Effect of the Brazilian Conditional Cash Transfer and Primary Health Care Programs on the New Case Detection Rate of Leprosy
Effect of the Brazilian Conditional Cash Transfer and Primary Health Care Programs on the New Case Detection Rate of Leprosy
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DOI：
10.1371/journal.pntd.0003357
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发表时间：
2014-11-01
影响因子：
3.8
通讯作者：
Penna, Gerson Oliveira
中科院分区：
文献类型：
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作者：
Nery, Joilda Silva;Pereira, Susan Martins;Penna, Gerson Oliveira
背景：社会决定因素可以影响麻风的传播和疾病的发展。关于福利和初级卫生保健政策在减少麻风病发生方面的有效性，人们知之甚少。这项研究的目的是评估巴西现金转移计划(Bolsa Familia Program)和初级卫生保健(Family Health Program)计划(Family Health Program)对麻风病新病例发现率的影响。方法/主要研究结果：我们在2004-2011年期间以巴西市政当局为分析单位，采用混合生态设计、生态多组设计和时间趋势设计相结合的方式进行研究。主要自变量为市级BFP和FHP覆盖率，结果为新发麻风病例发现率。麻风新发病例、BFP和FHP覆盖率、人口和其他相关社会人口学协变量从国家数据库中获得。我们对面板数据使用固定效应的负二项模型，并对相关的社会人口协变量进行了调整。共有1,358个城市被纳入分析。在研究期间，随着BFP和FHP市级覆盖率的提高，麻风新病例发现率下降。麻风新病例发现率在合并BFP覆盖的城市中显著降低(风险比0.79；95%CI=0.74-0.83)，而在FHP覆盖率处于中等水平(72-95%)(风险比1.05；95%CI=1.02-1.09)和较高覆盖率(>；95%)(风险比1.12；95%CI=1.08-1.17)。结论：家庭健康计划在提高巴西麻风新病例发现率的同时，与降低麻风新病例发现率有关，这反映了麻风发病率的降低。
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 Familia Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy.Methodology/Principal Findings: 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 Familia Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.