Group | Household Health Systems

The Household Health Systems research group focuses on in environmental health and health systems research. We consider the perspective of the household at the interface to the health and social system in socio-ecological environments in the global South and North. The intention is to discover how household health practices and behaviours can be better integrated with formal public services and become integral and supported parts of the health system and programme.    

Research in the South

In the context of the South, the purpose of our research in two South American and five African countries is to link marginalised and rural (high altitude) communities with an effective higher-level health system by improved engagement of householders and community level health workers. The intention is to discover how household health practices and behaviours but also environmental and health intervention can be better integrated with formal public services and become integral and supported parts of the health system and programmes.

Research in Switzerland

In the Swiss context, we investigate processes that link human behaviour, illness experience, and health seeking on the one hand and the physicians’ behaviour, case management, and diagnostic and treatment strategies as well as the diagnostic practices of laboratories on the other hand; all those factors are influencing disease reporting and shape the so-called “burden of illness pyramid”. Our research on food- and waterborne disease epidemiology and control including on acute gastroenteritis, campylobacteriosis and Legionnaires’ disease fosters the understanding of the aforementioned processes.

Patient Pyramid

We apply this model to depict our multiple research projects in the field health systems research on infectious diseases in Switzerland. 

Epidemiology of Legionella in Switzerland

Legionnaires’ disease/legionellosis is a severe form of pneumonia. The disease is notifiable to the Swiss Federal Office of Public Health. Over the past ten years, annual reported incidence rates of Legionnaires’ disease in Switzerland increased continuously. The reason for this increase and the main sources of infection remain unknown. Since 2015, our research group is investigating the trajectory from exposure to Legionella spp. to final and mandatory reporting of Legionnaires’ disease cases to the Swiss notification system for infectious diseases. So far, several studies investigating trends in disease notification rates, diagnostic testing behaviour, and physicians’ disease perception and treatment strategies were conducted. These studies informed the design of a prospective, national case-control study for which recruitment is planned to start in spring 2022. Read more about the Study and our research work here.

WHO and 14 collaborating research institutions have estimated that 842,000 diarrhoea deaths in low- and middle- income countries can be attributed to poor water, sanitation and hygiene. This amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. The Household Health Systems group has contributed substantially to this series. For more information please consult WHO Programme "Water Sanitation Health"

Early child development intervention at household level in Peru
Improved kitchen environment with running water, sink and improved cookstove.

Fischer F.B, Mäusezahl D, Wymann M.N. Temporal trends in legionellosis national notification data and the effect of COVID-19, Switzerland, 2000-2020. Int J Hyg Environ Health. 2023;247:113970. DOI: 10.1016/j.ijheh.2022.113970

Larson A.J et al. Household-level risk factors for water contamination and antimicrobial resistance in drinking water among households with children under 5 in rural San Marcos, Cajamarca, Peru. One Health. 2023;16:100482. DOI: 10.1016/j.onehlt.2023.100482

Nuño N et al. Acceptance and uptake of improved biomass cookstoves in Peru: learning from system level approaches to transform large-scale cooking interventions. Energy Research & Social Science. 2023;97:102958. DOI: 10.1016/j.erss.2023.102958

Fischer F.B, Deml M.J, Mäusezahl D. Legionnaires' disease: a qualitative study on Swiss physicians' approaches to the diagnosis and treatment of community-acquired pneumonia. Swiss Med Wkly. 2022;152:w30157. DOI: 10.4414/smw.2022.w30157

Fischer F.B, Fanderl J, Mäusezahl D. Évolution dans le temps et influence de différents facteurs sur la distribution géographique de la maladie du légionnaire en Suisse. BAG Bulletin. 2022;3:8-11