Publications by authors named "Lucas Resende de Carvalho"

7 Publications

  • Page 1 of 1

Geospatial modeling of microcephaly and zika virus spread patterns in Brazil.

PLoS One 2019 26;14(9):e0222668. Epub 2019 Sep 26.

Duke University, Duke School of Medicine, Department of Surgery, Division of Emergency Medicine, Durham, North Carolina, United States of America.

Microcephaly and Zika Virus infection (ZIKV) were declared Public Health Emergencies of International Concern by the World Health Organization in 2016. Brazil was considered the epicenter of the outbreak. However, the occurrence of both ZIKV and microcephaly in Brazil was not evenly distributed across the country. To better understand this phenomenon, we investigate regional characteristics at the municipal level that can be associated with the incidence of microcephaly, our response variable, and its relationship with ZIKV and other predictors. All epidemiological data in this study was provided by the Ministry of Health official database (DATASUS). Microcephaly was only confirmed after birth and the diagnostic was made regardless of the mother's ZIKV status. Using exploratory spatial data analysis and spatial autoregressive Tobit models, our results show that microcephaly incidence is significantly, at 95% confidence level, related not only to ZIKV, but also to access to primary care, population size, gross national product, mobility and environmental attributes of the municipalities. There is also a significant spatial autocorrelation of the dependent variable. The results indicate that municipalities that show a high incidence of microcephaly tend to be clustered in space and that incidence of microcephaly varies considerably across regions when correlated only with ZIKV, i.e. that ZIKV alone cannot explain the differences in microcephaly across regions and their correlation is mediated by regional attributes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222668PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6762139PMC
March 2020

Transition to universal primary health care coverage in Brazil: Analysis of uptake and expansion patterns of Brazil's Family Health Strategy (1998-2012).

PLoS One 2018 10;13(8):e0201723. Epub 2018 Aug 10.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.

Family Health Strategy, the primary health care program in Brazil, has been scaled up throughout the country, but its expansion has been heterogeneous across municipalities. We investigate if there are unique municipal characteristics that can explain the timing of uptake and the pattern of expansion of the Family Health Strategy from years 1998 to 2012. We categorized municipalities in six groups based on the relative speed of the Family Health Strategy uptake and the pattern of Family Health Strategy coverage expansion. We assembled data for 11 indicators for years 2000 and 2010, for 5,507 municipalities, and assessed differences in indicators across the six groups, which we mapped to examine spatial heterogeneities. Important factors differentiating early and late adopters of the Family Health Strategy were supply of doctors and population density. Sustained coverage expansion was related mainly to population size, marginal benefits of the program and doctors' supply. The uptake was widespread nationwide with no distinct patterns among regions, but highly heterogeneous at the state and municipal level. The Brazilian experience of expanding primary health care offers three lessons in relation to factors influencing diffusion of primary health care. First, the funding mechanism is critical for program implementation, and must be accompanied by ways to support the supply of primary care physicians in low density areas. Second, in more developed and bigger areas the main challenge is lack of incentives to pursue universal coverage, especially due to the availability of private insurance. Third, population size is a crucial element to guarantee coverage sustainability over time.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201723PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086633PMC
February 2019

Brazil's Family Health Strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012).

Health Policy Plan 2018 Apr;33(3):368-380

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, EUA.

Universal Health Coverage (UHC) is one of the United Nations Sustainable Development Goals (SDGs). Achieving UHC will require strong health systems to promote and deliver equitable and integrated healthcare services through primary healthcare (PHC). In Brazil, the Family Health Strategy (FHS) delivers PHC through the public health system. Created in 1994, the FHS covered almost 123 million individuals (63% of the Brazilian population) by 2015. The FHS has been associated with many health improvements, but gaps in coverage still remain. This article examines factors associated with the implementation and expansion of the FHS across 5419 Brazilian municipalities from 1998 to 2012. The proportion of the municipal population covered by the FHS over time was assessed using a longitudinal multilevel model for change that accounted for variables covering eight domains: economic development, healthcare supply, healthcare needs/access, availability of other sources of healthcare, political context, geographical isolation, regional characteristics and population size. Data were obtained from multiple publicly available sources. During the 15-year study period, national coverage of the FHS increased from 4.4% to 54%, with 58% of the municipalities having population coverage of 95% or more, and municipalities that had not adopted the programme decreased from 86.4% to 4.9%. The increase in FHS uptake and coverage was not homogenous across municipalities, and was positively associated with small population size, low population density, low coverage of private health insurance, low level of economic development, alignment of the political party of the Mayor and the state Governor, and availability of healthcare supply. Efforts to expand the FHS coverage will need to focus on increasing the availability of health personnel, devising financial incentives for municipalities to uptake/expand the FHS and devising new policies that encompass both private and public sectors.
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http://dx.doi.org/10.1093/heapol/czx189DOI Listing
April 2018

Family health strategy and equity in prenatal care: a population based cross-sectional study in Minas Gerais, Brazil.

Int J Equity Health 2017 01 21;16(1):24. Epub 2017 Jan 21.

