Sífilis congênita: construção e validação de ferramenta informatizada para qualificação da vigilância epidemiológica
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Data
2019-02-28
Autores
Dias, Mariana Souza
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A sífilis congênita é importante problema de saúde pública, monitorado pela vigilância epidemiológica que identifica, acompanha a criança até 18 meses de vida e orienta ações de prevenção e controle, com finalidade de erradicar a doença no país. Objetivo: Desenvolver e validar ferramenta informatizada para monitorar o acompanhamento de crianças notificadas como caso de sífilis congênita. Método: Estudo desenvolvido em três etapas. A primeira constitui-se em estudo transversal desenvolvido junto ao Núcleo Hospitalar de Epidemiologia do Hospital das Clínicas da Faculdade de Medicina de Botucatu, com o objetivo de analisar o acompanhamento prestado às crianças notificadas como caso de sífilis congênita, nascidas nesse serviço. Foram incluídas 190 crianças notificadas entre janeiro de 2013 a junho de 2016. Os dados foram obtidos dos prontuários eletrônicos e analisados por meio da estatística descritiva, tendo por base as recomendações oficiais. Na segunda etapa foi construída ferramenta informatizada, desenvolvida na plataforma Moodle, destinada ao monitoramento compartilhado do seguimento das crianças notificadas com sífilis congênita pelo hospital de referência e os serviços de vigilância epidemiológica dos municípios. Na terceira etapa, validou-se a ferramenta por meio da análise de profissionais com reconhecida expertise clínica e em vigilância epidemiológica deste agravo, a fim de avaliar seu conteúdo e funcionalidade pelo método de Índice de Validade de Conteúdo. Esta pesquisa foi submetida e aprovada pelo Comitê de Ética em pesquisa da Faculdade de Medicina de Botucatu. Resultados: A análise do acompanhamento das crianças no serviço de referência mostrou inconformidades com o preconizado pelo Ministério da Saúde, apontado que os seguimentos clínicos e laboratoriais não ocorreram na quantidade e períodos recomendados. Também verificado falhas no seguimento das crianças notificadas como casos de neurossífilis, com a coleta de líquor de seguimento realizada em menos da metade dos casos. A ferramenta informatizada está disponibilizada no link: https://www3.fmb.unesp.br/sete/ de acesso gratuito, seguro e restrito aos serviços de vigilância epidemiológica municipais, cadastrados com senha individual de acesso exclusivo aos casos de sua abrangência. Possui quatro funções: banco de dados dos casos; comunicação entre os serviços; espaço de educação permanente e sistema de alerta de prazos. A ferramenta apresentou índice de validade de conteúdo de 0,97. Conclusão: Ocorreram lacunas no acompanhamento das crianças com sífilis congênita, confirmando que apenas com os dados do seguimento na referência não é possível concluir adequadamente a investigação epidemiológica do caso, demonstrando necessidade de comunicação entre os serviços de acompanhamento e vigilância desse agravo e, assim, a importância da ferramenta desenvolvida e validada neste estudo. Esta poderá favorecer a qualificação do cuidado a essas crianças e aprimoramento da vigilância epidemiológica.
