Lygia Carmen de Moraes Vanderlei

[Infant death surveillance as an indicator of health care system effectiveness--a study conducted in northeastern Brazil].

OBJECTIVE To evaluate the access to and quality of health care administered to infants based on postmortem data. METHODS A descriptive cross-sectional census-based study was carried out to assess the infant deaths that occurred in the town of Bom Conselho, state of Pernambuco, between January 1st 1999 and December 31st 1999. Home interviews and inspection of medical records were used for data collection. Deaths were identified by consulting the Mortality Information System, health centers, public notary services, cemeteries, health workers, and midwives. RESULTS Seventy-one of 72 deaths were investigated, with a loss of 1.4%. The majority (69.4%) of deaths occurred in the postneonatal period and 67.6% of them occurred at home. In 77.5% of the cases medical help was sought at least once, most frequently at emergency units (65.1%). However, 22.5% of the patients were not taken to any kind of health care service. Most health care services (90.9%) were less than one hour away from the patients home, 78.5% were located in the town of residence and 97% of the consultations were carried out by doctors. Of 88 consultations, 39.8% resulted in hospitalization and 27.3% in discharge without arrangement of a follow-up appointment. In 84% of the cases the medication was provided free of charge. CONCLUSIONS Death surveillance revealed restricted access to medical care and poor quality of health care administered to infants living in the referred town. The high rate of home deaths is related to access, whilst the journeys made by some of the mothers to health care units, during the illness that caused the death of their infants, points to the precarious organization of those services.

Avaliação da notificação de óbitos infantis ao Sistema de Informações sobre Mortalidade: um estudo de caso

OBJECTIVES: to assess infant mortality notification to the Mortality Information System (MIS) and other notification sources support in Bom Conselho, Pernambuco, PE, 1999. METHODS: case study using child mortality data from homes in Bom Conselho collected by the municipal and state databanks, complemented by an active search in civil registration offices, healthcare units, cemeteries and communities, healthcare agents and traditional midwives. Household investigations was performed for all deaths and used to validate addresses. The percentage of under-notification to the Infant Mortality Information System and deaths grouped according to information location and notifying sources was calculated. RESULTS: high under-notification rate (46%) was determined as well as a high number of deaths at home. This data is suggestive of poor access to healthcare services as one of the most important issues. The principal source for notification were the community health agents followed by civil registration offices and healthcare clinics, the last as a preferred source in collecting information notwithstanding the high rates of hospital deaths not notified to the Mortality Information System. CONCLUSIONS: under-notification of infant mortality is a complex problem evading Information Systems. Overcoming the problems related to health-care services access is a basic condition to face the issue.

Avaliação da série histórica dos nascidos vivos em unidade terciária de pernambuco: 1991 a 2000

OBJECTIVES This study aimed to analyze some variables found in the Birth Certificates at the Instituto Materno Infantil de Pernambuco, Recife, from July 1991 to December 2000, according to Sinasc (National Informations data base of Births). METHODS The statistical analysis was performed using the chi-square test for trend (p<0.05) on EpiInfo software (version 6.0), considering the years 1993 to 2000. RESULTS The sample comprised a predominance of non-surgical deliveries, adequate gestational age of newborns, weight > 2500 g, Apgar score 1st min and 5th min between 8-10 and mature mothers who had attended from 4 to 6 appointments at prenatal care system. It showed the following rates: cesarean-section of 29.4% to 35.2% (chi2 = 73.7; p<0.01), low weight at birth of 15.9% to 22.8% (chi2 = 170.6; p < 0.01); premature newborns of 9.7% to 23.8% (chi2 = 503.6; p<0.01); teenage mothers of 24.1% to 28.8% (chi2 = 13.3; p<0.01), moreover a high percentage of newborns with Apgar index lower than 3 at the 1st minute (3.4% to 5.%) and (0.7% to 1.6%) at the 5th minute. CONCLUSION These results confirm the role of IMIP as an institution for referral of high-risk pregnancies in Pernambuco.

