Abstract

INTRODUCTION

Work-related accidents and diseases represent a major public health problem worldwide and challenge various countries regarding the quality and comprehensiveness of official information¹1. Hämäläinen P, Leena Saarela K, Takala J. Global trend according to estimated number of occupational accidents and fatal work-related diseases at region and country level. J Safety Res 2009; 40(2): 125-39. .

The reliable investigation of health outcomes of workers in the world varies between countries¹1. Hämäläinen P, Leena Saarela K, Takala J. Global trend according to estimated number of occupational accidents and fatal work-related diseases at region and country level. J Safety Res 2009; 40(2): 125-39. . In general, the surveying of the proportion of accidents is very low, and the basis for the calculation usually considers only insured workers, not covering all of them, especially those in the informal sector¹1. Hämäläinen P, Leena Saarela K, Takala J. Global trend according to estimated number of occupational accidents and fatal work-related diseases at region and country level. J Safety Res 2009; 40(2): 125-39. .

The field of occupational health in Brazil, over the years, made use of secondary data to describe the epidemiological profile²2. Santana V, Nobre L, Waldvogel BC. Acidentes de trabalho no Brasil entre 1994 e 2004: uma revisão. Ciênc Saúde Colet 2005; 4(10): 841-55.. With the implementation, by the Brazilian Ministry of Health (MH), of the mandatory reporting of work-related injuries in 2004, the issue of coverage and quality of information showed great advancements³3. Brasil. Ministério da Saúde. Portaria nº 104, de 25 de janeiro de 2011. Define as terminologias adotadas em legislação nacional, conforme o disposto no Regulamento Sanitário Internacional 2005 (RSI 2005), a relação de doenças, agravos e eventos em saúde pública de notificação compulsória em todo o território nacional e estabelece fluxo, critérios, responsabilidades e atribuições aos profissionais e serviços de saúde. Diário Oficial da União. 26 de janeiro de 2011, Seção 1:37. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt0104_25_01_2011.html (Acessado em 13 de outubro de 2012)
http://bvsms.saude.gov.br/bvs/saudelegis... ^,44. Facchini LA, Nobre LCC, Faria NMX, Fassa AG, Thumé E, Tomasi E, et al. Sistema de Informação em Saúde do Trabalhador: desafios e perspectivas para o SUS. Ciênc Saúde Coletiva 2005; 4(10): 857-67..

The appreciation of the role of information in the construction of health policies is directly related to the quality of health information systems (HIS) available⁵5. Jorge MHPM, Laurenti R, Gotlieb SLD. Avaliação dos sistemas de informação em saúde no Brasil. Cad Saúde Colet 2010; 18(1): 7-18.^,66. Laguardia J, Domingues CMA, Carvalho C, Lauerman CR, Macário E, Glatt R. Sistema de Informação de Agravos de Notificação (Sinan): desafios no desenvolvimento de um sistema de informação em saúde. Epidemiol Serv Saúde 2004; 13(3): 135-47.. Quality of the data on HIS is in one of the attributes advocated by the Center for Disease Control and Prevention (CDC) of the United States for evaluating health surveillance systems, and it must be examined by the quantification of "ignored" or "blank answers" in fields, for data duplicity, and also for the consistency of records, that is, how much they approach the truth⁷7. Center For Disease Control And Prevention (CDC). Update guidelines for evaluation public health surveillance systems: recommendations from the guideline working group. MMWR 2001; 50(RR13): 1-36..

However, in Brazil, in spite of all technical, administrative and political developments in the use of health information in the management process, the systematic and continuous assessment of data quality does not follow a regular plan, but happens in sporadic and isolated initiatives⁸8. Lima CRA, Schramm JMA, Coeli CM. Gerenciamento da qualidade da informação: uma abordagem para o setor saúde. Cad Saúde Coletiva 2010; 18(1): 19-31.^,99. Lima CRA, Schramm JMA, Coeli CM, Silva MEM. Revisão das dimensões de qualidade dos dados e métodos aplicados na avaliação dos sistemas de informação em saúde. Cad Saúde Pública 2009; 25(10): 2095-109..

