ABSTRACT

Brazilian quilombola communities are predominantly located in remote and poor regions. These communities’ territorial and sociocultural realities shape parenting practices that influence child development. This research aimed to analyze the scientific production on practices and beliefs related to caring for children under six in Brazilian quilombola communities. This integrative review was conducted in six databases from November to December 2023. We identified 501 studies, of which 22 comprise this review. The studies focus on 2020 and 2021 and were primarily conducted in the Northeast with a qualitative approach. The findings were organized into three themes: ‘interactions and quilombola identity’, ‘healthcare and disease care’, and ‘dietary practices and associated problems’. There is an appreciation of children’s freedom and relationship with the territory and the community, with intentions of belonging to the quilombola. Although human milk is valued, it is considered insufficient, which leads to the early introduction of other foods. The relationship with health services is weak, prevailing in situations of illness. Popular knowledge is widely used in childcare. Culturally congruent care is indicated.

KEYWORDS
Quilombola communities; Infant; Child, preschool; Parents; Review

Introduction

Brazil has a robust legal framework for protecting children committed to their comprehensive development¹1 Presidência da República (BR). Lei n° 8.069, de 13 de julho de 1990. Dispõe sobre o Estatuto da Criança e do Adolescente e dá outras providências. Diário Oficial da União [Internet], Brasília, DF. 1990 jul 16 [acesso em 2024 jun 26]; Seção I:13563. Disponível em: https://www.planalto.gov.br/ccivil_03/leis/l8069.htm
https://www.planalto.gov.br/ccivil_03/le... ,²2 Presidência da República (BR). Lei n° 13.257, de 8 de março de 2016. Dispõe sobre as políticas públicas para a primeira infância e altera a Lei n° 8.069, de 13 de julho de 1990 (Estatuto da Criança e do Adolescente), o Decreto-Lei n° 3.689, de 3 de outubro de 1941 (Código de Processo Penal), a Consolidação das Leis do Trabalho (CLT), aprovada pelo Decreto-Lei n° 5.452, de 1º de maio de 1943, a Lei n° 11.770, de 9 de setembro de 2008, e a Lei n° 12.662, de 5 de junho de 2012. Diário Oficial da União [Internet], Brasília, DF. 2016 mar 9 [acesso em 2024 jun 26]; Seção I:1. Disponível em: https://www.planalto.govbr/ccivil_03/_ato2015-2018/2016/lei/l13257.htm
https://www.planalto.govbr/ccivil_03/_at... ,³3 Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome (BR). Programa Criança Feliz [Internet]. Gov.br [Internet]; 2023 [acesso em 2024 jun 26]. Disponível em: https://www.gov.br/mds/pt-br/acoes-e-programas/crianca-feliz
https://www.gov.br/mds/pt-br/acoes-e-pro... ,⁴4 Ministério da Saúde (BR), Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. Política Nacional de Atenção Integral à Saúde da Criança: orientações para implementação [Internet]. Brasília, DF: MS; 2018 [acesso em 2024 jun 5]. Disponível em: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2018/07/Pol%C3%ADtica-Nacional-de-Aten%C3%A7%C3%A3o-Integral-%C3%A0-Sa%C3%BAde-da-Crian%C3%A7a-PNAISC-Vers%C3%A3o-Eletr%C3%B4nica.pdf
https://portaldeboaspraticas.iff.fiocruz... , especially in the first six years of life²2 Presidência da República (BR). Lei n° 13.257, de 8 de março de 2016. Dispõe sobre as políticas públicas para a primeira infância e altera a Lei n° 8.069, de 13 de julho de 1990 (Estatuto da Criança e do Adolescente), o Decreto-Lei n° 3.689, de 3 de outubro de 1941 (Código de Processo Penal), a Consolidação das Leis do Trabalho (CLT), aprovada pelo Decreto-Lei n° 5.452, de 1º de maio de 1943, a Lei n° 11.770, de 9 de setembro de 2008, e a Lei n° 12.662, de 5 de junho de 2012. Diário Oficial da União [Internet], Brasília, DF. 2016 mar 9 [acesso em 2024 jun 26]; Seção I:1. Disponível em: https://www.planalto.govbr/ccivil_03/_ato2015-2018/2016/lei/l13257.htm
https://www.planalto.govbr/ccivil_03/_at... . In this context, one focus is strengthening parental, family, and community network functions to ensure essential care and reciprocal, affectionate, and positive interactions²2 Presidência da República (BR). Lei n° 13.257, de 8 de março de 2016. Dispõe sobre as políticas públicas para a primeira infância e altera a Lei n° 8.069, de 13 de julho de 1990 (Estatuto da Criança e do Adolescente), o Decreto-Lei n° 3.689, de 3 de outubro de 1941 (Código de Processo Penal), a Consolidação das Leis do Trabalho (CLT), aprovada pelo Decreto-Lei n° 5.452, de 1º de maio de 1943, a Lei n° 11.770, de 9 de setembro de 2008, e a Lei n° 12.662, de 5 de junho de 2012. Diário Oficial da União [Internet], Brasília, DF. 2016 mar 9 [acesso em 2024 jun 26]; Seção I:1. Disponível em: https://www.planalto.govbr/ccivil_03/_ato2015-2018/2016/lei/l13257.htm
https://www.planalto.govbr/ccivil_03/_at... ,³3 Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome (BR). Programa Criança Feliz [Internet]. Gov.br [Internet]; 2023 [acesso em 2024 jun 26]. Disponível em: https://www.gov.br/mds/pt-br/acoes-e-programas/crianca-feliz
https://www.gov.br/mds/pt-br/acoes-e-pro... and realize children’s fundamental rights.

