Author(s): Rasella, Davide ; Pereira, Rosana Aquino Guimarães ; Santos, Carlos Antonio de Souza Teles ; Paes-Sousa, Rômulo ; Barreto, Mauricio Lima ; Rasella, Davide ; Pereira, Rosana Aquino Guimarães ; Santos, Carlos Antonio de Souza Teles ; Paes-Sousa, Rômulo ; Barreto, Mauricio Lima
Date: 2014
Origin: Oasisbr
Subject(s): Bolsa Familia Programme; Public Health; Reduction in Child Mortality; Programa Bolsa Família; Saúde Pública; Redução Mortalidade Infantil
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Made available in DSpace on 2014-01-15T13:12:42Z (GMT). No. of bitstreams: 1 Davide Rasella. 2013.pdf: 183287 bytes, checksum: 44cd636416cd3bbe54c49b82640fd0d2 (MD5) Previous issue date: 2013
In the past 15 years, Brazil has undergone notable social and public health changes, including a large reduction in child mortality. The Bolsa Familia Programme (BFP) is a widespread conditional cash transfer programme, launched in 2003, which transfers cash to poor households (maximum income US$70 per person a month) when they comply with conditions related to health and education. Transfers range from $18 to $175 per month, depending on the income and composition of the family. We aimed to assess the effect of the BFP on deaths of children younger than 5 years (under-5), overall and resulting from specific causes associated with poverty: malnutrition, diarrhoea, and lower respiratory infections. Methods The study had a mixed ecological design. It covered the period from 2004—09 and included 2853 (of 5565) municipalities with death and livebirth statistics of adequate quality. We used government sources to calculate all-cause under-5 mortality rates and under-5 mortality rates for selected causes. BFP coverage was classified as low (0·0—17·1%), intermediate (17·2—32·0%), high (>32·0%), or consolidated (>32·0% and target population coverage ≥100% for at least 4 years). We did multivariable regression analyses of panel data with fixed-effects negative binomial models, adjusted for relevant social and economic covariates, and for the effect of the largest primary health-care scheme in the country (Family Health Programme).Findings Under-5 mortality rate, overall and resulting from poverty-related causes, decreased as BFP coverage increased. The rate ratios (RR) for the effect of the BFP on overall under-5 mortality rate were 0·94 (95% CI 0·92—0·96) for intermediate coverage, 0·88 (0·85—0·91) for high coverage, and 0·83 (0·79—0·88) for consolidated coverage. The effect of consolidated BFP coverage was highest on under-5 mortality resulting from malnutrition (RR 0·35; 95% CI 0·24—0·50) and diarrhoea (0·47; 0·37—0·61). Interpretation A conditional cash transfer programme can greatly contribute to a decrease in childhood mortality overall, and in particular for deaths attributable to poverty-related causes such as malnutrition and diarrhoea, in a large middle-income country such as Brazil.
London
