42
IMAPI Points
Fortaleza, CE
IMAPI is the Early Childhood Friendly Municipal Index. It was created to describe municipal contexts less or more favorable to early childhood development in Brazil and to support decision-making about early childhood.
About IMAPI
IMAPI domains
IMAPI was developed based on the Nurturing Care Framework. It uses indicators related to the provision of public policies, actions, and services, as well as family practices aimed at child development that reflect the five domains of the Nurturing Care Framework recommended by the World Health Organization, UNICEF and World Bank.
Indicators
Each of the 5,570 Brazilian municipalities has an IMAPI that summarizes a set of 31 indicators available at the municipal level in Brazilian databases.
good health
Early start of prenatal care
IMPORTANCE
The early start of prenatal care facilitates screening for risk factors and the possibility of treating possible complications early, promoting health and adequate fetal development.
DEFINITION
Total pregnant women who started prenatal care in the first 12 weeks of pregnancy in relation to the total number of pregnant women monitored, by year and municipality of residence.
SOURCE
Live Birth Information System (Ministry of Health) – Sistema de Informação sobre Nascidos Vivos (SINASC/Ministério da Saúde)
REFERENCE YEAR
2016
Prenatal care consultations
IMPORTANCE
The prenatal period is a sensitive period in the baby’s formation and development. Proper prenatal care, prevention, and early diagnosis of complications can affect child’s development, as well as promote and protect the health of the mother and baby.
DEFINITION
Number of pregnant women with 6 or more prenatal care consultations in relation to the total number of pregnant women monitored (number of live births), by year and municipality of residence.
SOURCE
Live Birth Information System (Ministry of Health) – Sistema de Informação sobre Nascidos Vivos (SINASC/Ministério da Saúde)
REFERENCE YEAR
2016
Adolescent pregnancy
IMPORTANCE
Adolescent pregnancy is a risky situation for the health of the adolescent and the newborn, with an increased chance of intrauterine growth retardation and developmental delays.
DEFINITION
Prevalence of pregnant adolescents (10 to 19 years), by year and municipality of residence.
SOURCE
Live Birth Information System (Ministry of Health) – Sistema de Informação sobre Nascidos Vivos (SINASC/Ministério da Saúde)
REFERENCE YEAR
2016
C-Section
IMPORTANCE
High rates of elective C-Section are associated with prematurity and increased maternal and child morbimortality.
DEFINITION
Number of births via C-Section in relation to the total number of births, by year and municipality of residence.
SOURCE
Live Birth Information System (Ministry of Health) – Sistema de Informação sobre Nascidos Vivos (SINASC/Ministério da Saúde)
REFERENCE YEAR
2016
Prematurity
IMPORTANCE
Premature birth is a risk factor for inadequate child development in the early years as well as an indicator of poor prenatal care.
DEFINITION
Percentage of children born at less than 37 completed weeks of gestation in relation to the total number of births, by year and municipality of residence.
SOURCE
Live Birth Information System (Ministry of Health) – Sistema de Informação sobre Nascidos Vivos (SINASC/Ministério da Saúde)
REFERENCE YEAR
2016
Low birth weight
IMPORTANCE
Low birth weight is a risk factor for inadequate child development, generating negative effects for mental and motor development as well as growth. It is also an indicator of poor prenatal care, maternal malnutrition, adolescent pregnancy, and untreated infections.
DEFINITION
Percentage of live births weighing less than 2500 g in relation to the total number of births, by year and municipality of residence.
SOURCE
Live Birth Information System (Ministry of Health) – Sistema de Informação sobre Nascidos Vivos (SINASC/Ministério da Saúde)
REFERENCE YEAR
2016
Congenital syphilis
IMPORTANCE
Congenital syphilis can cause severe changes in the child’s development, including pseudoparalysis of the limbs, neurological deafness, and learning difficulties.