Territorial and sociocultural realities influence parenting practices and stem from social norms, values, and beliefs learned and in force in life and existence. The Brazilian quilombola territories are remnants of the ancient quilombos and represent a political-social dimension of the struggle for land and racial issues⁵5 Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome (BR). Censo 2022: População quilombola é de 1,3 milhão, indica recorte inédito do censo. Serviços e Informações do Brasil [Internet]. 2023 jul 27 [acesso em 2024 jun 26]. Disponível em: https://www.gov.br/pt-br/noticias/assistencia-social/2023/07/populacao-quilombola-e-de-l-3-milhao-indica-recorte-inedito-do-censo
https://www.gov.br/pt-br/noticias/assist... ,⁶6 Alves HJ, Soares MRP, Costa RRS, et al. Saúde da Família, territórios quilombolas e a defesa da vida. Trab educ saúde. 2023;21:e02209219. DOI: https://doi.org/10.1590/1981-7746-ojs2209
https://doi.org/10.1590/1981-7746-ojs220... ,⁷7 Durães NA, Ramos JS. Saberes em Narrativas de uma comunidade tradicional: oralidade e decolonialidade. EE&S. 2021;14(16):1-17. DOI: https://doi.org/10.46551/ees.v14n16a08
https://doi.org/10.46551/ees.v14n16a08... . They are concentrated in remote and poor regions of the country and marked by historical discrimination and exclusion⁸8 Paiva SG, Klautau-Guimarães MN, Oliveira SF. Dinâmicas socioeconômicas e demográficas de comunidades quilombolas do Brasil Central: uma abordagem descritiva. Clím. 2022;22(6):611-25. DOI: https://doi.org/10.53660/CLM-595-663
https://doi.org/10.53660/CLM-595-663... and a sense of belonging⁶6 Alves HJ, Soares MRP, Costa RRS, et al. Saúde da Família, territórios quilombolas e a defesa da vida. Trab educ saúde. 2023;21:e02209219. DOI: https://doi.org/10.1590/1981-7746-ojs2209
https://doi.org/10.1590/1981-7746-ojs220... . In the last census, 494 quilombola territories were identified and distributed across 24 Brazilian states and the Federal District⁸8 Paiva SG, Klautau-Guimarães MN, Oliveira SF. Dinâmicas socioeconômicas e demográficas de comunidades quilombolas do Brasil Central: uma abordagem descritiva. Clím. 2022;22(6):611-25. DOI: https://doi.org/10.53660/CLM-595-663
https://doi.org/10.53660/CLM-595-663... , with different ways of being quilombola.

