Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities.

Abstract

BACKGROUND:

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.

FUNDING:

National Institutes of Science and Technology Programme, Ministry of Science and Technology, and Council for Scientific and Technological Development Programme (CNPq), Brazil.

• Authors: Davide Rasella, Rosana Aquino, Carlos A T Santos, Rômulo Paes-Sousa, Mauricio L Barreto
• Journal: Lancet (London, England) (Lancet) Vol. 382 Issue 9886 Pg. 57-64 (Jul 06 2013) ISSN: 1474-547X [Electronic] England
• PMID: 23683599 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Topics

• Brazil (epidemiology)
• Child Mortality (trends)
• Child Nutrition Disorders (economics, mortality, prevention & control)
• Child Welfare (economics)
• Child, Preschool
• Cities
• Diarrhea (economics, mortality, prevention & control)
• Epidemiologic Methods
• Financing, Government
• Humans
• Infant
• Poverty
• Program Evaluation
• Respiratory Tract Infections (economics, mortality, prevention & control)
• Social Security (economics)