DEFINITION
Number of confirmed and notified cases of congenital syphilis in children under 5 years old in relation to the total number of children under 5 years old, by year and municipality of residence.
SOURCE
Numerator: National System of Notifiable Diseases (Ministry of Health) – Sistema Nacional de Agravos de Notificação (SINAN/Ministério da Saúde); and Denominator: Brazilian Institute of Geography and Statistics – Instituto Brasileiro de Geografia e Estatística (IBGE).
REFERENCE YEAR
2015
Home visits in the first 10 days of child’s life
IMPORTANCE
Home visits by the health team in the first ten postpartum days help to detect, prevent, and quickly treat postpartum and breastfeeding complications (adequate nutrition). Home visits by health teams also reflect the mother’s and newborn’s access and ties with the health service.
DEFINITION
Percentage of primary care teams in the municipality that participated in the second cycle of the PMAQ (National Program for Improving Access and Quality in Primary Care) and reported carrying out home visits in the first 10 days of child’s life.
SOURCE
National Program for Improving Access and Quality in Primary Care – Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ 2º Ciclo)
REFERENCE YEAR
2013/2014
Coverage of child immunization
IMPORTANCE
Good vaccination coverage guarantees the maintenance of low incidences of immunopreventable illnesses that can influence children’s development.
DEFINITION
Percentage of children who received first dose of DTaP immunization (triple bacterial vaccine), by year and municipality of residence.
SOURCE
National Immunization Program Information System (Ministry of Health) – Sistema de Informações do Programa Nacional de Imunizações (SI-PNI/Ministério da Saúde)
REFERENCE YEAR
2016
Coverage of Primary Health Care
IMPORTANCE
The population coverage by Primary Health Care teams reflects access to health services. Primary Health Care is responsible for several actions to prevent and promote adequate child development and early diagnosis of complications.
DEFINITION
Percentage of the population covered by Primary Health Care, by year and municipality.
SOURCE
e-Manager Platform Primary Care/Ministry of Health – Plataforma e-Gestor Atenção Básica/Ministério da Saúde.
REFERENCE YEAR
2016
Child hospitalization for pneumonia or gastroenteritis
IMPORTANCE
Gastroenteritis and acute respiratory diseases result from a set of biological, environmental, and socio-cultural variables and indicate a high degree of vulnerability, which can cause greater risks and compromises child development. These are conditions that could be avoided or reduced by effective primary care (prevention, diagnosis, and early treatment).
DEFINITION
Percentage of hospitalizations of children under 5 years old with pneumonia or gastroenteritis in relation to the total number of children under 5 years old, by year and municipality of residence.
SOURCE
Numerator: Hospital Information System (Ministry of Health) Sistema de Informações Hospitalares (SIH/Ministério da Saúde); and Denominator: Brazilian Institute of Geography and Statistics – Instituto Brasileiro de Geografia e Estatística (IBGE).
REFERENCE YEAR
2015
Maternal mortality
IMPORTANCE
Maternal death can increase the risks of child mortality, morbidity, and developmental delay in early childhood.
DEFINITION
Number of women who died from causes related to pregnancy, childbirth, or puerperium for every 100,000 live births, per year and municipality of residence.
SOURCE
Numerator: Mortality Information System (Ministry of Health) – Sistema de Informação sobre Mortalidade (SIM/Ministério da Saúde); and Denominator: Live Birth Information System (Ministry of Health) – Sistema de Informação sobre Nascidos Vivos (SINASC/Ministério da Saúde).
REFERENCE YEAR
2016
Child mortality
IMPORTANCE
Most childhood deaths are concentrated in the first year of life, with a high share of perinatal causes (factors linked to pregnancy, childbirth and postpartum), which are generally preventable. After the first year of life, mortality is associated with exposure to environmental factors, for example lack of access to quality health care and other environmental stressors related to poverty. This indicator also expresses the failure in several public policies to promote healthy and complete child development.
DEFINITION
Number of deaths of children under 5 years old for every 1000 live births, per year and municipality of residence.
