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Epidemiologia e Serviços de Saúde

versão impressa ISSN 1679-4974versão On-line ISSN 2237-9622

Epidemiol. Serv. Saúde v.24 n.4 Brasília dez. 2015



Evaluation of the National Information System on Live Births in Brazil, 2006-2010*



Max Moura de Oliveira1; Silvânia Suely Caribé de Araújo Andrade1; George Santiago Dimech1; João Carlos Guedes de Oliveira2; Deborah Carvalho Malta1; Dácio de Lyra Rabello Neto1; Lenildo de Moura3

1Ministry of Health, Secretariat of Health Surveillance, Brasilia-DF, Brazil
2Université Laval, Faculté de Médecine, Département de Médecine Sociale et Préventive, Quebec City, Quebec, Canada
3Pan American Health Organization - World Health Organization, Technical Unit for Social Determinants and Health Risks, Chronic Noncommunicable Diseases and Mental Health, Brasilia-DF, Brazil





OBJECTIVE: to analyze attributes and usefulness of the Live Birth Information System (Sinasc), Brazil, 2006-2010.
METHODS: this evaluation was based on the Centers for Disease Control and Prevention Guidelines for Evaluating Public Health Surveillance Systems.
RESULTS: 21 of the 23 variables analyzed showed completeness above 90.0%. 97.9% of hospital birth variables had complete data; no differences in the proportion of births were found with regard to macroregion and sex when compared to the 2010 census; 82.6% of data was received on time in 2010; the ratio between reported and estimated live births was 89.4% in 2006 and 97.4% in 2010; this system was used to build 22 health monitoring indicators.
CONCLUSIONS: the aspects evaluated and usefulness of Sinasc confirm the quality and importance of the information it provides in serving as input for public policies on maternal and child health.

Key words: Information Systems; Health Information Systems; Birth Certificates; Live Birth; Health Evaluation.




The health information systems provide data that allows monitoring a population's health situation.1 In Brazil, secondary databases - filled with nationwide data - have been increasingly used in researches. Such interest may be related to the gratuity and speed of access and the quality of such data.2

Birth is a vital event and its monitoring may contribute to the knowledge of a population's health level, because it allows the construction of indicators that can support the planning, management and evaluation of policies and actions of health care and surveillance in the area of maternal and child health.3-5

In Brazil, the legal base for birth monitoring dates from the 1970s;6 however, only in the 1990s the National Information System on Live Births (Sinasc) was created.7 In 1998, this system was already working in all country's municipalities.3 The Sinasc - the function of which is to collect and process demographic and epidemiological data on the infant, mother, prenatal care and childbirth - is fed by the Live Birth Statement (DNV).8

Since its implementation, Sinasc uploading is continuous, keeping the newborn population throughout Brazil under surveillance. The system is universal, therefore, collecting the data is a passive action, in other words, professionals assigned on health services or on registry offices are expected to fill the Live Birth Statements (DNV). However, for some specific situations in which the DNV cannot be issued, it is necessary to perform active search of these records, e.g.: for births that were, for some reason, registered without the issuance of the DNV. The system was reformulated in 1999 and 2009.4,7,8

The periodic evaluation of a health information system allows verifying if the generated information is useful to direct the public policies, to bring to light the magnitude of events, estimate risks and identify vulnerable groups,1 as verified on systems' evaluation using data, for example, from the Notification Diseases Information System (Sinan)9, Population Based Registry of Cancer10 and from Sinasc.11-13

The objective of this study was to analyse attributes and usefulness of the National Information System on Live Births (Sinasc), Brazil, 2006-2010.



Sinasc's evaluation was conducted using as reference the Updated Guidelines for Evaluating Public Health Surveillance System, published by the Centers for Disease Control (CDC/USA).1

The study was divided into two stages. The first stage consisted of describing Sinasc and, in order to dimension its magnitude, the number of live births was raised and the percentage of births by sex and type of delivery was calculated. Sinasc's objectives were described, as well as the steps to information collection, data source and the system's operation, available on documents related to its creation.3,6,7,8,14

In the second stage Sinasc's attributes were evaluated: simplicity, flexibility, data quality, acceptability, representativeness, opportunity and stability; and their usefulness as an information system. Some evaluation criteria were adopted to each one of these attributes, as it follows.

