Luciana Caroline Albuquerque Bezerra

Metodologia de construção de um painel de indicadores para o monitoramento e a avaliação da gestão do SUS

This study sought to develop methodology for the construction of a Panel for the Monitoring and Evaluation of Management of the Unified Health System (SUS). The participative process used in addition to the systematization conducted made it possible to identify an effective strategy for building management tools in partnership with researchers, academic institutions and managers of the SUS. The final systematization of the Panel selected indicators for the management of the SUS in terms of Demand, Inputs, Processes, Outputs and Outcomes in order to provide a simple, versatile and useful tool for evaluation at any level of management and more transparent and easier communication with all stakeholders in decision-making. Taking the management of the SUS as the scope of these processes and practices in all normative aspects enabled dialog between systemic theories and those which consider the centrality of the social actor in the decision-making process.

Análise da sustentabilidade de uma política de avaliação: o caso da atenção básica no Brasil

This study analyzes the sustainability of Brazils National Policy for the Evaluation of Primary Health Care, based on the identification and categorization of representative critical events in the institutionalization process. This was an evaluative study of two analytical units: Federal Management of Primary Health Care and State Health Secretariats, using multiple case studies with data collected through interviews and institutional documents, using the critical incidents technique. Events that were temporally classified as specific to implementation, sustainability, and mixed were categorized analytically as pertaining to memory, adaptation, values, and rules. Federal management and one of the State Health Secretariats showed medium-level sustainability, while the other State Secretariat showed strong sustainability. The results indicate that the events were concurrent and suggest a weighting process, since the adaptation of activities, adequacy, and stabilization of resources displayed a strong influence on the others. Innovations and the development of technical capability are considered the most important results for sustainability.

Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study

BACKGROUND A Zika virus epidemic emerged in northeast Brazil in 2015 and was followed by a striking increase in congenital microcephaly cases, triggering a declaration of an international public health emergency. This is the final report of the first case-control study evaluating the potential causes of microcephaly: congenital Zika virus infection, vaccines, and larvicides. The published preliminary report suggested a strong association between microcephaly and congenital Zika virus infection. METHODS We did a case-control study in eight public maternity hospitals in Recife, Brazil. Cases were neonates born with microcephaly, defined as a head circumference of 2 SD below the mean. Two controls without microcephaly were matched to each case by expected date of delivery and area of residence. We tested the serum of cases and controls and the CSF of cases for detection of Zika virus genomes with quantitative RT-PCR and for detection of IgM antibodies with capture-IgM ELISA. We also tested maternal serum with plaque reduction neutralisation assays for Zika and dengue viruses. We estimated matched crude and adjusted odds ratios with exact conditional logistic regression to determine the association between microcephaly and Zika virus infection. FINDINGS We screened neonates born between Jan 15 and Nov 30, 2016, and prospectively recruited 91 cases and 173 controls. In 32 (35%) cases, congenital Zika virus infection was confirmed by laboratory tests and no controls had confirmed Zika virus infections. 69 (83%) of 83 cases with known birthweight were small for gestational age, compared with eight (5%) of 173 controls. The overall matched odds ratio was 73·1 (95% CI 13·0-∞) for microcephaly and Zika virus infection after adjustments. Neither vaccination during pregnancy or use of the larvicide pyriproxyfen was associated with microcephaly. Results of laboratory tests for Zika virus and brain imaging results were available for 79 (87%) cases; within these cases, ten were positive for Zika virus and had cerebral abnormalities, 13 were positive for Zika infection but had no cerebral abnormalities, and 11 were negative for Zika virus but had cerebral abnormalities. INTERPRETATION The association between microcephaly and congenital Zika virus infection was confirmed. We provide evidence of the absence of an effect of other potential factors, such as exposure to pyriproxyfen or vaccines (tetanus, diphtheria, and acellular pertussis, measles and rubella, or measles, mumps, and rubella) during pregnancy, confirming the findings of an ecological study of pyriproxyfen in Pernambuco and previous studies on the safety of Tdap vaccine administration during pregnancy. FUNDING Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

A vigilância epidemiológica no âmbito municipal: avaliação do grau de implantação das ações

This studys objective was to evaluate the degree of implementation of epidemiological surveillance activities by the Municipal Health Secretariat in Recife, Pernambuco State, Brazil. The design consisted of a case study with a normative approach. The logical model for epidemiological surveillance was outlined as the basis for selecting criteria that comprised a matrix submitted to specialists using the consensus technique or Delphi Method. This consensual matrix was used as the basis for the questionnaires used in the interviews. Three analytical levels were approached: the central level, 6 health districts, and 62 family health teams. According to the study, epidemiological surveillance has been partially implemented in the municipality, based on the degree of implementation at the three levels (already implemented at the central level and partially implemented in the health districts and family health teams). Despite the decentralization of epidemiological surveillance activities to the municipalities, different levels in the municipal system have different needs in dealing with the standards and norms, including the elaboration of internal guidelines to define responsibilities at the three levels.

