Boavista - Survive and Thrive Boa Vista Early Childhood Program

Background:  A growing body of evidence suggests that early life health and developmental outcomes can be improved through parental support programs. The objective of this project was to test the feasibility, impact, and relative cost-effectiveness of home visiting programs as well as center-based parenting groups on child health and development in the municipality of Boavista, Brazil.

Methods: A randomized stepped wedge design was used to roll out and evaluate the two parenting platforms in Boavista municipality.  A total of 39 neighborhoods with high vulnerability index were selected for the program.  For the first phase of the program, 9 neighborhoods were randomly selected for home visits, and 2 were randomly selected for the center based parenting groups. In the second phase of the program, 10 neighorhoods were added to the home visiting program, and 8 were added to the center-based program. In the final phase of the program, the remaining 10 control areas were also assigned to treatment. Study eligibility will be assessed through a baseline survey completed by all pregnant women in the 39 study areas.  Pregnant women will be eligible to participate in the study if they are either classified as poor, under age 20 when they became pregnant or if they indicate to have been exposed to domestic or sexual violence. To assess program impact, an endline survey will be conducted when children reach age 2. The primary study outcome is child development at age 2 as measured by the PRIDI instrument. Secondary outcome will be infant mortality, which will be assessed linking municipal vital registration systems to the program rollout.

Discussion: This trial will assess the feasibility and impact of parenting programs rolled out at medium scale. The results from trial should create evidence urgently needed for guiding Brazil’s national crianca feliz program as well as similar efforts in other countries.

Brentani A, Ferrer A.P.S, Bessa L, Chang S, Walker S, Powell C, Hamadani J, Grisi S, Fink G. Survive and thrive in Brazil: the Boa Vista Early Childhood program: study protocol of a stepped-wedge, randomized controlled trial. Trials. 2020;21:390. DOI: 10.1186/s13063-020-4217-3

Loss G, Fink G, Bessa L, Brentani A. Impact of COVID-19 on maternal health and child care behavior: evidence from a quasi-experimental study of vulnerable communities in Boa Vista, Brazil. Child Abuse Negl. 2022;129:105667. DOI: 10.1016/j.chiabu.2022.105667

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