01 September 2020- 01 September 2023
ED attendances continue to rise nationally, and this increase has been markedly dramatic in disadvantaged cities such as Liverpool. Liverpool has higher than national average population of children from the most deprived backgrounds, with approximately 28% of children in low income families, and these children are more likely to present to the ED with a febrile illness. Despite evidence to show an association between infectious diseases and disadvantaged socioeconomic conditions (SECs), it is unclear what is driving the current increase in ED use for febrile illness. This may plausibly reflect increased incidence of disease, greater unmet healthcare need, or a lack of access and use of appropriate primary care services. A report forecasting the future burdens in paediatric health care has predicted a ‘significant decline’ in the global burden of infections. However, it is expected that with worsening poverty and the widening gap in health inequalities, challenges in child health will continue to rise and with it, the number of children requiring care in an ED. It is also unclear whether the views of parents presenting to the ED with an unwell child, and the views of healthcare professionals influence the clinical management of febrile children, and whether childhood SECs influence whether tests are performed, and whether antibiotics are administered.
The research comprises three studies:
Study 1 This study will be a cross-sectional ecological analysis using data aggregated at the LSOA level, to explore the relationship between SECs and outcomes relevant to paediatric febrile illness for children with paediatric febrile illness in Liverpool and the UK,
Study 2 An analysis of secondary data from the PERFORM study. Routinely collected data will be used on the management and outcome of febrile children presenting to the ED at Alder Hey.
Study 3 conversational and/or small group interviews with parents and healthcare professionals to understand parental and HCP perceptions of the reasons for ED presentation, including decisions to perform further diagnostic tests or prescribe antibiotics for children with paediatric febrile illness in Liverpool.
This project involves working with Liverpool GenerationR Young Person’s Advisory Group (YPAG). The YPAG and existing parent forum will advise on approaching parents of children presenting with febrile illness for one-to-one conversational and/ or small group interviews, the design of parent information leaflets, design of interview schedules and the data generation templates for the qualitative work, and qualitative data analysis. In addition, they will support the wider study and advice on both how to communicate key messages to the local population and other dissemination work. This project involves members of the community who may be from a more socioeconomic disadvantaged background to better inform the direction of my research and design of the qualitative work.
In the context of rising admissions for children with paediatric febrile illness, and deteriorating social conditions for families in disadvantaged areas, the overall aim of this thesis is to investigate the effect of SECs on clinical outcomes and healthcare in children with paediatric febrile illness. This research has the capacity to better inform policies and interventions to address rising paediatric ED admissions in Liverpool and nationwide. If drivers of emergency healthcare use and child poverty are not addressed, healthcare activity, healthcare outcomes and the strain on our healthcare services will worsen. A better understanding of these pathways is urgently needed to inform policy and practice, to reduce the increasing burden of ED admissions. Exploring these pathways and possible thresholds in seeking medical advice will better inform policy makers as well as improve the quality of care for children presenting with febrile illness.
Maintaining a health equity lens, the research will provide evidence to ensure that already disadvantaged children with febrile illness are not further disadvantaged by existing care pathways. Findings from this research could inform policies that benefit equitable access to healthcare, effective safety netting and a better health education for parents with children experiencing a fever.