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Child day care risks of common infectious diseases revisited
N Lu1, M E Samuels, L Shi
1Department of Public Health, Western Kentucky University, Bowling Green, KY, USA. ning.lu@wku.edu
Insights
Children in day care face higher risks of infectious diseases like diarrhea and upper respiratory infections (URI). Younger children under 1.5 years and those on Medicaid experience the greatest risk increase compared to home-care settings.
Area of Science:
- Pediatric infectious diseases
- Public health epidemiology
- Childcare health risks
Background:
- Child day care attendance is linked to increased infectious disease risk.
- This risk may differ based on child's age, health plan, and parental education.
- Quantitative assessment of diarrheal illness and upper respiratory infection (URI) risk in day care versus home care was needed.
Purpose of the Study:
- To quantitatively determine the risk of diarrheal illness and URI in day-care versus home-care children.
- To examine how age, health plan, and parental education modify these risks.
- To compare infection risks under various conditions for children aged 5 or younger.
Main Methods:
- Household survey of 1188 children (aged ≤5 years) in Columbia, SC, over 18 months.
- Participants included 435 in out-of-home day care and 753 at home, recruited via Health Maintenance Organization (HMO) and Medicaid.
- Bimonthly contact with control for family characteristics to assess day care's effect on common infections.
Main Results:
- Day-care children generally have higher risks of diarrheal illness and URI than home-care children.
- Children younger than 1.5 years on Medicaid faced the highest risk.
- Risk differences diminished for older children (>1.5 years) and those with HMO coverage; Medicaid children had higher risks than HMO children.
Conclusions:
- Day-care children face elevated risks of common infectious diseases.
- The impact of day care on diarrheal illness and URI risk is significantly influenced by child's age and health insurance type.
Background:
The increased risk of common infectious diseases associated with child day care attendance may vary by age, health plan and parent educational level. This study determined quantitatively the risk of diarrhoeal illness and upper respiratory infection (URI) among day-care children in comparison with home-care children. It examined the extent of risks in day-care children under different conditions of three age groups, enrolled in two health plans, and from families of two levels of education.
Methods:
The study subjects were recruited through two health plans: a Health Maintenance Organization (HMO) and the Medicaid program in Columbia, South Carolina of the USA. The sample was collected using a household survey of children, aged 5 years or younger. The participants were contacted bimonthly for 18 months with 435 attending out-of-home day care facilities and 753 being cared for at home. The potential confounding factors of family characteristics were controlled in examining the odds ratios for day care effect on common infections in children under different conditions.
Results:
In general, risks of diarrhoeal illness and URI in day-care children are greater than in home-care children. Children younger than 1.5 years of age attending day care and covered by the Medicaid program are at the greatest risk. The difference in risks between day-care and home-care children, however, is reduced to an insignificant level for children older than 1.5 years of age and for children covered by the HMO health plan. Among day-care children, those who are covered by the Medicaid program are at a significantly higher risk than those who are covered by the HMO health plan.
Conclusions:
Although day-care children in general suffer a greater risk of common infectious diseases, the extent of day care effect on risks of diarrhoeal illness and URI varies significantly by age and type of health insurance plan.
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