The simplicity of a system reflects on its structure and operation convenience.1 The component elements of the DNV flow and responsibilities of each level of government were evaluated. From this evaluation, the attribute was defined as simple or complex, comparing to other systems.9,10

The flexibility was analysed by observing the system adaptation to changes resulting from the information needs or to improve its operational conditions.1 The DNV changes that occurred in 2009 were compared to the ones from 1999, such as the content changes in the number of variables (inclusion/exclusion) in the record files, reformulation of the normative material for filling the DNV, as well as the process for implementing these changes. This attribute allowed evaluating if the system was flexible or not to changes, including when comparing to other information systems evaluated in this attribute. 9,10

The data quality reflected the completeness and the validity of records in the system.1 Sinasc recommends filling all the fields on the DNV, however there is not a blockade of data entry if any of the fields is blank. In this study, the following variables were considered for quality analysis:

a) place of occurrence - place, administrative branch of the establishment (municipal, state, federal, private), municipality and Federative Unit where the childbirth took place;

b) mother - age, marital status, schooling, occupation, municipality and Federative Unit of residence;

c) pregnancy and childbirth - previous pregnancies (children, live births and stillbirths), pregnancy duration (in weeks), type of pregnancy, type of childbirth and number of prenatal care visits; and

d) newborn identification - year of birth, sex, ethnicity/skin color, Apgar score (1 minute and 5 minutes after birth), birth weight and congenital anomaly detection.

Since there are no evaluation parameters of data completeness for Sinasc, this study estimated as a standard reference of this quality, the (i) median of completeness of all variables at 90% - if the data filled were equal or above that proportion, it was considered adequate completeness9 and, consequently, inadequate if completeness was bellow it - and an (ii) exclusion percentage of up to 5%.

The acceptability was defined as the measure of people's and institutions' interest in conducting the system and participating of it, having the completeness of registered information1 as one of the parameters from the percentage calculation, adapted from Souza et al.9, that represents the relation between the sum of the percentage of completeness (excluding ignored and blank fields) and the number of variables. Data from the hospital childbirths were considered for this calculation. The variables included were those collected during the childbirth and initial assistance to the newborn: type of pregnancy, type of childbirth, gestational age, sex, ethnicity/skin color (newborn), Apgar score 1 minute and 5 minutes after birth, birth weight and congenital anomaly detection. This attribute, evaluated for Brazil and its geographic macroregions, was considered acceptable if the indicator presented completeness above 90%.

The representativeness of a system refers to its ability to accurately describe the occurrence of a health event over time and its distribution by place and person.1 A comparison between data on live births by sex, region and federative unit of residence of the mother, collected by 2010 Sinasc and the Demographic Census was performed. The year of 2010 was chosen for being a year with information available on the entire population derived from the Census and, therefore, could be compared to the population registered on Sinasc, a continuous collection system. In this comparison, deaths of children under 1 year of age were excluded, according to the Mortality Information System (SIM), because the Census considers all living people on the reference date of the demographic survey.15 Using the Pearson Chi-square test (χ2), the Sinasc's representativeness was considered acceptable when the region or Federative Unit presented statistical differences with 5% significance level.

The opportunity reflects the speed among all the steps of attainment of a surveillance system in public health.1 This attribute was evaluated from the information volume received from municipalities and federative units, considering the month of birth and of the first data entry in the national system. The parameter of this evaluation was defined by the value of 80% of the expected (agreed) volume data to be received up to 60 days after the end of the month of birth occurrence, as provided in the Ordinance of the Ministry of Health, MS/SVS No. 116 dated February 11, 2009;16 thereby, this attribute was analysed only for the year of 2010 in this study.

