Abstract
BackgroundThe mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections.MethodsMortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates.ResultsOur research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953–0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984–0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea.ConclusionsA conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections. The coverage should be maintained -or increased in a period of economic crisis- and its implementation strengthened.
Highlights
The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; thousands of children continue to die from causes related to poverty
Our results show that the implementation of the Bono de Desarrollo Humano (BDH) from 2009 to 2014 was associated with a reduction in U5MR from poverty-related causes such as malnutrition and lower respiratory infections at the county level
Our results showed that the BDH program has a positive effect on under-5 mortality resulting from malnutrition, we did not obtain the same effect on under-5 mortality resulting from diarrhea
Summary
The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. American and the Caribbean (LAC) have reduced the under-five mortality rate by 67% since 1990. Despite this progress, millions of children continue to live and die in conditions that are unacceptable. It has been described that the majority of child deaths are due to poverty and as a result of diseases that can be prevented and treated and economically [2]. 77% and 42% of countries have unconditional and conditional cash transfers, respectively; significant
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