A home visit-based early childhood stimulation programme in Brazil-a randomized controlled trial

Area of Science:

• Public Health
• Developmental Psychology
• Health Services Research

Background:

• Home visiting programs are effective for child development in low-income settings.
• Optimal delivery platforms for these interventions remain unclear.
• Early childhood development (ECD) is crucial for long-term outcomes.

Purpose of the Study:

• To compare the effectiveness of child development agents (CDAs) versus community health workers (CHWs) for ECD home visiting in Brazil.
• To evaluate the impact of two delivery platforms on child development outcomes.
• To inform the design of effective ECD policies in urban Brazil.

Main Methods:

• Randomized controlled trial involving 826 mother-child dyads in São Paulo, Brazil.
• Biweekly home visits delivered by either CHWs or CDAs for 12 months.
• Child development assessed using PRIDI and Caregiver-Reported Early Development Instruments.

Main Results:

• Intention-to-treat analysis showed no significant improvement in child development outcomes for either intervention.
• Per-protocol analysis indicated a significant positive effect of the CDA program (0.22 SD increase).
• The study highlights potential benefits of home visiting but questions the feasibility of using existing CHWs.

Conclusions:

• Home visiting interventions can potentially enhance child development in disadvantaged Brazilian families.
• Integrating ECD home visiting through existing CHWs may be challenging in the Brazilian context.
• Effective ECD policies require cross-sectoral coordination and potentially dedicated cadres like CDAs.