In scientific production in Brazil, CDC guidelines for analyzing the quality of HIS have been used by several researchers in different public health threats, such as tuberculosis, Chagas disease, dengue and hemorrhagic fever transmitted by the Hantavirus, among others¹⁰10. Malhão TA, Oliveira GP, Codennoti SB, Moherdaui F. Avaliação da completitude do Sistema de Informação de Agravos de Notificação da Tuberculose, Brasil, 2001-2006. Epidemiol Serv Saúde 2010; 19(3): 245-56.

11. Oliveira PB, Oliveira GP, Codenotti SB, Saraceni V, Nóbrega AA, Sobel J. Avaliação do sistema de vigilância da tuberculose no município do Rio de Janeiro, 2001 a 2006. Cad Saúde Coletiva 2010; 18(3): 337-46.

12. Muguande OF, Ferraz ML, França E, Gontijo ED. Avaliação da qualidade do Sistema de Vigilância Epidemiológica de doença de chagas aguda em Minas Gerais, 2005-2008. Epidemiol Serv Saúde 2011; 20(3): 317-25.

13. Duarte HHP, França EB. Qualidade dos dados da vigilância epidemiológica da dengue em Belo Horizonte, MG. Rev Saúde Pública 2006; 40(1): 134-42.^-1414. Santos ED, Garret DO. Avaliação do Sistema de Vigilância de Hantavírus no Brasil. Epidemiol Serv Saúde 2005; 14(1): 15-31.. However, no studies were found relating to the reported parameters of workers' health hazards listed in the Information System for Notifiable Diseases (SINAN). SINAN is a HIS of national coverage, that records several cases of notifiable diseases, and among them are those who are related to work, with 11 different definitions for accidents and diseases of this nature⁴4. Facchini LA, Nobre LCC, Faria NMX, Fassa AG, Thumé E, Tomasi E, et al. Sistema de Informação em Saúde do Trabalhador: desafios e perspectivas para o SUS. Ciênc Saúde Coletiva 2005; 4(10): 857-67.. The implementation of this system in the city of Betim, Minas Gerais, started on 2007 through the Health Surveillance records of the Municipal Health Department, and also of the Regional Reference Center for Occupational Health (CEREST).

Thus, the present study evaluated the data quality attribute of the information system that makes up the surveillance in occupational health, by analyzing the completeness of data on case report forms and investigation of work-related injuries recorded in the SINAN of the municipality of Betim, Minas Gerais, in the period 2007-2011.

METHODS

A descriptive research on the completeness of reporting forms/investigation of work-related diseases was conducted, comprising the total of 2,345 records stored in SINAN the municipality of Betim, Minas Gerais, during the period from 01/01/2007 to 31/12/2011.

POPULATION AND AREA OF STUDY

The municipality of Betim is located in the metropolitan region of Belo Horizonte and is considered a nationally prominent industrial hub, especially for its industries from automotive and petrochemical sectors. The city is also home to major companies in the logistics and services sectors¹⁵15. Betim. Prefeitura Municipal de Betim. Portal Betim. Disponível em: http://www.betim.mg.gov.br (Acessado em: 15 de abril de 2012).
http://www.betim.mg.gov.br... . In 2010, Betim had a population of 378,089 inhabitants, of whom 201,129 were economically active, and 6,313 registered companies¹⁶16. Instituto Brasileiro de Geografia e Estatística (IBGE). XII Censo Demográfico 2010. Disponível em: http://www.ibge.gov.br/cidadesat/topwindow.htm?1 (Acessado em 15 de abril de 2011).
http://www.ibge.gov.br/cidadesat/topwind... . In 1994, the local Unified Health System (SUS) began carrying out actions on Surveillance in Workers' Health (VISAT). The city hosts one CEREST that works in partnership with the three levels of health care. Due to its political, economic, demographic and health characteristics, Betim was chosen for this research.

