Bolsa Família program and incomplete childhood vaccination in two Brazilian cohorts

Abstract

OBJECTIVE: To estimate the effect of being a beneficiary of the Bolsa Família Program (BFP) in the vaccination of children aged 13 to 35 months. METHODS: Our study was based on all birth records of residents of Ribeirão Preto (SP) and probabilistic sampling with 1/3 of the births of residents of São Luís (MA), selecting low-income children, born in 2010, belonging to the cohorts Brazilian Ribeirão Preto and São Luís Birth Cohort Studies and eligible for the Bolsa Família program. The information of Cadastro Único (CadÚnico – Single Registry) was used to categorize the receipt of benefit from the BFP (yes or no). The final sample consisted of 532 children in Ribeirão Preto and 1,229 in São Luís. The outcome variable was a childhood vaccine regimen, constructed with BCG, tetravalent, triple viral, hepatitis B, poliomyelitis, rotavirus and yellow fever vaccines. The adjustment variables were: economic class, mother’s schooling and mother’s skin color. Children with monthly per capita family income of up to R$ 280.00 and/or economic class D/E were considered eligible for the benefit of the BFP. A theoretical model was constructed using a directed acyclic graph to estimate the effect of being a beneficiary of the BFP in the vaccination of low-income children. In the statistical analyses, weighing was used by the inverse of the probability of exposure and pairing by propensity score. RESULTS: Considering a monthly per capita family income of up to R$ 280.00, being a beneficiary of the BFP had no effect on the childhood vaccination schedule, according to weighing by the inverse of the probability of exposure (SL-coefficient: −0.01; 95%CI −0.07 to 0.04; p = 0.725 and RP-coefficient: 0.04; 95%CI −0.02 to 0.10; p = 0.244) and pairing by propensity score (SL-coefficient: −0.01; 95%CI −0.07 to 0.05; p = 0.744 and RP-coefficient: 0.04; 95%CI −0.02 to 0.10; p = 0.231). CONCLUSIONS: The receipt of the benefit of the BFP did not influence childhood vaccination, which is one of the conditionalities of the program. This may indicate that this conditionality is not being adequately monitored.

Does conditioning cash transfers on health treatment harm the health of other families on low incomes who depend on public services? Evidence from Brazil

“…This may help to explain why many studies find little-to-no relationship between BF assignment and vaccination compliance. Propensity score studies comparing beneficiary and non-beneficiary children find no compliance differential in surveys from 2005 (Andrade et al, 2012) and 2010 (Silva et al, 2020), consistent with difference-in-differences findings from a 2007 to 2009 panel of verified household medical records (Ford et al, 2020). One study shows BF enrolees in 2009 were more likely to get certain vaccinations on time, but beneficiaries and non-beneficiaries had indistinguishable 98% compliance rates, overall (de Brauw et al, 2012).…”

Effect of a conditional cash transfer programme on infant up-to-date and timely vaccination

“…However, the analysis was limited to data from 2005, a year when the enforcing of the CCT conditionalities was still deficient and when low-income regions (eg, North and Northeast Brazil) had barriers of access to primary care coverage 22. A study of children born in 2010, in Ribeirão Preto (Southeast Brazil) and São Luís (Northeast Brazil), concluded that there was no effect of CCT on completeness of the vaccination schedule for children under 2 years of age 24. More recently, a study in the city of Acrelândia (North Brazil) found no difference in the up-to-date vaccination coverage among CCT beneficiary and non-beneficiary children 23.…”

“…Regarding the PBF, the evidence is also in line with the international scenario. While the study by Rasella et al 8 demonstrated a positive association between the programme’s population coverage and the increase in childhood vaccination coverage against measles, polio and diphtheria, tetanus and pertussis, no associations were found in other studies 21–25. Moreover, there is no evidence about the effect of PBF on timely vaccination.…”

Avaliação da resposta imune de crianças acompanhadas no estudo MINA às vacinas de sarampo, caxumba e hepatite A

“…O PBF, é uma política pública de transferência de renda condicionada aos brasileiros em situação de pobreza e extrema pobreza com o objetivo de reduzir a desigualdade no país 112 . Em nosso estudo foi possível observar que crianças cujas famílias participavam do PBF tiveram maior risco de falha na soropositividade às vacinas de sarampo e caxumba, e embora não exista uma ligação direta entre resposta imunológica e o PBF, nossa hipótese é de a relação das duas variáveis se dá por questões sociais e nutricionais que não foram completamente ajustadas apesar da realização de modelos múltiplos hierárquicos.…”