Epidemiological vigilance system for accidents at work: first results from an experience in the Northern zone of S. Paulo City (Brazil)

The epidemiological approach to occupational accidents and diseases adopted in Brazil is inadequate for many reasons, among them being: 1) the fact that only employers may notify work accidents, thus permitting notorious undernotification of these occupational hazards; 2) the available information does not permit a better understanding of the causal relationship between work accidents and diseases; 3) the official policy exists only for purposes of insurance compensation. The official documents for occupational disease and accident registration are the CTA (Work accident report) and FTA (Casualty treatment card). The Worker's Health Program of SUDS-R-6 proposed, in October, 1988 a method for the codification, registration in a micro-computer data bank and analysis of this information, based on the records presently in use (CAT) for public health service planning and accident prevention purposes. The major interest was in identifying the most common types of accidents in the region and the work environments in which they most frequently occur. The target population were the workers who attended the health units licenced to deal with work accidents and diseases, in the Northern region of S. Paulo City. The data presented below refer to the months of October, November and December, 1988, the first three months of the project. During that period a total of 2,339 accidents were registered. They were classified as: typical work accidents - 87%: commuting accidents which occurred between the home and the work-place - 18% and work diseases (only 2 cases). The majority of workers (50%) were between 25 and 45 years of age, approximately 7% were under 18. Male workers represented 83.2% of accident cases. The most affected area of the body were the fingers and hands (31.5%). Collisions with objects present in the work environment (17.5%) and heavy weights falling on the body (16.9%) were the main causes of accidents. The medical diagnosis showed that about 60% were contusions and wounds without fractures. Of the accidents registered, 371 (15.86%) were considered serious, with a high incidence of contusion and trauma with fracture. As the data were taken from CAT no deaths were observed, because this event occurs generally after the accidents and is registered on the FTA. The majority of work accidents (75%) led to an estimated less than 15 days' sick leave on the first medical examination. Approximately 15.5% of the accidents registered in the period studied occurred in the civil construction and engineering industries. The identification of the interprises or industries with the highest accidents rates has given rise to the definition of the first criterion for the planning of the Worker's Health Program. The incidence of accidents involving fingers and hands, 31.5% of all accidents studied, has permitted the establishment of priorities for the structuring of health care services. The small number of work diseases observed is due in part to undernotification and also to the fact that medical assistance for work diseases had been centralized outside the area studied until December 1988. The records used for the notification of accidents at work are problematic, but the fact they are well known makes them useful as a basis on which epidemiological studies may be developed. As far as in known, this is the first attempt made in Brazil to correlate information from the CAT of a particular health region with the objective of establishing guide-lines for health planning. This project is being continued and further developed with the incorporation of the FTA data in the analysis. It is hoped that after the experience in this limited area, the system might be applied in other health regions of the city and maybe all over the country. The experience may also be useful in modifying the records presently in use and simplifying the bureaucracy involved.No Brasil, e em São Paulo em particular, o sistema de vigilância epidemiológica restringe-se a algumas doenças transmissíveis, não havendo, na prática, vigilância referente a doenças não transmissíveis, especialmente às decorrentes do trabalho. O atual sistema de informações para acidentes e doenças do trabalho tem sido utilizado mais para o processamento de benefícios aos acidentados e acometidos por doenças do trabalho, do que para a proposta de um sistema de vigilância. Assim, foi elaborado projeto visando a utilizar os instrumentos em uso nesse sistema de notificação, para extrair informações que possam, dentro de uma abordagem epidemiológica, dar suporte ao planejamento das atividades de saúde. O projeto encontra-se em andamento no Programa de Saúde dos Trabalhadores do SUDS-R-6 (Mandaqui), Região da Grande São Paulo (Brasil), e objetiva identificar os tipos de acidentes mais comuns na região e os ambientes de trabalho nos quais esses acidentes ocorrem com mais freqüência. Os primeiros dados analisados, correspondentes ao período de outubro a novembro de 1989, mostraram uma média de 780 acidentes mensais. As mãos e os dedos foram as partes do corpo mais atingidas, cerca de 31,5% de todos os acidentes estudados, particularmente causados por máquinas e equipamentos na indústria metalúrgica. Dos acidentes registrados, 371 (15,86%) foram considerados graves, com uma alta incidência de contusões e traumas com fraturas. Das CAT estudadas, 2.030 (87%) foram decorrentes de acidentes típicos e 298 (12,7%) de trajeto. Aproximadamente 7%, 165 casos, ocorreram em trabalhadores menores de 18 anos de idade e 10 casos tinham idade inferior a 14 anos de idade. A identificação das companhias dos ramos da construção civil, metalúrgica e indústria gráfica como aquelas que apresentam o maior número de acidentes, definiu os primeiros critérios para o planejamento das atividades do Programa de Saúde dos Trabalhadores do SUDS-R-6