SOURCE
Numerator: Mortality Information System (Ministry of Health) – Sistema de Informação sobre Mortalidade (SIM/Ministério da Saúde); and Denominator: Live Birth Information System (Ministry of Health) – Sistema de Informação sobre Nascidos Vivos (SINASC/Ministério da Saúde).
REFERENCE YEAR
2016
Preventable deaths in children under 1 years old
IMPORTANCE
Preventable deaths occur when support services fail to identify early and correctly intervene in a given problem. Thus, a child who dies from a preventable cause is a child who has been deprived of development due to problems involving the health services of a particular municipality.
DEFINITION
Deaths that could be prevented by the performance of health care services in children under one year old in relation to the total number of live births, by year and municipality of residence. Deaths caused by the following categories are considered “preventable”: a) Reducible by immunizations; b) Reducible by caring for women during pregnancy; c) Reducible by adequate care for women during childbirth; d) Reducible by actions, diagnosis, and appropriate treatment; e) Reducible by health promotion activities linked to Primary Health Care.
SOURCE
Numerator: Mortality Information System (Ministry of Health) – Sistema de Informação sobre Mortalidade (SIM/Ministério da Saúde); and Denominator: Live Birth Information System (Ministry of Health) – Sistema de Informação sobre Nascidos Vivos (SINASC/Ministério da Saúde).
REFERENCE YEAR
2016
adequate nutrition
Coverage of information on child nutritional status
IMPORTANCE
Adequate nutritional status is associated with better child development and, thus, must be monitored. The coverage of recorded information about nutritional status was used as a monitoring proxy.
DEFINITION
Percentage of children under 5 years of age with at least one record of information on nutritional status (BMI/age) in the Food and Nutrition Surveillance System (SISVAN), by year and municipality of residence.
SOURCE
Numerator: Food and Nutrition Surveillance System (Ministry of Health) – Sistema de Vigilância Alimentar e Nutricional (SISVAN/Ministério da Saúde); and Denominator: Brazilian Institute of Geography and Statistics– Instituto Brasileiro de Geografia e Estatística (IBGE).
REFERENCE YEAR
2015
Coverage of information on child food consumption
IMPORTANCE
Adequate food consumption is associated with better child growth and development. The registration of information on food consumption was used as a monitoring proxy.
DEFINITION
Percentage of children under 5 years old with at least one record of information on food consumption (breastfeeding, quality, and diversity of the diet) in the Food and Nutrition Surveillance System (SISVAN), by year and municipality of residence.
SOURCE
Numerator: Food and Nutritional Surveillance System (Ministry of Health) – Sistema de Vigilância Alimentar e Nutricional (SISVAN/Ministério da Saúde); and Denominator: Brazilian Institute of Geography and Statistics – Instituto Brasileiro de Geografia e Estatística (IBGE).
REFERENCE YEAR
2015
Severe Household Food Insecurity
IMPORTANCE
Children exposed to hunger in the home environment are very likely to experience developmental delays. The prediction of severe food insecurity was used as a proxy for hunger in the municipality
DEFINITION
Estimated prevalence of severe food insecurity in a given municipality. Severe food insecurity is characterized by children’s quantitative reduction in food, disruption in eating patterns resulting from lack of food, and hunger caused by the inability to buy food due to the lack of money.
SOURCE
Gubert MB, Pérez-Escamilla R. Severe food insecurity in Brazilian Municipalities, 2013. DOI: 10.1590/1413-812320182310.265120161
REFERENCE YEAR
2013
Brazilian Breastfeeding and Feeding Strategy
IMPORTANCE
The practice of breastfeeding and the introduction of healthy complementary feeding are associated with adequate child development. The Brazilian Breastfeeding and Feeding Strategy aims to qualify the actions to promote breastfeeding and healthy complementary food, improving the skills and abilities of health professionals for these activities, which should be monitored.