Política de monitoramento e avaliação da atenção básica no Brasil de 2003 a 2006: contextualizando sua implantação e efeitos

OBJETIVOS: este artigo apresenta um estudo da Implantacao da Politica de Monitoramento e Avaliacao da Atencao Basica no Brasil. Estima o grau de implantacao dos dispositivos institucionais e da Intervencao, alem de avaliar a sua influencia nos efeitos produzidos a partir da interacao com o contexto politico-organizacional. METODOS: pesquisa avaliativa do tipo analise de implantacao. Estudo de caso com niveis de analise imbricados e triangulacao de metodos. Para estimar o grau de implantacao consideraram-se os dispositivos institucionais produzidos, representativos dos componentes do modelo logico da intervencao. Foram realizadas 20 entrevistas e analisados 29 documentos relacionados. RESULTADOS: a intervencao foi classificada como implantada em um grau Avancado, com 78% das acoes realizadas. O contexto politico-institucional foi caracterizado pela conjuncao de decisao politico-institucional, recursos financeiros, mecanismos tecnicos e estrategias organizacionais de qualificacao dos recursos humanos para avaliacao com vistas a construcao da capacidade institucional. Foi encontrado conjunto significante de efeitos nao-intencionais como decorrencia da pluralidade de dispositivos utilizados para a implantacao da intervencao. CONCLUSOES: A politica revela um franco esforco objetivando a integracao das acoes no âmbito institucional e a descentralizacao das acoes de avaliacao. Neste sentido, duas caracteristicas sao marcantes: o desenvolvimento de capacidade tecnica, por meio de processos avaliativos formativos, e o foco no fortalecimento das Secretarias Estaduais de Saude.

Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil

BackgroundStarting in August 2015, there was an increase in the number of cases of neonatal microcephaly in Northeast Brazil. These findings were identified as being an epidemic of microcephaly related to Zika virus (ZIKV) infection. The present study aims to analyse the spatial distribution of microcephaly cases in Recife (2015–2016), which is in Northeast Brazil, and its association with the living conditions in this city.MethodsThis was an ecological study that used data from reported cases of microcephaly from the State Health Department of Pernambuco (August 2015 to July 2016). The basic spatial unit of analysis was the 94 districts of Recife. The case definition of microcephaly was: neonates with a head circumference of less than the cut-off point of −2 standard deviations below the mean value from the established Fenton growth curve. As an indicator of the living conditions of the 94 districts, the percentage of heads of households with an income of less than twice the minimum wage was calculated. The districts were classified into four homogeneous strata using the K-means clustering algorithm. We plotted the locations of each microcephaly case over a layer of living conditions.ResultsDuring the study period, 347 microcephaly cases were reported, of which 142 (40.9%) fulfilled the definition of a microcephaly case. Stratification of the 94 districts resulted in the identification of four strata. The highest stratum in relation to the living conditions presented the lowest prevalence rate of microcephaly, and the overall difference between this rate and the rates of the other strata was statistically significant. The results of the Kruskal-Wallis test demonstrated that there was a strong association between a higher prevalence of microcephaly and poor living conditions. After the first 6 months of the study period, there were no microcephaly cases recorded within the population living in the richest socio-economic strata.ConclusionThis study showed that those residing in areas with precarious living conditions had a higher prevalence of microcephaly compared with populations with better living conditions.

Monitoramento do desempenho da gestão da vigilância em saúde: instrumento e estratégias de uso

