Avaliação de implantação e de impacto da adoção do protocolo de vigilância do óbito por tuberculose em um município com alta carga da doença

Abstract

Introduction: Death from tuberculosis (TB) is considered a preventable event. The occurrence of underreporting of deaths and inconsistency between information systems are critical points that impact TB surveillance. The adoption of the death surveillance protocol with mention of TB is an indispensable strategy for meeting the goals for the end of TB by 2035. Knowing the implementation dynamics and the results obtained after this intervention is essential, so that changes are proposed and the objectives of the protocol are achieved. Objective: To assess the degree of implementation and impact of adopting the TB death surveillance protocol in a large city with a high TB burden. Methods: Evaluative research using logical model and judgment matrix per component of the logical model related to the triad structure, process and result proposed by Avedis Donabedian. Primary data were collected from a questionnaire and secondary data were obtained from the Municipal Health Department. In order to analyze the effects of adopting the protocol, in addition to considering the result indicators by component, the indicators of TB morbidity and mortality were calculated. Results: The degree of implementation of the death surveillance protocol with mention of TB was considered partial (51.0%). Three components “identification of deaths”, “epidemiological investigation” and “discussion of deaths” were classified as partially implemented, and the component “forwarding proposals and qualification of information systems” was classified as not implemented. The structure indicators (68.6%) were higher than the process indicators (37.7%). Regarding the evolution of TB morbidity and mortality indicators, there was a significant trend towards an increase in the TB incidence rate in the period from 2006 to 2019. In relation to TB mortality, an increase was observed after the implementation of the protocol, measured by percentage change. As for the proportion of deaths without laboratory confirmation for TB, there was a reduction after the implementation of the protocol. Conclusion: The partial implementation of the surveillance protocol indicates needs for changes in the work process of the team that manages the Mortality Information System and TB Control Program at the municipal level, and although this implementation is not 100%, changes are already being observed epidemiological and operational indicators of TB.