Bolsa Família Program and environmental health: a systematic review of the effects on diarrhea and malnutrition

Souza, Anelise Andrade de; Heller, Léo

doi:10.1590/1413-81232021268.07362020

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ARTICLE • Ciênc. saúde coletiva 26 (08) • Aug 2021 • https://doi.org/10.1590/1413-81232021268.07362020 copy

Bolsa Família Program and environmental health: a systematic review of the effects on diarrhea and malnutrition

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The Bolsa Família Programme and environmental health interventions are public policies that can have a combined positive effect on health inequities. The Bolsa Família Programme is designed to improve health conditions, reduce food insecurity and increase family incomes. Environmental health interventions aim to ensure public health and environmental protection. This study reviewed the literature for possible interactions between these two types of intervention that influence morbidity and mortality outcomes due to diarrhoea and malnutrition in the under-fives. A total of 1,658 articles were identified in the LILACS, SciELO and PubMed databases. The studies’ methodologies were evaluated by scores on an adapted Downs & Black scale and four met all the study inclusion criteria. The findings showed evidence of the positive independent effects of the Bolsa Família Programme and of environmental health interventions in reducing illness and death from diarrhoea and malnutrition in the study age group. However, none of the articles offered results that might elucidate a joint effect of these public policies on an interaction model, revealing a gap in the literature on these diseases attributable particularly to poverty.

Key words:
Systematic review; Environmental health interventions; Social programmes; Public policy

Authors Year Journal	Title	Unit of analysis (municipalities) (Year)	Study type	Comparison group	Dependent/independent variables of interest to this study	Statistical measures used / Values	Sample size	Impact of the BFP and environmental health on outcomes of interest
Rasella et al. (2013)¹¹ The Lancet	Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities	Nacional (2.853) (2004-2009)	Ecological	Yes	Mortality and morbidity from diarrhoea and malnutrition / BFP inadequate sanitation (water supply, sewers, and garbage collection)	Rate ratio (CI) Mortality: BFP x Diarrhoea: 0.83 (0.74-0.92) 0.68 (0.59-0.80) 0.47(0.37-0.61) BFP x Malnutrition: 0.66 (0.57-0.77) 0.54 (0.44-0.67) 0.35 (0.24-0.50) Morbidity: BFP x Diarrhoea: 0.86 (0.84-0.88) 0.80 (0.77-0.83) 0.61 (0.57-0.65) BFP x Malnutrition: 0.82 (0.76-0.87) 0.68 (0.62-0.75) 0.53 (0.44-0.63) Inadequate sanitation x overall mortality: 1.10 (1.05-1.15)	N = 2.853 Brazilian municipalities	Positive
Imada et al. (2016)¹³ Revista de Saúde Pública	Fatores socioeconômicos, higiênicos e de saneamento na redução de diarreia na Amazônia [Socioeconomic, hygiene and sanitation factors in reducing diarrhea in the Amazon]	Location (Jordão, Acre) (2005 and 2012)	Cross- sectional	Yes	Morbidity from diarrhoea / BFP and existence of toilet, water source, frequency of lack of water, treated drinking water, solid waste disposal, sewage disposal	Relative Risk (RR) BFP x Diarrhoea Families enrolled increased from 23.9% to 53.9%. Differences between 2005 and 2012 as regards: Income Mothers’ schooling Access to water x Diarrhoea 1.38 (well water) 1.17 (other sources)	N = 466 children (2005) N = 826 children (2012)	Positive
Authors Year Journal	Title	Unit of analysis (municipalities do Brazil) (Year)	Study type	Comparison group	Dependent/independent variables of interest to this study	Statistical measures used / Values	Sample size	Impact of the BFP and environmental health on outcomes of interest
Chagas et al. (2013)¹⁵15 Chagas DC, Silva AAM, Batista RFL, Simões VMF, Lamy ZC, Coimbra LC, Alves MTSSB. Prevalência e fatores associados à desnutrição e ao excesso de peso em menores de cinco anos nos seis maiores municípios do Maranhão. Rev Bras Epidemiol 2013;16(1):146-56. Revista Brasileira de Epidemiologia	Prevalência e fatores associados à desnutrição e ao excesso de peso em menores de cinco anos nos seis maiores municípios do Maranhão [Prevalence and factors associated to malnutrition and excess weight among under five year-olds in the six largest cities of Maranhão]	Location (São Luís, Imperatriz, Caxias, Codó, São José de Ribamar and Timon) (2006 and 2007)	Cross- sectional	No	Nutritional status: H/A, W/A, W/A / BFP and inadequate sanitation	Prevalence Ratio (PR) (CI) BFP x W/A: 1.4 (0.7-2.6) Inadequate sanitation x W/A: 1.1 (0.6-2.2)	N = 1,214 children (2006/2007)	No impact
Paes-Sousa, Santos e Miazaki (2011)¹⁷17 Paes-Sousa R, Santos LMP, Miazaki LS. Effects of a conditional cash transfer programme on child nutrition in Brazil. Bulletin of the World Health Organization 2011; 89(7):496-503. Bulletin of the World Health Organization	Effects of a conditional cash transfer programme on child nutrition in Brazil	Regional Brazilian States (23) (2005-2006)	Cross- sectional	Yes	Nutritional status: H/A, W/A, W/A / BFP and household access to water	OR (CI) BFP x H/A: 1.26 (1.16-1.37) Head of family’s schooling x H/A: 0.72 (0.66-0.79) Household access to water x H/A (under-fives): 0.90 (0.82-0.98) Household access to water x H/A (stratified by age 0-11 months): 0.85 (0.73-0.99)	N = 22,375 children (2005/2006)	Positive

Criteria

Score (%)

Study characteristics
Objectives and hypothesis clearly described
Main study findings presented clearly in the abstract
Main outcomes measured described in the methodology
Study inclusion and exclusion criteria defined
Interventions of interest applicable to the study are clearly described
Main confounders listed
Main study findings/outcomes described clearly
Data variability estimates provide for the main results
Losses to follow-up described
Actual probability values reported in full
External validity
Sample representativeness
Follow-up time equal for whole sample, when appropriate
Statistical tests appropriate
Outcome measurements valid and reliable
Internal validity
Individuals recruited from the same population, when appropriate
Individuals recruited at the same time, when appropriate
Appropriate adjustment for confounders
Study limitations clearly specified
Losses of individuals/municipalities/units of analysis reported
Study power
Study power of effect (p < 0.05)

100.0

75.0

100.0

75.0

100.0

25.0
100.0

100.0

100.0
75.0

75.0
100.0

100.0
100.0

100.0

100.0

25.0
25.0
25.0

100.0

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[1] Collaborations

Both authors contributed to the conception, planning, analysis, interpretation and drafting of the study. Both authors approved the final version submitted.