Childcare and parenting in quilombola territories have their particularities. They are intertwined with the symbolic and ethnic relationships established since ancestors⁹9 Salomão FV, Castro CV. A Identidade Quilombola: Territorialidade Étnica e Proteção Jurídica. CPPG-DirUFRGS. 2018;13(1)236-255. DOI: https://doi.org/10.22456/2317-8558.73034
https://doi.org/10.22456/2317-8558.73034... , combined with local particularities. Thus, for professionals, supporting parenting in quilombola territories involves recognizing and respecting the relationship between territory, culture, and traditions.

It is urgent to monitor and promote child development in quilombola communities. Parenting practices are circumscribed to them. Furthermore, they are imperative indicators for public policies, and guiding documents and professional practices toward human rights, ethnic-racial-cultural diversity, comprehensiveness, and equity. This study aimed to analyze the scientific production on practices and beliefs related to caring for children under six in Brazilian quilombola communities.

Material and methods

This five-stage integrative review followed the methods proposed by Whittemore and Knafl¹⁰10 Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-553. DOI: https://doi.org/10.1111/j.1365-2648.2005.03621.x
https://doi.org/10.1111/j.1365-2648.2005... . The stages were specification of the purpose of the review and definition of the research problem (guiding question), literature search, data extraction and evaluation, data analysis, and presentation of results (integrative synthesis). Among the different types of reviews, the integrative review allows approaching and combining studies with different methods, expanding the scope of evidence-based practice¹⁰10 Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-553. DOI: https://doi.org/10.1111/j.1365-2648.2005.03621.x
https://doi.org/10.1111/j.1365-2648.2005... . The PCC (Population, Concept, and Context) strategy was adopted to develop the guiding question, as detailed in box 1.

The guiding question of this review was, ‘What are the values, beliefs, and practices in the relationships of care for young children in Brazilian quilombola communities?’. The inclusion/exclusion criteria and the search strategies were defined from this question. The inclusion criteria adopted were 1) Studies that addressed values, beliefs, and practices in care relationships; 2) Children under six years of age as the target audience; and 3) Studies conducted in Brazilian quilombola communities. The exclusion criterion was the unavailability of the studies in full.

The following databases were selected for the research: LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), Embase (Elsevier), Web of Science, Scopus, and BDTD (Brazilian Digital Library of Theses and Dissertations). Databases were accessed through the Capes Periodical Portal via CAFe.

Database search was conducted on three different dates for testing purposes, comparison of the number of studies found, and refining the search strategy. Two preliminary search sessions were conducted in November (3^rd and 22^nd), and the final search was conducted on December 6, 2023. The search field filter (title, abstract, and subject) was applied in the databases, and the languages were limited to Portuguese, English, and Spanish. No other criteria and/or filters were applied due to restricting the scope of materials and because this is an integrative review. The search strategy adopted was (“criança” OR “infância”) AND (“quilombola” OR “ quilombo” OR “mocambo”). Details are shown in table 1.

We retrieved 501 studies in the databases, which were imported into the Rayyan® free web version. Duplicates (n=226) were identified and removed, leaving a total of 275 studies for screening. The initial screening of the 275 studies was performed by reading the title and abstract. It was conducted blindly by four independent reviewers, with disagreements resolved by a fifth reviewer in a consensus meeting. At this stage, 175 studies that did not meet the inclusion criteria were excluded, leaving 100 studies sent for full-text reading, conducted independently by the reviewers, and discussed in a team meeting, consolidating the second screening stage.