Stability refers to the system's ability to collect, manage and provide data properly and operates them as needed.1 Current documents, technical standards, legislation and official publications of the Ministry of Health and the Presidency of the Republic were evaluated during the study. The system was considered stable when the documents necessary for its continued operation were presented. To the recognition of Sinasc's stability, it was also considered their capacity to enlist events - or coverage - estimated by the ratio between live births reported in the system and estimated by demographic projections of IBGE, as the suggested indicator by the Inter-Network Information on Health (Ripsa):5 when the ratio was close to 100, it would indicate a coincidence between the frequencies obtained from both sources; above, it would indicate underestimation of demographic projections; and below this parameter, underreporting of the system.5

To evaluate the Sinasc's usefulness, the fulfilment of the proposed objective was assessed, namely, providing information on the live births characteristics and its ability to contribute to the definition of specific health indicators.1 A search for documents, technical standards, legislation and official publications of the Ministry of Health was performed for the purpose of checking Sinasc's usage as a data source for these indicators' construction5,17-19 and to verify the potential of the system data usage on technical publications from the Ministry of Health.20-24

The study used the Sinasc database (available on SUS IT Department [Datasus] website, of the Ministry of Health)25 and, for population data, census information from 2010 and the estimation of live birth provided by the Brazilian Institute of Geography and Statistics (IBGE).10 Tabwin and Microsoft Office® Excel 2007 software were used in the data analysis and processing.

The analysis of Sinasc data included information publicly available in aggregated form, accessible through the electronic site of the Datasus/Ministry of Health without identification of live births or implication on any harm to the them as the resolution of the National Health Council (CNS) No. 466, dated December 12, 2012.



From 2006 to 2010, there were 14,514,533 live births registries in Brazil: being 7,437,664 (51.0%) males, 14,172,782 (98.0%) of hospitals childbirths and 49.2% of those, from caesarean sections.

The Live Birth Statement (DNV) has been developed with the collaboration of a specific Technical Committee and adopted by the Ministry of Health as a single instrument as a source of Sinasc data. The DNV follows instructions appropriated to the place of birth conditions, and can be filled by (i) reporting units - hospitals where the childbirth took place or where the first care alter it was offered, (ii) individual notifiers - health professional or traditional midwife who attended homebirths or, by (iii) registry offices, subject to authorization granted by the State Justice of Internal Affairs. When the childbirth occurs without a healthcare professional assistance, in locations where families are enrolled in the Family Health Strategy (ESF) or in the Program of Community Health Agents (PACS), the DNV must be issued by a professional belonging to the staff or unit where the mother is registered.

DNV's flow happens as follows: the first copy of the document is sent to the local Municipal Health Department data processing organ, to be typed and filed; the duplicate is taken by the family or by a registrar at the registry's office for the issuance of the birth certificate; and the third copy (i) is filed at the health care unit where the childbirth happened, or (ii) is taken by the family to the health care unit responsible for the first care when the childbirth did not happen within hospital care, to medical records on file (Figure 1).



There is a strict control of data flow in the system at all levels of management. Since the files distribution process, there are some singularities concerning the notification. Regardless of the place of birth, expertise in maternal and child healthcare is necessary for filling the DNV clinical variables (Figure 1), which is why Sinasc was evaluated as a complex system.

With regard to the system's flexibility, the DNV used during the study period (2006-2010) was established in 1999 and altered in 2009, both in its contents and in its presentation. When comparing both models, it was observed that 14 fields were included, three were excluded and five were altered. For example, in 2009, 'father's age' variable was included in the new DNV which is now composed of eight blocks, 52 fields and 63 variables. In 2010, its distribution to the federative units began, accompanied by adjustments in the interface of data entry program and by review of instructional material - dictionary of variables, reasons why the system was considered flexible to change when necessary.

23 DNV variables were evaluated. In the assessment of filling completeness - a median of 99.6% - 13 (52.0%) variables were above this value, being considered adequate. Only the variables 'stillbirth' (85.8%) and 'occupation' (82.5%) presented completeness below 90.0%. Concerning data amount with ignored information, with the exception of 'marital status' (1.5%) and 'congenital anomaly detection' (2.5%), all the other variables held a percentage of ignored information below 1%. The median of ignored data was below 0.1%, and 8 (35.0%) variables were above this parameter, considering the filling as adequate (Table 1). The data was considered of good quality.



The data completeness rate on hospital childbirths in Brazil was 97.9%. Only the Northeast region was below this index (96.7%). The other regions remained at the same level or above it (Table 2). Therefore, the system was considered acceptable.