DATA SOURCE

The data on diseases analyzed were distributed in 9 reporting and investigation forms, contemplating 11 case definitions corresponding to the following events: fatal work accident, accident involving mutilation, accidents with children and adolescents; accident with exposure to biological material; exogenous intoxication; repetitive strain injuries or work-related musculoskeletal disorders (RSI/WMSD); occupational dermatoses; pneumoconiosis; Noise-induced hearing loss; work-related mental disorders; and work-related cancer³3. Brasil. Ministério da Saúde. Portaria nº 104, de 25 de janeiro de 2011. Define as terminologias adotadas em legislação nacional, conforme o disposto no Regulamento Sanitário Internacional 2005 (RSI 2005), a relação de doenças, agravos e eventos em saúde pública de notificação compulsória em todo o território nacional e estabelece fluxo, critérios, responsabilidades e atribuições aos profissionais e serviços de saúde. Diário Oficial da União. 26 de janeiro de 2011, Seção 1:37. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt0104_25_01_2011.html (Acessado em 13 de outubro de 2012)
http://bvsms.saude.gov.br/bvs/saudelegis... . The first three diseases make up the case definition of severe work accident and are arranged on a single reporting and investigation form. Access to data on work-related exogenous intoxications occurred after applying the selection filter by field 56 of the notification form, which identifies whether exposure/contamination was the result of work/occupation.

DEFINITION OF VARIABLES

The variables common to all notification forms were selected and then classified by type of field: key field, required field, essential field and not otherwise specified field, according to the SINAN data dictionary, which defines them as follows: the key field corresponds to the identifiers of the record in the system; the required fields are those whose lack of data prevents the inclusion of notification or investigation in SINAN; key fields register data necessary for the investigation of the case or the epidemiological or operational calculus; and the not otherwise specified field is not defined by the system's data dictionary¹⁷17. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Coordenação Geral de Doenças Transmissíveis. Gerência Técnica do Sinan. Roteiro para uso do Sinan net, análise da qualidade da base de dados e cálculo de indicadores epidemiológicos e operacionais. Brasília; 2008. Disponível em: http://www.sms.rio.rj.gov.br/coe/Documenta%E7%E3o%20SINANNET/Documenta%E7%E3o/caderno%20de%20analise%20SINANNET/HEPATITES.pdf (Acessado em 15 de outubro de 2012).
http://www.sms.rio.rj.gov.br/coe/Documen...

18. Brasil. Ministério da Saúde. SINAN-net: manual do sistema versão 4.0. SVS. Brasília; 2010. Disponível em: http://dtr2004.saude.gov.br/sinanweb/ (Acessado em 15 de outubro de 2012).
http://dtr2004.saude.gov.br/sinanweb/... ^-1919. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Sistema de Informação de Agravos de Notificação - Sinan: normas e rotinas. 2 ed. Brasília: Editora do Ministério da Saúde; 2007.. Variables were organized into identification sections of the forms themselves: "Patient data"; "Residence data"; "Company data"; "Epidemiological Background"; and "Case Conclusion". The distribution of records was made by year of notification, as well as by the proportional percentage for different diseases of 2007 and 2011. Some variables were arranged in tables by field type, percentage filled (number of fields completed/total notifications x 100), percentage of empty of ignored fields (number of empty fields, with 9 or 99 codes/total notifications x 100) and quality (according to the scale of the MH).

Due to the significant variability of the percentage of completion of the key fields, the non-parametric Spearman correlation coefficient (r_s), its p-value and the graphical representation of their completeness over time (2007 - 2011) were calculated. The use of non-parametric coefficient was preceded by the verification of the data distribution using the Kolmogorov-Smirnoff test.