Seventy-eight of the 100 studies were excluded because they did not meet the inclusion criteria. Thus, 22 studies were included in this review’s final sample. The screening and selection process of the studies is shown in figure 1 (PRISMA Flowchart), adapted for the integrative review¹¹11 Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:371. DOI: https://doi.org/10.1136/bmj.n71
https://doi.org/10.1136/bmj.n71... .

Data from the selected articles were extracted using a standardized instrument developed by the authors, containing the following information: author credentials, publication year, geographic region and quilombola community where the study was developed, problem/question or objectives, participants, theoretical and methodological framework, main results (complete transcription of the excerpts related to the object of this review), and implications (text prepared by the researcher related to the developments of the study for the research question established for the review). This information allowed for the detailed characterization of the studies and is presented in boxes 2 and 3.

The texts related to the results of the studies and their implications formed a corpus that was read and re-read to identify firstly the themes contained therein. The corpus was re-read with the themes and the research question under consideration. Codes were established through analytical processes to capture the semantic and conceptual content contained therein and subsequently grouped into categories representing the lifestyles, practices, and parental values in interactions with quilombola children under six. The result is presented in the format of an integrative thematic summary.

Result

The final sample of this integrative review consisted of 22 studies published between 2007 and 2023, focusing mainly on 2020 and 2021 (n=4 in each year). Regarding the location of the communities analyzed in the studies, three were from the Midwest (communities in Goiás), twelve were from the Northeast (communities in Alagoas – Bom Despacho, Muquém; Bahia – Monte Recôncavo, Vila Monte Alegre, Praia Grande, Bananeira, Martelo, Ponta Grossa, Porto dos Cavalos; Ceará – Córregos dos Iús), one from the North (Santa Rita de Barreira community, in Pará), four from the Southeast (São Paulo – Quilombo do Carmo; Minas Gerais – Buriti do Meio, Colônia do Paiol; Rio de Janeiro – Cafuringa), and three from the South (Santa Catarina – Morro do Fortunato and Quilombo Aldeia; and Rio Grande do Sul – Algodão Community).

Regarding theoretical and methodological frameworks, most studies (n=17) adopted a qualitative approach, including three ethnographies and two studies with participatory designs.

The study findings’ integration identified three thematic categories representing the practices, beliefs, and values in the parental and community care relationship aimed at children under six: ‘interactions and quilombola identity’, ‘healthcare and disease care’, and ‘dietary practices and associated problems’.

