Objectives. To describe the qualitative aspects of the notifiable diseases surveillance system of the Gauteng Province, South Africa; to conduct a cross-sectional survey on knowledge and practices pertaining to disease notification among private sector primary health care providers in Gauteng Province; to measure the degree of underreporting of notifiable diseases versus positive laboratory diagnoses using malaria as a cases study; and to identify the correctible short-comings in the Gauteng Health Department’s diseases surveillance system and to recommend ways of addressing these to improve the system and its performance. Design. This is an evaluation study consisting of both the qualitative aspects and quantitative descriptive components of the notifiable disease system in Gauteng Province. The study designs used for the qualitative description were literature and policy review and a semi-structured interview with communicable disease coordinators. The quantitative research comprised of a telephonic questionnaire administered to a random sample of private general practioners and secondary data analysis comparing malaria cases notified to the Gauteng Provincial Department of Health with public and private sector laboratory data and clinical surveillance data. Setting. The study setting was the Gauteng Provincial Health Department and public and private health care service providers in Gauteng Province. The study period extended from 1 January to 30 June 2006. Subjects. The subjects of the study were the Gauteng Health Department’s disease surveillance system, public and private sector health care providers including private primary health care practitioners. Outcome measures. Outcome measures for the qualitative system description were the status of selected system attributes namely usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness and stability. Outcome measures for the knowledge and practice survey of private general practitioners were reporting compliance and knowledge of notifiable conditions. The primary outcome measure for the secondary data analysis was the proportion of laboratory diagnosed cases of malaria notified to the provincial health department. Results. The notifiable disease surveillance system in Gauteng is deemed useful by the public sector communicable disease coordinators but less so by the private sector general practitioners. Data quality as indicated by completeness of residential detail reporting on meningococcal notifications varied between 29% and 57% by district. Thirty seven percent of general practitioners report compliance with notifications and the mean score for knowledge on notification status of medical conditions was 56%. The sensitivity of notifications of malaria compared with laboratory notifications was 26% with relatively higher notification rates where cases occurred in children under 15 years of age. Conclusions. The notifiable disease surveillance system in Gauteng Province is relatively flexible and reasonably structured however this research suggests that there is suboptimal use of the information for local action in certain areas. Private General Practitioners self-report a low level of compliance citing time constraints and lack of motivation; knowledge of the notification status of selected medical conditions is lower than expected. The completeness and accuracy of notification data, as demonstrated in malaria notifications, is insufficient to gauge a true picture of burden of disease in the province. / Dissertation (MMed)--University of Pretoria, 2007. / School of Health Systems and Public Health (SHSPH) / Unrestricted

MPH / Department of Public Health

Introdução: O Sistema de Informação de Agravos de Notificação (SINAN) é uma importante ferramenta no apoio às ações da vigilância epidemiológica, sendo capaz de fornecer informações necessárias para o planejamento e intervenções em saúde. Com a descentralização da gestão dos serviços de saúde, as ações de vigilância epidemiológica foram colocadas sob responsabilidade dos municípios, que contam com distintos graus de capacidade administrativa. Objetivo: Analisar as condições de operação do SINAN nos municípios paulistas, segundo o porte populacional, em relação à infraestrutura, processo e apoio institucional. Métodos: Foi aplicado questionário eletrônico para 644 responsáveis pela vigilância epidemiológica, em 2017. Os dados foram analisados segundo porte populacional dos municípios: pequenos (<30.000 habitantes), médios (30.001-200.000) e grandes (>200.000) e por meio de estatística descritiva, com medidas de distribuição e de tendência central; teste de qui-quadrado e ANOVA foram utilizados na comparação entre os grupos. Resultados: Obteve-se 63,2% de retorno. Nos municípios pequenos, os responsáveis são mulheres (88,5%), jovens com <40 anos (60,2%); formação superior (88,3%), experiência com o