Singapore Housing Index and prevalence of Serious Bacterial Infections among Febrile Infants

Annisa Rakun^1,2*Jin Wee Lee³Sarah Hui Wen Yao²Lena Wong²Rupini Piragasam²Gene Yong-Kwang Ong²Zi Xean Khoo²Andrew Ho³Sashikumar Ganapathy²Shu-Ling Chong²

• ¹National Healthcare Group, Singapore, Singapore
• ²KK Women's and Children's Hospital, Singapore, Singapore
• ³Duke-NUS Medical School, Singapore, Singapore

Background and Objective: This study aimed to examine the relationship between the Singapore Housing Index (SHI) and presence of serious bacterial infections (SBIs) among young febrile infants. Methods: A secondary analysis was conducted on infants ≤3 months old, who presented to a paediatric Emergency Department (ED) with temperature ≥38oC between December 2017 and 2021. SHI was categorised into low, medium and high groups. The primary outcome was presence of SBIs. Secondary outcome was a composite of the need for resuscitation, and/or need for high acuity care. We performed multivariable logistic regression to study if SHI was independently associated with SBIs and SBI outcomes. Results: Among 1001 infants, the median age was 32 days (interquartile range IQR 10-60), and 176 infants (17.6%) were diagnosed with SBIs. The SBI rates among low, medium, and high SHI groups were 12.6% (13/103), 17.5% (115/658), and 20% (48/240) respectively (p=0.256). After adjusting for male sex, neonate status, ethnicity, and late prematurity, neither high (aOR 1.714, 95% CI 0.844-3.480, p = 0.136) nor medium SHI (aOR 1.572, 95% CI 0.826-2.990, p = 0.168) was significantly associated with SBI compared with low SHI. No evidence of association was found between SHI and severe clinical outcomes. Conclusions: In our study population, young infants from low SHI were not at greater risk for SBIs. Future research should include other measures of social determinants in the understanding of SBI risk in young febrile infants.