title: Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy.
abstract: BACKGROUND
  Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy.
  
  
  RESULTS
  We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004-2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  =0.74-0.83) and significantly increased in municipalities with FHP coverage in the medium (72-95%) (Risk Ratio 1.05; 95% CI  =1.02-1.09) and higher coverage tertiles (>95%) (Risk Ratio 1.12; 95% CI  =1.08-1.17).
  
  
  CONCLUSIONS
  At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.
authors.affiliation: Federal University of Bahia, Institute of Collective Health, Salvador, Bahia, Brazil.
authors.forename: Joilda Silva
authors.initials: JS
authors.lastname: Nery
authors.affiliation: Federal University of Bahia, Institute of Collective Health, Salvador, Bahia, Brazil.
authors.forename: Susan Martins
authors.initials: SM
authors.lastname: Pereira
authors.affiliation: Federal University of Bahia, Institute of Collective Health, Salvador, Bahia, Brazil.
authors.forename: Davide
authors.initials: D
authors.lastname: Rasella
authors.affiliation: Fluminense Federal University, Health Sciences Center, Institute of Community Health, Niterói, Rio de Janeiro, Brazil.
authors.forename: Maria Lúcia Fernandes
authors.initials: ML
authors.lastname: Penna
authors.affiliation: Federal University of Bahia, Institute of Collective Health, Salvador, Bahia, Brazil.
authors.forename: Rosana
authors.initials: R
authors.lastname: Aquino
authors.affiliation: London School of Hygiene and Tropical Medicine, Department Infectious and Tropical Diseases, London, United Kingdom.
authors.forename: Laura Cunha
authors.initials: LC
authors.lastname: Rodrigues
authors.affiliation: Federal University of Bahia, Institute of Collective Health, Salvador, Bahia, Brazil.
authors.forename: Mauricio Lima
authors.initials: ML
authors.lastname: Barreto
authors.affiliation: University of Brasília, Tropical Medicine Center, Brasília, Distrito Federal, Brazil.
authors.forename: Gerson Oliveira
authors.initials: GO
authors.lastname: Penna
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006801:Humans; D007918:Leprosy / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control*; D011203:Poverty; D011320:Primary Health Care / Q000191:economics* / Q000379:methods*; D012052:Reimbursement, Incentive