Abstract

Objective:

to describe the quality of records on cases of sexual violence against women, reported in the Information System for Notifiable Diseases (Sinan), in Santa Catarina State, Brazil, from 2008 to 2013.

Methods:

normative assessment with data from records of sexual violence cases against women (≥10 years old); data quality was described according to the dimensions ‘non-duplicity’ (acceptable when >95%), ‘completeness’ (good when >75%), and ‘consistency’ (excellent when >90.0%) of information.

Results:

2,010 cases of sexual violence against women were studied, after the exclusion of four duplicate records; the percentage of non-duplicity was 99.9% (acceptable); of completeness was 93.3% (good) and of consistency was 98.9% (excellent).

Conclusion:

the results presented point out the usefulness of Sinan as a source of information for the surveillance of sexual violence against women and for planning actions to tackle this type of aggression.

Keywords:
Sex Offenses; Women; Adolescent; Notification; Epidemiology, Descriptive

Introduction

Sexual violence against women is understood as any sexual act, attempt to obtain a sexual act, comments or unwanted sexual advances, in any way, directed against the sexuality of the woman, using coercion, practiced by any person, regardless of their relationship, in any setting, including the household and working place, but not limited to them.¹1. Krug EG, Mercy JA, Dahlberg LL, Zwi AB. El informe mundial sobre la violencia y la salud. Biomédica. 2002 dez;22(Supl. 2):327-36. This violence often occurs in private situations, within families and at home, in relationships between intimate partners, relatives, friends and acquaintances.²2. Organização Mundial da Saúde. Prevenção da violência sexual e da violência pelo parceiro íntimo contra a mulher: ação e produção de evidência [Internet]. Genebra: Organização Mundial da Saúde; 2012 [citado 2017 set 19]. 94 p. Disponível em: Disponível em: http://apps.who.int/iris/bitstream/10665/44350/3/9789275716359_por.pdf
http://apps.who.int/iris/bitstream/10665...

The World Health Organization (WHO) estimates that one in three women suffered physical or sexual violence at some point in their lives worldwide.³3. Organización Mundial de la Salud. Violencia contra la mujer: respuesta del sector de la salud [Internet]. Genebra: Organización Mundial de la Salud ; 2013 [citado 2017 set 19]. 8 p. Disponible: Disponible: http://apps.who.int/iris/bitstream/10665/87060/1/WHO_NMH_VIP_PVL_13.1_spa.pdf
http://apps.who.int/iris/bitstream/10665... In Brazil, in 2005, one in ten women aged 16 to 65 reported at least one occurrence of sexual violence in their lives, identifying intimate partners as their aggressors.⁴4. Schraiber LB, D'Oliveira AF, Franca Junior I. Intimate partner sexual violence among men and women in urban Brazil, 2005. Rev Saúde Pública. 2008 Jun; 42 Suppl 1:127-37.

This kind of violence is considered one of the most hideous,⁵5. Bandeira LM. Violência de gênero: a construção de um campo teórico e de investigação. Soc Estado. 2014 mai-ago;29(2):449-69. because they are gender-related, based on machismo, on the subjugation of women’s body as an object for men and, therefore, on the loss of their autonomy as individuals.⁶6. Scott J. Gênero: uma categoria útil de análise histórica. Educ Real. 1995 jul-dez; 20(2):71-99.

The notification of sexual violence against women in the Health sector is performed by filling a notification form, whose information is included into the Information System for Notifiable Diseases (Sinan), a system of epidemiological surveillance. The filling of the violence notification form is essential to epidemiological and operational analysis, and to the analysis of sexual violence, in the construction of the case profile.

