The relation of cash transfer programs and food insecurity among families with preschool children living in semiarid climates in Brazil

Correia, Luciano Lima; Rocha, Hermano Alexandre Lima; Leite, Álvaro Jorge Madeiro; Cavalcante e Silva, Anamaria; Campos, Jocileide Sales; Machado, Márcia Maria Tavares; Lindsay, Ana Cristina; Cunha, Antonio José Ledo Alves da

doi:10.1590/1414-462X201800010341

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Original Article • Cad. saúde colet. 26 (1) • Jan-Mar 2018 • https://doi.org/10.1590/1414-462X201800010341 copy

The relation of cash transfer programs and food insecurity among families with preschool children living in semiarid climates in Brazil

A relação dos programas de transferência de renda e a insegurança alimentar entre famílias com pré-escolares da região semiárida do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Food insecurity has important effects on human health, particularly in children’s. It continues to increase, with an estimated prevalence of 14.9% in the USA and 35% in Brazil. There have been few studies on the effect of cash transfer programs (CTPs) on the prevalence of food security in Brazil.

Objective

Evaluate the association between cash transfer programs and reductions in inequity and food insecurity.

Method

Population-based cross-sectional study in the state of Ceará, Northeast Brazil, with a sample of 8.000 households. Ceará is one of the poorest states. The state population of 8.5 million inhabitants, social security benefits and government grants, “ Bolsa Família”, have become the most stable source of income. The main outcomes measures were food insecurity and CTP participation. Multivariate logistic models were constructed to assess the association between participation in CTPs and food security.

Results

Participation in CTPs was found to be independently related to the prevalence of food security (APR 2.29 95% CI 1.57-3.33), as are education level, residential setting, and children’s nutritional status.

Conclusions

CTPs and investment in education are initiatives that might be used to reduce food insecurity.

Keywords:
food insecurity; cash transfer; health equity; nutrition

Food unavailable at home⁽1 ⁾	Enough in quantity and quality	Enough in quantity, but not quality	Sometimes not enough	Always not enough	P value⁽2⁾
Staple food (rice, beans, flour)	8 (1.2)	6 (1.8)	14 (3.8)	12 (12.6)	<0.001
Protein food (meat, poultry, fish)	47 (6.8)	60 (17.6)	128 (35.1)	47 (49.5)	<0.001
Milk (cow’s, formula)	97 (14.1)	102 (30.0)	105 (28.8)	30 (31.6)	<0.001
Total	689 (46.3)	340 (22.8)	365 (24.5)	95 (6.4)	<0.001

Factors	Sample proportion (%)	Prevalence of Food Insecurity	PRR	Confidence Interval 95%	P value
Cash Transfer:
Eligible and participant	34.3	48.3	4.27	3.18-5.75	<0.001
Eligible, non-participant	13.1	46.9	2.81	2.06-3.84	<0.001
Non-eligible	52.6	15.5	1	1
Family size:
≤3 members	24.7	27.7	0.74	0.58-0.95	0.017
4-5 members	46	28.2	0.75	0.61-0.93	0.008
> 5 members	29.3	37.5	1	1
Children <3 years:
1 child	92.9	30.4	1	1
≥ 2 children	7.1	37.1	1.22	0.88-1.69	0.233
Household’s chief:
Father	75.5	30.3	0.56	0.33-0.94	0.018
Mother	15.6	31.2	0.58	0.33-1.04
Grandparents	4.5	22.7	0.38	0.17-0.81
Others	4.2	44	1	1
Chief’s schooling:
≤4 years	40.7	42.8	4.3	2.67-6.93	<0.001
5-8 years	25.6	28.6	2.88	1.75-4.75	<0.001
9-12 years	21.4	22.8	2.29	1.37-3.84	0.002
≥ 12 years	12.3	9.9	1	1
Health insurance:
Yes	14.5	9	1
No	85.5	34.5	3.84	2.38-5.88	<0.001
Setting of residence:
Rural	17.5	60	2.42	1.99-2.93	<0.001
Urban	82.5	24.8	1	1.99-2.93	<0.001

Drinking water source:
Mineral water	15.4	5.7	1
River/pound	3.4	76	13.39	7.13-25.13	< 0.001
Well	9.8	28.7	5.06	2.74-9.37	< 0.001
Tap water	60.4	33.4	5.88	3.37-10.24	< 0.001

