RESUMO
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.
Resumo Introdução A insegurança alimentar tem efeitos importantes na saúde humana, em particular na das crianças. Continua aumentando, com uma prevalência estimada de 14,9% nos EUA e de 35% no Brasil. Existem poucos estudos sobre o efeito de programas de transferência de renda (PTR) sobre a prevalência de segurança alimentar no Brasil. Objetivo Avaliar a associação de programas de transferência de renda e da redução da inequidade com a insegurança alimentar. Método Estudo transversal de base populacional no Estado do Ceará, no Nordeste do Brasil, em uma amostra de 8 mil domicílios. O Ceará é um dos estados mais pobres do país. A população estadual é de 8,5 milhões de habitantes e os benefícios da segurança social e subsídios governamentais, como o Bolsa Família, tornaram-se a fonte de renda mais estável. As principais variáveis foram insegurança alimentar e a participação em PTR. Foram construídos modelos logísticos multivariados para avaliar a associação entre participação em PTR e segurança alimentar. Resultados A participação em PTR foi relacionada de forma independente com a prevalência de segurança alimentar (APR 2,29 IC 95% 1,57-3,33), assim como nível educacional, ambiente residencial e estado nutricional das crianças. Conclusões PTR e investimentos em educação são iniciativas que podem ser utilizadas para reduzir a insegurança alimentar.
RESUMO
To describe the experience of Ceará, Northeast of Brazil, state on improving child survival, over a 20 year period, and discuss its contribution to Brazil's progress toward the achievement of MDG 4. Five population-based, statewide household surveys, with children <3 years of age, known as PESMIC (Mother and Child Health Survey of Ceará), were conducted in 1987, 1990, 1994, 2001 and 2007. They aimed to investigate levels and causes of mortality and access to child health services. The cluster sampling of 8,000 households identified 2,000 children on average. They used the same methodological approach and indicators. Important changes occurred in demographic and health indicators in the 20 year period, including 81 % reduction in the infant mortality rate, 43 % increase in breastfeeding rate and the achievement of a 95 % immunization rate. The prevalence of chronic malnutrition declined from 28 to 13 % and acute malnutrition from 13 to 5 %. Diarrheal diseases contributed with 36.6 % to the infant mortality in 1986 and 3.9 % in 2007. The major improvements in child health contributed substantially to the progress on MDG 4 in Brazil. Results of the 5 surveys produced reliable information for planning and evaluation that contributed to the remarkable progress made by the state.