Sexual violence against women is an event of compulsory notification in health services, whether public or private. The ordinance GM/MS No. 2,406, dated November 5^th, 2004,⁷7. Brasil. Ministério da Saúde. Portaria nº 2.406, de 5 de novembro de 2004. Institui o serviço de notificação compulsória de violência contra a mulher e aprova instrumento e fluxo para notificação. Diário Oficial da União, Brasília (DF), 2004 nov 05; Seção 1:84. approved the notification instrument and flow. Sinan is responsible for providing information for the situation diagnosis, which can subsidy actions to tackle violence. Since 2014, the notification of sexual violence, besides being compulsory, has become immediate, being communicated to the epidemiological surveillance in 24 hours at the latest, from the knowledge of the case occurrence.⁸8. Brasil. Ministério da Saúde. Portaria nº 1271, de 6 de junho de 2014. Define a Lista Nacional de Notificação Compulsória de doenças, agravos e eventos de saúde pública nos serviços de saúde públicos e privados em todo o território nacional, nos termos do anexo, e dá outras providências. Diário Oficial da União, Brasília (DF), 2014 jun 09; Seção 1:67. The objective of the immediate notification is to speed up assistance for the assaulted woman and to enable her access to emergency contraception, prophylactic measures of sexually transmitted infections (STIs) and viral hepatitis within 72 hours of the aggression.⁹9. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Área Técnica de Saúde da Mulher. Prevenção e tratamento dos agravos resultantes da violência sexual contra mulheres e adolescentes: norma técnica [Internet]. 3. ed. atual. ampl. Brasília: Ministério da Saúde; 2012 [citado 2017 set 19]. 123 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/prevencao_agravo_violencia_sexual_mulheres_3ed.pdf .
http://bvsms.saude.gov.br/bvs/publicacoe...

It is important to highlight that a study carried out in Belo Horizonte, Minas Gerais State, in 2011,¹⁰10. Kind L, Orsini MLP, Nepomuceno V, Gonçalves L, Souza GA, Ferreira MFF. Subnotificação e (in)visibilidade da violência contra mulheres na atenção primária à saúde. Cad Saúde Pública. 2013 set;29(9):1805-15. identified difficulties for health professionals to report violence against women. Among the difficulties, the lack of knowledge about the notification and the actions to be taken, as well as the non-notification of violence for fear of retaliations, difficulty or embarrassment in completing the form, or even an overload in the daily routine of the service. The challenge of the Health sector and its professionals lies in the recognition of the violence and the importance of its notification as a step of attention and care in health networks. Quality information enhances the structuring of these services.

The main purpose of surveillance systems is to provide valid, reliable information and to guide the interventions.¹¹11. Nsubuga P, White ME, Thacker SB, Anderson MA, Blount SB, Broome CV, et al. Public health surveillance: a tool for targeting and monitoring interventions. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al. Disease control priorities in developing countries [Internet]. 2nd ed. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2006 [cited 2017 Sep 19]. Chapter 53. Available in: Available in: https://www.ncbi.nlm.nih.gov/books/NBK11770/
https://www.ncbi.nlm.nih.gov/books/NBK11... Understanding and promoting the quality of sexual violence data included in Sinan can contribute to the strengthening of the surveillance system for this condition. However, there are few studies that analyze the quality of Sinan data, especially for violence.

In view of this scenario, the objective of this study was to describe the quality of the case records on sexual violence against women reported in the Information System for Notifiable Diseases (Sinan) in Santa Catarina State, Brazil, from 2008 to 2013.

Methods

This is a normative assessment, with Sinan data referring to reports of suspected and confirmed cases on sexual violence against women and adolescents living in Santa Catarina, in the period from 2008 to 2013.

Santa Catarina State, located in the South region of Brazil, has a population of 6,439,389 inhabitants, of whom 50.4% are women, according to data from Brazilian Institute of Geography and Statistics (IBGE) in 2012.¹²12. Instituto Brasileiro de Geografia e Estatística. Síntese de indicadores sociais. Uma análise das condições de vida da população brasileira 2012 [Internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2012 [citado 2017 mai 16]. 289 p. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/indicadoresminimos/sinteseindicsociais2012/
http://www.ibge.gov.br/home/estatistica/...

The information was recorded in the notification form of violence and included into Sinan by health professionals of municipal level, in Santa Catarina State, region of this study. Sinan is a system of national coverage, decentralized to municipalities. The municipalities insert the data of notifiable diseases and conditions - among them, the sexual violence - destined to compose the state and national data bank of the system. The adherence of health services to notification in Santa Catarina has occurred gradually, since 2007, through agreements between state and municipalities managers, under the coordination of the Epidemiological Surveillance of Non-communicable Diseases and Conditions of the State Health Department.

