Monitoring child development indicators in vaccination campaigns: a tool for planning and evaluating intersectoral actions

First Brazilian instrument to assess child development of children up to five years old and to monitor the care they are offered with respect to health, nutrition, timely learning, safety and protection and responsive care, following the domains of the “Nurturing Care Framework.” The questionnaire contains 9 to 24 questions about motor, cognitive, language and socioemotional domains related to the child’s reactions and behaviors. The length of the survey varies according to the child’s age and takes no longer than twenty minutes, while in line for a vaccine. Administering the survey takes place through an application developed for IOF and Android systems.

The group brought together experts to develop the Development Assessment Questionnaire (QAD-PIPAS) and carried out several validation steps (content, reliability, concurrent validity compared to the Caregiver Reported Early Development Index -CREDI, and convergent validity), with satisfactory results. Before the vaccination campaign, the researchers conducted a pilot assessment with 367 children in the selected cities. After training 243 interviewers and producing communication materials, the questionnaire was administered to the caregivers of 2,331 children between zero to five years old in the three cities. The data were tabulated and stored on a special project website, which could also be accessed by administrators, policy makers and decision makers.

The instrument was effective in mapping essential factors that provide clues about delays in child development. These include: low maternal education, having participated in a social program, health problems and a caregiver who suspects that the child has developmental problems, which can double the chances of having some type of deficit. On the other hand, stimuli like reading children’s books has a positive impact.

It is the first instrument for assessing child development on a large scale in Brazil, which also makes it possible to monitor the care provided to children.

The lack of tools to assess child development in the population and to identify important delays in order to support the child and identify public policies to resolves these issues.

The questionnaire proved to be an easy-to-use, low-cost and appropriate tool to be applied on a large scale. The information offers a snapshot of child development in each location which can be used by administrators to inform public policies.

The Brazilian experience can contribute to the development and validation of global instruments.

The next phase of the PIPAS Project in Ceará is enabling the development of a methodology to support municipal administrators in the development of intersectoral action plans, based on a process of prioritizing problems and identifying viable solutions for each context. The Ministry of Health will support research during the 2021 multi-vaccination campaign in Brazilian capitals and the Federal District, as well as 446 priority municipalities involved in a project that seeks to strengthen the implementation of the National Policy for Comprehensive Child Health Care. In addition, the PIPAS Project is establishing partnerships with universities and is in discussion with the IBGE to incorporate the PAF-PIPAS into population surveys.