Bolsa Familia Program Research Articles

CHILD FEEDING BEHAVIOUR, NUTRITIONAL STATUS, AND FOOD AND NUTRITION SECURITY AMONG PRESCHOOLERS IN A SOCIALLY VULNERABLE AREA

Food insecurity (FI) can directly impact children’s eating behaviour and nutritional status, potentially leading to long-term health issues. This study aimed to examine the relationship between children’s eating behaviour, nutritional status, and FI among preschoolers in a socially vulnerable area of a municipality in Southern Brazil. A cross-sectional, quantitative study was conducted involving children aged 2 to 5 who were beneficiaries of the Bolsa Família Program (BFP). Data were collected using the Child Eating Behavior Questionnaire (CEBQ) and the Brazilian Food Insecurity Scale (EBIA). Nutritional status was classified using height-for-age and BMI-for-age indices. The study comprised 90 children, with 59.0% experiencing food insecurity. Girls exhibited a higher average score of disordered eating behaviour compared to boys, indicating a stronger interest in food. Nutritional status analysis revealed a high prevalence of overweight risk (43.30%), particularly among boys. A significant association was observed between BMI-for-age (eutrophy) and food insecurity (p=0.003). The majority of eutrophic children also experience food insecurity. There is a need to carry out research on similar topics in order to support the development of public policies on food and nutritional security.

Income transfer and COVID-19 pandemic in Brazil: wrong and right at the same time

Abstract To alleviate the effects of socioeconomic inequalities and of the fall in economic activity on vulnerable populations during the COVID-19 pandemic, many countries have implemented or expanded income distribution programs. Brazil, amid the political and economic 2020 crisis, exacerbated by the pandemic, established Emergency Aid (EA). This longitudinal ecological study aimed to analyze whether the availability of EA contributed to the reduction of morbidity and mortality due to COVID-19 in the Brazilian 5,570 municipalities, from March 2020 to December 2021. The theoretical model considered as control covariates socioeconomic, sociodemographic and morbidity characteristics and access to health services, including COVID-19 testing availability and vaccination. Classical variable selection methods were applied considering the theoretical model, culminating in the adjustment of Bayesian hierarchical models with the inclusion of spatial and temporal effects. First dose COVID-19 vaccine coverage and EA had a protective effect against hospitalization (RR = 0.982 and RR = 0.986) and mortality (RR = 0.978 and RR = 0.976) due to COVID-19 in Brazil, when controlled by socioeconomic variables, access to health services and spatial-temporal effects. The results highlight the important role of income transfer in morbidity and mortality due to the disease, however, the way in which EA was implemented in Brazil presented a series of problems, the main ones being discontinued payment of aid, reduction in values throughout the duration of the benefit, in addition to the use of public resources to pay people who did not meet the eligibility criteria. Such problems might not have happened if the federal government had maintained the registration structure of Bolsa Familia Program (BFP), which did not happen. Furthermore, vaccination was started late for several reasons, that is, its role in reducing morbidity and mortality could have been even greater if started as soon as it become available. Key messages • Even with planning and execution problems, income transfer and specific vaccination were important in reducing COVID-19 morbidity and mortality in Brazil during the COVID-19 pandemic. • Income transfer during the COVID-19 pandemic in Brazil was not done in the best way possible, due to discontinued payment, reduction in values and payment to not eligible people.

Effect of the COVID-19 pandemic on malnutrition in socially vulnerable children in Brazil.

This article aims to evaluate the effect of the COVID-19 pandemic on malnutrition among children under two years of age enrolled in the Bolsa Família Program (BFP). Ecological study of interrupted time series (ITS), with low weight for age, stunting, and overweight as time-dependent variables of malnutrition, extracted monthly (Jan/2008 to June/2021) from the Food and Nutrition Surveillance System. The COVID-19 pandemic was the exposure, dichotomized into pre-pandemic and pandemic. In RStudio, the trend was obtained by Prais-Winsten regression, and the effect of the pandemic on the time-dependent variables was determined by SARIMA modeling, estimating the regression coefficients (RC) adjusted for trend and seasonality (α = 5%). The pandemic was associated with an increase in: i) low weight for age in the South (RC = 0.94; p < 0.001) and Southeast (RC = 1.97; p < 0.001); ii) height deficit in the Midwest (RC = 2.4; p = 0.01), South (RC = 2.15; p < 0.001) and Southeast (RC = 2.96; p < 0.001); and iii) and overweight in the North (RC = 1.51; p = 0.04), Midwest (RC = 2.29; p = 0.01), South (RC = 2.83; p < 0.001), and Southeast (RC = 0.72; p = 0.04). The pandemic increased underweight in the South and Southeast, and the double burden of malnutrition in the Midwest, South, and Southeast. In the Northeast and North, higher rates of malnutrition still persist.