In this study, all the notifications of sexual violence against women aged 10 years or more - without upper age limitation - were included. The age of 10 was defined according to the National Policy of Comprehensive Care to Women's Health of the Ministry of Health¹³13. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Política nacional de atenção integral à saúde da mulher: princípios e diretrizes. Plano de ação 2004 - 2007 [Internet]. Brasília: Ministério da Saúde ; 2004 [citado 2017 set 19]. 47 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/politica_nac_atencao_mulher2.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... and to the WHO delimitation for the adolescence phase: 10 to 19 years.¹⁴14. Organizacion Mundial de La Salud. Problemas de salud de la adolescência [Internet]. Genebra: Organização Mundial da Saúde ; 1965 [citado 2017 mai 15]. Disponible: Disponible: http://www.who.int/topics/adolescent_health/es/
http://www.who.int/topics/adolescent_hea...

Data quality was described according to the following dimensions: non-duplicity, completeness and consistency of information.¹⁵15. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise da Situação de Saúde. Departamento de Vigilância Epidemiológica. Roteiro para uso do SINAN NET, análise da qualidade da base de dados e cálculo de indicadores epidemiológicos e operacionais. Violência doméstica, sexual e/ou outras violências [Internet]. Brasília: Ministério da Saúde ; 2010 [citado 2017 set 19]. 100 p. Disponível em: Disponível em: http://www.dive.sc.gov.br/conteudos/agravos/publicacoes/Caderno_analise_violencia_final_16_12_2010.pdf
http://www.dive.sc.gov.br/conteudos/agra... ^,1616. 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 out;25(10):2095-109. The analysis of information completeness and consistency contained in the violence notification form followed the criteria established by the Ministry of Health¹⁵15. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise da Situação de Saúde. Departamento de Vigilância Epidemiológica. Roteiro para uso do SINAN NET, análise da qualidade da base de dados e cálculo de indicadores epidemiológicos e operacionais. Violência doméstica, sexual e/ou outras violências [Internet]. Brasília: Ministério da Saúde ; 2010 [citado 2017 set 19]. 100 p. Disponível em: Disponível em: http://www.dive.sc.gov.br/conteudos/agravos/publicacoes/Caderno_analise_violencia_final_16_12_2010.pdf
http://www.dive.sc.gov.br/conteudos/agra... and by Abath et al.¹⁷17. Abath MB, Lima MLLT, Lima PS, Silva MCM, Lima MLC. Avaliação da completitude, da consistência e da duplicidade de registros de violências do Sinan em Recife, Pernambuco, 2009-2012. Epidemiol Serv Saude. 2014 jan-mar;23(1):131-42. Non-duplicity is understood as the proportion in which each event in the coverage universe of an information system is presented only once in a set of records.¹⁵15. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise da Situação de Saúde. Departamento de Vigilância Epidemiológica. Roteiro para uso do SINAN NET, análise da qualidade da base de dados e cálculo de indicadores epidemiológicos e operacionais. Violência doméstica, sexual e/ou outras violências [Internet]. Brasília: Ministério da Saúde ; 2010 [citado 2017 set 19]. 100 p. Disponível em: Disponível em: http://www.dive.sc.gov.br/conteudos/agravos/publicacoes/Caderno_analise_violencia_final_16_12_2010.pdf
http://www.dive.sc.gov.br/conteudos/agra... According to Abath et al., a 95% of non-duplicity is acceptable.

Completeness is understood as the proportion by which the records of an information system displays not null values. The fields considered null or incomplete are those filled as unknown and those left blank.¹⁵15. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise da Situação de Saúde. Departamento de Vigilância Epidemiológica. Roteiro para uso do SINAN NET, análise da qualidade da base de dados e cálculo de indicadores epidemiológicos e operacionais. Violência doméstica, sexual e/ou outras violências [Internet]. Brasília: Ministério da Saúde ; 2010 [citado 2017 set 19]. 100 p. Disponível em: Disponível em: http://www.dive.sc.gov.br/conteudos/agravos/publicacoes/Caderno_analise_violencia_final_16_12_2010.pdf
http://www.dive.sc.gov.br/conteudos/agra... For the analysis of the completeness ratio of the variables, Abath et al.¹⁷17. Abath MB, Lima MLLT, Lima PS, Silva MCM, Lima MLC. Avaliação da completitude, da consistência e da duplicidade de registros de violências do Sinan em Recife, Pernambuco, 2009-2012. Epidemiol Serv Saude. 2014 jan-mar;23(1):131-42. propose completeness equal to or higher than 75.1% as good, regular from 75.0 to 50.1%, low from 50.0 to 25.1% and very low when equal to or less than 25.0%.

