Assessing municipal-level nurturing care indicators to inform strategies for promoting early childhood development in Brazil
1
School of Public Health, University of São Paulo, São Paulo/SP, Brazil
2
Health Institute, Secretariat of Health of São Paulo, São Paulo/SP, Brazil
3
Programa de Pós Graduação, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte/MG, Brazil
4
Ministry of Health, Brasilia/Federal District, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
This study aimed to evaluate municipal level indicators of the Nurturing Care Framework1,2 and their association with early childhood development.
METHODS:
The PIPAS study was conducted with caregivers of 6447 children aged 0–59 months during the 2019 vaccination campaign in Ceará State/Brazil3. QAD-PIPAS4,5 questionnaire assessed early childhood development (ECD). Municipalities (n=16) were grouped into tertiles according to prevalence of suspected developmental problems (SDP, children with z-scores < –1 SD). Nurturing care patterns (NCP) were identified using principal component factor analysis based on five domains: health, nutrition, responsive caregiving, opportunities for early learning, and security and safety. Three patterns explaining 55.9% of the total variance were retained using eigenvalue criteria, scree plot analysis, and interpretability. Varimax rotation was applied and factor loadings ≥ |0.60| were considered relevant. Associations between pattern scores and municipal prevalence of SDP were examined using survey-weighted adjusted linear regression models (p<0.05).
RESULTS:
The prevalence of SDP varied across municipalities, ranging from 9.1% to 19.4% . Each one-unit increase in adherence to NCP1 was associated with a 1.53-unit increase in SDP prevalence (95% CI: 0.43-2.61; p=0.01). NCP1 was characterized by participation in income transfer and early childhood programs, teenage motherhood, having fewer than seven books at home, and inadequate household sanitation. Similarly, each one-unit increase in adherence to NCP2 was associated with a 1.17-unit increase in SDP prevalence (0.08-2.26; p=0.04). NCP2 included lack of ECD information from care institutions, non-use of the Child Health Booklet, absence of routine child health consultations, insufficient prenatal visits, screen time ≥2 hours/day, and absence of postpartum home visits. NCP3, characterized by violent discipline and absence of skin-to-skin contact after birth, showed no significant association (p = 0.08).
CONCLUSIONS:
Municipal-level nurturing care patterns were significantly associated with early childhood development outcomes and can support local public health planning and targeted intervention strategies.
This study aimed to evaluate municipal level indicators of the Nurturing Care Framework1,2 and their association with early childhood development.
METHODS:
The PIPAS study was conducted with caregivers of 6447 children aged 0–59 months during the 2019 vaccination campaign in Ceará State/Brazil3. QAD-PIPAS4,5 questionnaire assessed early childhood development (ECD). Municipalities (n=16) were grouped into tertiles according to prevalence of suspected developmental problems (SDP, children with z-scores < –1 SD). Nurturing care patterns (NCP) were identified using principal component factor analysis based on five domains: health, nutrition, responsive caregiving, opportunities for early learning, and security and safety. Three patterns explaining 55.9% of the total variance were retained using eigenvalue criteria, scree plot analysis, and interpretability. Varimax rotation was applied and factor loadings ≥ |0.60| were considered relevant. Associations between pattern scores and municipal prevalence of SDP were examined using survey-weighted adjusted linear regression models (p<0.05).
RESULTS:
The prevalence of SDP varied across municipalities, ranging from 9.1% to 19.4% . Each one-unit increase in adherence to NCP1 was associated with a 1.53-unit increase in SDP prevalence (95% CI: 0.43-2.61; p=0.01). NCP1 was characterized by participation in income transfer and early childhood programs, teenage motherhood, having fewer than seven books at home, and inadequate household sanitation. Similarly, each one-unit increase in adherence to NCP2 was associated with a 1.17-unit increase in SDP prevalence (0.08-2.26; p=0.04). NCP2 included lack of ECD information from care institutions, non-use of the Child Health Booklet, absence of routine child health consultations, insufficient prenatal visits, screen time ≥2 hours/day, and absence of postpartum home visits. NCP3, characterized by violent discipline and absence of skin-to-skin contact after birth, showed no significant association (p = 0.08).
CONCLUSIONS:
Municipal-level nurturing care patterns were significantly associated with early childhood development outcomes and can support local public health planning and targeted intervention strategies.
| eISSN: | 2654-1459 |
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