scholarly journals Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Davide Rasella ◽  
Flávia Jôse Oliveira Alves ◽  
Poliana Rebouças ◽  
Gabriela Santos de Jesus ◽  
Maurício L. Barreto ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Fixed Effects ◽  
Access To Health Care ◽  
Negative Binomial ◽  
Longitudinal Design ◽  
Case Fatality ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Childhood And Adolescence

Abstract Background Reducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world’s largest CCT (the Brazilian Bolsa Familia Programme (BFP)) on maternal mortality during a period of 11 years. Methods The study had an ecological longitudinal design and used all 2548 Brazilian municipalities with vital statistics of adequate quality during 2004–2014. BFP municipal coverage was classified into four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables. Results BFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a rate ratio (RR) reaching 0.88 (95%CI 0.81–0.95), 0.84 (0.75–0.96) and 0.83 (0.71–0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among young mothers (RR 0.77; 95%CI 0.67–0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73; 95%CI 0.69–0.77), reductions in hospital case-fatality rate for delivery (RR 0.78; 95%CI 0.66–0.94) and increases in the proportion of deliveries in hospital (RR 1.05; 95%CI 1.04–1.07). Conclusion Our findings show that a consolidated and durable CCT coverage could decrease maternal mortality, and these long-term effects are stronger among poor mothers exposed to CCT during their childhood and adolescence, suggesting a CCT inter-generational effect. Sustained CCT coverage could reduce health inequalities and contribute to the achievement of the Sustainable Development Goal 3.1, and should be preserved during the current global economic crisis due to the COVID-19 pandemic.

scholarly journals The association between a conditional cash transfer programme and malaria incidence: a longitudinal ecological study in the Brazilian Amazon between 2004 and 2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Layana Costa Alves ◽  
Mauro Niskier Sanchez ◽  
Thomas Hone ◽  
Luiz Felipe Pinto ◽  
Joilda Silva Nery ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Negative Binomial ◽  
Malaria Incidence ◽  
Panel Study ◽  
Negative Binomial Regression ◽  
Brazilian Amazon ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Percentage Point Increase ◽  
The Impact

Abstract Background Malaria 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. Methods A 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. Results A 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. Conclusions Higher 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.

Adoption and Evolution of Cash Transfer Programs in Latin America

2019 ◽  
Author(s):  
Fabián A. Borges
Keyword(s):  
Latin America ◽  
Low Income ◽  
School Attendance ◽  
Debt Crisis ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Left Wing ◽  
Transfer Programs ◽  
Robust Evidence

The last two decades witnessed an unprecedented decline in poverty across the developing world, a decline partly explained by the adoption of social cash transfer programs. Ironically, Latin America, traditionally the world’s most unequal region, has been a global trendsetter in this regard. Beginning in the late 1990s, governments across the region and across the ideological spectrum began adopting conditional cash transfer (CCT) programs, which award poor families regular stipends conditional on their children attending school and/or getting regular medical check-ups, and non-contributory pension (NCP) schemes for low-income and/or uncovered seniors. There is robust evidence that CCT programs achieve their short-term goals of reducing poverty while increasing school attendance and usage of health services. However, they do not improve learning and appear to be failing at their long-term goal of breaking the intergenerational transmission of poverty. Likely as a result of low-quality education, long-term CCT beneficiaries do not have significantly better economic prospects than comparable non-beneficiaries. CCTs also have electoral effects—there is robust evidence from across the region that they increase support for incumbent presidential candidates. CCTs were a response to the two big transformations the region underwent during the 1980s: the debt crisis and subsequent lost decade and the transition of most countries to democracy. Increased economic insecurity following the crisis and subsequent neoliberal reforms represented both a threat to the survival of newly elected governments and an opportunity for politicians to win over voters through increased social assistance. Pioneered by Mexico and Brazil in the mid-1990s, CCTs were by far the most effective policies to emerge from that context. They quickly diffused across the region, often with support from international financial institutions. Counterintuitively, adoption appears to be unrelated to the ascendance of left-wing governments in the region during the 2000s. The politics of CCT design are less understood. The myriad ways in which design can be conceptualized and measured, combined with the relative newness of this literature, have limited the accumulation of knowledge. It does appear that left-wing governments adopt more expansive CCTs and de-emphasize conditionality enforcement. Whereas their initial adoption and expansion, which coincided with the 2000s economic boom, proved politically easy, further reductions in poverty will require politically difficult choices, namely, raising taxes and/or redirecting funds away from programs benefiting the better-off. Improving the long-term effectiveness of CCTs will require improving education quality, which in turn will require challenging the region’s powerful teachers’ unions.