Avaliação da qualidade de preenchimento das declarações de óbito em unidade terciária de atenção à saúde materno-infantil

Resumo Apesar de duas decadas e meia de implantacao do Sistema de Informacoes sobre Mortalidade (SIM) no Brasil, as estatisticas de mortalidade ainda apresentam problemas de confiabilidade, pois, mesmo em unidades de saude de referencia, existem Declaracoes de Obito (DO), que apresentam distorcoes nos registros. O objetivo do estudo foi avaliar a qualidade da DO quanto ao grau de preenchimento das variaveis e verificar o ganho de informacao posresgate no prontuario medico em unidade de saude terciaria em Recife (Pernambuco- PE). Foram comparadas as DO originais com as corrigidas no primeiro semestre de 1999. Os resultados mostraram omissoes no preenchimento das variaveis indispensaveis e essenciais entre 0,7 e 10,9%, com resgate completo de informacao no prontuario. Para as variaveis exclusivas de menores de um ano, as omissoes ficaram entre 27 e 47% e os ganhos de informacao obtidos foram inferiores a 50%, chegando a total ausencia, apesar de sua fundamental importância para analises clinico- epidemiologicas dos fatores de risco para a mortalidade infantil. As omissoes no preenchimento das variaveis contidas na DO e o ganho pouco satisfatorio de informacoes pos-resgate nos prontuarios refletem o desconhecimento medico de seu papel, sendo prioritaria a implementacao dos nucleos de epidemiologia hospitalar, garantindo treinamento e educacao continuada ao corpo clinico institucional. Palavras-Chave Mortalidade Infantil; Declaracao de Obito; Avaliacao da Qualidade; Sistemas de Informacao. Summary After more than two decades of use, the Mortality Information System in Brazil still has problems of credibility. Distortions in the registration of Death Certificates (DC) are observed even at reference health centers. The objective of this study was to evaluate the completeness of DC and the gain of recovering abscent data from medical records in a tertiary health care unit in Recife, Pernambuco-Brazil. The study was conducted during the first semester of 1999. Original DC were compared before and after they had been corrected. Essential variables of the DC were unfilled in 0.7 to 10.9%. Compared to those obtained all missing data were recovered from the medical records. The information for children under one year of age was absent in 27 to 47% and data could be recovered in less than 50% of the medical records, being absent in most cases despite of the clinical and epidemiological importance for the analysis of infant mortality risk factors. The uncompleteness of DC and the unsatisfactory recovery of missing data from medical records underscare the lack of recognition by doctors of their role in generating information. Hospital Epidemiology Units should be developed to offer training and continuing education to clinical staff.

Análise da cobertura do Sistema de Informações sobre Mortalidade em Olinda, Pernambuco, Brasil

This article analyzes the coverage of the Mortality Information System (SIM) in Olinda, Pernambuco State, Brazil, in the year 2008. The study involved secondary data from SIM on deaths (excluding stillbirths) in residents of the municipality and primary data from the Active Search of Deaths and Births in the Northeast and Legal Amazonia, which collected the events from multiple sources and located deaths that had not been reported to the system. Coverage was calculated as the number of deaths recorded in SIM divided by the total (SIM + active search). The study showed 94.8% coverage and detected an important contribution by notary public offices to the identification of deaths that were missing from the SIM. Of these unreported deaths, 29.7% occurred in health services, 49% occurred at home with death certificates signed by private physicians, and 25.5% had been attested by the forensic examiners office. The method allowed calculating the coverage rate for the Mortality Information System in a municipality in the metropolitan area. Despite the low proportion of deaths missing in the system, the study detected problems with data collection and flow.En este trabajo se analiza la cobertura del Sistema de Informacion sobre Mortalidad (SIM) en Olinda, Pernambuco, Brasil, durante el ano 2008. El estudio incluyo datos secundarios sobre obitos no fetales de residentes del municipio, obtenidos del SIM y datos primarios de la investigacion Busqueda activa de obitos y nacimientos en el Nordeste y Amazonia legal, que recogio los casos procedentes de multiples fuentes y localizo obitos no informados al sistema. La cobertura fue representada por la proporcion de obitos constantes en el SIM, en relacion con el total informado (SIM + busqueda activa). El estudio identifico un 94,8% de cobertura y observo la importante contribucion de los registros civiles para el conocimiento de los obitos ausentes en el SIM. De ellos, un 29,7% se produjeron en establecimientos de salud; un 49,0% se produjeron en domicilios y fueron certificados por medicos privados; y un 25,5% del total de obitos localizados fueron certificados por el IML (Instituto Medico Legal). El metodo aplicado permitio identificar la cobertura del SIM en el municipio de la region metropolitana. A pesar de la pequena proporcion de obitos ausentes en el SIM, el estudio senalo problemas relacionados con la recogida y flujo de los mismos.

