title: Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities.
abstract: BACKGROUND
  In the past 15 years, Brazil has undergone notable social and public health changes, including a large reduction in child mortality. The Bolsa Familia Programme (BFP) is a widespread conditional cash transfer programme, launched in 2003, which transfers cash to poor households (maximum income US$70 per person a month) when they comply with conditions related to health and education. Transfers range from $18 to $175 per month, depending on the income and composition of the family. We aimed to assess the effect of the BFP on deaths of children younger than 5 years (under-5), overall and resulting from specific causes associated with poverty: malnutrition, diarrhoea, and lower respiratory infections.
  
  
  METHODS
  The study had a mixed ecological design. It covered the period from 2004-09 and included 2853 (of 5565) municipalities with death and livebirth statistics of adequate quality. We used government sources to calculate all-cause under-5 mortality rates and under-5 mortality rates for selected causes. BFP coverage was classified as low (0·0-17·1%), intermediate (17·2-32·0%), high (>32·0%), or consolidated (>32·0% and target population coverage ≥100% for at least 4 years). We did multivariable regression analyses of panel data with fixed-effects negative binomial models, adjusted for relevant social and economic covariates, and for the effect of the largest primary health-care scheme in the country (Family Health Programme).
  
  
  RESULTS
  Under-5 mortality rate, overall and resulting from poverty-related causes, decreased as BFP coverage increased. The rate ratios (RR) for the effect of the BFP on overall under-5 mortality rate were 0·94 (95% CI 0·92-0·96) for intermediate coverage, 0·88 (0·85-0·91) for high coverage, and 0·83 (0·79-0·88) for consolidated coverage. The effect of consolidated BFP coverage was highest on under-5 mortality resulting from malnutrition (RR 0·35; 95% CI 0·24-0·50) and diarrhoea (0·47; 0·37-0·61).
  
  
  CONCLUSIONS
  A conditional cash transfer programme can greatly contribute to a decrease in childhood mortality overall, and in particular for deaths attributable to poverty-related causes such as malnutrition and diarrhoea, in a large middle-income country such as Brazil.
  
  
  BACKGROUND
  National Institutes of Science and Technology Programme, Ministry of Science and Technology, and Council for Scientific and Technological Development Programme (CNPq), Brazil.
authors.affiliation: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Davide
authors.initials: D
authors.lastname: Rasella
authors.forename: Rosana
authors.initials: R
authors.lastname: Aquino
authors.forename: Carlos A T
authors.initials: CA
authors.lastname: Santos
authors.forename: Rômulo
authors.initials: R
authors.lastname: Paes-Sousa
authors.forename: Mauricio L
authors.initials: ML
authors.lastname: Barreto
mesh_terms: D001938:Brazil / Q000453:epidemiology; D046688:Child Mortality / Q000639:trends; D015362:Child Nutrition Disorders / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D002669:Child Welfare / Q000191:economics*; D002675:Child, Preschool; D002947:Cities; D003967:Diarrhea / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005380:Financing, Government; D006801:Humans; D007223:Infant; D011203:Poverty; D015397:Program Evaluation; D012141:Respiratory Tract Infections / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D012943:Social Security / Q000191:economics*