According to the Ministry of Health,¹⁵15. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise da Situação de Saúde. Departamento de Vigilância Epidemiológica. Roteiro para uso do SINAN NET, análise da qualidade da base de dados e cálculo de indicadores epidemiológicos e operacionais. Violência doméstica, sexual e/ou outras violências [Internet]. Brasília: Ministério da Saúde ; 2010 [citado 2017 set 19]. 100 p. Disponível em: Disponível em: http://www.dive.sc.gov.br/conteudos/agravos/publicacoes/Caderno_analise_violencia_final_16_12_2010.pdf
http://www.dive.sc.gov.br/conteudos/agra... consistency is the proportion with which related variables present coherent, non-contradictory values. Abath et al.¹⁷17. Abath MB, Lima MLLT, Lima PS, Silva MCM, Lima MLC. Avaliação da completitude, da consistência e da duplicidade de registros de violências do Sinan em Recife, Pernambuco, 2009-2012. Epidemiol Serv Saude. 2014 jan-mar;23(1):131-42. and Souza et al.¹⁸18. Souza VMM, Brant JL, Arsky MLS, Araújo WN. Avaliação do Sistema Nacional de Vigilância Epidemiológica da leptospirose - Brasil, 2007. Cad Saúde Colet. 2010 jan-mar;18(1):95-105. propose the analysis of the consistency proportion as excellent for results equal to or higher than 90.0%, regular from 70.0 to 89.0% and low when it is lower than 70.0%.

The detection of notifications duplicity was performed by exporting the report to Tabwin of possibly duplicate cases, from the following key variables: first/last name; notification number; occurrence date; mother's name; date of birth; sex; violence notification date; and notifying unit.¹⁹19. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Sinan relatórios: manual de operações [Internet]. Brasília: Ministério da Saúde ; 2014 [citado 2017 set 19]. 124 p. Disponível em: Disponível em: http://portalsinan.saude.gov.br/images/documentos/Aplicativos/relatorios/Manual%20de%20Operacao%20SINAN%20Relatorios%20-%20versao_4.8.pdf
http://portalsinan.saude.gov.br/images/d... On the report of possibly duplicate cases, the analysis was performed case-by-case, manually. When duplicity was confirmed, one of the records of each duplicate case was excluded.

For the completeness analysis, we selected 59 variables from the notification form, representing 83.0% of the total variables in that document:

All variables were analyzed with regard to their completeness from 2008 to 2013, by calculating the percentage and the average of complete fields in each year. In order to verify if there was a difference in the proportion of fields filled as unknown and in blank, over the years studied, the same variables were tested in relation to the year of occurrence, with the linear trend test.

In order to verify the consistency, the following comparisons were made between the variables categories in the notification form of violence:

For each comparison, the pairing of the indicated categories was considered as inconsistency.

The number of notifying units in each year of the period was also described. The notifications of sexual violence were extracted from Santa Catarina Sinan databank on May 16^th, 2014, using the Tabwin software, version 3.6b. The analyses were carried out with the statistical software Stata (Stata Corp College Station, United States of America), version 13.0.

The study was approved by the Committee of Ethics in Research with Human Beings of the State Health Department of Santa Catarina (CEPSH/UDESC): Report No. 550,496, on March 26^th, 2014. The data were provided after signing of the Responsibility Statement to use the database.

Results

Among the 15,508 records of violence against women aged 10 years or over, in the period from 2008 to 2013, 2,029 cases were of sexual violence, representing 13.0% of the total. Among those cases of sexual violence, 15 victims did not live in Santa Catarina, so they were not considered in this study. The analyzed database initially included 2,014 cases, of which there were four record duplicities, one in 2011 and three in 2013, resulting in a non-duplicity percentage of 99.9%, considered acceptable. After all, 2,010 notifications were analyzed.

There was an increase in the number of notifications during the analyzed period, compatible with the increase in the number of notifying units from four (2008) to 188 (2013). It is important to highlight the prevalence of notified cases in the age group from 10 to 14 years (Table 1).

The lowest completeness was observed in the variable 'time of the occurrence' (67.2%), and the highest, in the variable ‘sex of the probable aggressor' (98.7%). The proportion of completeness, taking all 59 variables, was of 93.3%, considered good (Tables 2 to 4).

