Linkage entre bancos de dados de nascidos vivos e óbitos infantis em município do Nordeste do Brasil: qualidade dos sistemas de informação

Mortality after discharge from a public tertiary cardiovascular referral hospital

It is critically important for stakeholders with distinct foci of attention on healthcare to understand patient evolution in the presence of an established diagnosis or with a suspected diagnosis of various diseases, specially considering death as an outcome. To study the long-term mortality of patients at a cardiovascular referral hospital. Deterministic binding (selection of pairs of registers from the hospital electronic health records and the mortality records of São Paulo state) from 2002 to 2017 was performed. Studied variables were: age, sex, hospital treatment unit where the first visit occurred (Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostics Services), treatment type, elapsed time between the first visit and death, diagnosis at first and last visits and variables related to death. Statistical Methods: descriptive, survival (with Kaplan-Meier method), correspondence and competitive risks analyses; in case of nonoccurrence of death until the end of 2017, the patients were considered alive. Statistical significance was set at values of P < .05. Median age at the first visit to the Hospital was 51.9 years. Birth locations included 4496 cities, 17.33% in São Paulo, 0.41% in Rio de Janeiro, 0.40% in Osasco, 24.04% in other cities. Sex included females (46.7%), males (44.2%), not defined (6.3%), and other (2.8%). We observed an association between diseases in ICD-10 Chapter 16 (certain conditions originating in the perinatal period) and Chapter 17 (congenital malformations, deformations, and chromosomal abnormalities), both as diagnoses and underlying causes of death, as well as between neoplasms as diagnoses and as the underlying cause of death. In this sample, there was an association between admission diagnoses and underlying causes of death, such as neoplasms, cardiovascular diseases, and congenital heart malformations. Additionally, patients who underwent a cardiac intervention had a smaller less mortality rate than those who were not operated on. There were also differences in cardiovascular mortality between distinct treatment units of the hospital ((Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostic Services).

Towards neonatal mortality risk classification: A data-driven approach using neonatal, maternal, and social factors

Infant mortality is an important health measure in a population as a crude indicator of the poverty and socioeconomic level. It also shows the availability and quality of health services and medical technology in a specific region. Although improvements have been observed in the last decades, the implementation of actions to reduce infant mortality is still a concern in many countries. To address such an important problem, this paper proposes a new support decision approach to classify newborns according to their neonatal mortality risk. Using features related to mother, newborn, and socio-demographic, we model the problem using a data-driven classification model able to provide the probability of a newborn dying until 28 t h days of life. More than a theoretical study, decision support tools as the one proposed here is relevant in countries in development as Brazil, because it aims at identifying risky neonates that may die to raise the attention of medical practitioners so that they can work harder to reduce the overall neonatal mortality. Overcoming an AUC of 96%, the proposed method is able to provide not just the probability of death risk but also an explicable interpretation of most important features for model decision, which is paramount in public health applications. Furthermore, we provide an extensive analysis across different rounds of experiments, including an analysis of pre and post partum features influence over data-driven model. Finally, different from previously conducted studies which rely on databases with less than 100,000 samples, our model takes advantage from a new proposed database, constructed using more than 1,400,000 samples comprising births and deaths extracted from public records in São Paulo-Brazil from 2012 to 2018.

Qualidade dos sistemas de informações sobre nascidos vivos e sobre mortalidade no Rio Grande do Sul, Brasil, 2000 a 2014

Resumo O estudo avalia a qualidade do SIM e do SINASC nos aspectos cobertura, incompletitude e consistência, bem como a contribuição do “linkage” para a recuperação de dados. Foram analisados nascimentos e óbitos de menores de um ano ocorridos no Rio Grande do Sul entre 2000 e 2014. Os registros foram pareados por “linkage” determinístico através do número da DNV e, na ausência deste, por “linkage” probabilístico. A cobertura do SINASC aumentou 37%, passando de 72,2% em 2000 para 98,9%. O grau de incompletitude do SINASC foi excelente para todas as variáveis, exceto quantidade de filhos mortos e ocupação materna. No SIM, até 2003 a maioria das variáveis apresentou preenchimento ruim ou muito ruim. Apesar da melhoria, seis delas ainda possuíam preenchimento regular ou ruim em 2014. Após o “linkage”, a incompletitude reduziu-se para grande parte das variáveis. Houve alta variabilidade quanto à consistência: sexo apresentou percentual superior a 97% em todo período, enquanto para outras cinco variáveis essa fração segue inferior a 75% em 2014. Destaca-se a alta cobertura e a excelente incompletitude do SINASC. Persistem problemas relacionados à consistência de informações. Evidencia-se a relevância do “linkage” como método para recuperar informações.