Interactions and quilombola identity

Quilombola women share a sense of shared responsibility for children and their care¹²12 Rabinovich EP, Bastos ACS. Famílias e projetos sociais: analisando essa relação no caso de um quilombo em São Paulo. Psicol Estud. 2007;12(1):3-11. DOI: https://doi.org/10.1590/S1413-73722007000100002
https://doi.org/10.1590/S1413-7372200700... ,¹⁴14 Morais AC. O Cuidado às Crianças Quilombolas no Domicílio à luz da Teoria Transcultural de Leininger [tese]. Salvador: Universidade Federal da Bahia; 2013. 200 p.,¹⁹19 Melo LO. Atenção à saúde da criança quilombola menor de 2 anos: saberes e práticas de cuidado à luz da teoria transcultural [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 105 p., and the principal caregivers were mothers and grandmothers¹²12 Rabinovich EP, Bastos ACS. Famílias e projetos sociais: analisando essa relação no caso de um quilombo em São Paulo. Psicol Estud. 2007;12(1):3-11. DOI: https://doi.org/10.1590/S1413-73722007000100002
https://doi.org/10.1590/S1413-7372200700... ,¹⁵15 Marques AS, Freitas DA, Leão CDA, et al. Atenção Primária e saúde materno-infantil: a percepção de cuidadores em uma comunidade rural quilombola. Ciênc saúde coletiva. 2014;19(2):365-371. DOI: https://doi.org/10.1590/1413-81232014192.02992013
https://doi.org/10.1590/1413-81232014192... ,¹⁹19 Melo LO. Atenção à saúde da criança quilombola menor de 2 anos: saberes e práticas de cuidado à luz da teoria transcultural [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 105 p.. The care provided involves the transmission of habits and knowledge specific to the quilombola community to promote cultural belonging in children¹²12 Rabinovich EP, Bastos ACS. Famílias e projetos sociais: analisando essa relação no caso de um quilombo em São Paulo. Psicol Estud. 2007;12(1):3-11. DOI: https://doi.org/10.1590/S1413-73722007000100002
https://doi.org/10.1590/S1413-7372200700... ,¹⁷17 Paula E. Vem brincar na rua!: entre o Quilombo e a Educação Infantil: capturando expressões, experiências e conflitos de crianças quilombolas no entremeio desses contextos [tese]. Florianópolis: Universidade Federal de Santa Catarina; 2014. 355 p.,²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p.. The feeling of belonging has repercussions and is evidenced in the tendency of these children to disseminate their traditions in interactions with non-quilombola peers¹⁷17 Paula E. Vem brincar na rua!: entre o Quilombo e a Educação Infantil: capturando expressões, experiências e conflitos de crianças quilombolas no entremeio desses contextos [tese]. Florianópolis: Universidade Federal de Santa Catarina; 2014. 355 p..

Aligned with the above, play is valued and encouraged as it fosters an appreciation of community values and because of the benefits it brings to children’s development and autonomy²⁴24 Perez BC. Entre cercas, brincadeiras e feitiços: os conflitos e as apropriações do território por crianças e jovens quilombolas. ChildPhilo. 2020;16(36):1-27. DOI: https://doi.org/10.12957/childphilo.2020.48351
https://doi.org/10.12957/childphilo.2020... ,³⁰30 Gocks C. Vicissitudes do brincar e do aprender em uma escola rural do 4º distrito de Pelotas/RS – Brasil [dissertação]. Pelotas: Universidade Federal de Pelotas; 2021. 90 p.. A study conducted in a quilombola community in Rio de Janeiro highlighted that ties with the territory are built from childhood, primarily through collective outdoor play²⁴24 Perez BC. Entre cercas, brincadeiras e feitiços: os conflitos e as apropriações do território por crianças e jovens quilombolas. ChildPhilo. 2020;16(36):1-27. DOI: https://doi.org/10.12957/childphilo.2020.48351
https://doi.org/10.12957/childphilo.2020... . These activities value the natural environment and include creating toys by the children themselves²⁴24 Perez BC. Entre cercas, brincadeiras e feitiços: os conflitos e as apropriações do território por crianças e jovens quilombolas. ChildPhilo. 2020;16(36):1-27. DOI: https://doi.org/10.12957/childphilo.2020.48351
https://doi.org/10.12957/childphilo.2020... . Moreover, the study revealed that sharing stories with traditional characters from Brazilian popular culture is common in these interactions.

Caring for quilombola children broadly incorporates popular knowledge, such as using herbs and oils, songs, beliefs, and prayers¹⁴14 Morais AC. O Cuidado às Crianças Quilombolas no Domicílio à luz da Teoria Transcultural de Leininger [tese]. Salvador: Universidade Federal da Bahia; 2013. 200 p.,¹⁶16 Martins LA. Cuidado ao recém-nascido em comunidade quilombola e a influência intergeracional [dissertação]. Salvador: Universidade Federal da Bahia; 2014. 122 p.. Examples include using teas and songs for a peaceful sleep¹⁶16 Martins LA. Cuidado ao recém-nascido em comunidade quilombola e a influência intergeracional [dissertação]. Salvador: Universidade Federal da Bahia; 2014. 122 p., prayers, blessings, and rituals in caring for newborns¹⁶16 Martins LA. Cuidado ao recém-nascido em comunidade quilombola e a influência intergeracional [dissertação]. Salvador: Universidade Federal da Bahia; 2014. 122 p.,²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p.. Specifically aimed at the umbilical stump is using oils mixed with pepper due to its healing properties¹⁶16 Martins LA. Cuidado ao recém-nascido em comunidade quilombola e a influência intergeracional [dissertação]. Salvador: Universidade Federal da Bahia; 2014. 122 p., and the ritual of burying the stump in the Quilombo to guarantee the return and connection with the territory²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p..

