Critical analysis of investigation of respiratory infectious disease in children attending daycare centers

Abstract

OBJECTIVE: Social-economic and cultural changes are increasingly leading families to share the children's care and education with daycare centers. Nevertheless, this practice is being widely criticized. Medical literature, for example, points to the high risk of illnesses in these environments. Searching to assess theoretical- methodological aspects underlying disease/daycare research, a bibliography review was done. METHOD: The last five years production was reviewed, through Current Contents, Med-Line and Lilacs, using creche / daycare center as keywords. RESULTS: 665 papers were obtained and organized in subgroups. Selecting the group of papers on respiratory infectious diseases, 34 papers were obtained, being 22 of them empirical, and 12 theoretical or review article, etc. The empirical studies used large populations; data were collected by interviews, medical reports and laboratory analyses; 50% were cross-sectional. Disease/daycare relation was obtained mainly by quantitative analysis, based on a multivariate model and logistic regression. Seventy per cent concluded that attending daycare implies an illness high risk, especially for youngers than 2 years. The papers with a preventive character, and-in more subtler ways - 50% of the others point alternative solutions for this clinical and social problem (vaccination, immunity stimulation, environmental organization). CONCLUSION: The structure and the discussion of the majority of the studies seem to be guided by implicit assumptions, based on conceptions of an ideal situation of care (at house, by the mother). The results are legitimized by large populations and sophisticated statistic systems. Nevertheless, they express a prediction risk, which highlights static aspects, not the dynamic ones, of health/ disease processes. At last, they treat a social problem on clinical individual assumptions.