Survive and Thrive in Brazil: estimating the impact of the Boa Vista early childhood program

This study aimed to evaluate the impact of the Survive and Thrive program on neonatal mortality and child development in Boa Vista, Brazil. Between November 2017 and May 2021, the program to support pregnant women as well as mothers of children under age 3 was rolled out in three phases. Neighborhoods were selected either for home visits or for group meetings held at Social Assistance Reference Centers. To allow for an evaluation of the program, the timing of the rollout was randomized at the neighborhood level. To assess the impact of the program on neonatal mortality, we used complete vital registration data from the period 2010 to 2010, and estimated differences in child mortality before and after the program were launched. Impact on child development was assessed through a detailed assessment of 744 children born in 2019 using the Caregiver Reported Early Child Development Index and Regional Project on Child Development Indicators instruments. Home visits resulted in a significant improvement in child development [d = 0.28, 95% Confidence Interval (CI) (-0.013, 0.57), P-value of .06] and reduction of neonatal mortality [Risk Ratio (RR) 0.58, 95% CI (0.36, 0.93), P-value of .02]. No impacts were found for the group meetings. The findings indicate that a home visiting program beginning in pregnancy can significantly reduce neonatal mortality and improve child development in poor urban neighborhoods of Brazil.