Healthcare and disease care

Protection against infections and diseases is the focus of attention. It is promoted through teas¹⁶16 Martins LA. Cuidado ao recém-nascido em comunidade quilombola e a influência intergeracional [dissertação]. Salvador: Universidade Federal da Bahia; 2014. 122 p.,¹⁹19 Melo LO. Atenção à saúde da criança quilombola menor de 2 anos: saberes e práticas de cuidado à luz da teoria transcultural [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 105 p.,²⁰20 Siqueira SMC, Jesus VS, Camargo CL. Itinerário terapêutico em situações de urgência e emergência pediátrica em uma comunidade quilombola. Ciênc saúde coletiva. 2016;21(1):179-89. DOI: https://doi.org/10.1590/1413-81232015211.20472014
https://doi.org/10.1590/1413-81232015211... ,³³33 Souza LN, Nogueira LMV, Rodrigues ILA, et al. Práticas de cuidado em saúde com crianças quilombolas: percepção dos cuidadores. Esc Anna Nery. 2023;27:e20220166. DOI: https://doi.org/10.1590/2177-9465-EAN-2022-0166pt
https://doi.org/10.1590/2177-9465-EAN-20... and by reinforcing footwear and warm clothing¹⁷17 Paula E. Vem brincar na rua!: entre o Quilombo e a Educação Infantil: capturando expressões, experiências e conflitos de crianças quilombolas no entremeio desses contextos [tese]. Florianópolis: Universidade Federal de Santa Catarina; 2014. 355 p.. When faced with illness, it is common to resort to religion, home remedies, syrups, baths (especially with leaves), teas, and massages²⁰20 Siqueira SMC, Jesus VS, Camargo CL. Itinerário terapêutico em situações de urgência e emergência pediátrica em uma comunidade quilombola. Ciênc saúde coletiva. 2016;21(1):179-89. DOI: https://doi.org/10.1590/1413-81232015211.20472014
https://doi.org/10.1590/1413-81232015211... ,²⁶26 Siqueira SMC. Prevenção e manejo domiciliar da doença diarreica aguda infantil em comunidade quilombola [tese]. Salvador: Universidade Federal da Bahia; 2020. 303 p.. For example, homemade serum and herbal remedies are described in cases of diarrhea and childhood dehydration²⁶26 Siqueira SMC. Prevenção e manejo domiciliar da doença diarreica aguda infantil em comunidade quilombola [tese]. Salvador: Universidade Federal da Bahia; 2020. 303 p..

