Vigilancia de obitos infantis em sistemas locais de saude: avaliacao da autopsia verbal e das informacoes de agentes de saude
Surveillance of infant deaths in local health systems: assessment of verbal autopsies and of information collected by community health agents
Rev. panam. salud pública; 7 (5), 2000
Publication year: 2000
Conhecer os eventos vitais de uma populaçao e de fundamental importancia para combater a morbimortalidade e melhorar as condicoes de vida. Contudo, no Brasil, os sistemas de informacao de saude tem-se mostrado ineficientes. No presente estudo, realizado em tres municipios do Estado do Ceara (Quixada, Icapui e Jucas), com boa cobertura de servicos de atencao primaria a saude, foram investigados, atraves de um instrumento epidemiologico denominado autopsia verbal, 215 obitos de criancas menores de 1 ano de idade, representando 90 por cento do total dos obitos em 1993 e 1994. Foram averiguadas as caracteristicas socioeconomicas, cuidados e higiene, estado nutricional, o processo de doenca, assistencia e morte, a causa basica do obito e o funcionamento do sistema de informacao sobre mortalidade e do sistema de informacao de agentes de saude. Segundo a autopsia verbal, 39 por cento dos obitos tiveram como causa basica a diarreia, seguida da prematuridade (17 por cento) e infeccao respiratoria aguda (10 por cento); 49 por cento das criancas morreram no domicilio, embora 79 por cento das familias tenham procurado os servicos de saude no decorrer da doenca fatal, sugerindo uma baixa efetividade na identificacao e no tratamento de lactentes com doencas graves. Em 84 por cento dos casos, a familia procurou a rezadeira. Os agentes de saude foram procurados em 29 por cento dos casos, embora tenham notificado 78 por cento dos obitos investigados. A concordancia estatistica entre diagnostico dos agentes de saude para a causa basica do obito e autopsia verbal foi boa para a diarreia, regular para outras causas, e fraca para a infeccao respiratoria aguda. A incorporacao da autopsia verbal a rotina dos servicos de atencao primaria a saude do Estado propiciaria informacoes valiosas para as equipes locais de saude e geraria uma consciencia critica que favorece a reducao da mortalidade infantil
Knowing the vital statistics of a population is fundamental in controlling morbidity
and mortality and improving living conditions. In Brazil, however, the available
health information systems do not provide reliable vital statistics. This study was carried out in Quixadá, Icapuí, and Jucás, three municipalities in the state of Ceará that
had good coverage by primary health care services. The study used an epidemiological instrument known as a “verbal autopsy” and investigated 215 (90%) of the 237
deaths of children younger than 1 year identified in 1993 and 1994 in the three communities. We investigated socioeconomic characteristics; sanitary conditions; nutritional status; the course of illness, health care, and death; the cause of death; and the
operation of the national mortality information system and of the community health
agents system. According to the verbal autopsies, diarrhea was the cause of death in
39% of the cases, followed by premature birth (17%), and acute respiratory infections
(10%). Even though 79% of the families had sought formal health care services during
the child’s illness, 49% of the infants had died at home. This suggests limited effectiveness in the identification and treatment of sick infants. In 84% of the cases the family sought help from folk healers. Although community health agents reported 78% of
the deaths, only 29% of the families had sought help from the agents during the children’s illnesses. In terms of the statistical agreement between the information on the
cause of death provided by community health agents and by the verbal autopsies, the
agreement was good for diarrhea, intermediate for other causes, and low for acute
respiratory infections. Making verbal autopsy a routine part of primary health care
services in Ceará would provide invaluable information for local health care teams
and would raise a critical consciousness fostering a reduction in infant mortality.