Abstract
BackgroundMalaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with nearly all (99%) Brazilian cases in the Amazon region. The Bolsa Família Programme (BFP) is a conditional cash transfer (CCT) programme launched in 2003 to reduce poverty and has led to improvements in health outcomes. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, however this relationship is underexplored. This study investigated the association between BFP coverage and malaria incidence in Brazil.MethodsA longitudinal panel study was conducted of 807 municipalities in the Brazilian Amazon between 2004 and 2015. Negative binomial regression models adjusted for demographic and socioeconomic covariates and time trends were employed with fixed effects specifications.ResultsA one percentage point increase in municipal BFP coverage was associated with a 0.3% decrease in the incidence of malaria (RR = 0.997; 95% CI = 0.994–0.998). The average municipal BFP coverage increased 24 percentage points over the period 2004–2015 corresponding to be a reduction of 7.2% in the malaria incidence.ConclusionsHigher coverage of the BFP was associated with a reduction in the incidence of malaria. CCT programmes should be encouraged in endemic regions for malaria in order to mitigate the impact of disease and poverty itself in these settings.
Highlights
Malaria causes 400 thousand deaths worldwide annually
This study investigated the association between the expansion of the Bolsa Família Programme (BFP) in Brazil and malaria incidence in endemic Brazilian municipalities between 2004 and 2015
Descriptive analysis of trends of malaria incidence and for all the variables along the period under study was performed, after which regression models were fitted to verify the association between the BFP coverage and malaria incidence
Summary
Malaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with most (99%) Brazilian cases in the Amazon region. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, this relationship is underexplored. Malaria is a major health burden that occurs mainly in the tropical regions of Africa, Asia and South America – the most impoverished regions of the planet. In 2018, there were 228 million cases and 405,000 deaths due to malaria worldwide. Of all malaria cases in the Americas in 2018, 25% were in Brazil [1]. The endemic area for malaria coincides with rural zones in the Brazilian Amazon, the poorest region of the country [2, 3]. 89% of these infections were due to Plasmodium vivax, while the rest were caused mainly by P. falciparum or mixed infections [3, 4]
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