Dataset Information

Bolsa Familia Program and Perinatal Outcomes: NISAMI Cohort.

ABSTRACT: This study aimed to assess the impact of the Bolsa Familia Program on perinatal outcomes of pregnant women. A cohort study was conducted with pregnant women supported by prenatal services at 17 Family Health Units in Bahia, Brazil. A previously tested structured questionnaire, which has sociodemographic, economic, prenatal care, lifestyle, and nutritional variables, has been used to collect data. The outcomes included premature birth and low birth weight. A hierarchical conceptual model was constructed, and logistic regression analysis was performed. From a total of 1173 pregnant women, the identified average age was 25.44 years and 34.10% had pre-gestational overweight. The non-beneficiary pregnant women presented a 1.54 (95% CI = 0.46-5.09) times higher chance of giving birth to children with low weight and a 1.03 (95% CI = 95% CI = 0.53-2.00) times chance of premature birth when compared to the beneficiary group. In the multilevel model, some variables were statistically significant, such as age between 18 and 24 years (p = 0.003), age greater than or equal to 35 years (p = 0.025), family income (p = 0.008), employment status (p = 0.010), and maternal height (p = 0.009). The Bolsa Familia Program, as an integrated strategy of social inclusion and economic development, is suggested to exert a protective effect on the health of mother-concept binomial.

SUBMITTER: Lisboa CS

PROVIDER: S-EPMC9105772 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Bolsa Familia Program and Perinatal Outcomes: NISAMI Cohort.

Lisboa Cinthia Soares CS da Mota Santana Jerusa J de Cássia Ribeiro-Silva Rita R de Araújo Edna Maria EM Lima da Silva Carlos Alberto CA Barreto Mauricio Lima ML Pereira Marcos M Santos Djanilson Barbosa Dos DBD

International journal of environmental research and public health 20220428 9

This study aimed to assess the impact of the Bolsa Familia Program on perinatal outcomes of pregnant women. A cohort study was conducted with pregnant women supported by prenatal services at 17 Family Health Units in Bahia, Brazil. A previously tested structured questionnaire, which has sociodemographic, economic, prenatal care, lifestyle, and nutritional variables, has been used to collect data. The outcomes included premature birth and low birth weight. A hierarchical conceptual model was cons ...[more]

PMID: 35564740

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Project description:Conditional cash transfer (CCT) programs provide poor families with cash conditional on investments in health and education. Brazil's Bolsa Família program began in 2003 and is currently the largest CCT program in the world. This community-based study examines the impact of Bolsa Família on child health in a slum community in a large urban center.In 2010, detailed household surveys were conducted with randomly selected Bolsa Família beneficiaries and non-beneficiaries in a Brazilian slum community of approximately 14,000 inhabitants in a large urban center. 567 families (with 1,266 children) were interviewed. Propensity score methods were used to control for differences between beneficiary and non-beneficiary children to estimate program impacts on health care utilization and health outcomes.Bolsa Família has increased the odds of children's visits to the health post for preventive services. In children under age seven, Bolsa Família was associated with increased odds for growth monitoring (OR?=?3.1; 95% CI 1.9-5.1), vaccinations (OR?=?2.8; 95% CI 1.4-5.4), and checkups (OR?=?1.6; 95% CI 0.98-2.5), and with the number of growth monitoring visits (??=?0.6; p?=?0.049) and checkups (??=?0.2; p?=?0.068). There were positive spillover effects on older siblings (ages 7-17) no longer required to meet the health conditionalities. Bolsa Família increased their odds for growth monitoring (OR?=?2.5; 95% CI 1.3-4.9) and checkups (OR?=?1.7; 95% CI 0.9-3.2) and improved psychosocial health (??=?2.6; p?=?0.007).Bolsa Família has improved health care utilization, especially for services related to the health conditionalites, and there were positive spillover effects on older siblings. The findings of this study are promising, but they also suggest that further improvements in health may depend on the quality of health care services provided, the scope of services linked to the health conditionalities, and coordination with other social safety net programs.