ANALYSIS

The quality evaluation of the data was based on the Guidelines for Evaluating Public Health Surveillance Systems created by CDC and procedures standardized by the MH for SINAN⁷7. Center For Disease Control And Prevention (CDC). Update guidelines for evaluation public health surveillance systems: recommendations from the guideline working group. MMWR 2001; 50(RR13): 1-36.^,1717. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Coordenação Geral de Doenças Transmissíveis. Gerência Técnica do Sinan. Roteiro para uso do Sinan net, análise da qualidade da base de dados e cálculo de indicadores epidemiológicos e operacionais. Brasília; 2008. Disponível em: http://www.sms.rio.rj.gov.br/coe/Documenta%E7%E3o%20SINANNET/Documenta%E7%E3o/caderno%20de%20analise%20SINANNET/HEPATITES.pdf (Acessado em 15 de outubro de 2012).
http://www.sms.rio.rj.gov.br/coe/Documen... ^,1818. Brasil. Ministério da Saúde. SINAN-net: manual do sistema versão 4.0. SVS. Brasília; 2010. Disponível em: http://dtr2004.saude.gov.br/sinanweb/ (Acessado em 15 de outubro de 2012).
http://dtr2004.saude.gov.br/sinanweb/... . According to the CDC, the completeness of the fields of a HIS is constituted by one of the attributes that measure their quality. In this sense, it is measured by the quantification of "unknown" or "blank" fields⁷7. Center For Disease Control And Prevention (CDC). Update guidelines for evaluation public health surveillance systems: recommendations from the guideline working group. MMWR 2001; 50(RR13): 1-36.. The MH defined a performance scale for the quality of SINAN based on the percentage of completion of the fields related to the total reported cases in the system, and considers the following criteria for the classification of quality: excellent (above 90%); Regular (between 70 and 89%); poor (below 70%)¹⁷17. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Coordenação Geral de Doenças Transmissíveis. Gerência Técnica do Sinan. Roteiro para uso do Sinan net, análise da qualidade da base de dados e cálculo de indicadores epidemiológicos e operacionais. Brasília; 2008. Disponível em: http://www.sms.rio.rj.gov.br/coe/Documenta%E7%E3o%20SINANNET/Documenta%E7%E3o/caderno%20de%20analise%20SINANNET/HEPATITES.pdf (Acessado em 15 de outubro de 2012).
http://www.sms.rio.rj.gov.br/coe/Documen... . For this evaluation, fields filled with "unknown", coded by numbers 9, 99, or empty, were considered as not filled⁷7. Center For Disease Control And Prevention (CDC). Update guidelines for evaluation public health surveillance systems: recommendations from the guideline working group. MMWR 2001; 50(RR13): 1-36.^,2020. Romero DE, Cunha CB. Avaliação da qualidade das variáveis epidemiológicas e demográficas do Sistema de Informações sobre Nascidos Vivos, 2002. Cad Saúde Pública 2007; 23(3): 701-14.. The processing and data analyzes were performed by computer programs SPSS version 14 and Microsoft Office Excel 2007.

This investigation was approved by the Municipal Health Department of Betim and the Research Ethics Committee of Universidade Federal de Minas Gerais.

RESULTS

A total of 2,345 notifications and investigations of work-related diseases were analyzed for the period from 2007 to 2011. An increasing trend was observed in the frequency of records with growth between 2009 and 2010 of approximately 3.6 times. In 2011, the percentage of growth in the total number of notifications, compared to 2007, was approximately 1,567%, corresponding to a jump from 68 to 1,134 records (Table 1).

Health problems with the largest number of records were serious work accidents, RSI/WMSD and accidents with biological material. Lower occurrences of notifications were related to pneumoconiosis and work-related cancer (Table 1).

In the classification of the 53 common fields present in the instruments for data collection, it can be observed that the majority (53%, n = 28) belonged to the 'essential' category, 26% (n = 14) were 'required' fields, 8 % (n = 4) were considered 'key' fields and about 13% (n = 7) showed no manual categorization by the system and were identified as 'not otherwise specified' (NOS).

The completeness of the 'key' fields was classified as excellent (100% filled), ranged between 0 and 25% (bad) for most NOS fields and showed great variability for the 'essential' fields (0 - 98%) (Table 2).

Although there is the premise for the complete filling of 'required' fields, it was observed that some of them, namely 'occupation' (95%), 'date of birth' (96%), 'specific ICD' (93%); 'pregnancy' (87%) and 'issuance of work accident notice' (87%), were less than 100% filled (Table 2). In this category, the variables patient's name, age, sex, date of accident, municipality of residence, state of residence, country, notifying unit, and state of the notifying unit showed 100% completion of the fields in all years. Note that the analyzed fields were unchanged in their ratings during the years studied.

The essential fields neighborhood of residence and company neighborhood were not filled at all, as well as the NOS fields Unified Health System card, geofield1 and geofield2 during the data time series. It is noteworthy that among the not otherwise specified fields (n = 7), only one (notification type) was 100% filled in all the years analyzed.