Hidden deaths: corrected estimates of homicides in Bahia, Brazil, 1996- 2015

The objective of this study was to correct and estimate five-year homicide rates in Bahia, Brazil, for the 1996-2015 period. An ecological study of the homicides was carried out using official data from the Mortality Information System of the Ministry of Health. Deaths due to assault are classified in the codes X85-Y09 of the International Classification of Disease 10th Revision (ICD-10). A proportional redistribution of deaths classified as events of undetermined intent (Y10-Y34) was carried out and mortality correction factors were applied. In the analyzed period, 67,599 homicides were registered in the Mortality Information System; after the second correction, 88,429 homicide deaths were estimated. Comparing the official and adjusted figures, there was an underreporting of 30.8%. The highest corrected homicide rates were observed in the eastern region, in Pojuca (129.8 homicides per 100,000 inhabitants), Lauro de Freitas (117.7) and Simões Filho (114.3); in the southern region, in Santa Luzia (121.4), Valença (87.6) and Itabuna (86.5); and in the far south, Santa Cruz Cabrália (128.2), Itabela (113.3) and Porto Seguro (106.8). After correction, there was an increase in homicides in all of the five-year periods in the municipalities analyzed, which resulted in an even higher mortality rate.

[Sexual violence and co-occurrences suffered by children and adolescents: study of incidents over a decade]

The study analyzes the evolution of the incidence of sexual violence (SV) and co-occurrences between 2001 and 2010. The records of the Guardianship Councils in Feira de Santana, State of Bahia, Brazil were used and the incidence rates and graphs of the events during the period were calculated. Of the total of the different types of violence, 21.8 % involved co-occurrences, the majority being female, most frequently during adolescence. There was a high proportion of abuse in male children, with most offenders bring family members or acquaintances. The incidence of SV revealed an increasing trend in both sexes during the decade, more significantly in females in 2002 and 2009. The age groups indicated the same trend, with a higher proportion of cases in adolescence. The record of co-occurrences with SV was more pronounced in the second half of the decade, namely psychological violence in 2008, neglect in 2008 and physical violence in 2009. The conclusion is that the increase in the coefficients of sexual violence and co-occurrences may indicate an improvement of the reporting system of instances in reference, as well as greater citizen participation through the Dial 100 complaint hotline. The indicators help to prevent and control violence against children.

Effectiveness of the Live Births Information System in the Far-Western Brazilian Amazon

The Live Birth Information System (SINASC) was implemented in 1990 for the purpose of providing information about the live-birth characteristics for the establishment of specific health indicators. This work evaluates the information quality of SINASC in relation to its data completeness and coverage for five municipalities from the State of Acre from 2005 to 2010. Lack of information (not filled out or stated as "unknown") was estimated for each variable. Coverage was estimated comparing the Civil Register office statistics in accordance with the mother's municipality of residence. An increase in incompleteness of the majority of variables was observed, and also a decrease in coverage between 2005 and 2010 in these municipalities. These findings do not tally with results from the majority of studies that use SINASC as a data source. The results of this work highlight the relevance of continuous capacity building and the incentive for accurate and complete data inclusion, as well as awareness of the importance of SINASC for public health policies.

[Evaluation of data on live birth certificates from the Information System on Live Births (SINASC) in Campinas, São Paulo, 2009]

Objective:

To assess the completeness and reliability of the Information System on Live Births (Sinasc) data.

Methods:

A cross-sectional analysis of the reliability and completeness of Sinasc's data was performed using a sample of Live Birth Certificate (LBC) from 2009, related to births from Campinas, Southeast Brazil. For data analysis, hospitals were grouped according to category of service (Unified National Health System, private or both), 600 LBCs were randomly selected and the data were collected in LBC-copies through mothers and newborns' hospital records and by telephone interviews. The completeness of LBCs was evaluated, calculating the percentage of blank fields, and the LBCs agreement comparing the originals with the copies was evaluated by Kappa and intraclass correlation coefficients.

Results:

The percentage of completeness of LBCs ranged from 99.8%-100%. For the most items, the agreement was excellent. However, the agreement was acceptable for marital status, maternal education and newborn infants' race/color, low for prenatal visits and presence of birth defects, and very low for the number of deceased children.

Conclusion:

The results showed that the municipality Sinasc is reliable for most of the studied variables. Investments in training of the professionals are suggested in an attempt to improve system capacity to support planning and implementation of health activities for the benefit of maternal and child population.

Agreement on underlying causes of infant death between original records and after investigation: analysis of two biennia in the years 2000

OBJECTIVE

To analyze the agreement between underlying causes of infant deaths obtained from Death Certificates (DC) with those defined after investigation by the Municipal Committee for the Prevention of Maternal and Infant Mortality (CMPMMI), in Londrina, Paraná State, in the biennia 2000-2001 and 2007-2008.

METHODS

DC of infants and records of investigations were obtained from the CMPMMI. The causes of death registered in both sources were coded according to the International Classification of Diseases, tenth revision (ICD-10), and the underlying causes of deaths were selected. Agreement between underlying causes of deaths was verified by Kappa's (k) test and analyzed according to ICD-10 chapters and blocks of categories in both biennia.

