# Singapore Housing Index and prevalence of serious bacterial infections among febrile infants

## TL;DR

This study found no significant link between housing conditions in Singapore and the risk of serious bacterial infections in febrile infants under three months old.

## Contribution

The study is the first to investigate the association between the Singapore Housing Index and serious bacterial infections in febrile infants.

## Key findings

- SBI rates were 12.6%, 17.5%, and 20% for low, medium, and high SHI groups, but differences were not statistically significant.
- Adjusted analyses showed no significant association between SHI and SBI risk or severe clinical outcomes.

## Abstract

This study aimed to examine the relationship between the Singapore Housing Index (SHI) and presence of serious bacterial infections (SBIs) among young febrile infants.

A secondary analysis was conducted on infants ≤3 months old, who presented to a paediatric Emergency Department (ED) with temperature ≥38°C 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.

Among 1,001 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.

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.