Avaliação de preditores do óbito neonatal em uma série histórica de nascidos vivos no Nordeste brasileiro

OBJECTVES: to evaluate predictors of neonatal death among live births and the quality of use of the institutional Live Birth Information System register (Sinasc). METHODS: a time serie based on data from the Sinasc of the Instituto de Medicina Integral Prof. Fernando Figueira (1995-2006) in the city Recife, Pernambuco, Brazil. The following were evaluated: the completeness of the forms and the tendency regarding risk factors for infant mortality (low birth weight; anoxia; premature birth; caesarian birth; lack of prenatal care; adolescent pregnancy; illiteracy; and having had no live or still born child). Statistical significance was tested using Students t test with p<0.05 in a linear regression model. RESULTS: 58,689 live births occurred with a continued rise from 2002 onwards; low birth weight, 22.8%; Apgar <7 1o minute 15.3%; premature 22.4%; Caesarian birth 38,2%; adolescent mothers 27.2%; illiteracy 2.7% and 89% with no live or still born child. One percent of variables were not recorded. The following variables increased (p<0.05): Apgar in the 1st minute, low birth weight, premature birth and caesarian birth; and the following decreased (p<0,05): no pre-natal consultation, adolescent pregnancy, illiteracy and having had no live or still born child. CONCLUSIONS: increasing percentages for the predictors of infant mortality suggest problems with the quality of pre-natal care. With only 1% of information overlooked, the quality of the keeping of SINASC records at the institution was found to be excellent. Routine evaluation of births allows for agility of information and appropriate intervention to prevent neonatal mortality at local level.

Avaliação da confiabilidade da causa básica de óbito em unidade terciária de atenção à saúde materno-infantil

Informe Epidemiologico do SUS 2002; 11(1) : 15 23. Resumo Numerosos estudos enfatizam a imprecisao na definicao da causa basica de obito, em pesquisas baseadas em revisao nos prontuarios medicos, apesar da implantacao do Sistema de Informacoes sobre Mortalidade (SIM) no Brasil desde 1975. O objetivo do estudo foi a avaliacao da confiabilidade da causa basica de obito no âmbito institucional, a partir da implantacao do Nucleo de Epidemiologia Hospitalar, comparando-se as causas referidas na Declaracao de Obito (DO) original com as definidas apos a correcao no prontuario medico no primeiro semestre de 1999. Utilizou-se a concordância observada e o indice kappa. Evidenciou-se uma nao incorporacao pelos medicos do conceito de causa basica do obito, havendo superestimacao para os diagnosticos de infeccoes, prematuridade e hipoxia, que dispensam conhecimentos sobre o desencadeamento dos fatores que levam ao obito. Sugerese a implantacao de nucleos de epidemiologia hospitalar como estrategia para viabilizar o resgate sistematico de dados em tempo oportuno e garantir o treinamento do corpo clinico da unidade de saude, minimizando o desconhecimento medico quanto ao seu papel como elo inicial da cadeia de informacoes sobre os eventos vitais, contribuindo para o aperfeicoamento do SIM a partir do monitoramento da qualidade das DO no nivel hospitalar.