DEFINITION
The indicator Brazilian Breastfeeding and Feeding Strategy (EAAB) is an indicator composed a workshop and/or training for instructors and/or certification of the basic health unit in the municipality.
SOURCE
General Coordination of Food and Nutrition/Department of Primary Care/Ministry of Health – Coordenação-Geral de Alimentação e Nutrição (CGAN)/Departamento de Atenção Básica (DAB)/Ministério da Saúde (MS).
REFERENCE YEAR
Workshop and training for instructors: 2013–2019. Certification of the Basic Health Unit: 2015 and 2016.
responsive caregiving !
Visits by national home-visiting parenting skills program
IMPORTANCE
These home visits focus on strengthening parenting skills, especially for socially vulnerable parents, help these families better understand the child development process, as well as how to behave and respond to provide adequate development. In addition, they help identify problems and difficulties and, if necessary, seek additional support services.
DEFINITION
Percentage of individuals visited by the national home-visiting parenting skills program in relation to the target agreed for the year by municipalities in phase II of implementation.
SOURCE
National Secretariat for the Promotion of Human Development/Ministry of Citizenship – Secretaria Nacional de Promoção do Desenvolvimento Humano/Ministério da Cidadania.
REFERENCE YEAR
2019
opportunities for early learning
Coverage of daycare and preschool
IMPORTANCE
Children need access to free, quality daycare and preschools, where they will receive, under adequate supervision, the stimuli and care necessary for development.
DEFINITION
Number of enrollments in daycare and preschool in relation to the total number of children under 5 years, by year and municipality of residence.
SOURCE
School Census – Censo Escolar
REFERENCE YEAR
2015
Number of students per daycare professional
IMPORTANCE
The number of children per professional should enable all children to receive the attention, responsibility, and interaction necessary for adequate development.
DEFINITION
Number of students enrolled for each professional employed in public and private daycares in the municipality per year.
SOURCE
School Census – Censo Escolar
REFERENCE YEAR
2016
Number of students per preschool professional
IMPORTANCE
The number of children per professional should enable all children to receive the attention, responsibility, and interaction necessary for adequate development.
DEFINITION
Number of students enrolled for each professional employed in public and private preschools in the municipality per year.
SOURCE
School Census – Censo Escolar
REFERENCE YEAR
2016
Percentage of qualified daycare teachers
IMPORTANCE
Teachers with specific and qualified training are better prepared to understand the needs and provide early stimulation to children that supports their proper development.
DEFINITION
Percentage of teachers with higher education employed in public and private daycares in the municipality per year.
SOURCE
School Census – Censo Escolar
REFERENCE YEAR
2016
Percentage of qualified preschool teachers
IMPORTANCE
Teachers with specific and qualified training are better prepared to understand the needs and provide early stimulation to children that supports their proper development.
DEFINITION
Percentage of teachers with higher education employed in public and private preschools in the municipality per year.
SOURCE
School Census – Censo Escolar
REFERENCE YEAR
2016
Daycare educational resources
IMPORTANCE
Daycares must have adequate infrastructure for children, such as the presence of a reading room, playgrounds, adapted restrooms, and educational material available. An adequate infrastructure is fundamental for the stimulation and learning of children, thus favoring complete and adequate development.
DEFINITION
Presence of library/study room and/or playground and/or children’s restroom in daycares in the municipality per year.
SOURCE
School Census – Censo Escolar
REFERENCE YEAR
2016
Preschools educational resources
IMPORTANCE
Preschools must have adequate infrastructure for children, such as the presence of a reading room, playgrounds, adapted restrooms, and educational material available. An adequate infrastructure is fundamental for the stimulation and learning of children, thus favoring complete and adequate development.
DEFINITION
Presence of library/study room and/or playground and/or children’s restroom in schools for early childhood in the municipality per year.
SOURCE
School Census – Censo Escolar
REFERENCE YEAR
2016
security and safety
Notification of violence against children
IMPORTANCE
The notification of violence by the health service is a method to create a qualified service network against the child’s chronic exposure to violence, which impacts child development.