Long-Term Effects of a Conditional Cash Transfer Program in Nicaragua

2018 ◽  
Author(s):  
Karen Macours ◽  
john maluccio ◽  
Laura Abadia ◽  
Keesler Welch ◽  
Tatiana Melnikova
Keyword(s):  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Transfer Program ◽  
Long Term Effects ◽  
Conditional Cash Transfer Program

scholarly journals Introduction: Assessing the Effects of Conditional Cash Transfers in Latin American Societies in the Early Twenty-First Century

2016 ◽  
Vol 15 (3) ◽  
pp. 417-420
Author(s):  
Theodoros Papadopoulos ◽  
Ricardo Velázquez Leyer
Keyword(s):  
Social Policy ◽  
Latin American ◽  
Policy Instruments ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
First Century ◽  
Poverty And Inequality ◽  
Early Twenty ◽  
The Social

Latin America has emerged as a social policy ‘laboratory’ in recent decades and most prominent among the social policy innovations developed in the region are the so-called Conditional Cash Transfer (CCT) programmes (Cecchini et al., 2015; Borges Sugiyama, 2011; Martínez Franzoni et al., 2009). They have been widely promoted by international organisations across the world as policy instruments that enhance human capital and the agency of participants while reducing poverty and inequality and promoting co-responsibility and self-help in the long-term (see Sandberg, 2015; Bastagli, 2009; Lomelí, 2008, 2009).

scholarly journals Zero-Inflated gaussian mixed models for analyzing longitudinal microbiome data

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242073
Author(s):  
Xinyan Zhang ◽  
Boyi Guo ◽  
Nengjun Yi
Keyword(s):  
16S Rrna ◽  
Em Algorithm ◽  
Mixed Models ◽  
Fixed Effects ◽  
Negative Binomial ◽  
Longitudinal Design ◽  
Linear Mixed Models ◽  
Shotgun Sequencing ◽  
Zero Inflation ◽  
Microbiome Data

Motivation The human microbiome is variable and dynamic in nature. Longitudinal studies could explain the mechanisms in maintaining the microbiome in health or causing dysbiosis in disease. However, it remains challenging to properly analyze the longitudinal microbiome data from either 16S rRNA or metagenome shotgun sequencing studies, output as proportions or counts. Most microbiome data are sparse, requiring statistical models to handle zero-inflation. Moreover, longitudinal design induces correlation among the samples and thus further complicates the analysis and interpretation of the microbiome data. Results In this article, we propose zero-inflated Gaussian mixed models (ZIGMMs) to analyze longitudinal microbiome data. ZIGMMs is a robust and flexible method which can be applicable for longitudinal microbiome proportion data or count data generated with either 16S rRNA or shotgun sequencing technologies. It can include various types of fixed effects and random effects and account for various within-subject correlation structures, and can effectively handle zero-inflation. We developed an efficient Expectation-Maximization (EM) algorithm to fit the ZIGMMs by taking advantage of the standard procedure for fitting linear mixed models. We demonstrate the computational efficiency of our EM algorithm by comparing with two other zero-inflated methods. We show that ZIGMMs outperform the previously used linear mixed models (LMMs), negative binomial mixed models (NBMMs) and zero-inflated Beta regression mixed model (ZIBR) in detecting associated effects in longitudinal microbiome data through extensive simulations. We also apply our method to two public longitudinal microbiome datasets and compare with LMMs and NBMMs in detecting dynamic effects of associated taxa.

Long-Term Effects of a Conditional Cash Transfer Program in Nicaragua

2018 ◽  
Author(s):  
Karen Macours ◽  
john maluccio ◽  
Laura Abadia ◽  
Keesler Welch ◽  
Tatiana Melnikova
Keyword(s):  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Transfer Program ◽  
Long Term Effects ◽  
Conditional Cash Transfer Program
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