SINAN <=9 anos (70,3%); com vínculo efetivo (56,4%); as equipes contam com <=2 profissionais (49,6%) receberam capacitação (75,9%) e apoio técnico do GVE (98,1%) para trabalhar com o SINAN; apresentam maior proporção de alta dificuldade em capacitação (16,9%) junto com os municípios médios (16,8%), e avaliam o preenchimento das fichas como bom (59,8%). Os municípios médios apresentam o perfil profissional e tempo de experiência com SINAN semelhante aos pequenos; com mais pós-graduados (47,7%); equipe com 3-6 membros; receberam mais capacitação (79,6%) em relação aos demais grupos. Receberam apoio técnico do GVE (91,2%); apresentam maior proporção de alta dificuldade no item fluxo de retorno (22,1%), como os grandes municípios (21,4%); avaliam o preenchimento das fichas como razoável (48,7%). Nos grandes municípios, predominou o responsável técnico com idade >=50 anos (60,7%) e mais pós-graduados (75,0%); maior número de efetivos (64,3%); profissionais com mais experiência no SINAN; 80,0% possuem >=11 funcionários; receberam capacitação (71,4%) e apoio do GVE (64,3%) para trabalhar com o SINAN em menor proporção que os demais; apresentam maior proporção de alta dificuldade com recursos humanos e avaliam o preenchimento das fichas como razoável (48,7%). Conclusões: O SINAN está implantado nos municípios paulistas, bem consolidado nos municípios grandes, porém os pequenos precisam de medidas de apoio que diminuam a disparidade entre os municípios: políticas e estratégias que estimulem a estabilidade profissional, bem como investimentos na capacitação profissional, aprimoramento dos recursos tecnológicos, avaliações periódicas do SINAN, além de incentivos financeiros voltados para gestão do SINAN. / Introduction: Notifiable Diseases Information System is an important tool in supporting actions of epidemiological surveillance, being able to provide information necessary for health planning and interventions. Regards to decentralization of health services management, actions of epidemiological surveillance were placed under the responsibility of municipalities, which have different degrees of administrative capacity. Objective: To analyze SINAN\'s operational conditions in the municipalities of São Paulo State, according to population size, in relation to infrastructure, process and institutional support. Methods: An electronic questionnaire was applied to 644 epidemiological surveillance managers in 2017. Data were analyzed according to the population size of the municipalities: small-sized (<30,000 inhabitants), medium-sized (30,001-200,000) and large-sized (> 200,000). We conducted a descriptive statistic analyse, distribution and central tendency measures were calculated. Chi-square test and ANOVA were used in the comparison between the groups. Results: 63.2% of questionnaires were answered. In small-sized municipalities, managers are female (88.5%), younger (<40 years old) (60.2%), with higher education degree (88.3%); mainly nurses; with experience with SINAN <=9 years (70.3%); with career civil servant (56.4%); teams have <=2 professionals (49.6%), that received training (75.9%) and technical support from the GVE (98.1%) to work with SINAN. Small-sized municipalities present a higher proportion of high difficulty in the training item (16.9%) as well as the medium-sized municipalities (16.8%), and evaluated the completion of records as good (59.8%). Medium-sized municipalities is similar to smaller ones in relation to time of experience with SINAN and professional profile. Team have more postgraduate persons (47.7%), being composed of 3-6 members. staff received more training (79.6%) in relation to the other groups. Team received technical support from the GVE (91.2%). Staff reported a higher difficulty for flow of return item (22.1%), as well as the large-sized municipalities (21.4%). Team evaluated completeness of the records as reasonable (48.7%). In the large-sized municipalities SINAN\'s managers are >=50 years old (60.7%). This group have a higher percentage of postgraduate professionals (75.0%); higher number of career civil servant (64.3%), 80.0% of teams have >=11members, that received training (71.4%) and GVE support (64.3%) to work with SINAN; professionals have more experience with SINAN. Units have higher number of computers. Managers reported higher difficulty for human resources item, and evaluated completeness of records as reasonable (48.7%). Conclusions: SINAN was implemented in the municipalities of São Paulo State, being consolidated in large-sized municipalities, but small ones need government support measures that reduce disparities between municipalities: policies and strategies that stimulate professional stability, as well as investments in professional training, improvement of technological resources, periodic evaluations of SINAN and financial incentives for the management of SINAN.

