Time trend of the prevalence of malnutrition in children under five years of age assisted by the Bolsa Família Program (2008-2019)

Abstract

The objective of this study was to analyze the temporal trend of malnutrition in children under five years of age assisted by the Bolsa Família Program (PBF) between 2008 and 2019, exploring regional inequalities and seeking to determine the impact of the economic and political crises worsened in 2014 and of government adherence to fiscal austerity policies on the trend. Analyses were conducted using aggregate data from infants (0-23 months) and preschoolers (24-59 months) extracted from the Food and Nutrition Surveillance System (SISVAN) assisted by the PBF (n=34,272,024). Trends were analyzed using generalized linear models with age-specific mixed effects (negative binomial distribution and log-link function). Regional inequalities were analyzed by grouping the federative units according to the social vulnerability index (SVI) and the influence of crises and austerity policies on the prevalence of malnutrition by means of the interaction between "year" and "crisis" (2008-2013 vs. 2014-2019). There was a reduction in the prevalence of child malnutrition until mid-2013, when trends became stationary for preschoolers and upward for infants. Higher risk of malnutrition was also observed in states with medium and high social vulnerability compared to those with low social vulnerability. The turning point in the trends supports the hypothesis that the political and economic crises, and government responses to these crises, have negatively impacted the nutritional status of children in poverty and extreme poverty in Brazil.