Effect of a conditional cash transfer program on length-for-age and weight-for-age in Brazilian infants at 24 months using doubly-robust, targeted estimation

Jeremy A. Labrecque; Jay S. Kaufman; Laura B. Balzer; Richard F. Maclehose; Erin C. Strumpf; Alicia Matijasevich; Iná S. Santos; Kelen H. Schmidt; Aluísio J.D. Barros

doi:10.1016/j.socscimed.2018.05.040

Effect of a conditional cash transfer program on length-for-age and weight-for-age in Brazilian infants at 24 months using doubly-robust, targeted estimation

Jeremy A. Labrecque, Jay S. Kaufman, Laura B. Balzer, Richard F. Maclehose, Erin C. Strumpf, Alicia Matijasevich, Iná S. Santos, Kelen H. Schmidt, Aluísio J.D. Barros

Epidemiology

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Objective: Conditional cash transfer programs are popular internationally and represent a large investment in child health. Evidence of their impact on child nutrition status remains weak and inconsistent, particularly for Bolsa Família, the Brazilian conditional cash transfer program and one of the world's largest. Our objective was to estimate the effect of the Brazilian conditional cash transfer program, Bolsa Família (BF), on child nutritional status as measured by length-for-age z-score (LAZ) and weight-for-age z-score (WAZ) at 24 months. Methods: We analyzed the 1703 children eligible for BF from the 2004 Pelotas Birth Cohort. Children were divided into three exposure groups by total amount of money their household received from BF in 24 months: no BF, low BF (≤R$1000) and high BF (>R$1000). Using a doubly robust semiparametric estimation method we estimated the effect of receiving low and high levels of BF on LAZ and WAZ at 24 months. Results: After adjustment for measured confounders, the expected difference in LAZ between children that received low or high levels of BF compared to no BF was −0.14 [95% confidence interval (CI): −0.27, −0.02] and −0.20 (95% CI: −0.33, −0.08) respectively. For WAZ the estimated differences were −0.04 (95% CI: −0.17, 0.08) for low levels versus no BF and −0.18 (95% CI: −0.30, −0.05) for high levels versus no BF. The expected difference in population LAZ had all eligible households received it and population LAZ under no BF was −0.15 (95% CI: −0.26, −0.04). Sensitivity analyses suggested only a strong confounder could explain away these results. Conclusions: Among participants of the 2004 Pelotas Birth Cohort, BF was associated with a reduction in LAZ and WAZ in 24 month old children.

Original language	English (US)
Pages (from-to)	9-15
Number of pages	7
Journal	Social Science and Medicine
Volume	211
DOIs	https://doi.org/10.1016/j.socscimed.2018.05.040
State	Published - Aug 2018

Bibliographical note

Funding Information:
JAL was supported a Banting and Best Doctoral Award from the Canadian Institutes of Health Researhc. JSK is a Canada Research Chair in Health Disparities. ES is supported by a Chercheur boursier Junior 2 from the Fonds de recherche du Québec – Santé. AM, ISS and AJDB are supported by the CNPq. This article is based on data from the 2004 Pelotas Birth Cohort, conducted by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association (ABRASCO). The World Health Organization, National Support Program for Centers of Excellence (PRONEX), Brazilian National Research Council (CNPq), Brazilian Ministry of Health, and Children's Pastorate supported the study in its two first years.

Funding Information:
We would like to thank Dr. Mark van der Laan for answering our questions about specific aspects of TMLE. The operation of guillimin, the supercomputer used in this study, is funded by the Canada Foundation for Innovation (CFI), ministère de l’Économie, de la Science et de l’Innovation du Québec (MESI) and the Fonds de Recherche du Québec - Nature et Technologies (FRQ-NT).

Publisher Copyright:
© 2018 Elsevier Ltd

Keywords

Brazil
Child growth
Conditional cash transfer
Doubly robust estimation
Health policy
Sensitivity analysis
Targeted
Targeted estimation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Labrecque, J. A., Kaufman, J. S., Balzer, L. B., Maclehose, R. F., Strumpf, E. C., Matijasevich, A., Santos, I. S., Schmidt, K. H., & Barros, A. J. D. (2018). Effect of a conditional cash transfer program on length-for-age and weight-for-age in Brazilian infants at 24 months using doubly-robust, targeted estimation. Social Science and Medicine, 211, 9-15. https://doi.org/10.1016/j.socscimed.2018.05.040