Project description:BackgroundPsychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders.Methods and findingsThis cohort study utilised Brazilian administrative datasets, linking social and health system data from the 100 Million Brazilian Cohort, a population-representative study. We followed individuals who applied for BFP following a single hospitalisation with a psychiatric disorder between 2008 and 2015. The outcome was mortality and specific causes, defined according to International Classification of Diseases 10th Revision (ICD-10). Cox proportional hazards models estimated the hazard ratio (HR) for overall mortality and competing risks models estimated the HR for specific causes of death, both associated with being a BFP recipient, adjusted for confounders, and weighted with a propensity score. We included 69,901 psychiatric patients aged between 10 and 120, with the majority being male (60.5%), and 26,556 (37.99%) received BFP following hospitalisation. BFP was associated with reduced overall mortality (HR 0.93, 95% CI 0.87,0.98, p 0.018) and mortality due to natural causes (HR 0.89, 95% CI 0.83, 0.96, p < 0.001). Reduction in suicide (HR 0.90, 95% CI 0.68, 1.21, p = 0.514) was observed, although it was not statistically significant. The BFP's effects on overall mortality were more pronounced in females and younger individuals. In addition, 4% of deaths could have been prevented if BFP had been present (population attributable risk (PAF) = 4%, 95% CI 0.06, 7.10).ConclusionsBFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.

Project description:IntroductionBrazil's Bolsa Familia Program (BFP) is the world's largest conditional cash transfer scheme. We shall use a large cohort of applicants for different social programmes to evaluate the effect of BFP receipt on premature all-cause and cardiovascular mortality.Methods and analysisWe will identify BFP recipients and non-recipients among new applicants from 2004 to 2015 in the 100 Million Brazilian Cohort, a database of 114 million individuals containing sociodemographic and mortality information of applicants to any Brazilian social programme. For individuals applying from 2011, when we have better recorded income data, we shall compare premature (age 30-69) cardiovascular and all-cause mortality among BFP recipients and non-recipients using regression discontinuity design (RDD) with household monthly per capita income as the forcing variable. Effects will be estimated using survival models accounting for individuals follow-up. To test the sensitivity of our findings, we will estimate models with different bandwidths, include potential confounders as covariates in the survival models, and restrict our data to locations with the most reliable data. In addition, we will estimate the effect of BFP on studied outcomes using propensity score risk-set matching, separately for individuals that applied ≤2010 and >2011, allowing comparability with RDD. Analyses will be stratified by geographical region, gender, race/ethnicity and socioeconomic position. We will investigate differential impacts of BFP and the presence of effect modification for a combination of characteristics, including gender and race/ethnicity.Ethics and disseminationThe study was approved by the ethics committees of Oswaldo Cruz Foundation and the University of Glasgow College of Medicine and Veterinary Life Sciences. The deidentified dataset will be provided to researchers, and data analysis will be performed in a safe computational environment without internet access. Study findings will be published in high quality peer-reviewed research articles. The published results will be disseminated in the social media and to policy-makers.

