Brazil

Brazil

The conclusiveness of many findings from the needs assessment in Brazil was limited by a lack of sufficient data, particularly locally representative data. In order to supplement the population data at the state or national level gathered through literature review, a cross-sectional community-based study was conducted in Poções, a city in the state of Bahia (Brazil northeast region), and Padre Paraíso, in the Minas Gerais state (Brazil southeast region), from October to December 2017. These locations were chosen by key stakeholders given their status as underserved municipalities and their socioeconomic similarities to the HealthRise intervention areas (Appendix B).

The estimated prevalence of NCDs in Brazil varied substantially across studies and data sources: for hypertension, from 27% to 44%, for diabetes, from 6% to 15%, and for high cholesterol, from 4% to 11%. The prevalence of these NCDs was found to be higher among women than men and among people with less education; however, estimates were based on self-report and may reflect differences in awareness between groups rather than true differences in disease status.

In Padre Paraíso and in Poções, where individuals had their blood pressure and random blood glucose measured, prevalence of diabetes was around 9.5%, while prevalence of hypertension was over 55% in both locations. No significant difference was seen by sex. Overall, higher prevalence of these conditions was found among older individuals, those with low education and low socioeconomic status, those reporting no or low physical activity, and those with central obesity (Appendix B).

Of those living with these diseases, many were found to be undiagnosed, with as many as 52% of men with hypertension from Poções and 25% of men with diabetes from Padre Paraíso unaware of their disease. According to the literature, this was likely an even greater problem for high cholesterol, as a larger proportion of people reported never having been tested for this condition in Brazil. In regard to treatment, an important gap was seen among women with diabetes in Poções, where over one-third of previously diagnosed patients reported not being on treatment. Among those on treatment, 14–40% had their blood glucose under control. Among diagnosed hypertension patients, 78–90% were receiving treatment, with 11–25% meeting treatment targets.

The literature also suggested that major NCD risk factors were highly prevalent in Brazil: over 40% of the population in the two HealthRise states were overweight or obese and reported low physical activity, and among males, binge drinking and smoking were common. The level of health awareness in relation to NCDs was low. Individuals did not demonstrate knowledge of disease symptoms, were hesitant to seek preventive care, and were unaware of educational activities and support groups available in health facilities.

Several important limitations were identified in the provision of NCD-related health services. Patients described health facilities as having inconvenient operating hours and long wait times, being understaffed, and facing medication shortages. A small minority of patients reported ever having received an in-home visit from a health professional. From the supply side, primary health care facilities lacked the infrastructure, equipment, and drugs to diagnose and treat NCDs. Despite patients reporting crowding and long wait times, facility data indicated that primary care physicians saw only nine to 13 patients per day in both Vitória da Conquista and Teófilo Otoni.