Propoe-se um instrumento para monitorar o desempenho da Vigilância em Saude no âmbito estadual e estrategias para ampliar seu uso. Advoga-se o emprego de metodologias participativas em todas as etapas do monitoramento, desde a elaboracao do instrumento ate a analise e interpretacao dos indicadores, como forma de envolver os interessados e (co)responsabiliza-los nas decisoes tomadas, aumentando sua utilizacao. O instrumento de monitoramento foi construido apos o delineamento do modelo logico da gestao da vigilância em saude e os indicadores representativos de cada componente da gestao passaram por processo de validacao. Alem de subsidiar a tomada de decisao, o monitoramento e entendido enquanto pratica reflexiva capaz de promover o aprendizado pessoal e institucional, melhoria continua dos processos de gestao, maior transparencia e responsabilizacao.This work is a survey of information gathered from waste pickers in the south, southeast and northeast of Brazil in order to provide input for the development of a waste collection vehicle and a support system to define waste collection routes. Thus, the research sought to establish the profile of waste pickers, diagnose their working conditions and identify the physical and operational structure of the organizations to which they are linked. To achieve these objectives it was necessary to apply questionnaires to waste pickers from organizations who performed the collection of recyclable materials using human- and animal-drawn vehicles and the waste picking organizations themselves. These results were subsequently used for the development of the proposed technologies. It can be concluded that the profession of waste picker still suffers from numerous forms of deprivation, resulting in marginalization, prejudice and exclusion of individuals who make their livings from it. It is therefore indispensable to promote activities that contribute to the full productive inclusion of waste pickers.

Análise da implantação de um programa com vistas à institucionalização da avaliação em uma Secretaria Estadual de Saúde

Objectives: to evaluate the implementation of the Strengthening of Technical Capacity in Monitoring and Evaluation Project at a State Department of Health and thereby assessing the degree to which the program has been introduced and the influence of the political and institutional context. Methods: an evaluative implementation analysis study was carried out using the theoretical concepts proposed by Denis & Champagne (1997) and Matus (1987; 1996). These concepts form the basis of the analysis and allow for dialogue between theories of evaluation and planning. Results: 80% of the project was found to have been implemented, 91% in the field of technical financial management, 95% in information and communications, and only 56% in the field of integration. Conclusions: implementation of the program was found to be satisfactory, thereby corroborating the Government Project and the Government Capacity. Although a certain degree of governability had been achieved, limitations were identified regarding insufficient integration of sectors, difficulties in relation to the department in the capital city and electoral changes, which explain the partial implementation of the Integration component of Monitoring and Evaluation.

Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases

Resumen: El aumento de las notificaciones de casos de microcefalia en Pernambuco, Brasil, y en el Nordeste caracterizo una epidemia que condujo al Ministerio de Salud a decretar una emergencia nacional de salud publica. En un primer momento, el Ministerio de Salud definio como casos sospechosos a recien nacidos de 37 semanas o mas de edad gestacional (EG) y con perimetro cefalico (PC) ≤ 33cm, siendo, en diciembre de 2015, reducida esa medida a 32cm. Este estudio tuvo por objetivo estimar la precision, sensibilidad y especificidad de diferentes puntos de corte para el PC, utilizando curvas ROC y, como patrones oro, las curvas de Fenton y de Intergrowth (2014). Se describieron los casos notificados en Pernambuco entre 2 de agosto de 2015 y 28 de noviembre de 2015, segun sexo y categorias de EG. Los metodos de Fenton y de Intergrowth proporcionan curvas de crecimiento para el PC ,de acuerdo con EG y sexo, considerando positivos para microcefalia los recien nacidos con un PC debajo del percentil 3 de estas distribuciones. De los 684 casos notificados, 599 fueron recien nacidos a termino/pos-termino. Para estos, los analisis con curvas ROC muestran, segun Fenton, que el punto de corte que presento una mayor area bajo la curva ROC, con sensibilidad mayor que especificidad, fue 32cm, para ambos sexos. Por el metodo de Intergrowth los puntos de corte, respetando los mismos criterios, son 32cm y 31,5cm para los sexos masculino y femenino, respectivamente. El punto de corte identificado, segun Fenton (32cm), coincidio con la recomendacion del Ministerio de Salud. Adoptandose Intergrowth como patron, la eleccion seria 32 cm para el sexo masculino y 31,5cm para el sexo femenino. Como conclusion, se apunta la necesidad de realizar analisis criticos y continuados para evaluar puntos de corte, incluyendo otras caracteristicas para definicion de casoThe increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition.

Procedimentos operacionais para a vigilância epidemiológica da Aids em mulheres e crianças em Pernambuco

OBJECTIVES: to divulge procedures and operational routines of epidemiological surveillance of AIDS in women and children in the state of Pernambuco in order to promote its use towards the improvement of the quality of health care. METHODS: normative and literature review, standardization and systematization of essential information on operational categories - case definition, notification, investigation, measurements of prevention, control and sampling collection. RESULTS: standardized operational procedures for the epidemiological surveillance of AIDS in women and children. CONCLUSIONS: standardization and systematization associated with adequate publicizing and dissemination among health professionals and health services contributes to interventions on time and to the quality of standardized actions.