For 17 variables, the linear trend test showed a statistically significant difference in its completeness over the period (p <0.05). Among these 17 variables, 11 presented an increase in the completeness percentage and 6 had a decrease, when observing the edges of time series (2008 to 2013) (Tables 2 to 4).

Taking the total of variables assessed in the period, the consistency percentage was of 98.9%, considered excellent. The smallest percentage was observed in the comparison between the categories of variables 'sexual violence - yes' and 'final outcome - inconclusive/unknown/blank' (96.7%) (Table 5).

Discussion

Considering the analyzed criteria, sexual violence notifications in the studied period had percentages of non-duplicity and consistency close to 100%, which is perfectly acceptable, and completeness close to 95%, considered excellent.

For the dimensions studied, the data quality of sexual violence notifications in Santa Catarina during the analyzed period had a better result than that found by Abath et al. in the study of all types of violence recorded into Sinan bank in Recife, from 2009 to 2012,¹⁷17. Abath MB, Lima MLLT, Lima PS, Silva MCM, Lima MLC. Avaliação da completitude, da consistência e da duplicidade de registros de violências do Sinan em Recife, Pernambuco, 2009-2012. Epidemiol Serv Saude. 2014 jan-mar;23(1):131-42. when 0.3% of duplicity, 70.3% of completeness and 99.0% of consistency were detected. The most consistent results of this study corroborate Veloso et al.,²⁰20. Veloso MMX, Magalhães CMC, Dell'Aglio DD, Cabral IR, Gomes MM. Notificação da violência como estratégia de vigilância em saúde: perfil de uma metrópole do Brasil. Ciênc Saúde Coletiva. 2013 mai;18(5):1263-72. who, for Belém, Pará State, identified a greater commitment of health professionals with the registry when the case involved children and adolescents, especially in cases of sexual abuse, from 2009 to 2011.

In the present study, the age group from 10 to 14 years was predominant: almost half of the victims, among the reported cases, were at that age. When we add to these cases, the notifications referring to the age group from 15 to 19 years, it summed 69.7% of total notifications in the state. This percentage is higher than that found in similar studies, such as the one conducted in Belém (2009 to 2011)²⁰20. Veloso MMX, Magalhães CMC, Dell'Aglio DD, Cabral IR, Gomes MM. Notificação da violência como estratégia de vigilância em saúde: perfil de uma metrópole do Brasil. Ciênc Saúde Coletiva. 2013 mai;18(5):1263-72. and Recife (2012),²¹21. Silva MCM, Brito AM, Araújo AL, Abath MB. Caracterização dos casos de violência física, psicológica, sexual e negligências notificados em Recife, Pernambuco, 2012. Epidemiol Serv Saúde. 2013 jul-set;22(3):403-12. with 45.9% and 43.0%, respectively, for adolescents aged 10 to 19. The finding presented here may reflect a greater sensitivity of professionals from Santa Catarina in the identification and notification of sexual violence for this age group.

There was a large increase in the number of notifications of sexual violence against women in Santa Catarina during the period studied, which suggests the strengthening of the surveillance on sexual violence against women by health services. The actions developed by the State Health Department in partnership with the Ministry of Health and municipalities, from the decentralization of Sinan, as well as the qualification programs carried out by the state during this period, aimed at raising awareness and preparing health professionals for violence notifications, may have contributed to this result. The positive influence of the qualification of professionals is corroborated by a study conducted in Ceará in 2011 and 2012, which pointed out the association between the act of notifying and questions regarding knowledge and training on the subject among the professionals involved.²²22. Moreira GAR, Vieira LJES, Deslandes SF, Pordeus MAJ, Gama IS, Brilhante AVM. Fatores associados à notificação de maus-tratos em crianças e adolescentes na atenção básica. Ciênc Saúde Coletiva. 2014 out;19(10):4267-76.