Regarding the quality of the essential fields, a predominance of poor completeness (57%, n = 16) was observed; 18% (n = 5) were regular and 25% (n = 7) were rated as excellent. Among the essential fields, important variables for the design of the health situation of the worker, such as education, race, and NCEA (National Classification of Economic Activities) were poorly completed, with 37, 32 and 0.5%, respectively (Table 2).

Regarding the trend of growth, 64% (n = 18) of the essential fields showed a negative completeness correlation over the years, while 21% (n = 6) increased their rates of completion and 14% (n = 4) were stationed or were not filled in the same period. Graphic study on the correlation between the completeness and the time of essential variables, in some situations, was insufficient to affirm it due to small visual variations (Figure 1). This trend of positive or negative growth was confirmed by Spearman coefficient (Table 3). Through graphical analysis, it was possible to analyze that most essential fields (n = 18, 64%) showed a decrease in the percentage of completion over time, while 34% (n = 6) showed growth over the same period.

The analysis of correlation coefficients (r_s) has shown that the variables education, company Corporate Taxpayer Number and type of occupation time showed a strong negative completeness and statistically significant correlation over the years (r_s = -0.9; p = 0, 0347). Among the variables that showed a tendency of increase in completeness, mother's name, employment situation, years of service in the occupation and the company neighborhood, the only one that showed significant statistical growth time was years of service in the occupation (r_s = 0.9; p = 0.0374) (Table 3).

DISCUSSION

In the overall analysis, this study pointed at data quality ratings from regular to excellent for most of the variables analyzed, based on the completeness of the field attribute. Studies on the quality of data from several HIS, carried out in Brazil, using the CDC methodology for the evaluation, found a heterogeneous distribution of the degree of completeness of data contained in the files of SINAN, with better completion rates in the patient identification section and regular rates for case monitoring¹⁰10. Malhão TA, Oliveira GP, Codennoti SB, Moherdaui F. Avaliação da completitude do Sistema de Informação de Agravos de Notificação da Tuberculose, Brasil, 2001-2006. Epidemiol Serv Saúde 2010; 19(3): 245-56.

11. Oliveira PB, Oliveira GP, Codenotti SB, Saraceni V, Nóbrega AA, Sobel J. Avaliação do sistema de vigilância da tuberculose no município do Rio de Janeiro, 2001 a 2006. Cad Saúde Coletiva 2010; 18(3): 337-46.

12. Muguande OF, Ferraz ML, França E, Gontijo ED. Avaliação da qualidade do Sistema de Vigilância Epidemiológica de doença de chagas aguda em Minas Gerais, 2005-2008. Epidemiol Serv Saúde 2011; 20(3): 317-25.

13. Duarte HHP, França EB. Qualidade dos dados da vigilância epidemiológica da dengue em Belo Horizonte, MG. Rev Saúde Pública 2006; 40(1): 134-42.^-1414. Santos ED, Garret DO. Avaliação do Sistema de Vigilância de Hantavírus no Brasil. Epidemiol Serv Saúde 2005; 14(1): 15-31., which was also observed in the present study.

In similarity with this research, an evaluation of the surveillance system for Chagas disease found lower completeness of data of variables Unified Health System card, ZIP Code, neighborhood and reference of the patient's residence and, in general, identified that the reduced completeness of the SINAN investigation form prevented an epidemiological analysis of the health problem examined¹²12. Muguande OF, Ferraz ML, França E, Gontijo ED. Avaliação da qualidade do Sistema de Vigilância Epidemiológica de doença de chagas aguda em Minas Gerais, 2005-2008. Epidemiol Serv Saúde 2011; 20(3): 317-25..

