Identification of Service Areas for Nurseries Serving Mildly Ill Children in 105 Major Japanese Cities before and during the COVID-19 Pandemic.

INTRODUCTION: To prevent the spread of infectious diseases, general day care centers in Japan ask children to not attend when they are feeling unwell, even if they only have mild symptoms. Thus, when a child becomes ill, their continuity of childcare is disrupted. For this reason, specialized nurseries for children who are mildly ill have been established in Japan, aiming to ensure continuity of care. However, there is limited knowledge regarding the impact on nursery use caused by the distance between a child's residence and the nearest facility. METHODS: This survey targeted 105 major cities nationwide: 20 designated cities, 23 special wards of Tokyo, and 62 core cities. Using panel data analysis with generalized estimating equations, I determined the monthly number of users of day care for mildly ill children from April 2018 to March 2023 based on the average shortest distance in each city from each child's residence to the corresponding facility. The analysis was adjusted for factors that included general infectious disease trends, childcare capacity for mildly ill children, child population, the coronavirus disease 2019 (COVID-19) pandemic, and presence/absence of a declaration of state emergency/priority infection control measures. RESULTS: Both before and during the COVID-19 pandemic, the utilization rate decreased by a factor of 0.825 for every 1-km increase (approximately 17.5% decrease per kilometer) in the shortest distance to a nursery for mildly ill children. When the distance reached 12 km, the utilization rate decreased to 10%. CONCLUSIONS: Defining the service area as the distance range where utilization rates become one-tenth to equivalent compared with childcare facilities in the same neighborhood as a child's home, the radius remained approximately 12 km both before and during the COVID-19 pandemic.