In 2014, the migration rate per 1,000 inhabitants in Brazil was estimated at about -0.73. Between 1950 and 2014, the figure dropped by approximately 0.91, though the decline followed an uneven course rather than a steady trajectory. From 2014 to 2100, the rate will rise by around 0.59, showing an overall upward trend with periodic ups and downs.

Abstract

This study is an experiment designed to compare the performance of three methodologies for sampling households with migrants:

• a stratified sample using the census to sample census tracts randomly, in which each household is then listed and screened to determine whether or not it has a migrant, with the full length questionnaire then being applied in a second phase only to the households of interest;
• a snowball survey in which households are asked to provide referrals to other households with migrant members;
• an intercept point survey (or time-and-space sampling survey), in which individuals are sampled during set time periods at a prespecified set of locations where households in the target group are likely to congregate.

Researchers from the World Bank applied these methods in the context of a survey of Brazilians of Japanese descent (Nikkei), requested by the World Bank. There are approximately 1.2-1.9 million Nikkei among Brazil’s 170 million population.

The survey was designed to provide detail on the characteristics of households with and without migrants, to estimate the proportion of households receiving remittances and with migrants in Japan, and to examine the consequences of migration and remittances on the sending households.

The same questionnaire was used for the stratified random sample and snowball surveys, and a shorter version of the questionnaire was used for the intercept surveys. Researchers can directly compare answers to the same questions across survey methodologies and determine the extent to which the intercept and snowball surveys can give similar results to the more expensive census-based survey, and test for the presence of biases.

Geographic coverage

Sao Paulo and Parana states

Analysis unit

Japanese-Brazilian (Nikkei) households and individuals

The 2000 Brazilian Census was used to classify households as Nikkei or non-Nikkei. The Brazilian Census does not ask ethnicity but instead asks questions on race, country of birth and whether an individual has lived elsewhere in the last 10 years. On the basis of these questions, a household is classified as (potentially) Nikkei if it has any of the following: 1) a member born in Japan; 2) a member who is of yellow race and who has lived in Japan in the last 10 years; 3) a member who is of yellow race, who was not born in a country other than Japan (predominantly Korea, Taiwan or China) and who did not live in a foreign country other than Japan in the last 10 years.

Kind of data

Sample survey data [ssd]

Sampling procedure

1) Stratified random sample survey

Two states with the largest Nikkei population - Sao Paulo and Parana - were chosen for the study.

The sampling process consisted of three stages. First, a stratified random sample of 75 census tracts was selected based on 2000 Brazilian census. Second, interviewers carried out a door-to-door listing within each census tract to determine which households had a Nikkei member. Third, the survey questionnaire was then administered to households that were identified as Nikkei. A door-to-door listing exercise of the 75 census tracts was then carried out between October 13th, 2006, and October 29th, 2006. The fieldwork began on November 19, 2006, and all dwellings were visited at least once by December 22, 2006. The second wave of surveying took place from January 18th, 2007, to February 2nd, 2007, which was intended to increase the number of households responding.

2) Intercept survey

The intercept survey was designed to carry out interviews at a range of locations that were frequented by the Nikkei population. It was originally designed to be done in Sao Paulo city only, but a second intercept point survey was later carried out in Curitiba, Parana. Intercept survey took place between December 9th, 2006, and December 20th, 2006, whereas the Curitiba intercept survey took place between March 3rd and March 12th, 2007.

Consultations with Nikkei community organizations, local researchers and officers of the bank Sudameris, which provides remittance services to this community, were used to select a broad range of locations. Interviewers were assigned to visit each location during prespecified blocks of time. Two fieldworkers were assigned to each location. One fieldworker carried out the interviews, while the other carried out a count of the number of people with Nikkei appearance who appeared to be 18 years old or older who passed by each location. For the fixed places, this count was made throughout the prespecified time block. For example, between 2.30 p.m. and 3.30 p.m. at the sports club, the interviewer counted 57 adult Nikkeis. Refusal rates were carefully recorded, along with the sex and approximate age of the person refusing.

In all, 516 intercept interviews were collected.

3) Snowball sampling survey

The questionnaire that was used was the same as used for the stratified random sample. The plan was to begin with a seed list of 75 households, and to aim to reach a total sample of 300 households through referrals from the initial seed households. Each household surveyed was asked to supply the names of three contacts: (a) a Nikkei household with a member currently in Japan; (b) a Nikkei household with a member who has returned from Japan; (c) a Nikkei household without members in Japan and where individuals had not returned from Japan.

The snowball survey took place from December 5th to 20th, 2006. The second phase of the snowballing survey ran from January 22nd, 2007, to March 23rd, 2007. More associations were contacted to provide additional seed names (69 more names were obtained) and, as with the stratified sample, an adaptation of the intercept survey was used when individuals refused to answer the longer questionnaire. A decision was made to continue the snowball process until a target sample size of 100 had been achieved.

The final sample consists of 60 households who came as seed households from Japanese associations, and 40 households who were chain referrals. The longest chain achieved was three links.

Mode of data collection

Face-to-face [f2f]

Research instrument

1) Stratified sampling and snowball survey questionnaire

This questionnaire has 36 pages with over 1,000 variables, taking over an hour to complete.

If subjects refused to answer the questionnaire, interviewers would leave a much shorter version of the questionnaire to be completed by the household by themselves, and later picked up. This shorter questionnaire was the same as used in the intercept point survey, taking seven minutes on average. The intention with the shorter survey was to provide some data on households that would not answer the full survey because of time constraints, or because respondents were reluctant to have an interviewer in their house.

2) Intercept questionnaire

The questionnaire is four pages in length, consisting of 62 questions and taking a mean time of seven minutes to answer. Respondents had to be 18 years old or older to be interviewed.

Response rate

1) Stratified random sampling 403 out of the 710 Nikkei households were surveyed, an interview rate of 57%. The refusal rate was 25%, whereas the remaining households were either absent on three attempts or were not surveyed because building managers refused permission to enter the apartment buildings. Refusal rates were higher in Sao Paulo than in Parana, reflecting greater concerns about crime and a busier urban environment.

2) Intercept Interviews 516 intercept interviews were collected, along with 325 refusals. The average refusal rate is 39%, with location-specific refusal rates ranging from only 3% at the food festival to almost 66% at one of the two grocery stores.

Close to 11.4 thousand Japanese residents were registered in São Paulo as of October 2018. The number steadily declined throughout the surveyed period. The statistic, which is based on the information gathered by Japanese diplomatic missions abroad, does not include descendants of Japanese emigrants (nikkeijin) who do not hold Japanese citizenship. People with multiple citizenship are counted.

Background/MethodsIn a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients.ResultsThe majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed.ConclusionAn interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system.