Nurturing Care domain	Name of the indicator	Technical definition	Theoretical justification and influence on ECD	Calculation method	Interpretation	Source of information	Year of reference
Good health	Prenatal care consultations	Number of pregnant women with six 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	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	(Number of women with six or more prenatal care consultations/total live births) * 100, per year and municipality of residence	An adequate number of prenatal care consultations can protect the child from suboptimal early child development	Sistema de Informação sobre Nascidos Vivos (SINASC/Ministry of Health)	2016
	Early start of prenatal care	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	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	(Total pregnant women who started prenatal care at 12 weeks or less/total pregnant women monitored) * 100, per year and municipality of residence	The early start of prenatal care can protect the child from suboptimal early child development	Sistema de Informação sobre Nascidos Vivos (SINASC/Ministry of Health)	2016
	Congenital syphilis	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	Congenital syphilis can cause severe changes in the child's development, including pseudo‐paralysis of the limbs, neurological deafness and learning difficulties	(Number of confirmed and notified cases of congenital syphilis in children under 5 years old/population under 5 years old) * 10,000, per year and municipality of residence	Congenital syphilis is a risk factor for suboptimal early child development	Numerator: Sistema Nacional de Agravos de Notificação (SINAN/Ministry of Health); and denominator: Instituto Brasileiro de Geografia e estatística (IBGE)	2015
	C‐section	Number of births via C‐section in relation to the total number of births, by year and municipality of residence	High rates of elective C‐section are associated with prematurity and increased maternal and child morbimortality	(Total live births via C‐section/total live births) * 100, per year and municipality of residence	C‐section is a risk factor for suboptimal early child development	Sistema de Informação sobre Nascidos Vivos (SINASC/Ministry of Health)	2016
	Home visits in the first 10 days of child's life	Percentage of primary care teams in the municipality that participated in the second cycle of the PMAQ (national programme for improving access and quality in primary care) and reported carrying out home visits in the first 10 days of child's life	Home visits by the health team in the first 10 post‐partum days help to detect, prevent and quickly treat post‐partum 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	(number of teams that conduct home visits in the first 10 days of child's life/total teams that participated in the PMAQ 2nd cycle) * 100, per year and municipality of residence	Home visits in the first 10 days of child's life can protect the child from suboptimal early child development	Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ 2° Ciclo)/Ministry of Health	2013/2014
	Child hospitalization for pneumonia or gastroenteritis	Percentage of children under 5 years old hospitalized for pneumonia or gastroenteritis in relation to the total number of children under 5 years old, by year and municipality of residence	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)	(Total children under 5 years old hospitalized for pneumonia or gastroenteritis/total children under 5 years old) * 100, per year and municipality of residence	Child hospitalization for pneumonia or gastroenteritis is a risk factor for suboptimal early child development	Numerator: Sistema de Informações Hospitalares (SIH/Ministry of Health) and denominator: Instituto Brasileiro de Geografia e Estatística (IBGE)	2015
	Adolescent pregnancy	Prevalence of pregnant adolescents (10–19 years), by year and municipality of residence	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	(Number of live births to mothers aged 10–19 years old/total live births) * 100, per year and municipality of residence	Adolescent pregnancy is a risk factor for suboptimal early child development	Sistema de Informação sobre Nascidos Vivos (SINASC/Ministry of Health)	2016
	Low birth weight	Percentage of live births weighing less than 2500 g in relation to the total number of births, by year and municipality of residence	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	(Total live births weighing less than 2500 g/total live births) * 100, per year and municipality of residence	Low birth weight is a risk factor for suboptimal early child development	Sistema de Informação sobre Nascidos Vivos (SINASC/Ministry of Health)	2016
	Child mortality	Number of deaths of children under 5 years old for every 1000 live births, per year and municipality of residence	Most childhood deaths are concentrated in the first year of life, with a high share of perinatal causes (factors linked to pregnancy, childbirth and post‐partum), 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 healthcare and other environmental stressors related to poverty. This indicator also expresses the failure in several public policies to promote healthy and complete child development	(Number of deaths of children under 5 years old/total live births) * 1,000, per year and municipality of residence	Higher child mortality rates are associated with negative exposure to environmental factors, which are risk factors for suboptimal early child development	Numerator: Sistema de Informação sobre Mortalidade (SIM/Ministry of Health) and denominator: Sistema de Informação sobre Nascidos Vivos (SINASC/Ministry of Health).	2016
	Preventable deaths in children under 1 year old	Deaths that could be prevented by the performance of healthcare services in children under 1 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; and (e) reducible by health promotion activities linked to primary healthcare	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	(Number of preventable deaths in children under 1 year/total live births) * 1000, per year and municipality of residence	Higher numbers of preventable deaths in children under 1 year old are a reflect of failures in the support services, which are risk factors for suboptimal early child development	Numerator: Sistema de Informação sobre Mortalidade (SIM/Ministry of Health). Denominator: Sistema de Informação sobre Nascidos Vivos (SINASC/Ministry of Health)	2016
