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Conditional Cash Transfer Program and Leprosy Incidence: Analysis of 12.9 Million Families From the 100 Million Brazilian Cohort.

Abstract

Leprosy is a neglected tropical disease predominately affecting poor and marginalized populations. To test the hypothesis that poverty-alleviating policies may be associated with reduced leprosy incidence, we evaluated the association between the Brazilian Bolsa Familia conditional cash transfer Program (BFP) and new leprosy case detection using linked records from 12,949,730 families in the 100 Million Brazilian Cohort (2007-2014). After propensity score matching BFP beneficiary to non-beneficiary families, we used Mantel-Haenszel tests and Poisson regressions to estimate incidence rate ratios (IRRs) for new leprosy case detection and secondary endpoints related to operational classification and leprosy-associated disabilities at diagnosis. Overall, cumulative leprosy incidence was 17.4/100,000 pyr (95%CI: 17.1, 17.7), and markedly higher in "priority" (high-burden) versus "non-priority" (low-burden) municipalities (22.8/100,000 pyr, 95%CI: 22.2, 23.3 versus 14.3/100,000, 95%CI: 14.0, 14.7). After matching, BFP participation was not associated with leprosy incidence overall (IRRPoisson 0.97, 95%CI: 0.90, 1.04) but was associated with lower leprosy incidence when restricted to families living in high-burden municipalities (IRRPoisson 0.86, 95%CI: 0.77, 0.96). In high-burden municipalities, the association was particularly pronounced for paucibacillary cases (IRRPoisson 0.82, 95%CI: 0.68, 0.98) and cases with leprosy-associated disabilities (IRRPoisson 0.79, 95%CI: 0.65, 0.97). These findings provide policy-relevant evidence that social policies may contribute to on-going leprosy control efforts in high-burden communities.

More information

Type
Journal Article
Author
Pescarini J
Williamson E
Ichihara M
Fiaccone R
Forastiere L
Ramond A
Nery J
Penna M
Strina A
Reis S
Smeeth L
Rodrigues L
Brickley E
Penna G
Barreto M