DEFINITION
Total reported cases of any type of violence against children under 5 years old in relation to the total number of children under 5 in the municipality per year.
SOURCE
Numerator: National System of Case Reports (Ministry of Health) – Sistema Nacional de Agravos de Notificação (SINAN/Ministério da Saúde); and Denominator: Brazilian Institute of Geography and Statistics – Instituto Brasileiro de Geografia e Estatística (IBGE).
REFERENCE YEAR
2015
Notification of violence against women
IMPORTANCE
Violence against women can result in several health problems such as abortion, low birth weight, and prematurity. The notification of violence by the health service is a method to create a qualified service network against chronic exposure to violence, which impacts child development.
DEFINITION
Total reported cases of any type of violence against women of childbearing age (10 to 49 years) in relation to the number of women in this age group in the municipality per year.
SOURCE
National System of Case Reports (Ministry of Health) – Sistema Nacional de Agravos de Notificação (SINAN/Ministério da Saúde); and Denominator: Brazilian Institute of Geography and Statistics – Instituto Brasileiro de Geografia e Estatística (IBGE).
REFERENCE YEAR
2015
Coverage of the national conditional cash transfer program
IMPORTANCE
Cash transfer programs protect the development of children in extreme poverty. The coverage of the National conditional cash transfer program reflects the percentage of children in situations of poverty assisted in a social program.
DEFINITION
Percentage of families benefiting from the National conditional cash transfer program among families in the Brazilian single registry with children under 5 years old
SOURCE
Brazilian single registry (Ministry of Citizenship) – Cadastro Único (CADUNICO)/Ministério da Cidadania.
REFERENCE YEAR
2016
Air pollution
IMPORTANCE
During pregnancy and early childhood, the rapid development of children makes them especially vulnerable to environmental stressors. Exposure to air pollution is a stressor that can affect children of all social classes, facilitating the development of childhood respiratory diseases, which can impact cognitive development and increase susceptibility to diseases in general.
DEFINITION
Estimated daily concentration of fine particulate matter (PM2.5) (ug/m3) by municipality.
SOURCE
Brentani A et al. Child Development Center. Faculty of Medicine. University of Sao Paulo.
REFERENCE YEAR
2015
Homicides
IMPORTANCE
Early exposure to violent environments can impair childhood development, including brain development, and damage other parts of the nervous system with lifelong consequences. A safe environment with low levels of violence allows the children and their caregivers to be safe and protected, free to come and go, which permits them to explore the environment around them.
DEFINITION
Homicide rate estimated per 100 thousand inhabitants for each municipality.
SOURCE
Institute of Applied Economic Research (IPEA) - Atlas of Violence – Instituto de Pesquisa Econômica Aplicada (IPEA) - Atlas da Violência
REFERENCE YEAR
2017
Good Health
Relates to the health and well-being of children and their mothers as well as the ability of the caregiver to provide adequate healthcare.
Adequate Nutrition
Relates to the child’s nutrition and the ability of the caregiver to provide adequate nutrition.
Responsive Caregiving
Relates to the ability of parents or caregivers to perceive, understand, and respond to their children’s in a timely and responsive manner.
Opportunities for Early Learning
Relates to opportunities for the child to interact with people, places, or objects in their environment.
Security and Safety
Relates to the provision of safe and protected environments for children and their families.
Steps
IMAPI was created following a systematic scientific process in 8 steps. Federal, state, and municipal stakeholders were involved in its construction, as well as specialists in early childhood and public policies.
MethodologyIndicators
Conceptual model: identification of indicators in the Nurturing Care Framework
Review of documents, internal committee of specialists and technical panels to consult key stakeholders.