Trends in Complementary Feeding Indicators in Children Aged 6-23 Months According to Participation in a Conditional Cash Transfer Program: Data from the Brazilian Food and Nutrition Surveillance System, 2015-2019.

Inadequate practices during complementary feeding are associated with malnutrition, especially in children experiencing vulnerable conditions and social inequality. The aim of this study was to evaluate the trends in complementary feeding indicators (CFIs) according to participation in a Brazilian cash transferu program-the Bolsa Família Program (BFP). This was a time-series study with secondary data from 600,138 children assisted from 2015 to 2019 and registered within the Brazilian Food and Nutrition Surveillance System. The CFIs assessed were food introduction, minimum meal frequency and appropriate consistency, minimum dietary diversity, iron-rich food, vitamin A-rich food, ultra-processed food consumption, and zero vegetable or fruit consumption. Prevalence and 95% confidence intervals were calculated for the CFIs according to BFP, the region of residence, and the child's age. The Prais-Winsten regression method was used to analyze the temporal trend. There was a steady trend for all CFIs of a healthy diet. A decrease in ultra-processed food consumption for both BFP (-10.02%) and non-BFP children (-9.34%) was observed over the years. Children residing in the North and Northeast regions and those enrolled in the BFP were more distant from the recommended feeding practices when compared to the other regions and non-BFP children. The results highlight the relevance of nutritional surveillance and the need to improve food and nutrition public policies for children aged 6-23 months, particularly for those experiencing greater social vulnerability.

Income Segregation, Conditional Cash Transfers, and Breast Cancer Mortality Among Women in Brazil

Women living in income-segregated areas are less likely to receive adequate breast cancer care and access community resources, which may heighten breast cancer mortality risk. To investigate the association between income segregation and breast cancer mortality and whether this association is attenuated by receipt of the Bolsa Família program (BFP), the world's largest conditional cash-transfer program. This cohort study was conducted using data from the 100 Million Brazilian Cohort, which were linked with nationwide mortality registries (2004-2015). Data were analyzed from December 2021 to June 2023. Study participants were women aged 18 to 100 years. Women's income segregation (high, medium, or low) at the municipality level was obtained using income data from the 2010 Brazilian census and assessed using dissimilarity index values in tertiles (low [0.01-0.25], medium [0.26-0.32], and high [0.33-0.73]). The main outcome was breast cancer mortality. Mortality rate ratios (MRRs) for the association of segregation with breast cancer deaths were estimated using Poisson regression adjusted for age, race, education, municipality area size, population density, area of residence (rural or urban), and year of enrollment. Multiplicative interactions of segregation and BFP receipt (yes or no) in the association with mortality (2004-2015) were assessed. Data on 21 680 930 women (mean [SD] age, 36.1 [15.3] years) were analyzed. Breast cancer mortality was greater among women living in municipalities with high (adjusted MRR [aMRR], 1.18; 95% CI, 1.13-1.24) and medium (aMRR, 1.08; 95% CI, 1.03-1.12) compared with low segregation. Women who did not receive BFP had higher breast cancer mortality than BFP recipients (aMRR, 1.17; 95% CI, 1.12-1.22). By BFP strata, women who did not receive BFP and lived in municipalities with high income segregation had a 24% greater risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.24: 95% CI, 1.14-1.34); women who received BFP and were living in areas with high income segregation had a 13% higher risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.13; 95% CI, 1.07-1.19; P for interaction = .008). Stratified by the amount of time receiving the benefit, segregation (high vs low) was associated with an increase in mortality risk for women receiving BFP for less time but not for those receiving it for more time (<4 years: aMRR, 1.16; 95% CI, 1.07-1.27; 4-11 years: aMRR, 1.09; 95% CI, 1.00-1.17; P for interaction <.001). These findings suggest that place-based inequities in breast cancer mortality associated with income segregation may be mitigated with BFP receipt, possibly via improved income and access to preventive cancer care services among women, which may be associated with early detection and treatment and ultimately reduced mortality.

