A Brazilian “Continent” and its Geographical Challenges toward a National Health Survey
Like India, Brazil can also be considered a “continent” given its size and complexity in geographical accessibility of remote regions. Brazil has an area of about 8.5 million Km2 (201.1 million people, i.e., a population density of 23.6 inhabitants/km2)[1] with 5,570 municipalities, 27 states and 5 regions: north (where we have the Amazon Region), northeast (one of the most deprived areas), southeast and southern (the most industrialized, with São Paulo, Rio de Janeiro, Rio Grande do Sul, for example), and the central-west (with subsistence agriculture). Poverty is also present as a mosaic of inequalities within the same city, such as the neighborhood of Old Delhi and New Delhi in India. For example, in Rio de Janeiro, we have one of the most vulnerable areas, a slum, similar to what we see in Old Delhi; but geographically the area is a jagged hill. Houses have been constructed in such a way that some Brazilian architects even dubbed it as the “architecture of the impossible” [Figure 1].
Figure 1.
View of one of the major slums in Rio de Janeiro, Brazil. Source: Photo taked by Vinicius Ribeiro in Rio de Janeiro, Brazil
Amazon Region of Brazil: A Giant Challenge to Household Surveys
The Amazon region of Brazil comprises 773 municipalities spanning over three geographic regions and part of nine states.[2] This region has a population of ≈23.6 million inhabitants living in an area of 5.2 million km2 (≈61% of Brazil), and a demographic density that is 10 × less than the national average. Its population, however, corresponds to 12.3% of the total inhabitants of Brazil. The Northern Region still consists of large urban voids due to the giant interiorization and large uninhabited areas such as the one occupied by the Amazon Forest. Only the immunization health actions (vaccines) and IBGE were able to reach those locations and conduct their houeshold surveys, as they have a structure of over 500 data collection support agencies, distributed throughout the country (the same used by the National Demographic Census).
IBGE and the Launch of the Major National Household Survey using PCAT in the World
Until 2016, the largest sample survey performed with PCAT in a single city in the world was in Rio de Janeiro (n = 6,675).[3,4] In August 2019, IBGE began the major fieldwork ever done using PCAT by visiting more than 108,000 households in all Brazilian regions, including the Amazon Region mentioned previously. In partnership with the Brazilian Ministry of Health, 2,167 selected municipalities will be visited from a statistical sample of the same geographic database that will be used in the 2020 Census. PCAT – Brazilian short validated version - is being applied to adults 18 years and older, as a part of the major household survey ever conducted: the Brazilian National Health Survey (PNS-2019).[5] We believe this initiative is a pioneer in the world and that it can encourage other countries like India to develop similar initiatives in partnership with Indian Statistical Institute to draw up a baseline for future studies and support National Government for decision-making in primary health care.
Financial support and sponsorship
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Conflicts of interest
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References
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