Establishment Of Absenteeism Surveillance System In Rural Jiangxi And Studies Of Its Influence Factors

In recent years, the continuous appearances of infectious diseases epidemic have attracted significant attention in China as well as in other countries over the world. In order to prevent and control infectious disease out-breaks effectively, the most critical step is the timely detection of epidemic premonition, which depends on effective disease surveillance systems. Syndromic surveillance system, which collects non-specific syndromes in the early stages of disease development, has great advantages in promoting the early detection of epidemics and reducing the necessity of disease confirmation。With increasing availability of electronic data, syndromic surveillance, which uses pre-diagnostic data for surveillance purposes, has been growing in popularity. Public health agencies and others have invested substantial resources in the development and operation of automated systems for syndromic surveillance.Absenteeism surveillance system, which is an important components of syndromic surveillance system, is attracting more and more attention and research. In facing the continuing threat of infectious diseases, to which school-aged children are most sensitive, an effective early outbreak detection system in school is essential for public health and social welfare. In 2010, European Commission started to fund a FP7 project on developing a syndromic surveillance system in rural China. This study aims to evaluate the effect of absenteeism surveillance system, as well as explore the influencing factors to implement absenteeism surveillance system in rural areas.[Objective](1) To analyze absenteeism data collected from primary schools in rural Jiangxi and to investigate the regular pattern of situation that elementary school student absent from class because of illness in rural Jiangxi, to render us scientific evidence in the course of exploring feasible illness monitoring and precautionary system in primary schools.(2) To investigate knowledge, attitude and practice of infectious diseases among teachers in charge of class in primary school of rural area in Jiangxi, and discuss the feasibility of developing a absenteeism surveillance system in rural Jiangxi(3) To investigate the correlation between occurrence of common infectious diseases and absenteeism among pupils, evaluate the efficiency of school absenteeism surveillance system, furthermore, to provide strategy and recommendation for the improvement of the system.[Method](1) Analysis the data of the elementary school absented from class because of illness in rural Jiangxi.(2) An interviewing questionnaire survey on knowledge, attitude and practice of infectious diseases was conducted on 644 teachers in charge of class from 63 primary schools in Jiangxi.(3) An questionnaire survey was conducted on 1445 parents or guardians of primary school students. The subjects were selected from rural Jiangxi Province through multistage sampling, The risk of absenteeism for different diseases and symptoms was measured by the absenteeism risk index.[Result](1) In rural Jiangxi, an absenteeism surveillance system which selects 63 elementary schools as surveillance points has been preliminary established.12426 initial absenteeism records were collected from 4.1.2012 to 4.1.2014.The absent rate of primary school students is 0.16%, the absent rate because of illness is 0.11%. The absent rate of boys is higher than that of girls. The absent rate declined gradually with grade increasing. The absent rate due to illness reach its peak in spring and fall, and the most frequent reason for absence is fever and cold, which is account for 64.3%. The other reasons are chicken pox, mumps and gastro-intestinal symptoms.(2) The status of teacher in charge of a class on knowledge towards infectious diseases was not satisfied, the overall correct rate of knowledge was only 60%, the correct rate in county,township and village schools declined gradually. Most teachers thought it was very important to prevent and control infectious diseases in school, however, more than half of the teachers were not willing to participate in it.89% of classes conducted morning surveillance, over 95% of classes traced and recorded absence.96% of the teachers would like to acquire the knowledge of infectious diseases.(3) The absenteeism risk for a common cold was 0.35, and it was 0.7 for common infectious diseases and 0.37 for all diseases. The absenteeism risk declined gradually among students from county, township and village schools. The risk for respiratory symptoms was about 0.3, while it was 0.6 for gastrointestinal symptoms. About 74.7% of the students who had a history of diseases during the last three months were absent from school for one day or less. Majority (68%) of the parents would seriously follow the introduction on the quarantine of infectious diseases, but only 20.1% of parents thought sick children should not attend class. Regarding health care seeking,61.1% of the parents would take children to hospital after school.[Conclusion](1) Through this study, an absenteeism surveillance system which works smoothly has been preliminary established. The schools should stick at the direct report of absenteeism information, keep better track of the absence. Meanwhile, intensifying publicity and education of common disease and infectious diseases prevention among teachers, parents and students and cultivating good health habit and skills of students, then the absent rate due to illness can be lowered.(2) To develop an absenteeism surveillance system in primary school of rural Jiangxi, it is very necessary to strengthen the guidance over knowledge, attitude and practice of infectious diseases among primary school teachers.(3) Health seeking behavior of pupils and attitude of parents and guardians towards absenteeism have important influences on the effectiveness of school absenteeism surveillance system. The recommended strategy suggestion for the improvement of the surveillance system are, strengthening health education on infectious diseases among parents and guardians, implementing the quarantine policies strictly, enhancing the surveillance of attending sick children in the schools and defining the categories of absenteeism surveillance precisely.