RESULTS

In 2000/2001, according to ICD-10 chapters, high agreement rates were observed for conditions originated in the perinatal period (k = 0.85) and for external causes (k = 0.84), while, for congenital malformations, there was a substantial agreement (k = 0.71). In 2007/2008, agreement was considered poor for all analyzed chapters. For blocks of categories, high or substantial agreement rates were observed only in the first biennium for "congenital malformations of the circulatory system" (k = 0.78) and for "other external causes of accidental injury" (k = 0.91).

CONCLUSIONS

A decrease in agreement between the sources during the study period indicates either an improvement in the process of investigation of infant death by the CMPMMI and/or a worsening in the quality of the DC information.

Vigilância da qualidade da água para consumo humano no âmbito municipal: contornos, desafios e possibilidades

A amplitude das atribuições da vigilância da qualidade da água para consumo humano (VQACH) associada à heterogeneidade dos municípios brasileiros (perfil demográfico e epidemiológico, recursos humanos e financeiros) impõe ao nível local de gestão o desafio de implementar com efetividade e sustentabilidade as ações previstas no modelo de atuação da VQACH. Tendo como cenário de estudo um município mineiro de pequeno porte, o trabalho apresenta desafios e possibilidades vivenciados durante a implementação do modelo. O atendimento às ações estratégicas e básicas e aos princípios doutrinários, organizacionais e executivos previstos no modelo de atuação foi verificado e as estratégias para o enfrentamento dos desafios impostos ao exercício da VQACH foram apresentadas. A conformação de uma equipe de profissionais em quantidade e qualidade compatíveis com as ações de VQACH foi aspecto fundamental, além da melhor explicitação de procedimentos como análise integrada dos sistemas de informação e análise e classificação do grau de risco à saúde das diferentes formas de abastecimento de água. O estudo permite adiantar aos gestores dos diferentes níveis de governo desafios e estratégias para contorná-los, bem como instrumentaliza a coordenação da VQACH no nível federal sobre questões que necessitam tratamento mais detalhado e específico.

[Quality of the Information System on Live Births /SINASC: a critical analysis of published studies]

The scope of this study was to carry out a review of scientific literature about the quality of data from the Information System on Live Births (SINASC). Studies in the Medline, Lilacs and SciELO databases were then reviewed. The articles were characterized according to journal of publication, location and period of the study, evaluation parameters, methodology and main results. A total of thirteen articles were reviewed. Eight studies analyzed coverage, four assessed completeness and seven evaluated reliability. Coverage higher than 90% was presented in the majority of the studies, indicating its viability for the calculation of indicators. However, the under-reporting of births in SINASC prevailed with variation between 75.8% and 99.5%. The mother's educational level, number of prior childbirths and frequency of prenatal visits were the variables that led to greater inconsistency. For its part, the parity variable was the one that led to greater incompleteness. In conclusion, the development of studies to find new ways of assessing SINASC is highlighted as a privileged strategy for the enhancement of the quality of the system.

[Probabilistic record linkage: recovery of data on infant deaths and stillbirths in Maranhão State, Brazil]

This study used probabilistic record linkage to estimate underreporting of stillbirths and infant deaths in Maranhão State, Northeast Brazil, in 2008. Records were linked between the Hospital Information System (SIH) (N = 374,418) and the Mortality Information System (SIM) (N = 26,597), using data extraction, identification, and processing software. Under-recording rates were 9.7% for stillbirths, 12% for neonatal deaths, and 5.3% for post-neonatal deaths. In the larger municipalities, the correction of the infant mortality rate was greater than 19%. The superiority of information on infant deaths in the SIH (as compared to the SIM) was 6.5% in municipalities with < 25 thousand inhabitants, 2% in municipalities with 25-80 thousand inhabitants, and 8.3% in those with > 80 thousand inhabitants. Inconsistencies involved non-completion of items/variables, discordant data on the same event, and in some cases even total absence of death records. The method proved useful for retrieving mortality data for the SIM from the SIH.

[Infant mortality rate in Cuiabá, Mato Grosso State, Brazil, 2005: a comparison between direct calculation and linkage between the live birth and infant mortality databases]

This study aimed to analyze the infant mortality rate (IMR) by linking the Live Birth Information System (SINASC) and the Mortality Information System (SIM) and comparing the result to direct calculation using crude data provided by the same databases. The systems used were SINASC, containing 9,590 certificates of live birth from January 1 to December 31, 2005, and SIM, containing 156 death certificates from the reference population (2005). Of the 156 deaths in the year 2005, 126 (80.8%) were paired by the direct method and 11 (7%) by manual search, totaling 137 deaths (87.8%). The rates found with the linkage method allowed calculating the real IMR (14.2 deaths/1,000 live births) and its components. The IMR using linkage was 17.3% lower than as calculated using crude SIM data. The early neonatal component (7.2 deaths/1,000 live births) accounted for half of the deaths in the first year of life (50.4%).