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, also known as legionellosis, is a severe form of pneumonia that must be reported to the Swiss Federal Office of Public Health. Over the past ten years, the annual reported incidence rate of Legionnaires' disease in Switzerland has increased continuously. The reasons for this increase and the main sources of infection remain unknown. Since 2015, our research group has been investigating the trajectory from exposure to Legionella spp. to the final, mandatory reporting of cases of Legionnaires' disease to the Swiss infectious disease notification system. Several studies have been conducted to investigate trends in notification rates, diagnostic testing behaviour, and physicians’ perception of and strategies for treating the disease. The results of these studies informed the design of a prospective, national case-control study. Read more

Early child development intervention at household level in Peru (Photo: Swiss TPH)

Digital Support Systems to Improve Child Health and Development

A Swiss TPH-led research project tested an AI-powered mobile app that supports parents in nurturing their children’s development during the crucial first 1,000 days of life. Involving 2,400 families in Peru, the study showed how digital tools can bridge gaps in healthcare access, provide personalised guidance, and offer scalable, low-cost solutions to improve early childhood care in remote and resource-limited settings. Read more

Bigler M, Mäusezahl D, Gaia V, Roloff T, Julian T, SwissLEGIO. Die Legionärskrankheit in der Schweiz:eine nationale Fall-Kontroll-Studie zur Untersuchung von Risikofaktoren und Infektionsquellen (SwissLEGIO). BAG Bulletin. 2025;24:10-16

Bigler M et al. Long-term impacts of Legionnaires' disease on health and wellbeing: rationale, study design and baseline findings of a matched cohort study (LongLEGIO). Swiss Med Wkly. 2025;155(6):4333. DOI: 10.57187/s.4333

Bigler M, Zacher F, Dräger S, Albrich W.C, Mäusezahl D, SwissLEGIO Hospital Network. Test and treat-impact of microbiological testing on antibiotic prescribing for Legionnaires' disease in Switzerland: results of the multicentre SwissLEGIO study. Pneumonia (Nathan). 2025;17(1):17. DOI: 10.1186/s41479-025-00171-1

Hammes F et al. Foresight 2035: a perspective on the next decade of research on the management of Legionella spp. in engineered aquatic environments. FEMS Microbiol Rev. 2025;49:fuaf022. DOI: 10.1093/femsre/fuaf022

Hinckley K et al. Caregivers' perceptions and practices regarding responsive caregiving and early learning in Cajamarca, Andean Peru: a qualitative study. Infant Child Dev. 2025;34(4):e70036. DOI: 10.1002/icd.70036