Analytical model: definition of the analytical weight for IMAPI indicators
External panel of early childhood and public policies specialists and construction of analytical weight
Consolidation: final selection of indicators to compose IMAPI
Selection of the 31 indicators allocated in the domains of the Nurturing Care Framework
Data engineering
Extraction of indicators
Data were extracted from Brazilian government databases or requested from the competent agencies.
Quality and consistency analysis
Consistency analysis of the indicators individually. Evaluation of minimum, average, maximum, and anomalies. Missing data was imputed.
Data pre-processing and standardization
Methods were applied to standardize the scale.
Generation of IMAPI
IMAPI domains
IMAPI score for domain of the Nurturing Care Framework generated for each municipality, adding the weight assigned by the external panel of specialists. Municipalities were classified as high, medium, and low according to tercile.
General IMAPI
The general IMAPI score was generated for each municipality, adding the weight attributed by the external panel of specialists. Municipalities were classified as high, medium, and low according to tercile.
IMAPI Team
We believe that we can make a difference in the world through science. IMAPI was born from the desire of its researchers to produce science that support stakeholders in prioritizing investments, actions, and policies for Early Childhood.
Meet the team that built IMAPI.
Downloads
Here you will find all publications related to IMAPI. In addition, you can download the complete methodology (available in Portuguese) .
Projects
We are grateful to the participants of the technical panel for the identification and validation of the indicators
- Coordenação Geral de Alimentação e Nutrição (CGAN - Ministério da Saúde)
- Coordenação Geral de Garantia dos Atributos da Atenção Primária (CGAB - Ministério da Saúde)
- Coordenação de Saúde da Criança e Aleitamento Materno (CGSCAM - Ministério da Saúde)
- Coordenação Geral do Programa Nacional de Imunizações (CGPNI - Ministério da Saúde)
- Coordenação do Programa Saúde na Escola (Ministério da Saúde)
- Coordenação Geral de Alimentação e Nutrição (CGEAN - Ministério da Cidadania)
- Secretaria de Avaliação e Gestão da Informação (SAGI - Ministério da Cidadania)
- Secretaria Nacional de Promoção do Desenvolvimento Humano (Ministério da Cidadania)
- Instituto Nacional de Estudos e Pesquisas (INEP)
- Yale School of Public Health
- Companhia de Plajamento do Distrito Federal (CODEPLAN)
- Secretaria de Saúde do Distrito Federal
- Programa Criança Feliz Brasiliense
- Frente Parlamentar da Primeira Infância
- Fundo das Nações Unidas para a Infância (UNICEF)
- Organização Pan-Americana da Saúde (OPAS)
- Secretaria de Saúde de Recife
- Instituto de Saúde de São Paulo
- Todos pela Educação
Thanks to the participants of the panel of specialists in Early Childhood and Public Policies who defined the analytical weights of each indicator
- Yale School of Public Health
- Harvard School of Public Health
- Harvard University Center on the Developing Child
- China Development Research Foundation
- Instituto de Saúde de São Paulo
- Universidade Federal do Ceará
- Fundação Maria Cecilia Souto Vidigal
- Universidade de São Paulo
- Universidade Federal de Minas Gerais
- Secretaria Nacional de Promoção do Desenvolvimento Humano (Ministério da Cidadania)
- Insper
- Instituto de Medicina Integral Professor Fernando Figueira
- Núcleo Ciência pela Primeira Infância (NCPI)
Special thanks
- To Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS) and the Companhia de Planejamento do Distrito Federal (CODEPLAN) for the institutional support.
- To Fundação de Empreendimentos Científicos e Tecnológicos (FINATEC) for their support in project management.
- To ODD Group for institutional support, design, and storytelling.
- To Café for their support in designing the website.
Financing
This project was awarded the “Grand Challenges Explorations: Data science approaches to improve maternal and child health in Brazil” and received funding from the Bill & Melinda Gates Foundation, the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq), the Brazilian Ministry of Health, the Federal District Research Support Foundation (Fundação de Apoio à Pesquisa do Distrito Federal FAP-DF).
Realization
