Costs Associated With Gastrointestinal-Tract Illness Among Children Attending Day-Care Centers in Houston, Texas

Substantial costs occur each year due to infectious illness attributable to day-care center attendance by young children.1-3 Estimates of the value of work missed by parents in the US due to day-care-associated upper respiratory tract and diarrheal illness combined have ranged from $1602 million to $4003 million per year. Infectious diarrhea is one of the most common illnesses among young children. Several epidemiologic studies have shown increased risk of developing infectious diarrhea with attendance in group care, especially among children under 3 years of age.4-6 The cost burden of diarrheal illness among children attending day-care centers (DCCs) has not been adequately quantified, and few analyses have considered the effect that the type of care arrangement given ill children exerts on cost. To estimate the cost burden of gastrointestinal-tract illness in day-care centers (DCCs), we used data collected during a 16-month cohort study of rotavirus diarrhea in four DCCs. In addition, we surveyed parents to assess factors affecting cost of illness and to assess the range of ill-child-care options used by parents. METHODS Selection of Day Care Centers Four DCCs in Houston, Texas, were selected for participation in the rotavirus cohort study from a list of licensed DCCs generated by the Texas Department of Human Services. Potential study sites were centers with sufficient numbers of infants and toddlers located within a 7-mile radius of the University of Texas Medical School. Center directors gave informed consent for their centers to participate in the study. Day-Care Center Population From October 1989 through April 1991, children age 1-18 months with no known underlying disease in four licensed DCCs were enrolled in the rotavirus cohort study.