According to the 2014 Public Security Yearbook, Santa Catarina ranked 5^th in the Brazilian sexual violence ranking, with record (in the police reports) of 42.8 cases of rape per 100,000 inhabitants, whilst the national average is of 23.5 cases per 100,000 inhabitants.²³23. Fórum Brasileiro de Segurança Pública. Anuário brasileiro de segurança pública 2015 [Internet]. 9. ed. São Paulo: Fórum Brasileiro de Segurança Pública; 2015 [citado 2017 set 19]. 153 p. Disponível em: Disponível em: http://www.forumseguranca.org.br/storage/9_anuario_2015.retificado_.pdf
http://www.forumseguranca.org.br/storage... These data suggest that the health sector does not identify or notify all sexual violence, with the aggravating fact that 75% of the Santa Catarina's population is covered by Family Health Strategy teams, composed of professionals responsible for the health care of the local population, for conducting active search and recording diseases and conditions of compulsory notification,²⁴24. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política nacional de atenção básica [Internet]. Brasília: Ministério da Saúde ; 2012 [citado 2017 set 19]. 110 p. Disponível em: Disponível em: http://189.28.128.100/dab/docs/publicacoes/geral/pnab.pdf
http://189.28.128.100/dab/docs/publicaco... including violence against women.⁷7. Brasil. Ministério da Saúde. Portaria nº 2.406, de 5 de novembro de 2004. Institui o serviço de notificação compulsória de violência contra a mulher e aprova instrumento e fluxo para notificação. Diário Oficial da União, Brasília (DF), 2004 nov 05; Seção 1:84. It is also important to highlight that the population may not see the importance of this issue for Public Health, either due to professionals’ misinformation or due to the little initiative of the services to talk about the subject.

The completeness of the fields in the present study (93.3%) was higher than that found by Abath et al. in Recife's study (2009-2012),¹⁷17. Abath MB, Lima MLLT, Lima PS, Silva MCM, Lima MLC. Avaliação da completitude, da consistência e da duplicidade de registros de violências do Sinan em Recife, Pernambuco, 2009-2012. Epidemiol Serv Saude. 2014 jan-mar;23(1):131-42. in which the proportion of completeness was considered regular (70.3%) and the comparison between the edges of the time series studied showed a reduction in most variables. In the current study, the field with the lowest percentage of completeness - 67.2% - was 'time of occurrence' of sexual violence; it is possible that their filling was influenced by the fact that the violence reported in this study was largely practiced in the household, repeatedly, and by someone living with the victim.

With regard to the type of sexual violence suffered, if there was 'rape' or 'sexual offense', there may have been a misclassification. During the studied period, Brazilian Penal Code was amended on what is considered rape. The law No. 12,015, dated August 7^th, 2009,²⁵25. Brasil. Casa Civil. Lei 12.015, de 7 de agosto de 2009. Altera o Título VI da parte especial do Decreto-Lei no 2.848, de 7 de dezembro de 1940 - Código Penal, e o art. 1o da Lei no 8.072, de 25 de julho de 1990, que dispõe sobre os crimes hediondos, nos termos do inciso XLIII do art. 5o da Constituição Federal e revoga a Lei no 2.252, de 1o de julho de 1954, que trata de corrupção de menores. Diário Oficial da União, Brasília (DF), 2009 ago 7; Seção 1:1. established the concept of rape as 'to constrain someone through violence or serious threat, to have carnal conjunction or to practice or to allow with the same person the practice of another libidinous act'. Thus, the sexual offense also came to be considered rape. Although this concept is explicit in Sinan's instructive provisions,²⁶26. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Viva: instrutivo de notificação de violência doméstica, sexual e outras violências [Internet]. Brasília: Ministério da Saúde ; 2011 [citado 2017 set 19]. 72 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/viva_instrutivo_notificacao_violencia_domestica.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... the professionals could have doubts at the moment they were filling the field, hence the option to fill it as 'unknown' or simply to leave it blank. This difficulty comes from the use of a legal concept as information base in a notification form of the health area. A possibility to minimize this type of doubts would be to modify this variable in the notification form to the type of contact that the aggressor had with the victim, such as, if there was penetration and which type, if the victim had contact with blood and/or semen of the aggressor. In the file updated by the Ministry of Health in 2014, for violence investigations,²⁷27. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde.Viva: instrutivo de notificação de violência interpessoal e autoprovocada. Brasília: Ministério da Saúde ; 2015. 65 p. the field 'type of penetration' for sexual violence was excluded. The withdrawal of this information impairs the analysis of the care performed by health professionals from the notification form, given that the need for prophylaxis procedures for sexually transmitted infections is related to the type of exposure suffered.

