Sistema de vigilância epidemiológica nas síndromes hipertensivas da gestação do município de Botucatu – SP segundo o sistema de informação geográfica
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2021-05-28
Autores
Prado, Josiane Estela de Oliveira
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Universidade Estadual Paulista (Unesp)
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Resumo Introdução - As síndromes hipertensivas da gestação estão entre as principais causas de morbimortalidade materna e perinatal no mundo, no Brasil, no estado de São Paulo e no município de Botucatu – SP. A hierarquização do sistema de saúde praticando a assistência pré-natal nos três níveis primário, secundário e terciário de atenção à saúde, melhora os resultados maternos e perinatais. O geoprocessamento é uma área do conhecimento que engloba os Sistemas de Informação Geográfica (SIG), o sensoriamento remoto e as técnicas de análise espacial, com interfaces com a Cartografia, a Geografia e a Estatística. Os SIG são programas de computador que permitem a visualização de mapas georreferenciados em conjunto com os atributos das características representadas, possibilitando a configuração de determinados atributos em mapas temáticos, com a visualização de seu valor em cada município. Nesse sentido, um serviço de hierarquização qualificado da assistência pré-natal associado ao (SIG) permite visualizar a distribuição espacial de uma população de gestantes, que desenvolvem hipertensão na gestação, segundo seu local de moradia, a unidade de atenção primária à saúde em que recebem assistência médica, bem como a unidade de referência secundária/terciária disponível, permitindo comparar esses parâmetros com outros fatores que estejam atrelados ao contexto da assistência que é oferecida a essa população. Objetivo - O objetivo do presente estudo foi desenvolver um SIG para mapeamento das gestantes com diagnóstico de hipertensão arterial, que iniciaram a assistência pré-natal nas Unidades Básicas de Saúde (UBS) e nos Programas de Saúde da Família (USF) do município de Botucatu – SP e tiveram a resolução da gestação na Maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu – Unesp (HC-FMB-Unesp). Sujeitos e método: Através de estudo retrospectivo e transversal analisou-se os dados de gestantes com diagnóstico de hipertensão arterial, oriundas do município de Botucatu – SP, no período de 1º de janeiro de 2015 a 31 de dezembro de 2017. A identificação da população foi obtida do “Livro de Parto” da Maternidade do HC-FMB-Unesp e do prontuário eletrônico do HC-FMB-Unesp. A relação dessas gestantes foi direcionada à Secretaria de Saúde do município de Botucatu – SP para se identificar a UBS ou USF em que iniciaram a assistência pré-natal. De acordo com essas unidades as gestantes foram georreferenciadas utilizando seus endereços, de acordo com a latitude e longitude. As informações de características demográficas e obstétricas, bem como sobre as unidades primárias de saúde foram elencadas e organizadas em planilhas eletrônicas, com posterior tabulação e análise dos dados, através do Microsoft Excel 2010 e software TerraView - Política Social 4.2.2. Os resultados foram apresentados em número e porcentagem, bem como em mapas de georeferenciamento. Resultados: Foram avaliadas 198 gestantes segundo suas características sociodemográficas e obstétricas. Observou-se que, essa população é majoritariamente caucasiana, está na faixa etária prevalente entre 20 e 35 anos e tem união estável. Em relação às características obstétricas, a maioria das gestantes eram multíparas, evoluíram com gestação a termo e tiveram a resolução da gestação via cesárea. Entre as formas de manifestação da hipertensão da gestação predominou a pré-eclâmpsia, isolada ou superposta à hipertensão arterial crônica, que evoluíram com sinais de gravidade em pelo menos 50% dos casos de 47,4% das unidades de saúde de origem. Pelo SIG foram identificadas a unidade primária de início de sua assistência pré-natal, bem como sua localização no espaço territorial do município, o quadro de funcionários com especificação do número de obstetras e enfermeiros e a faixa etária da população em idade reprodutiva. Conclusão: o SIG localizou territorialmente, no município de Botucatu – SP, cada unidade de UBS e USF em que a população estudada recebeu assistência pré-natal, bem como a caracterização dessa população ao chegar no serviço de atenção terciário de saúde, propiciando uma visão geral das síndromes hipertensivas da gestação no município de Botucatu – SP.