No statistical differences were found between live births proportions of both sexes in any of the five Brazilian macroregions (p> 0.05) and of the 27 federative unites (> 0.05) when comparing the Sinasc data with the 2010 Census information. Sinasc was considered a representative system (data not presented).

In view of the expected 80% - agreed -, the amount of data received on Sinasc was 82.2% in 2010. These are the system opportunity percentage variations presented monthly: 77.4% (January), 80.1% (February), 83.5% (March), 84.6% (April), 82.7% (May), 83.7% (June), 78.4% (July), 78.4 % (August), 81.8% (September), 81.8% (October), 86.6 (November) and 90.1% (December). However, considering 2010 as a whole (the year analysed), Sinasc proved to be opportune in receiving data.

In addition to the current Ordinances, others related to Sinasc were published during the study period, indicating their sustainability and stability in fulfilling the functions intended for the period (Figure 2). The system coverage ratio in relation to the data by collected IBGE Census was 89.4% (2006), 90.3% (2007), 94.5% (2008), 95.4% (2009) and 97.4% (2010). The system was concluded to be stable.



To analyse the births evolution during the study period, the Inter-Agency Health Information Network - Ripsa - used the Sinasc in the construction of 19 indicators, in its two editions, divided into four categories:

1) Demographics indicators — total fertility rate; specific fertility rate; and crude birth rate.

2) Mortality indicators — infant mortality rate; early neonatal mortality rate; late neonatal mortality rate; post neonatal mortality rate; perinatal mortality rate; mortality rate in children under five years of age; maternal mortality rate; and mortality rate by conditions originated from the perinatal period.

3) Morbidity indicators and risk factors - live births proportion by maternal age; and proportion of low-weight live births.

4) Coverage indicators - coverage of prenatal care; proportion of hospital childbirths; proportion of caesarean childbirths; proportion of caesarean childbirths at SUS; ratio between the reported and estimated live births; and vaccination coverage.

The Pact for Life and Management used the Sinasc system for elaborating two indicators: proportion of live births to mothers with four or more prenatal care visits; and tetravalent vaccine coverage in children under 1 year of age. The Programme of Surveillance Actions in Health (PAVS) used the Sinasc in one indicator: collection of Live Birth Statements.

The Sinasc proved itself useful for monitoring general conditions that subsidize the planning of maternal and child care - for example, in the description of the childbirth profile. The book Saúde Brasil (Health Brazil), in its 2006-2010 editions (except for 2008), presented specific chapters on live birth-related subjects. Here too, the system served its purpose and is considered useful on what it is proposed.



In the period studied, the Sinasc system was considered complex in its operation, yet flexible to change when necessary. Besides being rated as of adequate quality, the system proved to be acceptable considering the completeness of the variables of births in hospitals, and also representative when its data were compared with the 2010 Census records. Similarly, the data reception has proved itself opportune, stable and able to meet the goal set for it: support the planning of maternal and child care.

Sinasc was considered complex in its operation when compared to other systems.9,10 The apparently excessive strictness in the fulfilment of the record distribution flow, due to the legal implications involved, did not represent a downside and may also have contributed positively to the evaluation of the studied attributes. Furthermore, the heterogeneity of professionals responsible for the fulfilment of the Live Birth Statement - DNV -8 and specificity of the data included in the document led the Ministry of Health to recommend its filling to be conducted by previously trained staff.8,14 In a maternity hospital in Rio de Janeiro-RJ, in 2004, there was 50% agreement between DNV data and respective data records in the newborn and postpartum medical records, suggesting a need for continuous training of the professionals involved.11

Despite the operational complexity, the system was evaluated as flexible to the changes observed in the period. This complexity was also observed in a study that evaluated Brazil's national surveillance system on leptospirosis in 2007.9 The continuity in evaluating Sinasc is considered highly important, in order to observe the data quality after changes, especially those started in 2010. In 2011, with the gradual replacement of the DNV, 58% of births have been informed by the new instrument.25

