Magnitude, distribution, risk factors and care-seeking behaviour of acute, self-reported gastrointestinal illness among US Army Soldiers: 2015

Abstract

Throughout history, acute gastrointestinal illness (AGI) has been a significant cause of morbidity and mortality among US service members. We estimated the magnitude, distribution, risk factors and care seeking behaviour of AGI among the active duty US Army service members using a web-based survey. The survey asked about sociodemographic characteristics, dining and food procurement history and any experience of diarrhoea in the past 30 days. If respondents reported diarrhoea, additional questions about concurrent symptoms, duration of illness, medical care seeking and stool sample submission were asked. Univariable and multivariable logistic regression were used to identify the factors associated with AGI and factors associated with seeking care and submitting a stool sample. The 30-day prevalence of AGI was 18.5% (95% CI 16.66–20.25), the incidence rate was 2.24 AGI episodes per person-year (95% CI 2.04–2.49). Risk factors included a region of residence, eating at the dining facility and eating at other on-post establishments. Individuals with AGI missed 2.7–3.7 days of work, which costs approximately $ 847 451 629 in paid wages. Results indicate there are more than 1 million cases of AGI per year among US Army Soldiers, which can have a major impact on readiness. We found that care-seeking behaviours for AGI are different among US Army Service Members than the general population. Army Service Members with AGI report seeking care and having a stool sample submitted less often, especially for severe (bloody) diarrhoea. Factors associated with seeking care included rank, experiencing respiratory symptoms (sore throat, cough), experiencing vomiting and missing work for their illness. Factors associated with submitting a stool sample including experiencing more than five loose stools in 24 h and not experiencing respiratory symptoms. US Army laboratory-based surveillance under-estimates service members with both bloody and non-bloody diarrhoea. To our knowledge, this is the first study to estimate the magnitude, distribution, risk factors and care-seeking behaviour of AGI among Army members. We determined Army service members care-seeking behaviours, AGI risk factors and stool sample submission rates are different than the general population, so when estimating burden of AGI caused by specific foodborne pathogens using methods like Scallan et al. (2011), unique multipliers must be used for this subset of the population. The study legitimises not only the importance of AGI in the active duty Army population but also highlights opportunities for public health leaders to engage in simple strategies to better capture AGI impact so more modern intervention strategies can be implemented to reduce burden and indirectly improve operational readiness across the Enterprise.

Correlates of healthcare-seeking behavior for acute gastroenteritis—United States, October 1, 2016 –September 30, 2017

“…These findings support other work that has found that a long duration of illness [5,11], concurrent fever [2,5,15], longer diarrhea duration [2], and vomiting [2,16] were significantly associated with care seeking behavior in multivariable analyses. Other work has additionally shown other concurrent symptoms, including headaches [11] and abdominal cramps [15] to be associated with healthcare-seeking behavior, but these variables were not assessed in our study.…”

A population-based survey of the prevalence of self-reported acute gastrointestinal illness in Zhejiang Province, China

“…Primarily, National Health Interview Survey (NHIS) data showed that gastrointestinal illness was associated with income, with a negative correlation between income and overall health, including AGI [ 35 , 36 ]. This may be due to the different lifestyle behaviors in this group, such as health habits, patterns of dining out, and awareness of hygienic conditions [ 37 , 38 ]. Moreover, intestinal microorganisms may have a prominent effect on disease [ 39 , 40 ].…”

Antimicrobial resistance of enteric pathogens in the Military Health System, 2009 – 2019

“…SMs are at increased risk of developing AD due to their deployments to overseas locations [15], and exacerbated by the fact that a number of those locations have concerning levels of AMR in relevant pathogens [9][10][11][12]. Episodes of diarrheal disease can have detrimental impact on troop readiness and mission operations, underscoring the importance of timely resolution of symptoms in this population [16][17][18][19]. It is therefore essential for military medical providers to understand the current trends in resistance profiles of enteropathogens in SMs to inform proper, timely treatment options.…”