Introduction: Epidemiological surveillance guides actions to prevent and control diseases for eradication. It identifies new cases of congenital syphilis, an important public health issue, monitoring infants up to 18 months of age. Objective: To develop and validate a computerized tool to monitor medical follow-up of children notified with congenital syphilis. Method: This research study, performed in three subsequent stages, was approved by the Research Ethics Committee of the Faculty of Medicine of Botucatu, Sao Paulo State University, Botucatu, São Paulo, Brazil. Firstly, to analyze medical follow-up history of infants notified with congenital syphilis, an observational study was conducted at the Epidemiology Center of the Clinical Hospital of the Faculty of Medicine of Botucatu using electronical medical records of 190 children reported with the above-mentioned disease from January 2013 to June 2016. Data was collected following official recommendations and analyzed using descriptive statistics. Next, a computerized tool was developed using the MOODLE platform to share medical follow-up history of infants notified with congenital syphilis between the headquarter hospital, Clinical Hospital, and municipal epidemiological surveillance services where notified infants reside. Lastly, content and functionality of the computerized tool was evaluated and validated by health care professionals with clinical expertise of the disease and epidemiological surveillance using the Content Validity Index method. Results: The medical follow-up history of infants notified with congenital syphilis revealed failures of medical care to conform according to recommendations of the Brazilian Ministry of Health, lacking recommended frequencies of clinical care and medical laboratorial records of patients. In addition, but contrary to official guidelines, cerebrospinal fluid was collected in less than 50% of infants notified with neurosyphilis. Following, a computerized tool was developed to serve four basic functions: 1) database of congenital syphilis cases, 2) facilitated communication tool between hospital and epidemiological surveillance services, 3) continuous education, and 4) alert system for medical follow-up with patients. The tool is secure and freely available at https://www3.fmb.unesp.br/emv/, and of restricted access to municipal epidemiological surveillance professionals with exclusive, individual login access. Thereafter, the computerized tool was evaluated and validated to a Content Validity Index of 0.97. Conclusion: Medical follow-up of infants notified with congenital syphilis failed to perform according to official guidelines, probably due to miscommunication between hospital and municipal epidemiological surveillance services. The computerized tool developed and validated herein presents an alternative solution to enhance epidemiological surveillance services in improving care of affected infants.
Introduction: Epidemiological surveillance guides actions to prevent and control diseases for eradication. It identifies new cases of congenital syphilis, an important public health issue, monitoring infants up to 18 months of age. Objective: To develop and validate a computerized tool to monitor medical follow-up of children notified with congenital syphilis. Method: This research study, performed in three subsequent stages, was approved by the Research Ethics Committee of the Faculty of Medicine of Botucatu, Sao Paulo State University, Botucatu, São Paulo, Brazil. Firstly, to analyze medical follow-up history of infants notified with congenital syphilis, an observational study was conducted at the Epidemiology Center of the Clinical Hospital of the Faculty of Medicine of Botucatu using electronical medical records of 190 children reported with the above-mentioned disease from January 2013 to June 2016. Data was collected following official recommendations and analyzed using descriptive statistics. Next, a computerized tool was developed using the MOODLE platform to share medical follow-up history of infants notified with congenital syphilis between the headquarter hospital, Clinical Hospital, and municipal epidemiological surveillance services where notified infants reside. Lastly, content and functionality of the computerized tool was evaluated and validated by health care professionals with clinical expertise of the disease and epidemiological surveillance using the Content Validity Index method. Results: The medical follow-up history of infants notified with congenital syphilis revealed failures of medical care to conform according to recommendations of the Brazilian Ministry of Health, lacking recommended frequencies of clinical care and medical laboratorial records of patients. In addition, but contrary to official guidelines, cerebrospinal fluid was collected in less than 50% of infants notified with neurosyphilis. Following, a computerized tool was developed to serve four basic functions: 1) database of congenital syphilis cases, 2) facilitated communication tool between hospital and epidemiological surveillance services, 3) continuous education, and 4) alert system for medical follow-up with patients. The tool is secure and freely available at https://www3.fmb.unesp.br/emv/, and of restricted access to municipal epidemiological surveillance professionals with exclusive, individual login access. Thereafter, the computerized tool was evaluated and validated to a Content Validity Index of 0.97. Conclusion: Medical follow-up of infants notified with congenital syphilis failed to perform according to official guidelines, probably due to miscommunication between hospital and municipal epidemiological surveillance services. The computerized tool developed and validated herein presents an alternative solution to enhance epidemiological surveillance services in improving care of affected infants.
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Palavras-chave
Assistência à Saúde, Sífilis Congênita, Vigilância Epidemiológica, Health care, congenital syphilis, epidemiological surveillance