The composition of the SINAN data collection instrument for work-related health problems related provides important information for surveillance actions in working environments, such as the branch of economic activity of the company (NCEA), the occupation, the employment situation, the years of service in the occupation, company address, among others. The results of this study demonstrated an excellent completion rate for most of these variables, except for NCEA (0.5%) and business address (49%). In this context, the precarious completion of the NCEA variable is noteworthy, for its triggering potential for workers' health surveillance activities, by type of occupation, becomes impaired. This finding brings up reflections on the understanding of the professional services responsible for investigating and reporting health problems about the importance of this information and even on the handling of ratings tables provided by SINAN. This is also possible for the analysis of the completion of the occupation variable. It is observed that its standardization as a required field favored its high completion rate, although there are still difficulties in coding of occupational classes and families according to the list of classifications of the Brazilian classification of Occupations (CBO) and that provided by SINAN. In this sense, Vasconcellos et al.²¹21. Vasconcellos MM, Gribel EB, Moraes IHS. Registros em saúde: avaliação da qualidade do prontuário do paciente na atenção básica, Rio de Janeiro, Brasil. Cad Saúde Publica 2008; 24(Suppl 1): 5173-82. believe that improvements in the quality of health records can be encouraged by structuring required fields.

These observations regarding the NCEA and occupation were also studied by Neto et al.²²22. Neto DLR, Glatt R, Souza CAV, Gorla AC, Machado JMH. As fontes de informação do sistema único de saúde para a saúde do trabalhador. In: Chagas AMR, Salim CA, Servo LMS (orgs). Saúde e segurança no trabalho no Brasil: aspectos institucionais, sistemas de informação e indicadores. Brasília: Ipea; 2011., based on nationwide data from SINAN NET, in 2010. The authors found, for example, categories of occupations that are not classifiable as such, and considered that these aspects would point to certain difficulties in understanding concepts and in the use of the system tables.

For monitoring the workers' health situation, the residence identification variables street, number, mother's name and neighborhood help identify cases and provide important information for triggering territorial actions by Unified Health System's primary care health services. In many situations, the location of the residence is also the location of the individual's productive activity. These variables had excellent completion rates, ranging between 95 and 98%.

In this study, we observed a significant increase in the number of reports of work-related health problems in SINAN recorded in recent years, which was also reported by Galdino et al.²³23. Galdino A, Santana VS, Ferrite S. Os Centros de Referência em Saúde do Trabalhador e a notificação de acidentes de trabalho no Brasil. Cad Saúde Pública 2012; 28(1): 145-59. on severe accidents and with exposure to biological material, nationwide. According to Neto et al.²²22. Neto DLR, Glatt R, Souza CAV, Gorla AC, Machado JMH. As fontes de informação do sistema único de saúde para a saúde do trabalhador. In: Chagas AMR, Salim CA, Servo LMS (orgs). Saúde e segurança no trabalho no Brasil: aspectos institucionais, sistemas de informação e indicadores. Brasília: Ipea; 2011., in the period from 2007 to 2009, increasing numbers of notifications were observed in all the federal units. This growth may be related to the initiative of the Ministry of Health to include indicators of occupational health in the Pacto Pela Vida (Pro-Life Pact) program, establishing progressive targets for increasing the number of notifications of these diseases throughout the Brazilian territory²⁴24. Brasil. Ministério da Saúde. Portaria nº 2.669, de 3 de novembro de 2009. Estabelece as prioridades, objetivos, metas e indicadores de monitoramento e avaliação do Pacto pela Saúde, nos componentes pela Vida e de Gestão, e as orientações, prazos e diretrizes do seu processo de pactuação para o biênio 2010-2011. Diário Oficial da União. 6 de novembro de 2009, Seção 1:58-60. Disponível em: http://portalweb04.saude.gov.br/sispacto/portaria2669_versao_impressao.pdf (Acessado em 15 de outubro de 2012).
http://portalweb04.saude.gov.br/sispacto... . However, the quality of answers in the fields did not meet the progressive increase in the number of notifications in the same period. This provides some reflections on the reality of work and/or the preparation of professionals responsible for notification of health problems. Is there a real understanding and awareness of the importance of health records and their implications for health policy? Does the cycle of the information system reach the phase of consolidation and return of the data to those who collected them? Have the health services been prioritizing the apprehension of a greater number of cases/notifications, to the detriment of a more accurate and complete record? These are questions that deserve discussion and insights.

