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