title: Inequalities in gastrointestinal infections in families with young children: an ethnographic approach.
Creators: name: Rotheram, Suzanne
Publisher: name: University of Liverpool Repository
Year: 2023

description: Background Gastrointestinal (GI) infections are an important public health issue with one in four of the UK population experiencing at least one GI infection each year. Increasingly epidemiological evidence points to socio-economic inequalities in GI infections, particularly in the risk of infection in children and in the consequences of illness for all age groups. There is, however, currently little UK literature examining how or why these inequalities might come about with research instead largely focusing on the risk of infection and on individual behaviours taken to address this risk. This thesis therefore sets out to address this gap by examining how the management and consequences of GI infections are shaped in the context of households with young children in socio-economically contrasting places. Methods To examine inequalities in GI infections this study ‘followed’ GI infections through different domains: a review of existing literature; policy documents; standards, protocols and guidelines for the surveillance and management of GI infections; community childcare settings; and households with pre-school children in two socio-economically contrasting places. This ‘following’ of infection is done through a systematic review of existing literature to determine the extent and nature of the UK qualitative literature around the risk, diagnosis, management and consequences of GI infections; interviews with managers of childcare settings in the community (6 interviews); employees of Public Health England (PHE) (11 interviews); and a place-based ethnographic approach, including geo-ethnography in two socio-economically contrasting places (around 150 hours of observational fieldwork, 13 ethnographic interviews and 21 narrative interviews). Results The systematic review found that the UK qualitative literature was sparse (18 studies) and the majority of these studies focused solely on the risk of foodborne illness. The further analysis of the primary data in the reviewed studies did, however, give some indication that what people do around food might be shaped by the wider context in which people live. An analysis of national standards for GI infections found a hierarchy to the surveillance and management of GI infections. Within this hierarchy the most common GI infections in the community were afforded a low priority. The low priority afforded these infections in national standards contrasted starkly with the lived experience of childcare settings and families dealing with GI infections in their homes. In these settings and homes, the qualitative studies in this thesis found all GI infections as being highly disruptive events with serious consequences for individuals and organisations. The labour required to manage these infections and the economic consequences of illness however, were not evenly distributed. Participants living in more challenging individual and place-based socio-economic circumstances had to expend more labour to manage these infections and experienced greater financial consequences of illness. In the more ‘disadvantaged’ community GI infections were often experienced by multiple households in a small geographical area thereby concentrating the consequences of illness in that place. In contrast, in the more ‘advantaged’ area experiences of GI infection were more often confined to the one household or spread over larger geographical distances. Conclusion Taken together, these findings show that inequalities in GI infections in families with young children cannot be fully addressed by looking exclusively at risk, to individual behaviours taken to address risk, or by prioritising foodborne illness. In focusing on the consequences of all GI infections, this thesis makes visible the type of GI infection that has the most significant impact on childcare in the community thereby illuminating inequalities in the management and consequences of GI infections for families living in different socio-economic conditions.