• PLoS Negl Trop Dis · Nov 2014

    Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy.

    • Joilda Silva Nery, Susan Martins Pereira, Davide Rasella, Maria Lúcia Fernandes Penna, Rosana Aquino, Laura Cunha Rodrigues, Mauricio Lima Barreto, and Gerson Oliveira Penna.
    • Federal University of Bahia, Institute of Collective Health, Salvador, Bahia, Brazil.
    • PLoS Negl Trop Dis. 2014 Nov 1; 8 (11): e3357.

    BackgroundSocial 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 Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy.Methodology/Principal FindingsWe 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).ConclusionsAt the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.

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