SINAN's reporting and investigation forms present a significant amount of fields. However, despite the prerogative that all fields must be filled, the system mechanisms that reinforce this obligation only affect the key and required fields¹⁴14. Santos ED, Garret DO. Avaliação do Sistema de Vigilância de Hantavírus no Brasil. Epidemiol Serv Saúde 2005; 14(1): 15-31.. Most variables are essential fields, that is, its completion, although important for calculations of epidemiological indicators, is not required for entry into the system¹⁸18. Brasil. Ministério da Saúde. SINAN-net: manual do sistema versão 4.0. SVS. Brasília; 2010. Disponível em: http://dtr2004.saude.gov.br/sinanweb/ (Acessado em 15 de outubro de 2012).
http://dtr2004.saude.gov.br/sinanweb/... ^,1919. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Sistema de Informação de Agravos de Notificação - Sinan: normas e rotinas. 2 ed. Brasília: Editora do Ministério da Saúde; 2007.. This characteristic, coupled with the amount of fields and the lack of pre-defined criteria for the inclusion of variables in the forms, contributes to the failure to complete or to the option of ignoring that information by the notifiers⁶6. Laguardia J, Domingues CMA, Carvalho C, Lauerman CR, Macário E, Glatt R. Sistema de Informação de Agravos de Notificação (Sinan): desafios no desenvolvimento de um sistema de informação em saúde. Epidemiol Serv Saúde 2004; 13(3): 135-47..

The occurrence of variations in the completion of fields classified as required, for example, occupation, date of birth, specific ICD, pregnancy and issuance of work accident notice, was influenced by standardization factors of the data collection instrument itself, such as faults in the classification of fields in different forms and the possibility to opt for "unknown" information as a field filler.

The ability to calculate specific epidemiological indicators is threatened by the incompleteness of certain fields and mask data that measure the quality of care, failing to report recognized risk-predicting variables²⁵25. Scherer V, Miranda FMD, Sarquis LMM, Lacerda MR. Sinan net: um sistema de informação à vigilância na saúde do trabalhador. Cogitare Enferm 2007;12(3): 330-7.^,2626. Scussiato LA, Cespedes LDM, Sarquis LMM, von Stein Jr AJ, Miranda FMD. Análise dos agravos relacionados ao trabalho notificados pela unidade saúde do trabalhador. Rev Min Enferm 2010; 14(1): 88-9.. This is the cases of race and education variables, which commonly have completion rates lower than 20% in many national HIS¹⁰10. Malhão TA, Oliveira GP, Codennoti SB, Moherdaui F. Avaliação da completitude do Sistema de Informação de Agravos de Notificação da Tuberculose, Brasil, 2001-2006. Epidemiol Serv Saúde 2010; 19(3): 245-56.^,2020. Romero DE, Cunha CB. Avaliação da qualidade das variáveis epidemiológicas e demográficas do Sistema de Informações sobre Nascidos Vivos, 2002. Cad Saúde Pública 2007; 23(3): 701-14.^,2525. Scherer V, Miranda FMD, Sarquis LMM, Lacerda MR. Sinan net: um sistema de informação à vigilância na saúde do trabalhador. Cogitare Enferm 2007;12(3): 330-7.. This information is important because they configure risk factors for treatment dropout and death²⁵25. Scherer V, Miranda FMD, Sarquis LMM, Lacerda MR. Sinan net: um sistema de informação à vigilância na saúde do trabalhador. Cogitare Enferm 2007;12(3): 330-7.. In this study, these variables had the somewhat higher completion rates, 32 and 37%, respectively. Still, the reality of a completion qualified as bad to very bad prevails in various regions of the country for this information²⁷27. Félix JD, Zandonade E, Amorim MHC, Castro DS. Avaliação da completude das variáveis epidemiológicas do Sistema de Informação sobre Mortalidade em mulheres com óbitos por câncer de mama da Região Sudeste: Brasil (1998 a 2007). Cienc Saúde Coletiva 2012; 17(4): 945-53.

28. Macente LB, Zandonade E. Avaliação da completude do sistema de informação sobre mortalidade por suicídio na região Sudeste, Brasil, no período de 1996 a 2007. J Bras Psiquiatr 2010; 59(3): 173-81.

29. Moreira CMM, Maciel ELN. Completude dos dados do Programa de Controle da Tuberculose no Sistema de Informação de Agravos de Notificação no Estado do Espírito Santo, Brasil: uma análise do período de 2001 a 2005. J Bras Pneumol 2008; 34(4); 225-9.^-3030. Romero DE, Cunha CB. Avaliação da qualidade das variáveis sócio-econômicas e demográficas dos óbitos de crianças menores de um ano registrados no Sistema de Informações sobre Mortalidade do Brasil (1996/2001). Cad Saúde Pública 2006; 22(3): 673-81..