Introduction - Hypertensive syndromes of pregnancy are the main causes of maternal and perinatal morbidity and mortality worldwide, in Brazil, in the São Paulo state, and the Botucatu city. The health system hierarchy involving prenatal care in the primary, secondary and tertiary levels of health care improves maternal and perinatal outcomes. Geoprocessing is an area of knowledge that encompasses Geographic Information Systems (GIS), remote sensing, and spatial analysis techniques, with interfaces with Cartography, Geography and Statistics. GIS are computer programs that allow the visualization of georeferenced maps together with the attributes of the represented characteristics, allowing the representation of certain attributes in thematic maps, with the visualization of their value in each municipality. In this sense, a qualified hierarchical service of prenatal care associated with GIS allows visualizing the spatial distribution of a population of pregnant women, who develop hypertension during pregnancy, according to their characteristics, such as place of residence, the primary health care unit where they receive medical assistance, as well as the available secondary/tertiary referral unit, allowing to compare these parameters with other factors that are linked to the context of assistance that is offered to this population. Objective - The objective of this study was to develop a GIS for mapping pregnant women, diagnosed with arterial hypertension, who started prenatal care in Basic Health Units (UBS) and Family Health Programs (USF) in the city of Botucatu-SP, and had the pregnancy resolution at the Maternity of the Clinical Hospital of Botucatu Medical School - Unesp (HC-FMB-Unesp). Subjects and method: a retrospective and cross-sectional study, evaluated 8 data on pregnant women diagnosed with arterial hypertension, from the Botucatu, SP in the period from January 1, 2015, to December 31, 2017. The identification of the population was obtained from the “Childbirth Book” of the Maternity of HC-FMB-Unesp and from the electronic medical record of HC-FMB-Unesp. The list of these pregnant women was forwarded to the Health Department of Botucatu-SP to identify the UBS or USF where they started prenatal care. According to these units, pregnant women were georeferenced using addresses, according to latitude and longitude. Information on demographic and obstetric characteristics, as well as on primary health units, were listed and organized in electronic spreadsheets, with subsequent tabulation and data analysis, using Microsoft Excel 2010 and TerraView software - Social Policy 4.2.2. The results were presented in number and percentage, as well as in georeferencing maps. Results: A hundred ninety-eight pregnant women were evaluated according to their sociodemographic and obstetric characteristics. It was observed that this population is mostly Caucasian, is in the prevalent age group between 20 and 35 years old, and has a stable union. Regarding obstetric characteristics, most of the pregnant women were multiparous, evolved with a full-term pregnancy, and had their pregnancy resolved via cesarean section. Among the forms of manifestation of hypertension during pregnancy, pre-eclampsia predominated, isolated or superimposed on chronic hypertension, which evolved with signs of severity in at least 50% of the cases of 47.4% of the health units of origin. Through the GIS, the primary unit of initiation of their prenatal care was identified, as well as its location in the territorial space of the municipality, staff with the specification of the number of obstetricians and nurses and the age as well as the reproductive age of the population. Conclusion: the GIS territorially localized, in Botucatu, SP, each unit of UBS and USF in which the studied population received prenatal care, as well as the population’s characteristics when arrive at the tertiary health care service, providing an overview of the hypertensive syndromes of pregnancy in Botucatu, SP.
Introduction - Hypertensive syndromes of pregnancy are the main causes of maternal and perinatal morbidity and mortality worldwide, in Brazil, in the São Paulo state, and the Botucatu city. The health system hierarchy involving prenatal care in the primary, secondary and tertiary levels of health care improves maternal and perinatal outcomes. Geoprocessing is an area of knowledge that encompasses Geographic Information Systems (GIS), remote sensing, and spatial analysis techniques, with interfaces with Cartography, Geography and Statistics. GIS are computer programs that allow the visualization of georeferenced maps together with the attributes of the represented characteristics, allowing the representation of certain attributes in thematic maps, with the visualization of their value in each municipality. In this sense, a qualified hierarchical service of prenatal care associated with GIS allows visualizing the spatial distribution of a population of pregnant women, who develop hypertension during pregnancy, according to their characteristics, such as place of residence, the primary health care unit where they receive medical assistance, as well as the available secondary/tertiary referral unit, allowing to compare these parameters with other factors that are linked to the context of assistance that is offered to this population. Objective - The objective of this study was to develop a GIS for mapping pregnant women, diagnosed with arterial hypertension, who started prenatal care in Basic Health Units (UBS) and Family Health Programs (USF) in the city of Botucatu-SP, and had the pregnancy resolution at the Maternity of the Clinical Hospital of Botucatu Medical School - Unesp (HC-FMB-Unesp). Subjects and method: a retrospective and cross-sectional study, evaluated 8 data on pregnant women diagnosed with arterial hypertension, from the Botucatu, SP in the period from January 1, 2015, to December 31, 2017. The identification of the population was obtained from the “Childbirth Book” of the Maternity of HC-FMB-Unesp and from the electronic medical record of HC-FMB-Unesp. The list of these pregnant women was forwarded to the Health Department of Botucatu-SP to identify the UBS or USF where they started prenatal care. According to these units, pregnant women were georeferenced using addresses, according to latitude and longitude. Information on demographic and obstetric characteristics, as well as on primary health units, were listed and organized in electronic spreadsheets, with subsequent tabulation and data analysis, using Microsoft Excel 2010 and TerraView software - Social Policy 4.2.2. The results were presented in number and percentage, as well as in georeferencing maps. Results: A hundred ninety-eight pregnant women were evaluated according to their sociodemographic and obstetric characteristics. It was observed that this population is mostly Caucasian, is in the prevalent age group between 20 and 35 years old, and has a stable union. Regarding obstetric characteristics, most of the pregnant women were multiparous, evolved with a full-term pregnancy, and had their pregnancy resolved via cesarean section. Among the forms of manifestation of hypertension during pregnancy, pre-eclampsia predominated, isolated or superimposed on chronic hypertension, which evolved with signs of severity in at least 50% of the cases of 47.4% of the health units of origin. Through the GIS, the primary unit of initiation of their prenatal care was identified, as well as its location in the territorial space of the municipality, staff with the specification of the number of obstetricians and nurses and the age as well as the reproductive age of the population. Conclusion: the GIS territorially localized, in Botucatu, SP, each unit of UBS and USF in which the studied population received prenatal care, as well as the population’s characteristics when arrive at the tertiary health care service, providing an overview of the hypertensive syndromes of pregnancy in Botucatu, SP.
Descrição
Palavras-chave
Gestação, Pré-eclâmpsia, Sistema de vigilância epidemiológica, Mapeamento geográfico, Sistema de informação geográfica, Pregnancy, Pre-eclampsia, Epidemiological surveillance system, Geographic mapping, Geographic information system