Factors	Sample proportion (%)	Prevalence of Food Insecurity	PRR	Confidence Interval 95%	P value
Age:
10-19 years	15.4	29.5	0.71	0.49-1.00	0.054
20-29 years	48.9	26.3	0.63	0.47-0.84	0.002
30-39 years	26.1	35	0.84	0.61-1.14	0.26
40-49 years	9.6	41.9	1
Literacy:
Literate	90	26.8	1
Illiterate	10	61	2.27	1.80-2.88	<0.001
Job:
Housewife	74.1	33.6	1	1	<0.001
Work outside home	18.9	18.7	0.45	0.32-0.63
Work at home	7	28.3	0.79	0.49-1.22
Body image satisfaction:
Yes, satisfied	50.7	32.3	1.07	0.79-1.45	0.679
No, wish lose weight	37.8	27.7	0.91	0.66-1.25	0.552
No, wish gain weight	11.6	30.5	1	1
Diabetes:
Yes	4.4	38.7	1.28	0.85-1.94	0.235
No	95.6	30.2	1	0.85-1.94	0.235
Hypertension
Yes	16.5	33.5	1.12	0.92-1.37	0.269
No	83.5	29.8	1	0.92-1.37	0.269
Contraceptive usage:
Yes	62.8	30	0.94	0.77-1.14	0.518
No	37.2	32	1	0.77-1.14	0.518
Nutritional status
Low weight (BMI<18)	5.7	29.6	0.86	0.53-1.37	0.517
Normal (BMI18-24)	51.9	20.4	0.88	0.66-1.16	0.361
Overweight (BMI25-30)	12.9	29.3	0.85	0.63-1.15	0.285
Obesity (BMI>30)	29.4	34.6	1	1

Factors	Sample proportion (%)	Prevalence of Food Insecurity	PRR	Confidence Interval 95%	P value
Gender:
Male	55.7	28.6	0.84	0.70-1.01	0.069
Female	44.3	33.8	1	0.70-1.01	0.069
Age:
<6 months	19	29.6	0.93	0.71-1.22	0.593
6-11 months	16.5	33.2	1.04	0.79-1.37	0.772
12-23 months	34.5	29.8	0.94	0.74-1.18	0.569
24-36 months	29.9	31.9	1	1
Father at home:
Absence	25.1	32.3	1.06	0.86-1.31	0.576
Presence	74.9	30.4	1	0.86-1.31	0.576
Birth weight:
< 2,500g	8.4	37.9	1.26	0.93-1.70	0.141
≥ 2,500g	91.6	30.2	1	1	0.141
Breast feeding:
Never breastfed	5.5	21.5	0.64	0.39-1.04	0.071
1-6 months	28.8	27.9	0.83	0.66-1.03	0.089
7-12 months	8.4	30	0.89	0.63-1.26	0.5
> 12 months	6.9	28.6	0.84	0.57-1.25	0.396
Still breastfeeding	50.4	33.8	1	1
Weight in child’s card:
Yes	55.9	32.7	0.99	0.77-1.27	0.921
No	27.6	22.5	1	0.77-1.27	0.921
Diarrhoea prev. 24 hours:
Yes	12.8	37.8	1.19	0.79-1.78	0.402
No	87.2	30.3	1	0.79-1.78	0.402
Nutritional status⁽1⁾:
Underweight (<-1 SD)	15.4	41	1.67	1.21-2.29	0.002
Normal (-1 – 1 SD)	52.9	31.5	1.28	0.97-1.69	0.078
Overweight (1 – 2 SD)	14.3	25.4	1.03	0.72-1.48	0.873
Obesity (> 2 SD)	17.5	24.6	1	1
Stunting⁽1⁾ (<-2 SD):
Yes	30.3	39.2	1.44	1.19-1.74	<0.001
No	69.7	27.3	1	1.19-1.74	<0.001

Factors	Adjusted PRR	95% Confidence Interval	P value
Cash transfer program participation:
Participant	2.29	1.57-3.33	<0.001
Eligible, non-participant	1.75	1.20-2.55	0.004
Non-eligible	1
Schooling of household’s chief:
≤4 years	2.11	1.14-3.89	0.017
5-8 years	1.89	1.02-3.53	0.045
9-12 years	2	1.06-3.78	0.032
≥ 12 years	1
Setting of residence:
Rural	1
Urban	1.69	1.28-2.24	<0.001
Drinking water source:
River/pound	4.33	2.06-9.12	<0.001
Well	2.18	1.08-4.40	0.029
Tap water	2.97	1.59-5.54	0.001
Mineral water	1
Literacy of mother:
Literate	1
Illiterate	1.49	1.11-2.00	0.009
Child’s nutritional status⁽1⁾:
Underweight	1.88	1.21-2.93	0.005
Eutrophic	1.57	1.05-2.33	0.026
Overweighed	1.53	0.95-2.48	0.081
Obese	1

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[1] Correspondence: Hermano Alexandre Lima Rocha – Departamento de Saúde Comunitária, Universidade Federal do Ceará (UFC), Rua Professor Costa Mendes, 1608, 5º andar – Bairro Rodolfo Teófilo – CEP: 60430-140 – Fortaleza (CE), Brasil – Email: hermano@ufc.br; hermanoalexandre@gmail.com