0238/2022 - AVALIAÇÃO DO PROGRAMA CRIANÇA FELIZ: UM ESTUDO RANDOMIZADO EM 30 MUNICÍPIOS BRASILEIROS EVALUATION OF THE HAPPY CHILD PROGRAM: A RANDOMIZED STUDY IN 30 BRAZILIAN MUNICIPALITIES
O Programa Criança Feliz (PCF) atinge 1,4 milhão de crianças brasileiras menores de três anos com visitas domiciliares visando o desenvolvimento neuropsicomotor. Com base em modelo conceitual, avaliou-se implementação e impacto do PCF em estudo randomizado, em 30 municípios. Ao todo 3.242 crianças foram alocadas para o grupo intervenção (GI) ou controle (GC), sendo 80,0% acompanhadas prospectivamente durante três anos. O desenvolvimento foi avaliado pelo Ages and Stages Questionnaire (ASQ3). Análises por intenção de tratar mostraram escores médios de 203,3 no GI e 201,3 no GC (p=0,427). Análises adicionais com variáveis instrumentais e emparelhamento por escores de propensão tampouco mostraram efeito, uma vez que o número de contatos recebidos não esteve associado aos escores ASQ3 (correlação=-0,013; p=0,436). Tampouco foi observado impacto sobre estimulação, interações responsivas ou atributos psicológicos das crianças. As visitas foram interrompidas durante 12 meses devido à COVID-19, sendo substituídas por contatos virtuais. O estudo de implementação revelou baixa cobertura no GI, contaminação do GC, deficiências na gestão e baixa qualidade das visitas em muitos municípios. O estudo não demonstrou impacto do PCF implementado sob condições de rotina e fornece elementos para aprimoramento.
Palavras-chave:
Desenvolvimento infantil; Avaliação de programas; Impacto
Abstract:
The Happy Child Program (Programa Criança Feliz – PCF, in Portuguese) reaches 1.4 million Brazilian children under three years of age with home visits aimed at neuropsychomotor development. Based on a conceptual model, the implementation and impact of the PCF were evaluated in a randomized study in 30 municipalities. A total of 3,242 children were allocated to the intervention (IG) or control (CG) group, 80.0% of which were prospectively followed up for three years. Development was assessed by the Ages and Stages Questionnaire (ASQ3). Intention-to-treat analyzes showed mean scores of 203.3 in the IG and 201.3 in the CG (p=0.427). Additional analyzes with instrumental variables and pairing by propensity scores also showed no effect, since the number of contacts received was not associated with ASQ3 scores (correlation=-0.013; p=0.436). No impact was observed on stimulation, responsive interactions or psychological attributes of children. Visits were interrupted for 12 months due to COVID-19, being replaced by virtual contacts. The implementation study revealed low coverage in the IG, contamination of the GC, deficiencies in management and low quality of visits in many municipalities. The study did not demonstrate the impact of PCF implemented under routine conditions and provides elements for its improvement.
EVALUATION OF THE HAPPY CHILD PROGRAM: A RANDOMIZED STUDY IN 30 BRAZILIAN MUNICIPALITIES
Resumo (abstract):
The Happy Child Program (Programa Criança Feliz – PCF, in Portuguese) reaches 1.4 million Brazilian children under three years of age with home visits aimed at neuropsychomotor development. Based on a conceptual model, the implementation and impact of the PCF were evaluated in a randomized study in 30 municipalities. A total of 3,242 children were allocated to the intervention (IG) or control (CG) group, 80.0% of which were prospectively followed up for three years. Development was assessed by the Ages and Stages Questionnaire (ASQ3). Intention-to-treat analyzes showed mean scores of 203.3 in the IG and 201.3 in the CG (p=0.427). Additional analyzes with instrumental variables and pairing by propensity scores also showed no effect, since the number of contacts received was not associated with ASQ3 scores (correlation=-0.013; p=0.436). No impact was observed on stimulation, responsive interactions or psychological attributes of children. Visits were interrupted for 12 months due to COVID-19, being replaced by virtual contacts. The implementation study revealed low coverage in the IG, contamination of the GC, deficiencies in management and low quality of visits in many municipalities. The study did not demonstrate the impact of PCF implemented under routine conditions and provides elements for its improvement.