	Prematurity	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	Premature birth is a risk factor for inadequate child development in the early years as well as an indicator of poor prenatal care	(Total children born before 37 completed weeks of gestation/total live births) * 100, per year and municipality of residence	Prematurity is a risk factor for suboptimal early child development	Sistema de Informação sobre Nascidos Vivos (SINASC/Ministry of Health)	2016
	Maternal mortality	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	Maternal death can increase the risks of child mortality, morbidity and developmental delay in early childhood	(Number women who died due to causes related to pregnancy, childbirth and puerperium/number of live births) * 100,000, per year and municipality of residence	Maternal mortality is a risk factor for suboptimal early child development	Numerator: Sistema de Informação sobre Mortalidade (SIM/Ministry of Health) and denominator: Sistema de Informação sobre Nascidos Vivos (SINASC/Ministry of Health)	2016
	Coverage of child immunization	Percentage of children who received first dose of DTaP immunization (triple bacterial vaccine), by year and municipality of residence	Good vaccination coverage guarantees the maintenance of low incidences of immunopreventable illnesses that can influence children's development	(Number of doses of the first DTaP immunization (triple bacterial vaccine) /target population) * 100, per year and municipality of residence.	Child immunization is associated with low incidences of immune preventable illnesses, protecting the child from suboptimal early child development	Sistema de Informações do Programa Nacional de Imunizações (SI‐PNI/Ministry of Health)	2016
	Coverage of primary healthcare	Percentage of the population covered by primary healthcare, by year and municipality	The population coverage by primary healthcare teams reflects access to health services. Primary healthcare is responsible for several actions to prevent and promote adequate child development and early diagnosis of complications	[Number of family health teams * 3450 + (number of parameterized primary care teams + number of equivalent family health teams) * 3000] in the reference month (December) /population estimate * 100	Coverage of primary healthcare can protect the child from suboptimal early child development	Plataforma e‐Gestor Atenção Básica/Ministry of Health.	2016
Adequate nutrition	Coverage of information on child feeding practices	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	Adequate food consumption is associated with better child growth and development. The registration of information on food consumption was used as a monitoring proxy	(Children under 5 years old with at least one record on food consumption in SISVAN/population under 5 years old) * 100, per year and municipality of residence	Coverage of information on child food consumption is a monitoring proxy of an adequate food consumption, which can protect the child from suboptimal early child development	Numerator: Sistema de Vigilância Alimentar e Nutricional (SISVAN/Ministry of Health) and denominator: Instituto Brasileiro de Geografia e Estatística (IBGE)	2015
	Severe household food insecurity	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	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	Estimated prevalence of severe food insecurity in the municipality	Severe household food insecurity is a risk factor for suboptimal early child development	Gubert MB, Pérez‐Escamilla R. Severe food insecurity in Brazilian Municipalities, 2013. DOI: 10.1590/1413‐812320182310.265120161	2013
	Brazilian breastfeeding and feeding strategy a	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	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	[(∑ workshop held, training instructors, certified health unit in the municipality)/3]	Brazilian breastfeeding and feeding strategy qualifies the actions to promote breastfeeding and healthy complementary food, which can protect the child from suboptimal early child development	Coordenação‐Geral de Alimentação e Nutrição (CGAN)/Departamento de Atenção Básica (DAB)/Ministry of Health	*2013–2019
	Coverage of information on child nutritional status	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	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	(Children under 5 years old with at least one record of nutritional status in SISVAN/population under 5 years old) * 100, per year and municipality of residence	Coverage of information on child nutritional status is a monitoring proxy of an adequate nutritional status, which can protect the child from suboptimal early child development	Numerator: Sistema de Vigilância Alimentar e Nutricional (SISVAN/Ministry of Health) and denominator: Instituto Brasileiro de Geografia e Estatística (IBGE)	2015
Responsive caregiving	Visits by national home‐visiting parenting skills programme c	Percentage of individuals visited by the national home‐visiting parenting skills program in the municipality in relation to the target agreed for the year	These home visits focus on strengthening parenting skills, especially for socially vulnerable parents, and 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	[(Total number of individuals visited in the municipality in 2019/goal of the municipality in 2019) * 100]	Visits by national home‐visiting parenting skills programme can strengthening parenting skills, which protect the child from suboptimal early child development	Coordenação do Programa Criança Feliz/Ministry of Citizenship	2019
Opportunities for early learning	Coverage of daycare and preschool	Number of enrolments in daycare and preschool in relation to the total number of children under 5 years, by year and municipality of residence	Children need access to free, quality daycare and preschools, where they will receive, under adequate supervision, the stimuli and care necessary for development	[(∑ daycare enrolment and preschool enrolment)/(population under 5 years old)] * 100, per year and municipality	Coverage of daycare and preschool can protect the child from suboptimal early child development	Censo Escolar (school census)	2015
	Number of students per daycare professional	Number of students enrolled for each professional employed in public and private daycares in the municipality per year	The number of children per professional should enable all children to receive the attention, responsibility and interaction necessary for adequate development	(Number of daycare enrolments/number of daycare professionals) * 100, per year and municipality	A higher number of students per daycare professional is a risk factor for suboptimal early child development	Censo Escolar (school census)	2016