Introdução: O Sistema de Informação de Agravos de Notificação (SINAN) é uma importante ferramenta no apoio às ações da vigilância epidemiológica, sendo capaz de fornecer informações necessárias para o planejamento e intervenções em saúde. Com a descentralização da gestão dos serviços de saúde, as ações de vigilância epidemiológica foram colocadas sob responsabilidade dos municípios, que contam com distintos graus de capacidade administrativa. Objetivo: Analisar as condições de operação do SINAN nos municípios paulistas, segundo o porte populacional, em relação à infraestrutura, processo e apoio institucional. Métodos: Foi aplicado questionário eletrônico para 644 responsáveis pela vigilância epidemiológica, em 2017. Os dados foram analisados segundo porte populacional dos municípios: pequenos (<30.000 habitantes), médios (30.001-200.000) e grandes (>200.000) e por meio de estatística descritiva, com medidas de distribuição e de tendência central; teste de qui-quadrado e ANOVA foram utilizados na comparação entre os grupos. Resultados: Obteve-se 63,2% de retorno. Nos municípios pequenos, os responsáveis são mulheres (88,5%), jovens com <40 anos (60,2%); formação superior (88,3%), experiência com o SINAN <=9 anos (70,3%); com vínculo efetivo (56,4%); as equipes contam com <=2 profissionais (49,6%) receberam capacitação (75,9%) e apoio técnico do GVE (98,1%) para trabalhar com o SINAN; apresentam maior proporção de alta dificuldade em capacitação (16,9%) junto com os municípios médios (16,8%), e avaliam o preenchimento das fichas como bom (59,8%). Os municípios médios apresentam o perfil profissional e tempo de experiência com SINAN semelhante aos pequenos; com mais pós-graduados (47,7%); equipe com 3-6 membros; receberam mais capacitação (79,6%) em relação aos demais grupos. Receberam apoio técnico do GVE (91,2%); apresentam maior proporção de alta dificuldade no item fluxo de retorno (22,1%), como os grandes municípios (21,4%); avaliam o preenchimento das fichas como razoável (48,7%). Nos grandes municípios, predominou o responsável técnico com idade >=50 anos (60,7%) e mais pós-graduados (75,0%); maior número de efetivos (64,3%); profissionais com mais experiência no SINAN; 80,0% possuem >=11 funcionários; receberam capacitação (71,4%) e apoio do GVE (64,3%) para trabalhar com o SINAN em menor proporção que os demais; apresentam maior proporção de alta dificuldade com recursos humanos e avaliam o preenchimento das fichas como razoável (48,7%). Conclusões: O SINAN está implantado nos municípios paulistas, bem consolidado nos municípios grandes, porém os pequenos precisam de medidas de apoio que diminuam a disparidade entre os municípios: políticas e estratégias que estimulem a estabilidade profissional, bem como investimentos na capacitação profissional, aprimoramento dos recursos tecnológicos, avaliações periódicas do SINAN, além de incentivos financeiros voltados para gestão do SINAN. / Introduction: Notifiable Diseases Information System is an important tool in supporting actions of epidemiological surveillance, being able to provide information necessary for health planning and interventions. Regards to decentralization of health services management, actions of epidemiological surveillance were placed under the responsibility of municipalities, which have different degrees of administrative capacity. Objective: To analyze SINAN\'s operational conditions in the municipalities of São Paulo State, according to population size, in relation to infrastructure, process and institutional support. Methods: An electronic questionnaire was applied to 644 epidemiological surveillance managers in 2017. Data were analyzed according to the population size of the municipalities: small-sized (<30,000 inhabitants), medium-sized (30,001-200,000) and large-sized (> 200,000). We conducted a descriptive statistic analyse, distribution and central tendency measures were calculated. Chi-square test and ANOVA were used in the comparison between the groups. Results: 63.2% of questionnaires were answered. In small-sized municipalities, managers are female (88.5%), younger (<40 years old) (60.2%), with higher education degree (88.3%); mainly nurses; with experience with SINAN <=9 years (70.3%); with career civil servant (56.4%); teams have <=2 professionals (49.6%), that received training (75.9%) and technical support from the GVE (98.1%) to work with SINAN. Small-sized municipalities present a higher proportion of high difficulty in the training item (16.9%) as well as the medium-sized municipalities (16.8%), and evaluated the completion of records as good (59.8%). Medium-sized municipalities is similar to smaller ones in relation to time of experience with SINAN and professional profile. Team have more postgraduate persons (47.7%), being composed of 3-6 members. staff received more training (79.6%) in relation to the other groups. Team received technical support from the GVE (91.2%). Staff reported a higher difficulty for flow of return item (22.1%), as well as the large-sized municipalities (21.4%). Team evaluated completeness of the records as reasonable (48.7%). In the large-sized municipalities SINAN\'s managers are >=50 years old (60.7%). This group have a higher percentage of postgraduate professionals (75.0%); higher number of career civil servant (64.3%), 80.0% of teams have >=11members, that received training (71.4%) and GVE support (64.3%) to work with SINAN; professionals have more experience with SINAN. Units have higher number of computers. Managers reported higher difficulty for human resources item, and evaluated completeness of records as reasonable (48.7%). Conclusions: SINAN was implemented in the municipalities of São Paulo State, being consolidated in large-sized municipalities, but small ones need government support measures that reduce disparities between municipalities: policies and strategies that stimulate professional stability, as well as investments in professional training, improvement of technological resources, periodic evaluations of SINAN and financial incentives for the management of SINAN.