Chronic Disease Disparities in Students: Findings from a Novel School Clinic Surveillance Project in Coastal Georgia

BACKGROUND:   The Syndromic Surveillance Program (SSP) of the Georgia Department of Public Health collects chief complaint data from hospitals to characterize health trends in near real time. These data were critical for situational awareness during the 2009 H1N1 pandemic. In 2012, SSP and the Effingham County Schools began a project collecting syndromic surveillance data from school clinics. The hypothesis was that these data may be used to inform interventions during a pandemic, guide school health programs, and quantify nursing staff needs in schools. Analysis of data has provided a novel look at the disparate burden of disease among students across schools in the county.

METHODS: Every day during the 2012-2013 and 2013-2014 school years, 12 nurses in Effingham County entered data into a web-based module for clinic visits meeting the following syndrome definitions: Influenza-Like Illness, Rash/Fever, Gastrointestinal, Injury, Asthma, Diabetes, and Total Daily Visits. After the 2012-2013 school year “Asthma” and “Diabetes” were modified to include “Acute Asthma” and “Acute Diabetes” counts. New categories captured urgent visits while “Asthma” and “Diabetes” captured routine management. “Oral Health” and “Mental Health” were added to the syndrome list. Given the modification of syndromes, only data from the 2013-2014 school year were analyzed.

RESULTS:   During the 2013-2014 school year, Effingham County school nurses provided care in 79,906 student visits; 24,301 (30.4%) met syndrome case definitions. Injury (6,469, 26.6%) was the most common chief complaint, followed by diabetes management (4,477, 18.4%). Visits for asthma ranged from 10.6% of surveillance-related visits in Elementary Schools to 2.5% in High Schools. The proportion of visits related to asthma varied from 0.1% at one elementary school to 18.8% at another elementary school. Similarly, one middle school reported 21.3% of visits were related to diabetes, while the other two middle schools had less than 2% diabetes-related.

CONCLUSIONS:   This project demonstrated that school clinics are a significant resource for primary healthcare among school-aged children and that clinic syndromic surveillance is valuable for preparedness and education programs. Baseline burdens of both infectious and chronic diseases may be established. These data also show priority targets for school and community programs include injury prevention, asthma, and diabetes control. Evidence of poor chronic disease management among some students provided an opportunity for collaboration with chronic disease programs at DPH. Further analysis will be done to look at environmental factors and socioeconomic status to determine the possible effect on disease burden and management of chronic disease.