Avaliação da completitude dos instrumentos de investigação do óbito infantil no município de Arapiraca, Alagoas

Abstract Objective: To evaluate the completeness of the instruments for research of infant death at the municipal level. Methods: Evaluative study, descriptive of completeness and degree of filling in the research forms of deaths of infants under one year of age, non-fetal, from Arapiraca, Alagoas (October 2009 to December 2010). For each variable, we calculated the percentage of completeness (Epi-Info v. 3.4.2) and degree of completion. Results: Of the 81 existing deaths, 54.32% were investigated through the home sheet and 8.64, 7.41 and 3.70% of the through outpatient, hospital and synthesis sheets, respectively. The overall degree of completion of each sheet was considered in bad form, ranging from 70.34% (outpatient) to 76.12% (home). Conclusion: The investigations of infant death were not performed satisfactorily, showing obstacles in the process of deploying the research sheets. Despite the small number of cases, the novelty regarding the evaluation of a new instrument can contribute to the legitimacy of surveillance of death in consolidation in the country.Keywords: health evaluation; evaluation of research of programs and tools; health information systems.

Avaliação normativa da ação programática imunização nas equipes de saúde da família do Município de Olinda, Estado de Pernambuco, Brasil, em 2003

Summary This study aims to evaluate the degree of implantation of the immunization program, and to verify the activities relative to this action carried out in the municipality of Olinda, Pernambuco State, Brazil. A cross-sectional study was performed in the period of June to July of 2003 among the local 40 family health teams. A structured instrument was used, with questions related to the criteria and norms recommended by the Ministry of Health National Program of Immunizations, contemplating both process and structural aspects. Low implantation degree was detected in the teams (100% partially implanted). The activities found more frequently were: “Availability of basic scheme vaccines”, “Complete accomplishment of immunization scheme”, and “Multi-professional involvement” in the execution of this program (100% for all). The results indicate that the teams don’t follow the norms and recommended routines, demonstrating necessity of implementing actions of political and operational character to reach the program goals. Key-words: immunization; child health; normative evaluation.

Analysis of coverage in the Mortality Information System in Olinda, Pernambuco State, Brazil

This article analyzes the coverage of the Mortality Information System (SIM) in Olinda, Pernambuco State, Brazil, in the year 2008. The study involved secondary data from SIM on deaths (excluding stillbirths) in residents of the municipality and primary data from the Active Search of Deaths and Births in the Northeast and Legal Amazonia, which collected the events from multiple sources and located deaths that had not been reported to the system. Coverage was calculated as the number of deaths recorded in SIM divided by the total (SIM + active search). The study showed 94.8% coverage and detected an important contribution by notary public offices to the identification of deaths that were missing from the SIM. Of these unreported deaths, 29.7% occurred in health services, 49% occurred at home with death certificates signed by private physicians, and 25.5% had been attested by the forensic examiners office. The method allowed calculating the coverage rate for the Mortality Information System in a municipality in the metropolitan area. Despite the low proportion of deaths missing in the system, the study detected problems with data collection and flow.En este trabajo se analiza la cobertura del Sistema de Informacion sobre Mortalidad (SIM) en Olinda, Pernambuco, Brasil, durante el ano 2008. El estudio incluyo datos secundarios sobre obitos no fetales de residentes del municipio, obtenidos del SIM y datos primarios de la investigacion Busqueda activa de obitos y nacimientos en el Nordeste y Amazonia legal, que recogio los casos procedentes de multiples fuentes y localizo obitos no informados al sistema. La cobertura fue representada por la proporcion de obitos constantes en el SIM, en relacion con el total informado (SIM + busqueda activa). El estudio identifico un 94,8% de cobertura y observo la importante contribucion de los registros civiles para el conocimiento de los obitos ausentes en el SIM. De ellos, un 29,7% se produjeron en establecimientos de salud; un 49,0% se produjeron en domicilios y fueron certificados por medicos privados; y un 25,5% del total de obitos localizados fueron certificados por el IML (Instituto Medico Legal). El metodo aplicado permitio identificar la cobertura del SIM en el municipio de la region metropolitana. A pesar de la pequena proporcion de obitos ausentes en el SIM, el estudio senalo problemas relacionados con la recogida y flujo de los mismos.