Intersectorality in a conditional cash transfer programme: Actors, convergences and conflicts.

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

Factors Associated With the Probability of Leaving Bolsa Família Program

ABSTRACT: Conditional cash transfer programs (CCTs) are increasingly common in Latin American countries and have become the main strategy for combating poverty and social inequality. Among many, noteworthy programs include Progresa-Oportunidades, later renamed Prospera, in Mexico in 1997; Programa Familias en Acción in Colombia; Chile Solidario in Chile in 2002; and Bolsa Família Program in Brazil in 2003. The central feature of the Bolsa Família Program (BFP) was that the receipt of monetary benefits by families was tied to the fulfillment of certain conditions, or conditionalities, involving healthcare and education for children and adolescents. The purpose of this design was, in the short term, to combat the negative effects of poverty on family well-being through the transfer of monetary resources, and in the long term, through the requirement of conditionalities, to break the poverty trap caused, in large part, by intergenerational transmission of income and education. The literature on conditional cash transfers has largely focused on entry conditions, paying less attention to exit conditions. This study aims to explore the trajectory of participant families in the Bolsa Família Program, using information obtained from the cohort of individuals born in the city of Pelotas in 2004. The research focuses on the socioeconomic characteristics of families at the time of their child’s birth in 2004 and the follow-up conducted in 2015. Survival analysis models are used to analyze the probability of exiting the program. The results reported by the survival analysis, Kaplan-Meier method, indicate that a BRL 1.00 (US$ 0.30) increase in income reduces, on average, the likelihood of successful departure from the BFP beneficiary family by 1%. Conversely, exercises conducted by family groups indicate that for families receiving benefits above the average, BRL 141.00 (US$ 42.32), the mother’s age and her employment status positively influence the chances of leaving the program. Overall, the results demonstrate that the values of the benefits received are subject to decreasing returns. For families receiving benefits below the average, a one-unit increase in the amount received reduces the probability of exiting the program by an average of 1%. Regarding successful exits, it was observed that having a white father increases the chances by 40%, and if the father is employed, it increases the likelihood of successfully exiting the program by 48%. These results indicate that the successful exit of families from the program is primarily associated with parental characteristics.

Use and filling out of the child health booklet among beneficiaries of the Bolsa Família Program in Salvador-Bahia, Brazil: a cross-sectional study, 2023.

To compare child health booklet (CHB) use and filling out among mothers who were or were not Bolsa Família Program (BFP) beneficiaries. Cross-sectional study with mothers of children <6years attending health centers in Salvador, Bahia, Brazil, between January-February/2023. The CHB was evaluated regarding its use (having a CHB, having it in hand, and having read it) and filling out (growth curves, development monitoring forms, and vaccination completeness). Descriptive statistics and the chi-square test were used. Of the 411 study participants, 66% were BFP beneficiaries. Significant differences were found between the groups regarding CHB use: having a CHB (p < 0.001), having it in hand (p = 0.037), and having read it (p < 0.001). Significant difference in vaccination completeness was found (p = 0.005). There was a significant difference in CHB use and vaccination completeness when comparing mothers who were BFP beneficiaries and those who were not.

Efeito da pandemia da COVID-19 sobre a má nutrição em crianças em vulnerabilidade social, no Brasil

Abstract This article aims to evaluate the effect of the COVID-19 pandemic on malnutrition among children under two years of age enrolled in the Bolsa Família Program (BFP). Ecological study of interrupted time series (ITS), with low weight for age, stunting, and overweight as time-dependent variables of malnutrition, extracted monthly (Jan/2008 to June/2021) from the Food and Nutrition Surveillance System. The COVID-19 pandemic was the exposure, dichotomized into pre-pandemic and pandemic. In RStudio, the trend was obtained by Prais-Winsten regression, and the effect of the pandemic on the time-dependent variables was determined by SARIMA modeling, estimating the regression coefficients (RC) adjusted for trend and seasonality (α = 5%). The pandemic was associated with an increase in: i) low weight for age in the South (RC = 0.94; p &lt; 0.001) and Southeast (RC = 1.97; p &lt; 0.001); ii) height deficit in the Midwest (RC = 2.4; p = 0.01), South (RC = 2.15; p &lt; 0.001) and Southeast (RC = 2.96; p &lt; 0.001); and iii) and overweight in the North (RC = 1.51; p = 0.04), Midwest (RC = 2.29; p = 0.01), South (RC = 2.83; p &lt; 0.001), and Southeast (RC = 0.72; p = 0.04). The pandemic increased underweight in the South and Southeast, and the double burden of malnutrition in the Midwest, South, and Southeast. In the Northeast and North, higher rates of malnutrition still persist.