Some relevant fields for the analysis of the workers' health situation had unsatisfactory completion, which asks for the rethinking of the most effective mechanisms for improving completeness. Changes in the standardization of the operating system, such as a reclassification of fields from "essential" to "required", could also enhance the completion rate of fields.

The correct use of SINAN in the workers' health field can define the health status of this population group in a broader level, in addition to guiding public policies, investigations, inspections, evaluations and monitoring of work environments and processes, as well as assistance to workers, such as subsidizing specific studies and research³¹31. Costa JMBS, Frias PG. Avaliação da completitude das variáveis da declaração de óbitos de menores de um ano residentes em Pernambuco, 1997-2005. Ciênc Saúde Coletiva 2011; 16(Suppl 1): 1267-74.^,3232. Almeida MF, Alencar GP, Schoeps D, Minuci EG, Silva ZP, Ortiz LP, et al. Qualidade das informações registradas nas declarações de óbito fetal em São Paulo, SP. Rev Saúde Pública 2011; 45(5): 845-53.. However, a recent study on this system identified limitations in its use, functioning only as a system for registering, information flow and data tabulations¹²12. Muguande OF, Ferraz ML, França E, Gontijo ED. Avaliação da qualidade do Sistema de Vigilância Epidemiológica de doença de chagas aguda em Minas Gerais, 2005-2008. Epidemiol Serv Saúde 2011; 20(3): 317-25..

SINAN aggregates information about various factors and characteristics of work-related health problems, which are important to guide the actions of workers' health care and surveillance. However, routine assessments of their quality attributes are essential to ensuring a more efficient monitoring of the health problems in this population. The increase in quantity of information on health cannot do without attention to its quality, thus allowing the generation of qualified information that are to support decisions on health.

Although replication of the methods used in this study to evaluate the data from HIS is possible in any Brazilian city, regional characteristics that are peculiar to the health services of the municipality may have influenced the results. With regard to this observation, Muguande et al.¹²12. Muguande OF, Ferraz ML, França E, Gontijo ED. Avaliação da qualidade do Sistema de Vigilância Epidemiológica de doença de chagas aguda em Minas Gerais, 2005-2008. Epidemiol Serv Saúde 2011; 20(3): 317-25. consider that the degree of completeness of data reporting in HIS are influenced by the resources and priorities of health managers, especially those responsible for public health surveillance.

Health information contained in secondary databases are valuable sources of research. However, they have biases arising from the complexity of care and utilization of health services³³33. Terris DD, Litaker DG, Koroukian SM. Health state information derived from secondary databases is affected by multiple sources of bias. J Clin Epidemiol 2007; 60(7): 734-41.. A more complete assessment of the quality of HIS data with an already established usage requires summative assessments with further qualitative studies for verification of subjective aspects³⁴34. Lau F, Kuziemsky C, Price M, Gardner J. A review on systematic reviews of health information system studies. J Am Med Inform Assoc 2010; 17(6): 637-45. . It must be recognized that the use of HIS in Brazil has improved significantly, but its improvement is in an ongoing process of assessments and adjustments⁵5. Jorge MHPM, Laurenti R, Gotlieb SLD. Avaliação dos sistemas de informação em saúde no Brasil. Cad Saúde Colet 2010; 18(1): 7-18..

CONCLUSION

Considering the completeness of fields, it was found that the quality of data stored in SINAN of Betim, Minas Gerais, was mostly rated between regular and excellent throughout 2007 to 2011. Thus, there was great possibility of using SINAN to outline the conditions of employee health and to plan surveillance actions for the workers' health status and work environments. However, the routine use of data quality assessments in the information systems that make up the area of occupational health in the Unified Health System is recommended, as well as the incentive to awareness raising and training of professionals involved in the information, reporting and investigation process of health problems as a whole.

ACKNOWLEDGEMENTS

The authors would like to thank the Health Surveillance sectors and Cerest, in Betim, for providing the data to perform this study.

References

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