Societal Burden and Correlates of Acute Gastroenteritis in Families with Preschool Children

Abstract

Gastrointestinal infection morbidity remains high amongst preschool children in developed countries. We investigated the societal burden (incidence, healthcare utilization, and productivity loss) and correlates of acute gastroenteritis (AGE) in families with preschoolers. Monthly for 25 months, 2000 families reported AGE symptoms and related care, productivity loss, and risk exposures for one preschooler and one parent. Amongst 8768 child-parent pairs enrolled, 7.3% parents and 17.4% children experienced AGE (0.95 episodes/parent-year and 2.25 episodes/child-year). Healthcare utilization was 18.3% (children) and 8.6% (parents), with 1.6% children hospitalized. Work absenteeism was 55.6% (median 1.5 days) and day-care absenteeism was 26.2% (median 1 day). Besides chronic enteropathies, antacid use, non-breastfeeding, and toddling age, risk factors for childhood AGE were having developmental disabilities, parental occupation in healthcare, multiple siblings, single-parent families, and ≤ 12-month day-care attendance. Risk factors for parental AGE were female gender, having multiple or developmentally-disabled day-care-attending children, antimicrobial use, and poor food-handling practices. Parents of AGE-affected children had a concurrent 4-fold increased AGE risk. We concluded that AGE-causing agents spread widely in families with preschool children, causing high healthcare-seeking behaviours and productivity losses. Modifiable risk factors provide targets for AGE-reducing initiatives. Children may acquire some immunity to AGE after one year of day-care attendance.

Figure 1. Flowchart of the sampling design.

AGE = acute gastroenteritis; RR = risk ratio; 95%CI = 95% confidence interval. *The most common unreliable/conflicting answers leading to the questionnaire being discarded were those denoting mixing up of answers for the child with those for the parent and vice versa, or when the parents had reported data for a child other than the one invited to participate. Other examples of unreliable data were, for instance, reporting to be male and pregnant, being too young to be a parent (e.g. 10 year old), evident mistakes in reporting the date of birth (e.g. being born in the 1800s), reporting to have a partner living in the household but that only 1 adult lived in the household, reporting that no children lived in the household, etc. **Adjusted for the variables presented in Table 3.

Figure 2. Incidence of acute gastroenteritis in children of <4 years of age and in their parents (n = 8768 child-parent pairs) by study month.

An optimized cubic smoothing P-spline function is fitted to the observed data. Autumn, September–November; winter, December–February; spring, March–May; summer, June–August.