Syndrome-Specific School Absenteeism Data for

Public Health Surveillance Shuying Shen, MStat

University of Utah

SettingDavis County in Utah

Smallest county in Utah, 3rd largest in population.22.6% of the population is between 5-18 years old

(large families)

School district includes 56 elementary, 14 junior high, 8 high schools, 3 alternative schools, and 8 year-round schools.

Surveillance SystemIn place since fall 2004

Absences reported by homeroom teachers and parents/guardians with:Date, classroom, teacher name, student nameReason for absence (Sick, Other, Unknown)

Entered into District Information System and available in real-time.

EnhancementTen public elementary schools recruited to

participate as sentinel schools in fall 2007.

Reason for absence expanded into syndrome categories:RespiratoryGIRashOtherUnknown

ResultsThe most common reason for absence was

unknown (59%), followed by sick (23%) and other (18%).

Other sickness-related absences accounted for 38% of the sick absences, followed by unknown (26%), GI (18%), respiratory (16%), and rash (0.6%).

Respiratory-related absences correlated well with influenza cases reported to UDOH.

Decrease in GI beginning of fall, otherwise stable

Absence Rate by Reason for Absence

Absence Rate by Syndrome

Other ObservationsNumerous schools not recruited used the

enhanced reporting voluntarily.

Requires minimal resource for enhanced reporting

Principals and school nurses very interested in feedback informationHow we compare to ourselvesHow we compare to other schools

LimitationsData quality needs to be improved

Too many unknowns and others

Potential SolutionsImprove data collection by

Promotion of importance of surveillance to parents/guardians

Implement proactive reporting system for parents/guardians

Statistical modelingMissing data imputation because likely bias in

unknownsAdjustment for misclassification errors using

Bayesian approach