Foco e cobertura do programa Bolsa Família em crianças das coortes de nascimento BRISA, Ribeirão Preto (São Paulo) e São Luís (Maranhão), Brasil

RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís): history, objectives and methods

This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.

Health services, intersectoriality and social control: a comparative study on a conditional income transfer program

The Bolsa Família Program (BFP) is one of the largest conditional cash transfer programs in the world, providing cash transfers and intersectoral actions. The aim of this study was to compare whether there is a difference in access to health services, intersectoral actions and social control, between families entitled or not, to the BFP. A cross-sectional study was carried out. A representative sample of a peripheral, socioeconomically vulnerable population from a large urban center in southeastern Brazil was calculated, totaling 380 families. Chi-square or Fisher's exact tests and multiple correspondence analysis were used to compare groups. Families entitled to the BFP had worse living conditions in general and greater access to health services, such as: medical care (p-value 0.009), community healthcare agent (p-value 0.001) and home visits (p-value 0.041). Being entitled or not affected the variability in the pattern of access to services by 31%; low access to intersectoral actions was identified in both groups; social control was incipient. There was an adequate focus on the program; greater access to health services was related to compliance with conditionalities; low access to intersectoral actions can restrict the interruption of the cycle of intergenerational transmission of poverty.