The findings of this assessment indicate: the Sinasc data showed high completeness and low percentage of ignored information during the study period, being the system considered of good quality. Its information has improved over time, as pointed in an evaluative study of the DNV variables completeness for residents in the state of Pernambuco, over the period 1996-2005.12 However, another study evaluating the completeness of Sinasc variables, held between 2000 and 2009, focusing on the states of the Brazilian Northeast region, found differences in completeness between the states: for the ethnicity/ skin color variable, for example, the system showed a higher percentage of incompleteness (20.5%) in 2009 in the state of Sergipe. Nevertheless, its authors considered the completeness of DNV throughout the Northeast region as good to excellent.26

An evaluation on the completeness of Sinasc data conducted in Campinas-SP, in 2009, pointed out that the completeness percentage of variables ranged from 99.8 to 100%.27 This data corroborate with those found for Brazil, highlighting the importance of studies in specific geographical areas since there can be regional differences in the quality of the data.

For Costa and Frias,12 problems such as ignored variables in monitoring systems are the result of a number of deficiencies, from the lack of information on medical records to the lack of certain information by the women's companions; not to mention the blank variables, possible reflection of the lack of care and importance given to complete the DNV by the responsible staff.

Positive findings for the 'data quality' attribute reflected in the results of the 'acceptability' attribute. The completeness percentage reached 97.9% for the country. However, the selection of variables used among those that could have had data observed and measured at the childbirth moment would justify a completeness percentage closer to 100%. Therefore, these results should be seen with caution, because there is a possibility of discrepancies between hospital records and Sinasc data, as noted on a reliability study conducted in hospitals of Rio de Janeiro-RJ, in 2004.11

The system's implementation may interfere with the results of the studied attributes, including the acceptability. Sinasc's implementation in 132 municipalities of Minas Gerais State, in 2010, did not occur properly in most of these locations. This conclusion is based on the lack of a qualified professional, unsatisfactory collection and completion of DNV, data sub-utilization and poor dissemination of information.13

The system was considered representative, when compared to the proportions of live births — by sex, federative unit and macroregions — with the 2010 Demographic Census data. Since 1998, there was an improvement in Sinasc's coverage reaching at least 90% of registered children on registry offices. It is noteworthy that during this period, Sinasc already had more than a decade of implementation in all Brazilian municipalities.3

The system proved to be opportune concerning data reception. The monitoring of this system attribute must be maintained, since this evaluation was performed on data from 2010, the first year after the publication of Ordinance No. 116/2009.16 Sinasc was also considered stable, thanks to the legislation that gives it sustainability. The very obligation of the issuance of Live Birth Statements to the Civilian Birth Record8 may have interfered positively in the results found for the attributes of acceptability, representativeness, opportunity and stability. Furthermore, the results of this evaluation showed the potential of Sinasc information and its usefulness in Public Health context as a source of data for the development of health indicators.2,5,17-19,28

As limitations of this research, there is the lack of comparative parameters for some of the attributes evaluated. This happened because the parameters considered for this study were used for evaluating information systems9,10 with distinct characteristics, restricting comparisons with this study.

Periodic evaluations of the information systems must be integrate into the routine of the health surveillance systems. Quality information is essential for the health situation analysis and taking evidence-based decisions.5 In this study, the evaluated attributes and the National Information System on Live Births — Sinasc — ratify the quality and the importance generated by it to subsidy public policies for maternal and child health.



To the Training Program in Epidemiology Applied to the National Health System Services, Department of Communicable Disease Surveillance (Episus).

To the Brazilian National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq) of the Brazilian Ministry of Science, Technology and Innovation (Ministério da Ciência, Tecnologia e Inovação - MICT) for the financial support.




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2. Drumond EF, Machado CJ, Vasconcelos MR, França E. Utilização de dados secundários do SIM, Sinasc e SIH na produção científica brasileira de 1990 a 2006. R Bras Est Pop. 2009 jan-jun;26(1):7-19.

3. Mello Jorge MHP, Gotlieb SLD, Soboll MLMS, Almeida MF, Latorre MRDO. Avaliação do Sistema de Informação sobre Nascidos Vivos e o uso de seus dados em epidemiologia e estatísticas de saúde. Rev Saude Publica. 1993; 27(Suppl):1-46.

