualitative evidence concerning the risks, diagnosis, management and consequences of gastrointestinal infections in the community in the United Kingdom? A systematic review and meta-ethnography. PLoS One 2020; 15:e0227630. [PMID: 31951600 PMCID: PMC6968854 DOI: 10.1371/journal.pone.0227630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gastrointestinal (GI) infections cause a significant public health burden worldwide and in the UK with evidence pointing to socio-economic inequalities, particularly among children. Qualitative studies can help us understand why inequalities occur and contribute to developing more effective interventions. This study had two aims: 1. Conduct a systematic review to determine the extent and nature of UK qualitative evidence on gastrointestinal infections; 2. Use meta-ethnography to examine the influences of the differing social contexts in which people live. METHODS MEDLINE, Scopus, Web of science, CINAHL and JSTOR were searched for UK qualitative studies engaging with the risk, diagnosis, management or consequences of gastrointestinal infections from 1980 to July 2019. Five reviewers were involved in applying inclusion and exclusion criteria, extracting and synthesising data (PROSPERO CRD 42017055157). RESULTS Searches identified 4080 studies, 18 met the inclusion criteria. The majority (n = 16) contained data relating to the risk of gastrointestinal infection and these made up the main synthesis. The tenets of meta-ethnography were used to glean new understandings of the role of social and environmental contexts in shaping the risk of gastrointestinal infection, specifically with respect to foodborne GI illness. Three main explanations concerning risk emerged from the data: explanations of risk in the community were underpinned by understandings of 'bugs', dirt and where food comes from; risks were negotiated in households alongside diverse processes of decision making around food; and resources available to households shaped food practices. CONCLUSION This systematic review highlights the scarcity of UK qualitative evidence examining gastrointestinal infections. Apart from risk, questions around diagnosis, management and consequences of illness were largely untouched. No studies investigated patterning by socio-economic status. Nevertheless, the meta-ethnography yielded wider contextual theories and explanations as to why people might not follow food hygiene guidance, giving pointers to the types of qualitative enquiry needed to develop more effective interventions.
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Affiliation(s)
- Suzanne Rotheram
- Health Protection Research Unit in Gastrointestinal Infection (NIHR), Farr Institute @ The Health eResearch Centre, University of Liverpool, Liverpool, United Kingdom
- Department of Public Health & Policy, The University of Liverpool, Liverpool, United Kingdom
| | - Jessie Cooper
- Division of Health Services Research and Management, School of Health Sciences, University of London, London, United Kingdom
| | - Sara Ronzi
- Department of Public Health & Policy, The University of Liverpool, Liverpool, United Kingdom
| | - Benjamin Barr
- Department of Public Health & Policy, The University of Liverpool, Liverpool, United Kingdom
| | - Margaret Whitehead
- Department of Public Health & Policy, The University of Liverpool, Liverpool, United Kingdom
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13
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Adams N, Byrne L, Rose T, Adak B, Jenkins C, Charlett A, Violato M, O'Brien S, Whitehead M, Barr B, Taylor-Robinson D, Hawker J. Sociodemographic and clinical risk factors for paediatric typical haemolytic uraemic syndrome: retrospective cohort study. BMJ Paediatr Open 2019; 3:e000465. [PMID: 31909217 PMCID: PMC6936988 DOI: 10.1136/bmjpo-2019-000465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/07/2019] [Accepted: 08/25/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Haemolytic uraemic syndrome (HUS) following Shiga toxin-producing Escherichia coli (STEC) infection is the the most common cause of acute renal failure among children in the UK. This study explored differential progression from STEC to HUS by social, demographic and clinical risk factors. METHODS We undertook a retrospective cohort study linking two datasets. We extracted data on paediatric STEC and HUS cases identified in the Public Health England National Enhanced Surveillance System for STEC and British Paediatric Surveillance Unit HUS surveillance from 1 October 2011 to 31 October 2014. Using logistic regression, we estimated the odds of HUS progression by risk factors. RESULTS 1059 paediatric STEC cases were included in the study, of which 207 (19.55%, 95% CI 17% to 22%) developed HUS. In the fully adjusted model, the odds of progression to HUS were highest in those aged 1-4 years (OR 4.93, 95% CI 2.30 to 10.56, compared with 10-15 years), were infected with an Shiga toxin (stx) 2-only strain (OR 5.92, 95% CI 2.49 to 14.10), were prescribed antibiotics (OR 8.46, 95% CI 4.71 to 15.18) and had bloody diarrhoea (OR 3.56, 95% CI 2.04 to 6.24) or vomiting (OR 4.47, 95% CI 2.62 to 7.63), but there was no association with progression to HUS by socioeconomic circumstances or rurality. CONCLUSION Combining data from an active clinical surveillance system for HUS with the national enhanced STEC surveillance system suggests that 20% of diagnosed paediatric STEC infections in England resulted in HUS. No relationship was found with socioeconomic status or rurality of cases, but differences were demonstrated by age, stx type and presenting symptoms.
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Affiliation(s)
- Natalie Adams
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
- National Infection Service, Public Health England, London, UK
| | - Lisa Byrne
- National Infection Service, Public Health England, London, UK
| | - Tanith Rose
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Bob Adak
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
| | - Claire Jenkins
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
- National Infection Service, Public Health England, London, UK
| | - Andre Charlett
- National Infection Service, Public Health England, London, UK
| | - Mara Violato
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah O'Brien
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Margaret Whitehead
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Benjamin Barr
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - David Taylor-Robinson
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jeremy Hawker
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK
- National Infection Service, Public Health England, Birmingham, UK
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Family income and exposure to norovirus in childhood: Findings from the UK Millennium Cohort Study. SSM Popul Health 2019; 8:100445. [PMID: 31440576 PMCID: PMC6698927 DOI: 10.1016/j.ssmph.2019.100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 11/22/2022] Open
Abstract
Children from low income families are at greater risk of poorer health outcomes than their wealthier peers. Hospital admissions for children with gastroenteritis increase as deprivation increases. Noroviruses are responsible for 47-96% of outbreaks of acute paediatric gastroenteritis, and 5-36% of sporadic cases worldwide. However, evidence on the relationship between family income and childhood exposure to norovirus is still limited, with published studies pointing to conflicting results. This study explored the relationship between family income and early childhood exposure to norovirus in the United Kingdom using data from the Millennium Cohort Study linked to serological data. Exposure to norovirus was measured by the level of human norovirus-specific antibodies (titres) obtained from oral fluid samples collected from 5962 pre-school age UK children and tested for Norovirus-specific Immunoglobulin G (IgG). Multivariable linear and quantile regression analyses were conducted to investigate the extent to which family income was associated with child norovirus exposure, and to explore the potential mechanisms through which income might translate into norovirus exposure. Higher norovirus-specific IgG titres were associated with higher family income, but the relationship weakened after controlling for potential mediating factors, mainly increased opportunities for person-to-person contacts, such as formal childcare arrangements. This study provides novel evidence that can help inform and prioritise policy interventions (e.g. vaccination) and health promotion programmes to reduce child health inequalities in the area of gastrointestinal infections.
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