Developmental health in the context of an early childhood program in Brazil: the “Primeira Infância Melhor” experience

Abstract

Design and evaluation of early child development (ECD) programs are poorly documented in low- or middle-income countries. The study aimed to identify family and child characteristics associated with developmental health outcomes among children aged from 4 to 6 years who participated in the “Primeira Infância Melhor” - PIM (Better Early Childhood), a home visiting program in Rio Grande do Sul State, Brazil. We also evaluated the impact of PIM on developmental vulnerability at school entry using a comparison group. Multistage sampling was first used to select cities, then families, in different regions of the state, resulting in a sample of eight cities and 571 children (364 PIM; 207 comparison). We used a sociodemographic questionnaire, completed by parents, and the Early Development Instrument (EDI), completed by teachers. Among PIM children, lower family income, time of exit from the program, city, and younger age were associated with higher risk of developmental vulnerability and/or with lower mean scores in EDI domains. Multivariate analysis controlling for covariates found no differences between the study groups in EDI outcomes even though the gaps in equity of the outcomes were smaller in the PIM group. These results are discussed in the context of challenges faced by home visiting programs in addressing complex social conditions of high-risk families and difficulties in finding an adequate comparison group in communities where an ECD program is universally accessible. We also note the importance of setting structured and longitudinal monitoring systems together with the implementation of ECD policies.

Effectiveness of a large-scale home visiting programme (PIM) on early child development in Brazil: quasi-experimental study nested in a birth cohort

“… 24 One cross-sectional study with a sample of 571 children found no differences in ECD between PIM intervention and control groups. 25 To support further planning of PIM and inform policies on similar interventions in LMICs, the current longitudinal, quasi-experimental study based on preintervention characteristics affecting selection into the intervention, and postintervention tests of ECD, aimed to assess the effects of PIM on ECD in real-life settings within a population-based birth cohort.…”

Scaling up of Brazil's Criança Feliz early childhood development program: an implementation science analysis

“…KIs chose the evidence‐based WHO/UNICEF CCD methodology to enable the effectiveness of home visits. Due to challenges in understanding and applying the CCD methodology in the context of home visits, a home‐visiting manual was created to present the methodology of home visits (step by step) based on the experience of Programa Primeira Infância Melhor ‐ PIM (Better Early Childhood Program) 28 . PIM is an intersectoral home visit ECD program implemented in Southern Brazil since 2003 based on the lessons learned from the Cuban program Educa a Tu Hijo (Educate Your Child) and has been a source of methodological inspiration for the PCF coordination team.…”

Advocacy efforts in Brazil to extend the recognition of children's rights in early childhood: A case study

“…The first state-level law on ECD was created in 2006 and the Better Early Childhood (Primeira Infância Melhor, PIM) programme was introduced as a state policy in the state of Rio Grande do Sul. PIM proved to be an effective programme 12 that facilitated later advocacy efforts to improve ECD in Brazil. 13 On 8 March 2016, Law No 13.257, known as the Legal Framework for ECD (the Legal Framework), 14 was sanctioned by the then President Dilma Rousseff after its approval in the Chamber of Deputies and the Senate.…”