4. Ministério da saúde (BR). Departamento de Informática do SUS. Eventos vitais [Internet]. Brasília: Ministério da Saúde; 2008. [citado 2012 dez 11]. Disponível em:

5. Rede Interagencial de Informação para a Saúde, Indicadores básicos para a saúde no Brasil: conceitos e aplicações [Internet]. 2 ed. Brasília: Organização Panamericana de Saúde; 2008. [citado 2014 mar 15]. Disponível em:

6. Brasil. Lei n° 6.015, de 31 de dezembro de 1973. Dispõe sobre os registros públicos, e dá outras providências. Diário Oficial da República Federativa do Brasil, Brasília, (DF), 1973 dez 31; Seção 1:13528.

7. Almeida MF, Alencar GP, Schoeps D. Sistema de Informações sobre Nascidos Vivos - Sinasc: uma avaliação de sua trajetória. In: Ministério da Saúde (BR). A experiência brasileira em sistemas de informação em saúde [Internet]. Brasília: Ministério da Saúde, Organização Pan-Americana da Saúde. Fundação Oswaldo Cruz; 2009. [citado 2014 mar 20] p. 11-37. (Série B. Textos Básicos de Saúde). Disponível em:

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9. Souza VMM, Brant JL, Arsky MLS, Araújo WN. Avaliação do sistema nacional de vigilância da leptospirose: Brasil, 2007. Cad Saude Colet. 2010;18(1):95-105.

10. Moura L, Curado MP, Simões EJ, Cezário AC, Urdaneta M. Avaliação do registro de câncer de base populacional do município de Goiânia, estado de Goiás, Brasil. Epidemiol Serv Saude. 2006 dez;15(4):7-17.

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12. Costa JMBS, Frias PG. Avaliação da completitude das variáveis da Declaração de Nascido Vivo de residentes em Pernambuco, Brasil, 1996 a 2005. Cad Saude Publica. 2009 mar; 25(3):613-24

13. Guimarães EAA, Hartz ZMA, Loyola Filho AI, Meira AJ, Luz ZMP. Avaliação da implantação do Sistema de Informação sobre Nascidos Vivos em municípios de Minas Gerais, Brasil. Cad Saude Publica. 2013 out;29(10):2105-18.

14. Ministério da Saúde (BR). Fundação Nacional de Saúde. Manual de procedimentos do Sistema de Informações Sobre Nascidos Vivos. Brasília; 2001.

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17. Rede Interagencial de Informações para a Saúde. Indicadores básicos para a saúde no Brasil: conceitos e aplicações [Internet]. 2 ed. Brasília: Organização Pan-Americana da Saúde; 2008. [citado 2014 abr 15]. Disponível em:

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27. Gabriel GP, Chiquetto L, Morcillo AM, Ferreira MC, Bazan IGM, Daolio LD, et al. Avaliação das informações das declarações de nascidos vivos do Sistema de Informação sobre Nascidos Vivos (Sinasc) em Campinas, São Paulo, 2009. Rev Paul Pediatr. 2014 set;32(3):183-8.

28. Pedraza DF. Qualidade do Sistema de Informações sobre Nascidos Vivos (Sinasc): análise crítica da literatura. Cienc Saude Colet. 2012 out; 17(10):2729-37.



Max Moura de Oliveira
Ministério da Saúde,
Secretaria de Vigilância em Saúde
Departamento de Vigilância de Doenças
e Agravos Não Transmissíveis e Promoção da Saúde
SAF Sul, Trecho 2, Lotes 5-6, Bloco F, Torre 1,
Edifício Premium, Térreo, sala 15
Brasília-DF, Brasil. CEP: 70070-600

Received on 15/12/2014
Approved on 20/07/2015


* This work was conducted during Max Moura de Oliveira training, within the Training Program in Epidemiology Applied to the National Health System Services (Episus) 2012-2014, coordinated by the Secretariat of Health Surveillance of the Ministry of Health, Brasilia-DF, Brazil. The study was funded when its principal author had a scholarship of the National Scientific and Technological Development Council (CNPq)/Ministry of Science, Technology and Innovation (MCTI): Process No. 156254/2013-1.