Cash transfer in Brazil and nutritional outcomes: a systematic review

OBJECTIVE To analyze the influence of conditional cash transfer programs on diet and nutrition outcomes among beneficiary families in Brazil. METHODS A systematic review of literature was carried out with original evaluation studies conducted in Brazil, including all types of clinical trials and observational studies. The search was conducted in PubMed, Scopus, Web of Science and LILACS databases for papers published since 1990. The studies were analyzed according to the program evaluated, participants, study design, location, principal conclusions, confounding factors and methodological limitations. They were classified according to outcomes (nutritional status, dietary intake and food security) and level of evidence for the association with conditional cash transfer programs (adequacy or plausibility). RESULTS We found 1,412 non-duplicated papers. Fifteen met the eligibility criteria and twelve evaluated the Bolsa Família program. Five plausibility studies and two adequacy analyses indicated a positive influence of conditional cash transfer programs on nutritional status of the beneficiary children. The conditional cash transfer programs influence on dietary intake was analyzed in one population-based adequacy study and three cross-sectionals plausibility researches in different municipalities. All of them indicated that beneficiaries had higher food intake than non-beneficiaries. The three cross-sectional plausibility analyses suggest a positive influence of conditional cash transfer programs on the food security of the beneficiaries. The main methodological limitations found were using cross-sectional analysis and difficulties in data collection, small sample sizes and limitations of the instruments used. CONCLUSIONS The few studies found indicated a positive association between Brazilian conditional cash transfer programs and improvements in the recipients' diet and nutrition. Greater efforts to widen and qualify evaluations are needed in order to assess more comprehensively the impact of conditional cash transfer programs in Brazil.