Health outcomes of the Bolsa Familia program among Brazilian Amazonian children

Abstract

OBJECTIVE: One of the primary objectives of Brazil's conditional cash transfer program, Bolsa Familia, is to break the intergenerational transmission of poverty by improving human capital via conditionalities. In this study, we hypothesized that health indicators of Bolsa Familia participants would be comparable to those of other local children who were nonparticipants after two years of follow-up in the city of Acrelandia, Acre state, Western Brazilian Amazon. METHODS: Data from a population-based longitudinal study were analyzed to examine school enrollment, vaccination coverage, height and body mass index for age z-scores, and biomarkers of micronutrient deficiencies (iron and vitamin A) between Bolsa Familia participants (n = 325) and nonparticipants (n = 738). RESULTS: Out of 1063 children 10 years and younger included in the 2007 baseline survey, 805 had anthropometric measurements and 402 had biochemical indicators in the 2009 follow-up survey. Prevalence rate ratio (PRR) for non-enrollment in school at 4 years of age was 0.58 (95%CI: 0.34-1.02) when comparing Bolsa Familia participants with nonparticipants. No difference was found for vaccination coverage, which was insufficient for most vaccine-preventable diseases. Bolsa Familia participants were less likely to show a positive change in body mass index for age z-scores compared with nonparticipants (PRR = 0.81, 95%CI: 0.70-0.95), while a positive change in height for age z-scores was similar in the groups. No differences in micronutrient deficiencies were found between groups after 2 years. CONCLUSIONS: Early school enrollment and consistent nutritional indicators between Bolsa Familia participants and nonparticipants suggest Bolsa Familia was facilitating similarities between groups over time.