Labrecque, JA, Kaufman, JS, Balzer, LB, Maclehose, RF, Strumpf, EC, Matijasevich, A, Santos, IS, Schmidt, KH & Barros, AJD 2018, 'Effect of a conditional cash transfer program on length-for-age and weight-for-age in Brazilian infants at 24 months using doubly-robust, targeted estimation', Social Science and Medicine, vol. 211, pp. 9-15. https://doi.org/10.1016/j.socscimed.2018.05.040

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title = "Effect of a conditional cash transfer program on length-for-age and weight-for-age in Brazilian infants at 24 months using doubly-robust, targeted estimation",

abstract = "Objective: Conditional cash transfer programs are popular internationally and represent a large investment in child health. Evidence of their impact on child nutrition status remains weak and inconsistent, particularly for Bolsa Fam{\'i}lia, the Brazilian conditional cash transfer program and one of the world's largest. Our objective was to estimate the effect of the Brazilian conditional cash transfer program, Bolsa Fam{\'i}lia (BF), on child nutritional status as measured by length-for-age z-score (LAZ) and weight-for-age z-score (WAZ) at 24 months. Methods: We analyzed the 1703 children eligible for BF from the 2004 Pelotas Birth Cohort. Children were divided into three exposure groups by total amount of money their household received from BF in 24 months: no BF, low BF (≤R$1000) and high BF (>R$1000). Using a doubly robust semiparametric estimation method we estimated the effect of receiving low and high levels of BF on LAZ and WAZ at 24 months. Results: After adjustment for measured confounders, the expected difference in LAZ between children that received low or high levels of BF compared to no BF was −0.14 [95% confidence interval (CI): −0.27, −0.02] and −0.20 (95% CI: −0.33, −0.08) respectively. For WAZ the estimated differences were −0.04 (95% CI: −0.17, 0.08) for low levels versus no BF and −0.18 (95% CI: −0.30, −0.05) for high levels versus no BF. The expected difference in population LAZ had all eligible households received it and population LAZ under no BF was −0.15 (95% CI: −0.26, −0.04). Sensitivity analyses suggested only a strong confounder could explain away these results. Conclusions: Among participants of the 2004 Pelotas Birth Cohort, BF was associated with a reduction in LAZ and WAZ in 24 month old children.",

keywords = "Brazil, Child growth, Conditional cash transfer, Doubly robust estimation, Health policy, Sensitivity analysis, Targeted, Targeted estimation",

author = "Labrecque, {Jeremy A.} and Kaufman, {Jay S.} and Balzer, {Laura B.} and Maclehose, {Richard F.} and Strumpf, {Erin C.} and Alicia Matijasevich and Santos, {In{\'a} S.} and Schmidt, {Kelen H.} and Barros, {Alu{\'i}sio J.D.}",

note = "Funding Information: JAL was supported a Banting and Best Doctoral Award from the Canadian Institutes of Health Researhc. JSK is a Canada Research Chair in Health Disparities. ES is supported by a Chercheur boursier Junior 2 from the Fonds de recherche du Qu{\'e}bec – Sant{\'e}. AM, ISS and AJDB are supported by the CNPq. This article is based on data from the 2004 Pelotas Birth Cohort, conducted by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association (ABRASCO). The World Health Organization, National Support Program for Centers of Excellence (PRONEX), Brazilian National Research Council (CNPq), Brazilian Ministry of Health, and Children's Pastorate supported the study in its two first years. Funding Information: We would like to thank Dr. Mark van der Laan for answering our questions about specific aspects of TMLE. The operation of guillimin, the supercomputer used in this study, is funded by the Canada Foundation for Innovation (CFI), minist{\`e}re de l{\textquoteright}{\'E}conomie, de la Science et de l{\textquoteright}Innovation du Qu{\'e}bec (MESI) and the Fonds de Recherche du Qu{\'e}bec - Nature et Technologies (FRQ-NT). Publisher Copyright: {\textcopyright} 2018 Elsevier Ltd",

year = "2018",

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doi = "10.1016/j.socscimed.2018.05.040",

language = "English (US)",

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TY - JOUR

T1 - Effect of a conditional cash transfer program on length-for-age and weight-for-age in Brazilian infants at 24 months using doubly-robust, targeted estimation

AU - Labrecque, Jeremy A.

AU - Kaufman, Jay S.

AU - Balzer, Laura B.

AU - Maclehose, Richard F.

AU - Strumpf, Erin C.

AU - Matijasevich, Alicia

AU - Santos, Iná S.

AU - Schmidt, Kelen H.

AU - Barros, Aluísio J.D.