Participation in Conditional Cash Transfer Program During Pregnancy and Birth Weight–Related Outcomes

There is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes. To investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators. This cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023. Live births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery. Low birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as "brown" and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins. A total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88). This study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight-related outcomes.

Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort

Conditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality. To evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage. This cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022. Maternal death. A total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups. This cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.

Bolsa Família Program and deaths from oral cancer in Brazil: an ecological study.

To assess the effect of coverage of the Bolsa Família Program (BFP) on oral cancer mortality rates in Brazil between 2005 and 2017, adjusting for health care coverage and socioeconomic characteristics of the Brazilian federative units. This is an ecological study using annual data (2005-2017) from all the Brazilian federative units. The dependent variable for this study was the oral cancer mortality rate, standardized by gender and age using the direct standardization technique. BFP coverage was the main independent variable, calculated as the ratio of the number of BFP beneficiaries to those families that should potentially be entitled to this conditional cash transfer. Socioeconomic background and health care coverage were covariables. Choropleth maps were drawn, and space-time cube analysis was used to assess changes in the spatiotemporal distribution of BFP and oral cancer mortality rates. Mixed-effects linear regression analysis estimated the coefficients (β) and 95% confidence intervals (CI) for the association between BFP coverage and oral cancer mortality rates. BFP coverage trends increased and oral cancer mortality rate trends stabilized in Brazilian federative units, except for Maranhão, Goiás, and Minas Gerais, where the oral cancer mortality rates have increased. In the adjusted model, greater BFP coverage was associated with lower oral cancer mortality rates (β -2.10; 95% CI [-3.291, -0.919]). Egalitarian strategies such as BFP can reduce the oral cancer mortality rate. We recommend the follow-up of families benefiting from conditional cash transfer program by oral health teams to reduce the oral cancer mortality rate.

Policy capacity: Explaining the surprising durability of CCTs in Brazil

The central research finding of this article is that the standard policy feedback effects in the literature cannot alone explain the outcomes of the Brazilian Bolsa Familia program/ Programa Bolsa Família (PBF). While conditional cash transfers (CCTs) have remained a resilient policy instrument in Brazil – newly elected officials did not dismantle, replace or wholesale transform PBF – our empirical research tells us that this resilience is due not only to policy feedbacks, but also to another mechanism. We suggest that previous explanations have not paid sufficient attention to the concept of policy capacity or to the role of the bureaucracy in defending PBF over time. We analyse the internal dynamics of Brazil’s PBF in changing political and economic environments. Our key explanatory factor is the impact of alternations of power. We suggest that PBF’s resilience to changing political and economic contexts is underpinned by its policy capacity.

Influence of conditional cash transfer program on prenatal care and nutrition during pregnancy: NISAMI cohort study.

ABSTRACTBACKGROUND:There are few studies on the influence of a cash transfer program on nutritional outcomes from pregnancy.OBJECTIVES:To analyze how a Brazilian conditional cash transfer program (Bolsa Familia Program, BFP) was associated with changes in body mass index (BMI) and food consumption among pregnant women.DESIGN AND SETTING:Cohort study on 250 pregnant women (≥ 18 years of age) in Brazilian prenatal services.METHODS:A food frequency questionnaire was used to evaluate dietary intake. Weight was measured in each gestational trimester. Generalized estimation equations and structural equation modeling were used for statistical analyses. Correlations were analyzed using standardized coefficients (SCs).RESULTS:Women benefitting from the BFP were of greater age and had lower education. The BFP exerted a direct negative effect on the pregnant women’s consumption choices regarding refined grains, regional foods, vegetable oil, sausages, salted meats and snacks (SC = -0.10) and on maternal BMI (SC = -0.12). Among the intermediate variables, we observed that the time elapsed since pregnancy and the month of prenatal onset had direct negative effects; and that the number of visits to doctors, family income and number of years of education had direct positive effects.CONCLUSIONS:Beneficiaries were less likely to increase their BMI outside of the recommended standards and had a greater tendency to receive prenatal care. Participation in the BFP had a direct negative effect on adherence to unhealthy diets.

