Abstract
BackgroundThis study aims to assess the interactive effects of Brazilian public interventions, environmental health programs (access to water, sanitation and solid waste collection) and a Conditional Cash Transfer Program (PBF), on the mortality reduction due to diarrhea and malnutrition among children under 5 years old.MethodsThe study design is ecological, with longitudinal analysis in a balanced panel. The period covered is 2006 to 2016, including 3467 municipalities from all regions of the country, which resulted in 38,137 observations. The generalized linear models were adjusted considering the Negative Binomial (NB) distribution for the number of deaths due to malnutrition and diarrhea, with fixed effects. NB models with and without zero-inflation were assessed. Subsequent interaction models were applied to assess the combined effects of the two public policies.ResultsIn relation to the decline of mortality rates due to diarrhea in the municipalities, positive effect modification were observed in the presence of: high coverage of the target population by the PBF and access to water, 0.54 (0.28–1.04) / 0.55 (0.29–1.04); high coverage by the total population by the PBF and access to water, 0.97 (0.95–1.00) and high coverage by the total population by the PBF and access to sanitation, 0.98 (0.97–1.00). Decline on diarrhea mortality was also observed in the joint presence of high coverage of solid waste collection and access to water, categories 1 (> 60% ≤85%): 0.98 (0.96–1.00), 0.98 (0.97–1, 00) and 2 (> 85% ≤ 100%): 0.97 (0.95–0.98), 0.97 (0.95–0.99). Negative effect modification were observed for mortality due to malnutrition in the presence of simultaneous high coverage of the total population by the PBF and access to sanitation categories 1 (≥ 20 < 50%): 1.0061 (0.9991–1.0132) and 2 (≥ 50 < 100%): 1.0073 (1.0002–1.0145) and high coverage of the total population by the PBF and solid waste collection, 1.0004 (1.0002–1.0005), resulting in malnutrition mortality rates increase.ConclusionImplementation of environmental health services and the coverage expansion by the PBF may enhance the prevention of early deaths in children under 5 years old due to diarrhea, a poverty related disease.
Highlights
Brazil remains among the countries with the highest levels of inequality [1, 2]
Groups A00 - A04 and A06 A09 were used for mortality due to diarrhea. Those are classified as Diseases Related to Inadequate Environmental Sanitation (DRSAI) [30]
Population served by primary care related to the Family Health Strategy (FHS) and Primary Care Information System (SIAB) / DATASUS total municipal population aOnly categories related to deaths due to diarrhea were chosen, which were classified as Diseases Related to Inadequate Environmental Sanitation (DRSA I) [46]. bInternational Statistical Classification Codes for Diseases and Health-Related Problems - 10th revision (CID-10). cFor variables with information only for the years related to the censuses, 2000 and 2010, interpolation (2006 to 2009) and linear extrapolation (2011 to 2016) methods were applied
Summary
Brazil remains among the countries with the highest levels of inequality [1, 2]. Progress in poverty reduction achieved until 2014 began to reverse due to economic slowdown, after a period of sharp and sustained decline of poverty and inequality since 2004 [1, 2]. The list of deficits encompasses income, food, adequate housing, and public services, such as health, education, water, sanitation and solid waste collection [2, 3]. In relation to environmental health interventions, the main deficits that still prevail in the country are primarily related to sanitation, which is far from the necessary level of universalization [3,4,5,6]. This study aims to assess the interactive effects of Brazilian public interventions, environmental health programs (access to water, sanitation and solid waste collection) and a Conditional Cash Transfer Program (PBF), on the mortality reduction due to diarrhea and malnutrition among children under 5 years old
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