	Number of students per preschool professional	Number of students enrolled for each professional employed in public and private preschools in the municipality per year	The number of children per professional should enable all children to receive the attention, responsibility and interaction necessary for adequate development	(Number of preschool enrolments/number of preschool professionals) * 100, per year and municipality	A higher number of students per preschool professional is a risk factor for suboptimal early child development	Censo Escolar (school census)	2016
	Percentage of qualified daycare teachers	Percentage of teachers with higher education employed in public and private daycares in the municipality per year	Teachers with specific and qualified training are better prepared to understand the needs and provide early stimulation to children that supports their proper development	(Number of teachers with higher education in daycares/total number of daycare teachers) * 100, per year and municipality	A higher percentage of teachers with higher education in daycares can protect the child from suboptimal early child development	Censo Escolar (school census)	2016
	Percentage of qualified preschool teachers	Percentage of teachers with higher education employed in public and private preschools in the municipality per year	Teachers with specific and qualified training are better prepared to understand the needs and provide early stimulation to children that supports their proper development	(Number of teachers with higher education in preschools/total number of preschool teachers) * 100, per year and municipality	A higher percentage of teachers with higher education in preschools can protect the child from suboptimal early child development	Censo Escolar (school census)	2016
	Daycare educational resources	Presence of library/study room and/or playground and/or children's restroom in daycares in the municipality per year	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 favouring complete and adequate development	(∑ number of library/study rooms, playgrounds and children's restrooms in daycare)/total daycare, by year and municipality	The availability of daycare educational resources can protect the child from suboptimal early child development	Censo Escolar (school census)	2016
	Preschools educational resources	Presence of library/study room and/or playground and/or children's restroom in schools for early childhood in the municipality per year	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 favouring complete and adequate development	(∑ number of library/study rooms, playgrounds and children's restrooms in preschools)/total number of preschools, by year and municipality	The availability of preschool educational resources can protect the child from suboptimal early child development	Censo escolar (school census)	2016
Security and safety	Coverage of the national conditional cash transfer programme b	Percentage of families benefitting from the national conditional cash transfer programme among families in the Brazilian single registry with children under 5 years old	Cash transfer programmes protect the development of children in extreme poverty. The coverage of the national conditional cash transfer programme reflects the percentage of children in situations of poverty assisted in a social programme	(Total families benefitting from national conditional cash transfer programme with children under 5 years old in the reference month (December)/total families enrolled in the Brazilian single registry with children under 5 years old, in the reference month (December)) * 100, per municipality	The access to the national conditional cash transfer programme can protect the child from suboptimal early child development	Cadastro Único (CadÚnico/Ministry of Citizenship)	2016
	Air pollution	Estimated daily concentration of fine particulate matter (PM2.5) (ug/m3) by municipality	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	Estimation of the daily concentration of fine particulate matter (PM2.5) (ug/m3) from socio‐temporal models by municipality	Air pollution is a risk factor for suboptimal early child development	Brentani A et al., Child Development Center. Faculty of Medicine. University of São Paulo	2015
	Notification of violence against women	Total reported cases of any type of violence against women of childbearing age (10–49 years) in relation to the number of women in this age group in the municipality per year	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	(Number of cases with ICD Y09 (aggression by unspecified means) in women between 10 and 49 years old/population of women between 10 and 49 years old) * 1000, per year and municipality	The notification of violence against women create a qualified service network against chronic exposure to violence, which can protect the child from suboptimal early child development	Numerator: Sistema Nacional de Agravos de Notificação (SINAN/Ministry of Health) and denominator: Instituto Brasileiro de Geografia e Estatística (IBGE)	2015
	Notification of violence against children	Total reported cases of any type of violence against children under 5 years old in relation to the total number of children under five in the municipality per year	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	(Number of cases with ICD Y09 (aggression by unspecified means) for individuals under 5 years old/population under 5 years old) * 1000, per year and municipality	The notification of violence against children create a qualified service network against chronic exposure to violence, which can protect the child from suboptimal early child development	Numerator: Sistema Nacional de Agravos de Notificação (SINAN/Ministry of Health) and denominator: Instituto Brasileiro de Geografia e Estatística (IBGE)	2015
	Homicides	Homicide rate estimated per 100,000 inhabitants for each municipality	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	(∑ number of deaths due to aggression, number of deaths caused by legal intervention, number of hidden homicides/municipal population) * 100,000, per year and municipality	A higher homicide rate is a risk factor for suboptimal early child development	Instituto de Pesquisa Econômica Aplicada (IPEA—Institute of Applied Economic Research)—Atlas da Violência (Atlas of Violence)	2017

^a Estratégia Amamenta e Alimenta Brasil;

^b Programa Bolsa Família;

^c Programa Criança Feliz.