Conditional Income Transfer Program as a Means to Development in Brazil: An Intersection With Amartya Sen’s Concepts

The paper aims to examine the ability of income transfer programs in promoting development. More specifically, it utilizes the conception of development defended by Amartya Sen, to confirm or not the hypothesis that the Brazilian approach with the structuring of the Bolsa Familia Program serves the purpose of promoting the economic and social development of the country. For this purpose, the methodology used will be deductive, based on bibliographic research and official data. The article begins by analyzing how income distribution policies operate in the expansion of real freedoms and, more specifically the Brazilian reality with the Bolsa Familia Program, a public policy of direct income transfer, aimed at families in situations of poverty and extreme poverty throughout Brazil, which seeks to guarantee these families the right to food and access to education and health. It then exposes Sen’s conception of what is development, which goes beyond narrower views that limits it to GNP growth or industrialization, encompassing this perspective in a broader concept of development as a process of expanding the real freedoms that people enjoy. In the end, the paper makes an intersection of the Bolsa Familia Programs with Sen’s concept of development, presenting as a final result the conclusion that the program proved to be a relevant tool in removing causes of deprivation of freedom and, therefore, is a move in the right direction of the development process.

Impact of Cash Transfers on the Use of Oral Health Services and Oral Health Outcomes: A Systematic Review.

ABSTRACTObjective:The objective of the present study was to summarize the evidence available on the impact of cash transfers on the use of oral health services and oral health outcomes.Materials and Methods:9 databases were searched for studies on cash transfers and oral health: PubMed, Embase, The Cochrane Library, CINAHL, EconLit, Dentistry and Oral Sciences Source, Scopus, Web of Science, and LILACS. We conducted a systematic review of studies that evaluated the impact of cash transfers on the use of oral health services and other oral health outcomes.Results:Three studies with more than 13,000 participants conducted in Brazil and Argentina were included. One study from Brazil found that participants in the Bolsa Familia Program (BFP) were more likely not to use oral health services (aPR: 6.18; 95% CI: 3.07–12.45; P < 0.001) and had a higher probability of presenting dental caries (aPR: 2.00; 95% CI: 1.47–2.69) and severe caries (aRR: 1.53; 95% CI: 1.18–2.00). Another study conducted in Brazil found that the BFP was associated with fewer dental caries among those enrolled in the first 2 years of the BFP as well as after six years. On the other hand, the Argentina study found that the Universal Child Allowance program did not have a statistically significant average treatment effect (ATE = -0.05; P > 0.05) on the use of dental health services.Conclusion:There is a lack of evidence about the impact of CT on the use of oral health services and oral health outcomes. The evidence suggests that cash transfers might not have a positive impact on the use of oral health services. The results regarding the impact of receiving cash transfers on dental caries are contradictory. However, more evidence is needed to draw stronger conclusions for policy taking.Registration:The protocol was registered in PROSPERO (CRD42021268234).

Association Between Gestational Weight Gain in Each Trimester and Weight Retention at 6 and 12 Months Postpartum: Results From a National Administrative Dataset in Brazil

ObjectivesTo estimate the association between gestational weight gain (GWG) in the first, second, and third pregnancy trimesters and weight retention at 6 and 12 mo postpartum.MethodsIndividual data from the Brazilian National Food and Nutrition Surveillance System from 2008–2020 were used. Cumulative GWG was calculated as the difference between the last weight measured in each trimester and self-reported pre-pregnancy weight, standardized for gestational age and pre-pregnancy body mass index (BMI) into z-scores using the Brazilian charts. Postpartum weight retention (PWR) was calculated as the difference between weight measured close to (±1 month) 6 and 12 months postpartum and self-reported pre-pregnancy weight and categorized as < 5 or ≥ 5 kg. Median, interquartile ranges (IQR), frequencies, and proportions were calculated. Maternal age (y), participation in the Bolsa Familia conditional cash transfer program (yes/no), and pre-pregnancy BMI (kg/m2) were used to adjust linear regression models.ResultsAmong the 31,846 women included, 88.5% were < 35 y old; 77.2% participated in the Bolsa Familia program, and 52.7% were classified as normal weight before pregnancy. The median (IQR) cumulative GWG was 1.2 (0–2.8), 4.0 (1.2–7.0), and 9.0 (5.3–12.7) kg in the first, second, and third pregnancy trimesters, respectively. At 6 and 12 mo postpartum, 32.7% and 31.4% of the women had PWR ≥ 5 kg, respectively. The prevalence of PWR ≥ 5 kg at 6 and 12 mo was higher among women who gained weight > 90th percentile of the Brazilian charts than those who gained below those values (73.2 v. 29.6% for 6; 63.9 v. 28.7% for 12 mo, respectively). Each 1 z-score increase in the cumulative GWG in the first, second, and third trimesters was associated with an increase of 2.0, 2.3, and 2.4 kg, respectively, in the PWR at 6 mo. Similar trends were observed for PWR at 12 mo (P < 0.001 for all cases).ConclusionsGWG in all pregnancy trimesters was associated with PWR at 6 and 12 mo postpartum. The association between GWG in the first trimester and PWR highlights the importance of monitoring weight gain since the beginning of pregnancy to prevent the occurrence of adverse outcomes, such as maternal obesity, during the postpartum period.Funding SourcesBill & Melinda Gates Foundation.

