PUBLIC HEALTH REPORTS

VOL. 36

JULY 8, 1921

SICKNESS AMONG SCHOOL CHILDREN.

No. 27

Loss of Time From School Among 6,130 School Children in 13 Localities in Missouri.'

By SELWYN D. COLLINS, Assistant Statistician, United States Public Health Service.

At the present stage of our knowledge of disease problems, any records which show the true incidence of even a few diseases in an observed population are important. Ordinary morbidity reports as furnished by physicians to local health departments do not, for wellknown reasons, give an accurate picture of the incidence of any disease in a definitely enumerated population group. It is necessary, therefore, to utilize other methods for obtaining the desired information.

In a general way, the most promising directions for seeking data of this character are: (1) Records of disability among groups of insured persons associated in various kinds of sick-benefit associations; (2) records of sickness in groups of persons employed in industrial establishments where careful medical supervision and a system of disability records have been established; (3) records of sickness in groups of individuals living in institutions or attending school; and (4) special surveys of population groups made for the specific purpose of ascertaining the incidence of a given disease or group of diseases. In various prior publications the Public Health Service has presented statistics of disability among adult wage earners who are members of sick-benefit associations, and the results of special sickness surveys. In the hope of obtaining data regarding the incidence of discases among children, an attempt was made in connection with the field studies in child hygiene in Missouri during 1919-20, to institute a system of sickness records in connection with the schools. This was undertaken purely as an experiment, and a limited number of schools were requested to cooperate with the Public Health Service for this purpose. The results are presented in the following pages. The work is being undertaken on a larger scale, not only in Missouri but in other States for the school session of 1921-22.

From Field Investigations in Child Hygiene, United States Public Health Service. The statistical part of this study was conducted in the Statistical Office of the Public Health Service.

The data here presented were collected in 13 localities in the State of Missouri. These data were entered by the teachers on cards distributed by medical officers of the Public Health Service in charge of child hygiene studies in the several communities. A card was made out for each child, showing sex, color, and age, and record, by school months, of the total possible number of days of school attendance,1 the days present, the days absent on account of sickness, and the days absent from causes other than sickness. The card also contained a record of the diseases the child had during each month of the session.

After the cards had been completed and collected, they were carefully edited for errors, and only those which seemed to be properly and accurately used were included in the tabulation. It is believed that the necessary selection of properly filled out cards did not eliminate a disproportionate number of any particular class, such as those showing an excessive amount of absence or attendance.

The records, even after careful editing, however, can be considered only as a preliminary experiment. The data were incomplete in many ways. Records showing the specific data desired on the card were kept only after the first of the year 1920, and in some localities they were begun even later. Data for the months prior to the beginning of any special records were taken from the regular school records and, therefore, vary in completeness in the different localities. The entries showing the specific diseases causing the absence were not complete; in the majority of cases the number of days absent because of sickness was shown without specifying the disease. It was therefore decided to compute only the percentages of the total possible days of school attendance which were lost on account of sickness of all kinds and of causes other than sickness, with certain other data based on those cards reporting the specific disease causing the absence.

Table I shows the size and location of the cities from which data. were drawn. They range from one to twenty thousand in population, and are fairly representative, average-sized cities of the State. No data from the larger cities were included.

1 It was found that, according to the prevailing custom in keeping school records of enrollment, a child's name was dropped from the roll after three days' absence and reentered when he returned. In tabulating the records for the purpose of counting the absence from school on account of sickness, a child's name was not dropped from the roll except when he was permanently separated from the school, as in the case of a child who left the community, or who went to work, or some similar case. With this difference, the total possible number of days of school attendance is the total number of days enrolled during the period used for the computation.

TABLE I-Population and location of certain cities in Missouri and the number of children for whom sickness records were obtained in each place.

Table II, computed from the basic data shown in Table VII (see appended tables), shows by months the percentages of the total possible number of days of school attendance which were lost on account of sickness and of causes other than sickness. The data are shown by sex and for two age groups.

TABLE II.-Percentages of total possible number of days of school attendance which were lost on account of sickness and of causes other than sickness for each month of the school year 1919-20, in certain localities in Missouri.

As between the sexes, absence on account of sickness is, with some exceptions, greater for girls than for boys. The differences, however, are so small that they can hardly be considered significant. The

absence from causes other than sickness is greater for boys than for girls in practically all cases. Although the differences are not great, they persist in all months and therefore seem to indicate that causes other than sickness were responsible for a greater amount of absenteeism among boys than among girls.

From the point of view of age, the younger group seems to lose more time because of sickness than the older group. The percentages of total possible days of attendance which were lost on account

PERCENTAGES OF TOTAL Possible Days oF SCHOOL ATTENDANCE WHICH WERE LOST ON ACCOUNT OF SICKNESS AND OF CAUSES OTHER THAN SICKNESS FOR EACH MONTH OF THE SCHOOL YEAR 1919-20 BY CHILDREN IN CERTAIN Localities in Missouri

of sickness is greater for the younger group in practically all cases. The differences are large enough to be significant and suggest one of three things: that a larger number of cases of sickness occurred among the younger children, or that they recovered more slowly, or that they were kept at home for less serious illness or for a longer time after recovery than was the case with the older children. Unfortunately, the data available for this study were not in such a shape that the question could be settled as to which was actually the case.

Absence from causes other than sickness seems to differ less for the two age groups than absence from sickness. For the year as a whole, the children of the older group were absent slightly more from causes other than sickness than were those of the younger group. As to the seasonal distribution of such absence, the younger group seems to have more absence in the first half of the year, but less in the last half. However, the differences are too slight to be significant; but since the tendency is so general and applies to all groups, it is worth noting.