Effect of a conditional cash transfer programme on childhood mortality

A nationwide analysis of Brazilian municipalities

Bibliographic Data

ID23356986
AuthorsDavide Rasella (0000-0002-7260-4386, Universidade Federal da Bahia), Redford Aquino (0000-0003-3906-5170, Universidade Federal da Bahia), Rosana Aquino, Carlos AT Santos (Universidade Federal da Bahia), Rômulo Paes-Sousa (0000-0002-3384-6657, University of Sussex), Maurício Lima Barreto (0000-0002-0215-4930, Universidade Federal da Bahia, corresponding author)
Year2013
Volume382
Issue9886
Pages57-64
Publication date2013-07-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueThe Lancet (JOURNAL)
Journal identifiersISSN: 0099-5355 • E-ISSN: 0140-6736
PublisherElsevier BV (PUBLISHER)
DOI10.1016/s0140-6736(13)60715-1
PMID23683599
OpenAlexW2098554292
LanguageEN
Citations received184
References cited20

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.

Cash transfers · Child mortality · Conditional cash transfer · Economic growth · Economics · Environmental health · Geography · Mortality rate · Population · Poverty · Public health · Demography · Global Maternal and Child Health · Maternal and Neonatal Healthcare · Medicine · Poverty, Education, and Child Welfare