The information field about the procedure 'abortion provided by law' also presented significant variation in its completeness. The abortion procedure, according to article 128, item II of the Brazilian Penal Code,²⁸28. Brasil. Casa Civil. Decreto-Lei nº 2.848, de 7 de dezembro de 1940. Código Penal Brasileiro, 1940. Diário Oficial da União, Rio de Janeiro (RJ), 1940 dez 31; Seção 1:23911. is a lawful procedure when the pregnancy results from rape; however, despite being a procedure recognized by the country's legislation, it is surrounded by attitudes and personal values capable of interfering in the access of women sexually assaulted to a regulated right in the Brazilian National Health System (SUS), by the Ordinance GM/MS No. 1,508, dated September 1^st, 2005,²⁹29. Brasil. Ministério da Saúde. Portaria nº 1.508, de 1º de setembro de 2005. Dispõe sobre o Procedimento de Justificação e Autorização da Interrupção da Gravidez nos casos previstos em lei, no âmbito do Sistema Único de Saúde-SUS. Diário Oficial da União, Brasília (DF), 2005 set 2; Seção 1:124. and may also influence the filling of this information in the notification form.

Another field that stands out for the significant variation during the studied period is the 'nature of the lesion' suffered, whose fulfilling is required in cases where the violence practiced affects the physical structure of the victim. In this situation, the main lesion, that is, which motivated the search for the health service,²⁶26. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Viva: instrutivo de notificação de violência doméstica, sexual e outras violências [Internet]. Brasília: Ministério da Saúde ; 2011 [citado 2017 set 19]. 72 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/viva_instrutivo_notificacao_violencia_domestica.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... must be considered. The difficulty in filling this field may be related to the non-visualization of physical injury, since sexual violence, in most cases, does not result in extra-genital physical lesions.

Furthermore, the field 'evolution of the case' presented significant variation in the completeness during the studied period. The technical rule of assistance to victims of sexual violence determines the follow-up for, at least, six months after the first assistance, when the evolution can be concluded. However, if the form is filled and completed on the first visit, this information may not be available, and may influence the filling of this field. It should be highlighted that in the update of the notification of violence, which was renamed as 'notification form of interpersonal violence/self-violence',²⁷27. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde.Viva: instrutivo de notificação de violência interpessoal e autoprovocada. Brasília: Ministério da Saúde ; 2015. 65 p. the field 'evolution' was excluded, so the notification form should be closed on the first visit. Thus, the notification form will not have information resulting from the follow-up of the care given to the victim of sexual violence since the first visit, as, for example, death resulting from this type of aggression.

With regard to the consistency of the analyzed data, it was above 90% in all correlated variables, evaluated as excellent. The quality of data on consistency was better than on completeness; however, the variables available for consistency analysis in Sinan bank, which include sexual violence against women, are lower than those available for completeness analysis.

Moreover, it is important to highlight the duplicity found by the present study. Although there have been few notifications, they suggest that the identification routine to find duplicities followed by the surveillance services can still be strengthened, so that all duplicate cases could be identified and excluded.

With regard to the improvement in the filling of the violence notification form in Sinan, it is important to develop permanent education processes to raise awareness and give tools to the health professionals to generate quality information. Another relevant aspect is the need to provide feedback to the professionals on the information constructed from the data they notified.

Among the limitations of the study, it is necessary to consider its restriction to the study of duplicity, completeness and information consistency, given the importance of quality analysis on information of violence notifications using these criteria. Lima et al.¹⁶16. 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 out;25(10):2095-109. emphasize the small number of quality analyses in Sinan that use consistency and completeness criteria in the filling of information over time.

The presented results point to the possibility of using Sinan as a source of information for diagnosis, planning, monitoring, evaluating and performing public policies. The Information System for Notifiable Diseases (Sinan) demonstrates quality in the filling of notifications, concerning the criteria of completeness, consistency and duplicity. We emphasize that the study is innovative when analyzes the data quality for sexual violence against women and adolescents obtained from a state information system. This approach was not found in other studies on this matter.

We expect that this work contributes to reinforce Sinan's potential as a surveillance strategy for sexual violence, by subsidizing the planning and evaluation of public policies, as well as by raising awareness of managers, professionals, scholars and professors of the health area for the importance of the notification as an instrument to increase the visibility of sexual violence and of actions to tackle violence against women.

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