Vigilância do óbito por Doença de Chagas no Brasil: construção de estratégia incluindo eventos sentinelas

Abstract

Introduction: Chagas disease (CD) remains an infectious and neglected chronic disease in the 21st century, with a high burden of disease and death in endemic countries. Latin America stands out as a critical region, with an average of more than 14,000 deaths per year. In Brazil, CD is the neglected tropical disease (NTD) with the highest annual mortality burden, with 4,000 to 5,000 associated deaths. However, operational problems in local health systems limit the diagnosis and reporting of cases for proper management, making it difficult to know of the true burden of the disease in the country. Qualified mortality surveillance could help to propose prevention and control measures that can be effectively implemented. Objective: To structure a mortality surveillance strategy, including sentinel events, for the investigation of CD in Brazil. Methods: This research includes descriptive, exploratory and cross-sectional approaches, structured in three stages: 1- Definition of criteria for the inclusion of deaths in the investigation of CD, indicators and targets; 2- Development of a preliminary specific tool for the investigation of CD deaths; 3- Preliminary definition of flows for the composition and establishment of the process of investigation of death. Results: The preliminary analysis of mortality showed the importance of analysing multiple causes of death for the disease and the ICD-10 codes associated with those directly related to CD, which were agreed by the Ministry of Health's technical team and specialists. The analysis of mortality focusing on ICD-10 sentinel codes signals its potential importance if it is implemented in the country. In the end, seven inclusion criteria and ICD-10 sentinel codes were defined for the mortality study, seven for cardiac involvement and four for digestive involvement. Based on the benchmarks for death investigation in general in the country, as well as for CD itself, objectives and indicators were defined for the CD death investigation strategy in Brazil. By consensus, 3 specific forms of investigation were defined, including home, outpatient and hospital settings. Finally, procedures were defined to be followed, but they can be adapted to each reality. Conclusion: The strategy of surveillance of CD deaths integrated with sentinel events indicates a high potential to increase the sensitivity of measures to detect the disease in the SUS. In the context of the actions developed since 2020 to increase the sensitivity of the care and surveillance network to detect people with CD, the implementation of this strategy represents a significant step forward in achieving comprehensive care and improving the quality of life of those affected. Taken together, these actions can make a significant contribution to improving the national response by providing critical data for the formulation of public policies and interventions aimed at reducing the burden of morbidity and mortality and preventing new cases.