LAUSR

Early inequities in Early Childhood Development (ECD) are linked to inequalities across the five regions and within the 5570 municipalities in Brazil. We aimed to operationalize an index (IMAPI) to assess and monitor the enabling environment for nurturing care at the regional and municipal level in Brazil using existing national databases. We followed three steps to operationalize IMAPI. I) Selection of indicators. The literature review guided the identification of existing indicators to translate each domain of the Nurturing Care Framework (Good Health, Adequate Nutrition, Opportunities for Early Learning, Responsive Caregiving, and Safety and Protection). Subsequently, meetings with experts and key Brazilian stakeholders informed the identification and selection of existing data in the national databases. II) Consultation with experts. Weights for the selected indicators were defined through a process based on the SMART approach. III) Analyzing IMAPI. Statistical and machine learning methods were used to compute an overall IMAPI as well as an index for each nurturing care domain that ranges from 0 (lowest score) to 100 (highest score). Means were calculated for each region of Brazil-based on municipalities indexes. IMAPI summarizes a set of 29 indicators: good health (14 indicators), adequate nutrition (4), early learning (7), responsive caregiving (0), and security and safety (4). Adequate nutrition domain presented the lowest median indexes (ranging from 32 to 22) and it was one of the most challenging to get reliable indicators due to the low coverage of national nutritional databases. The biggest difference means (DM) between regions with the best and worst indexes were found for early learning (DM = 17, ranging), good health (DM = 15) and security and safety (DM = 11), respectively. Responsive caregiving indicators were not identified at the municipal level within the existing national databases. A final version of IMAPI for each of the 5570 Brazilian municipalities incorporating sensitive analysis is being tested. IMAPI discriminates regional and municipal enabling and constraining environments to promote ECD in Brazil which can facilitate informed policy decisions to address early inequities. Bill and Melinda Gates Foundation, CNPq, FAPDF.