Project description:BackgroundAlthough low socioeconomic status is a recognised risk factor for substance use disorders (SUDs), the potential of socioeconomic interventions, such as conditional cash transfer programmes, to mitigate this burden remains poorly explored. Our study investigated whether the Brazilian conditional cash transfer, the Bolsa Familia Program (BFP) was associated with reduced SUD hospitalisations (ie, both admission to and treatment within hospital).MethodsThis quasi-experimental study used national administrative hospitalisation and BFP payroll records linked to the 100 Million Brazilian Cohort baseline from 2008 to 2015. We used Poisson regression models with inverse probability of treatment weighting, using the propensity score, to evaluate the association of the BFP with SUD hospitalisations.FindingsThe study included 35 926 326 individuals registered at baseline from 2008 to 2015. BFP benefit was associated with a lower risk of SUD hospitalisations overall (incidence rate ratios [IRR] 0·83, 95% CI 0·81-0·85). BFP benefit was also associated with both a lower risk of alcohol-related hospitalisations (0·74, 0·71-0·77) and a lower risk of hospitalisations due to other substances except alcohol (0·89, 0·86-0·92). Both male and female beneficiaries had a lower risk of SUD hospitalisation compared with non-beneficiaries. We observed an increased gradient of protection against SUD hospitalisations among beneficiaries of the BFP as municipal deprivation increased. The reduction was 10% (IRR 0·90, 0·87-0·92) in less deprived municipalities and 41% (0·59, 0·49-0·71) in highly deprived municipalities.InterpretationReceiving BFP benefit was associated with lower risk of SUD hospitalisation, implicating conditional cash transfers as a potential tool to respond to SUD-related issues in individuals experiencing poverty. This protective association could be mediated by alleviating poverty, fulfilling basic needs, improving socioeconomic status, enhancing health access, and promoting education.FundingNational Institute of Mental Health-National Institutes of Health.TranslationFor the Portuguese translation of the abstract see Supplementary Materials section.

Project description:BackgroundSocioeconomic factors have been consistently associated with suicide, and economic recessions are linked to rising suicide rates. However, evidence on the impact of socioeconomic interventions to reduce suicide rates is limited. This study investigates the association of the world's largest conditional cash transfer programme with suicide rates in a cohort of half of the Brazilian population.Methods and findingsWe used data from the 100 Million Brazilian Cohort, covering a 12-year period (2004 to 2015). It comprises socioeconomic and demographic information on 114,008,317 individuals, linked to the "Bolsa Família" programme (BFP) payroll database, and nationwide death registration data. BFP was implemented by the Brazilian government in 2004. We estimated the association of BFP using inverse probability of treatment weighting, estimating the weights for BFP beneficiaries (weight = 1) and nonbeneficiaries by the inverse probability of receiving treatment (weight = E(ps)/(1-E(ps))). We used an average treatment effect on the treated (ATT) estimator and fitted Poisson models to estimate the incidence rate ratios (IRRs) for suicide associated with BFP experience. At the cohort baseline, BFP beneficiaries were younger (median age 27.4 versus 35.4), had higher unemployment rates (56% versus 32%), a lower level of education, resided in rural areas, and experienced worse household conditions. There were 36,742 suicide cases among the 76,532,158 individuals aged 10 years, or older, followed for 489,500,000 person-years at risk. Suicide rates among beneficiaries and nonbeneficiaries were 5.4 (95% CI = 5.32, 5.47, p < 0.001) and 10.7 (95% CI = 10.51, 10.87, p < 0.001) per 100,000 individuals, respectively. BFP beneficiaries had a lower suicide rate than nonbeneficiaries (IRR = 0.44, 95% CI = 0.42, 0.45, p < 0.001). This association was stronger among women (IRR = 0.36, 95% CI = 0.33, 0.38, p < 0.001), and individuals aged between 25 and 59 (IRR = 0.41, 95% CI = 0.40, 0.43, p < 0.001). Study limitations include a lack of control for previous mental disorders and access to means of suicide, and the possible under-registration of suicide cases due to stigma.ConclusionsWe observed that BFP was associated with lower suicide rates, with similar results in all sensitivity analyses. These findings should help to inform policymakers and health authorities to better design suicide prevention strategies. Targeting social determinants using cash transfer programmes could be important in limiting suicide, which is predicted to rise with the economic recession, consequent to the Coronavirus Disease 2019 (COVID-19) pandemic.

Dataset Information

Bolsa Familia Program and Perinatal Outcomes: NISAMI Cohort.

Publications

Bolsa Familia Program and Perinatal Outcomes: NISAMI Cohort.

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