N1 - Funding Information: JAL was supported a Banting and Best Doctoral Award from the Canadian Institutes of Health Researhc. JSK is a Canada Research Chair in Health Disparities. ES is supported by a Chercheur boursier Junior 2 from the Fonds de recherche du Québec – Santé. AM, ISS and AJDB are supported by the CNPq. This article is based on data from the 2004 Pelotas Birth Cohort, conducted by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association (ABRASCO). The World Health Organization, National Support Program for Centers of Excellence (PRONEX), Brazilian National Research Council (CNPq), Brazilian Ministry of Health, and Children's Pastorate supported the study in its two first years. Funding Information: We would like to thank Dr. Mark van der Laan for answering our questions about specific aspects of TMLE. The operation of guillimin, the supercomputer used in this study, is funded by the Canada Foundation for Innovation (CFI), ministère de l’Économie, de la Science et de l’Innovation du Québec (MESI) and the Fonds de Recherche du Québec - Nature et Technologies (FRQ-NT). Publisher Copyright: © 2018 Elsevier Ltd

PY - 2018/8

Y1 - 2018/8

N2 - Objective: Conditional cash transfer programs are popular internationally and represent a large investment in child health. Evidence of their impact on child nutrition status remains weak and inconsistent, particularly for Bolsa Família, the Brazilian conditional cash transfer program and one of the world's largest. Our objective was to estimate the effect of the Brazilian conditional cash transfer program, Bolsa Família (BF), on child nutritional status as measured by length-for-age z-score (LAZ) and weight-for-age z-score (WAZ) at 24 months. Methods: We analyzed the 1703 children eligible for BF from the 2004 Pelotas Birth Cohort. Children were divided into three exposure groups by total amount of money their household received from BF in 24 months: no BF, low BF (≤R$1000) and high BF (>R$1000). Using a doubly robust semiparametric estimation method we estimated the effect of receiving low and high levels of BF on LAZ and WAZ at 24 months. Results: After adjustment for measured confounders, the expected difference in LAZ between children that received low or high levels of BF compared to no BF was −0.14 [95% confidence interval (CI): −0.27, −0.02] and −0.20 (95% CI: −0.33, −0.08) respectively. For WAZ the estimated differences were −0.04 (95% CI: −0.17, 0.08) for low levels versus no BF and −0.18 (95% CI: −0.30, −0.05) for high levels versus no BF. The expected difference in population LAZ had all eligible households received it and population LAZ under no BF was −0.15 (95% CI: −0.26, −0.04). Sensitivity analyses suggested only a strong confounder could explain away these results. Conclusions: Among participants of the 2004 Pelotas Birth Cohort, BF was associated with a reduction in LAZ and WAZ in 24 month old children.

AB - Objective: Conditional cash transfer programs are popular internationally and represent a large investment in child health. Evidence of their impact on child nutrition status remains weak and inconsistent, particularly for Bolsa Família, the Brazilian conditional cash transfer program and one of the world's largest. Our objective was to estimate the effect of the Brazilian conditional cash transfer program, Bolsa Família (BF), on child nutritional status as measured by length-for-age z-score (LAZ) and weight-for-age z-score (WAZ) at 24 months. Methods: We analyzed the 1703 children eligible for BF from the 2004 Pelotas Birth Cohort. Children were divided into three exposure groups by total amount of money their household received from BF in 24 months: no BF, low BF (≤R$1000) and high BF (>R$1000). Using a doubly robust semiparametric estimation method we estimated the effect of receiving low and high levels of BF on LAZ and WAZ at 24 months. Results: After adjustment for measured confounders, the expected difference in LAZ between children that received low or high levels of BF compared to no BF was −0.14 [95% confidence interval (CI): −0.27, −0.02] and −0.20 (95% CI: −0.33, −0.08) respectively. For WAZ the estimated differences were −0.04 (95% CI: −0.17, 0.08) for low levels versus no BF and −0.18 (95% CI: −0.30, −0.05) for high levels versus no BF. The expected difference in population LAZ had all eligible households received it and population LAZ under no BF was −0.15 (95% CI: −0.26, −0.04). Sensitivity analyses suggested only a strong confounder could explain away these results. Conclusions: Among participants of the 2004 Pelotas Birth Cohort, BF was associated with a reduction in LAZ and WAZ in 24 month old children.

KW - Brazil

KW - Child growth

KW - Conditional cash transfer

KW - Doubly robust estimation

KW - Health policy

KW - Sensitivity analysis

KW - Targeted

KW - Targeted estimation

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Effect of a conditional cash transfer program on length-for-age and weight-for-age in Brazilian infants at 24 months using doubly-robust, targeted estimation

Abstract

Bibliographical note

Keywords

UN SDGs

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