Tereza Maciel Lyra

Avaliação do sistema de informações hospitalares - SIH/SUS como fonte complementar na vigilância e monitoramento de doenças de notificação compulsória

The objective of this paper was to explore the potentialities of the Hospital Information System - SIH/SUS for epidemiologic surveillance and monitoring of Notifiable Diseases. The states and regions of Brazil constituted the study area. Data relative to hospital admittances for Notifiable Diseases, during the period from 1984 to 1998, was obtained from the SIH/SUS and data from the National Center of Epidemiology – CENEPI, during the period from 1980 to 1997. Data bases were linked by pathologies, hospital admittances and by place of occurrence - distributed for states and regions of the country. The results of the classification of the states according to the four larger absolute frequencies of admittances and reports and the comparison between the reports and the number of admittances according to the need of admittances for the pathologies, showed a high level of coherence between CENEPI and SIH data. It was concluded that SIH/SUS has a great agility in obtaining the data and shows a good capacity for monitoring the analyzed pathologies, being an important complementary source of information for surveillance of Notifiable Diseases.

Assistência pública de saúde no contexto da transição demográfica brasileira: exigências atuais e futuras

This paper assesses inpatient and outpatient care and their capacity to respond to changing demands in the context of the demographic transition in Brazil. The data were obtained from studies by the Brazilian Institute of Geography and Statistics (IBGE) and databases in the National Health System (CNES, SIH, and SIA). The reduction in birth, fertility, and infant mortality rates and the increase in life expectancy at birth are still driving population growth, while decreasing the dependency rate, thereby providing the opportunity to make necessary adjustments. The population increased by more than 27.5 million from 1999 to 2009, with a 26.7% reduction in hospital beds and 947,000 hospitalizations, with distortions in the distribution by specialty, but with increases in high-complexity outpatient and inpatient care. The results show that Brazil is undergoing a transition in the healthcare model, requiring greater capacity for future planning of a more complex system and revising the model to prepare for a larger elderly population in the coming decades.This paper assesses inpatient and outpatient care and their capacity to respond to changing demands in the context of the demographic transition in Brazil. The data were obtained from studies by the Brazilian Institute of Geography and Statistics (IBGE) and databases in the National Health System (CNES, SIH, and SIA). The reduction in birth, fertility, and infant mortality rates and the increase in life expectancy at birth are still driving population growth, while decreasing the dependency rate, thereby providing the opportunity to make necessary adjustments. The population increased by more than 27.5 million from 1999 to 2009, with a 26.7% reduction in hospital beds and 947,000 hospitalizations, with distortions in the distribution by specialty, but with increases in high-complexity outpatient and inpatient care. The results show that Brazil is undergoing a transition in the healthcare model, requiring greater capacity for future planning of a more complex system and revising the model to prepare for a larger elderly population in the coming decades.

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.

Pyriproxyfen and the microcephaly epidemic in Brazil - an ecological approach to explore the hypothesis of their association

The microcephaly epidemic in Brazil generated intense debate regarding its causality, and one hypothesised cause of this epidemic, now recognised as congenital Zika virus syndrome, was the treatment of drinking water tanks with pyriproxyfen to control Aedes aegypti larvae. We present the results of a geographical analysis of the association between the prevalence of microcephaly confirmed by Fenton growth charts and the type of larvicide used in the municipalities that were home to the mothers of the affected newborns in the metropolitan region of Recife in Pernambuco, the state in Brazil where the epidemic was first detected. The overall prevalence of microcephaly was 82 per 10,000 live births in the three municipalities that used the larvicide Bti (Bacillus thuringiensis israelensis) instead of pyriproxyfen, and 69 per 10,000 live births in the eleven municipalities that used pyriproxyfen. The difference was not statistically significant. Our results show that the prevalence of microcephaly was not higher in the areas in which pyriproxyfen was used. In this ecological approach, there was no evidence of a correlation between the use of pyriproxyfen in the municipalities and the microcephaly epidemic.

Acesso e qualidade: avaliação das Equipes de Saúde Bucal participantes do PMAQ-AB 2012 em Pernambuco

Avaliou-se o acesso e a qualidade das acoes e servicos das Equipes de Saude Bucal participantes do Programa Nacional para Melhoria do Acesso e da Qualidade da Atencao Basica em Pernambuco no ano de 2012. Trata-se de um estudo transversal e descritivo em que se utilizou a base de dados do referido Programa. Foi constatada disponibilidade de equipamentos e insumos odontologicos garantindo a realizacao de procedimentos clinico-cirurgicos, com excecao dos referentes a protese dentaria. Dificuldades para marcacao de consulta ainda sao relatadas pelos usuarios e ainda ha indefinicao dos fluxos de referencia e contrarreferencia para os servicos especializados.

Evaluation of maternal and neonatal hospital care: quality index of completeness

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System. METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country. RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country. CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations.

Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study

Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.

Análise de política: estudo da política pública de saúde ambiental em uma metrópole do nordeste brasileiro

A analise de politicas de saude vem se consolidando no Brasil, embora com um conjunto de diferentes abordagens metodologicas. A partir do modelo elaborado por Walt e Gilson em 1994, analisou-se o Programa de Saude Ambiental (PSA) do Recife, como politica que se fundamenta nos principios do SUS da Promocao da Saude e Agenda 21. Buscou-se compreender: o contexto durante a elaboracao e implementacao do PSA; o processo de elaboracao; quais atores influenciaram a agenda e o conteudo propositivo do PSA. Realizou-se estudo qualitativo de caso, com entrevistas semiestruturadas de atores chaves. Os achados destacam: na esfera do contexto, a influencia da eleicao municipal, as caracteristicas sociosanitarias do Recife, a escolha do Secretario de Saude e da equipe de gestores, a adesao dos tecnicos e o incremento financeiro. Quanto ao processo, destacou-se a captacao da oportunidade pelos gestores. Em relacao aos atores destacaram-se: gestores; tecnicos setoriais; atores extrassetoriais com construcao de viabilidade. O conteudo do PSA guarda coerencia com os principios do SUS e da Promocao da Saude. A implementacao foi influenciada pela epidemia de dengue (2002), e por fatores culturais institucionais que exerceram pressao na ordem de implementacao das acoes previstas.