To the editor
The health information system (HIS) is a well-designed mechanism to gather, process
and
disseminate information about health (Yusof et al., 2008) and to monitor disease (Sligo
et al., 2017). In Brazil, there are six
different information systems: of mortality, of live births, of basic health attention,
of
national program of immunisation, of notifiable grievances (diseases, injuries and
events)
and of environmental health. All systems work together in order to promote health
and
prevent diseases and are subjected to the Ministry of Health (Carvalho et al., 2017).
Our attention has been drawn to the deficiency in the information system responsible
for
notifiable grievances (System for Reporting of Notifiable Conditions (SINAN)) in the
notification of human mercury intoxication (ICD-10: T56.1) (World Health Organization,
2016) in Brazil. Based on
the information provided by this system, from 2006 to 2014, 220 cases of exogenous
mercury
intoxication occurred in the country. Most of these (41%) occurred in São Paulo State
and a
considerable amount (24%) in Paraná State. Other states also presented notification
for
exogenous mercury intoxication: Espírito Santo, Pernambuco, Minas Gerais, Rio de Janeiro,
Distrito Federal, Tocantins, Bahia, Ceará, Acre, Mato Grosso do Sul, Paraíba, Alagoas,
Mato
Grosso and Goiás (Brasil,
2015).
What caught our attention was the absence of notifications for exogenous mercury
intoxication from Amazonas State, Pará State, Roraima State, Amapá State, Maranhão
State and
Rondônia State. All of these are located in the Amazonian region where cases of human
mercury intoxication have otherwise been reported (Câmara, 2017; Khoury et al., 2013;
Maria et al., 2017; Marques et al., 2007).
Reading the SINAN guidelines,
1
concepts such as exogenous intoxication; toxic agent; phase of intoxication; phase
of
exposure; phase of toxicokinetic; phase of toxicodynamic; clinical phase; periods
and types
of intoxication are clearly defined. According to the guidelines, exogenous intoxication
(ICD10: T65.9) (World Health
Organization, 2016) was defined as “a set of harmful effects represented by
clinical or laboratorial manifestations that reveals the organic imbalance produced
by the
interaction of one or more toxic agents.” Moreover, the guidelines suggest actions
that need
to be seriously considered by academics and scientists: the obligation for physicians
and
other health professionals to notify the information system about the existence of
patients
who present with exogenous intoxication (suspect or confirmed cases). Additionally,
the
system allows educational institutions (public or private), centres of hemotherapy,
laboratory units, research institutions or any citizen to communicate the occurrence
of an
exogenous intoxication (Brasil,
2017). The notifications are reported to health facilities, namely notification
units. Health professionals or others who wish to notify a case of exogenous intoxication
report cases to a notification unit. The notification units are responsible for updating
the
SINAN system weekly (Ministry of Health Government Ordinance Number 204, from 17 February,
2016).
Recently, we performed a systematic review of mercury exposure in Amazon. Our work
included
11,827 subjects who had been investigated for mercury exposure (exogenous intoxication)
(Castro and Lima, 2018). Our
results showed that all the populations that were studied presented mean levels of
mercury
on hair above 6 µg.g−1. Based on the data presented above, we observed a gap
between research data and the health information system, which poses several questions:
Why
is the Brazilian SINAN unable to report the mercury intoxication that occurs in Amazon?
Where is the reporting gap? Is the information system the problem? Is the absence
of
notification by researchers/academia the problem?
We need to strengthen the mesh between research and reporting to the HIS in order
to
promote health for mercury exposure populations that live in Amazon. Furthermore,
mercury is
a global problem. As a signatory to the Minamata Convention (United Nations, 2013),
Brazil should identify and
correct the barriers in the inter-sectorial approach in order to comply with the
agreement.
The authors recommend that:
Researchers who study mercury exposure in Amazon should adhere to the national SINAN
guidelines;
Public funding for research of mercury exposure in Amazon should require that the
approved projects follow the national SINAN guidelines.