CEPEAD, Federal University of Minas Gerais - UFMG, Av. Antônio Carlos 6627, sala 3040, Belo Horizonte, MG, 31270-901, Brazil.

Background: Prenatal care coverage is still not universal or adequately provided in many low and middle income countries. One of the main barriers regards the presence of socioeconomic inequalities in prenatal care utilization. In Brazil, prenatal care is supplied for the entire population at the community level as part of the Family Health Strategy (FHS), which is the main source of primary care provided by the public health system. Brazil has some of the greatest income inequalities in the world, and little research has been conducted to investigate prenatal care utilization of FHS across socioeconomic groups. This paper addresses this gap investigating the socioeconomic and regional differences in the utilization of prenatal care supplied by the FHS in the state of Minas Gerais, Brazil.

Methods: Data comes from a probabilistic household survey carried out in 2012 representative of the population living in urban areas in the state of Minas Gerais. The sample size comprises 1,420 women aged between 13 and 45 years old who had completed a pregnancy with a live born in the last five years prior to the survey. The outcome variables are received prenatal care, number of antenatal visits, late prenatal care, antenatal tests, tetanus immunization and low birthweight. A descriptive analysis and logistic models were estimated for the outcome variables.

Results: The coverage of prenatal care is almost universal in catchment urban areas of FHT of Minas Gerais state including both antenatal visits and diagnostic procedures. Due to this high level of coverage, socioeconomic inequalities were not observed. FHS supplied care for around 80% of the women without private insurance and 90% for women belonging to lower socioeconomic classes. Women belonging to lower socioeconomic classes were at least five times more likely to receive antenatal visits and any of the antenatal tests by the FHS compared to those belonging to the highest classes. Moreover, FHS was effective in reducing low birthweight. Women who had prenatal care through FHS were 40% less likely to have a child with low birthweight.

Conclusion: This paper presents strong evidence that FHS promotes equity in antenatal care in Minas Gerais, Brazil.
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http://dx.doi.org/10.1186/s12939-016-0503-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5251278PMC
January 2017

Logical Inconsistencies in 3 Preference Elicitation Methods for EQ-5D Health States: A Study in the Brazilian Population.

Med Decis Making 2016 02 19;36(2):242-52. Epub 2015 Aug 19.

Economics Department, Center for Regional Development and Planning, Universidade Federal de Minas Gerais, Minas Gerais, Brazil (MVA, KN, and LRDC)

Background: . Logical inconsistency for health states preferences occurs when one logically worse health state, in terms of quality of life, is ranked higher than a logically better health state.

Objective: . This study explores the presence of inconsistent responses for the EQ-5D health states valuations in a Brazilian population survey. It compares the level of inconsistency in 3 preference-based methods: ranking, visual analog scale (VAS), and time tradeoff (TTO). The influence of EQ-5D health state descriptions is explored by examining the distance between states using a city-block metric as an indicator of proximity. Moreover, it examines the association between formal education and the presence of inconsistencies, as well as the effect of removing inconsistent respondents on the estimation of social value sets from TTO and VAS.

Methods: . Data came from a valuation study with 3362 literate individuals aged between 18 and 64 years living in urban areas of Minas Gerais state, Brazil. Logical inconsistency was assessed using the percentage of inconsistent respondents and inconsistency rate. A logistic model was estimated to assess the association between formal education and the logical inconsistency. Societal preferences were estimated excluding inconsistent respondents considering city-block metric.

Results: . The percentage of inconsistent respondents and inconsistency rate are similar for TTO and ranking and lower for VAS. The probability of being inconsistent is higher among less educated groups in ranking and TTO. Inconsistency decreases with distance for all 3 methods. The removal of inconsistent individuals by considering city-block distance improves TTO estimation of social value sets.

Conclusion: . Findings suggest that removal of inconsistencies in TTO should consider city-block distance. For VAS, inconsistencies are not associated with formal education and do not affect social value set estimation.
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http://dx.doi.org/10.1177/0272989X15601047DOI Listing
February 2016

[Equity in coverage by the Family Health Strategy in Minas Gerais State, Brazil].

Cad Saude Publica 2015 Jun 1;31(6):1175-87. Epub 2015 Jun 1.

Faculdade de Ciências Econômicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.

The Family Health Strategy (FHS) plays an important role in prevention and in monitoring families in the Brazilian Unified National Health System. This study aims to analyze equity in the coverage of these services in the urban areas of Minas Gerais State, Brazil. The research is unprecedented and analyzes several markers for four target groups: women, pregnant women, children, and the elderly. The study is representative of the various health macro-regions. In 2012, 6,797 households were surveyed, with 5,820 women, 1,758 children, and 3,629 elderly. To analyze equity, FHS coverage rates were calculated according to family income, and concentration indices and curves were estimated. The results show that the FHS is an equitable policy. The indicators show that poorer households have higher visitation rates under the FHS. Coverage of the eligible population is quite high: 88% of households received at least one visit from FHS professionals in the previous 12 months, resulting in a concentration index near zero.
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http://dx.doi.org/10.1590/0102-311X00130414DOI Listing
June 2015