Evaluating the effect of Bolsa Familia, Brazil's conditional cash transfer programme, on maternal and child health: A study protocol.

Conditional Cash Transfer Programs have been developed in Latin America in response to poverty and marked social inequalities on the continent. In Brazil, the Bolsa Familia Program (BFP) was implemented to alleviate poverty and improve living conditions, health, and education for socioeconomically vulnerable populations. However, the effect of this intervention on maternal and child health is not well understood. We will evaluate the effect of BFP on maternal and child outcomes: 1. Birth weight; 2. Preterm birth; 3. Maternal mortality; and 4. Child growth. Dynamic retrospective cohort data from the 100 Million Brazilian Cohort (2001 to 2015) will be linked to three different databases: Live Birth Information System (2004 to 2015); Mortality Information System (2011 to 2015); and Food and Nutritional Surveillance System (2008 to 2017). The definition of exposure to the BFP varies according to the outcome studied. Those who never received the benefit until the outcome or until the end of the follow-up will be defined as not exposed. The effects of BFP on maternal and child outcomes will be estimated by a combination of propensity score-based methods and weighted logistic regressions. The analyses will be further stratified to reflect changes in the benefit entitlement before and after 2012. Harnessing a large linked administrative cohort allows us to assess the effect of the BFP on maternal and child health, while considering a wide range of explanatory and confounding variables.

Bolsa Familia Program and Perinatal Outcomes: NISAMI Cohort

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.

Evaluating the impact of social determinants, conditional cash transfers and primary health care on HIV/AIDS: Study protocol of a retrospective and forecasting approach based on the data integration with a cohort of 100 million Brazilians.

BackgroundDespite the great progress made over the last decades, stronger structural interventions are needed to end the HIV/AIDS pandemic in Low and Middle-Income Countries (LMIC). Brazil is one of the largest and data-richest LMIC, with rapidly changing socioeconomic characteristics and an important HIV/AIDS burden. Over the last two decades Brazil has also implemented the world’s largest Conditional Cash Transfer programs, the Bolsa Familia Program (BFP), and one of the most consolidated Primary Health Care (PHC) interventions, the Family Health Strategy (FHS).ObjectiveWe will evaluate the effects of socioeconomic determinants, BFP exposure and FHS coverage on HIV/AIDS incidence, treatment adherence, hospitalizations, case fatality, and mortality using unprecedently large aggregate and individual-level longitudinal data. Moreover, we will integrate the retrospective datasets and estimated parameters with comprehensive forecasting models to project HIV/AIDS incidence, prevalence and mortality scenarios up to 2030 according to future socioeconomic conditions and alternative policy implementations.Methods and analysisWe will combine individual-level data from all national HIV/AIDS registries with large-scale databases, including the “100 Million Brazilian Cohort”, over a 19-year period (2000–2018). Several approaches will be used for the retrospective quasi-experimental impact evaluations, such as Regression Discontinuity Design (RDD), Random Administrative Delays (RAD) and Propensity Score Matching (PSM), combined with multivariable Poisson regressions for cohort analyses. Moreover, we will explore in depth lagged and long-term effects of changes in living conditions and in exposures to BFP and FHS. We will also investigate the effects of the interventions in a wide range of subpopulations. Finally, we will integrate such retrospective analyses with microsimulation, compartmental and agent-based models to forecast future HIV/AIDS scenarios.ConclusionThe unprecedented datasets, analyzed through state-of-the-art quasi-experimental methods and innovative mathematical models will provide essential evidences to the understanding and control of HIV/AIDS epidemic in LMICs such as Brazil.