They seek health services to monitor child development²¹21 Oliveira EF, Camargo CL, Gomes NP, et al. Follow-up consultations on growth and development: the meaning for quilombo mothers. Esc Anna Nery. 2018;22(1):e20170054. DOI: https://doi.org/10.1590/2177-9465-EAN-2017-0054
https://doi.org/10.1590/2177-9465-EAN-20... ,²²22 Oliveira EF, Camargo CL, Gomes NP, et al. Factors related to quilombola attendance to child follow-up appointments. Rev Bras Enferm. 2019;72:9-16. DOI: https://doi.org/10.1590/0034-7167-2017-0605
https://doi.org/10.1590/0034-7167-2017-0... , but mainly in the face of serious illnesses¹⁹19 Melo LO. Atenção à saúde da criança quilombola menor de 2 anos: saberes e práticas de cuidado à luz da teoria transcultural [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 105 p.,²¹21 Oliveira EF, Camargo CL, Gomes NP, et al. Follow-up consultations on growth and development: the meaning for quilombo mothers. Esc Anna Nery. 2018;22(1):e20170054. DOI: https://doi.org/10.1590/2177-9465-EAN-2017-0054
https://doi.org/10.1590/2177-9465-EAN-20... ,²²22 Oliveira EF, Camargo CL, Gomes NP, et al. Factors related to quilombola attendance to child follow-up appointments. Rev Bras Enferm. 2019;72:9-16. DOI: https://doi.org/10.1590/0034-7167-2017-0605
https://doi.org/10.1590/0034-7167-2017-0... , such as dehydration resulting from diarrhea and vomiting²¹21 Oliveira EF, Camargo CL, Gomes NP, et al. Follow-up consultations on growth and development: the meaning for quilombo mothers. Esc Anna Nery. 2018;22(1):e20170054. DOI: https://doi.org/10.1590/2177-9465-EAN-2017-0054
https://doi.org/10.1590/2177-9465-EAN-20... . However, relationships with services are described negatively, with long waits and delays in scheduling and care²²22 Oliveira EF, Camargo CL, Gomes NP, et al. Factors related to quilombola attendance to child follow-up appointments. Rev Bras Enferm. 2019;72:9-16. DOI: https://doi.org/10.1590/0034-7167-2017-0605
https://doi.org/10.1590/0034-7167-2017-0... , added to health professionals’ insufficient time dedicated to appointments, their attitude during care²²22 Oliveira EF, Camargo CL, Gomes NP, et al. Factors related to quilombola attendance to child follow-up appointments. Rev Bras Enferm. 2019;72:9-16. DOI: https://doi.org/10.1590/0034-7167-2017-0605
https://doi.org/10.1590/0034-7167-2017-0... , and the lack of clarity in the therapeutic or medication guidelines provided²¹21 Oliveira EF, Camargo CL, Gomes NP, et al. Follow-up consultations on growth and development: the meaning for quilombo mothers. Esc Anna Nery. 2018;22(1):e20170054. DOI: https://doi.org/10.1590/2177-9465-EAN-2017-0054
https://doi.org/10.1590/2177-9465-EAN-20... .

Dietary practices and associated problems

Breastfeeding is an intergenerational value and custom among quilombola women, associated with satisfaction and contribution to the child’s health and growth²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p.. However, this practice is intersected by the belief that human milk is insufficient¹⁶16 Martins LA. Cuidado ao recém-nascido em comunidade quilombola e a influência intergeracional [dissertação]. Salvador: Universidade Federal da Bahia; 2014. 122 p.,¹⁹19 Melo LO. Atenção à saúde da criança quilombola menor de 2 anos: saberes e práticas de cuidado à luz da teoria transcultural [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 105 p.,²⁵25 Martins LA, Oliveira RM, Camargo CL, et al. Practice of breastfeeding in quilombola communities in the light of transcultural theory. Rev Bras Enferm. 2020;73(4):e20190191. DOI: https://doi.org/10.1590/0034-7167-2019-0191
https://doi.org/10.1590/0034-7167-2019-0... . This belief leads to the early introduction (around four months of age) of flour and other foods, which interferes with the duration of exclusive breastfeeding¹⁴14 Morais AC. O Cuidado às Crianças Quilombolas no Domicílio à luz da Teoria Transcultural de Leininger [tese]. Salvador: Universidade Federal da Bahia; 2013. 200 p.,²⁵25 Martins LA, Oliveira RM, Camargo CL, et al. Practice of breastfeeding in quilombola communities in the light of transcultural theory. Rev Bras Enferm. 2020;73(4):e20190191. DOI: https://doi.org/10.1590/0034-7167-2019-0191
https://doi.org/10.1590/0034-7167-2019-0... ,²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p.. Thus, based on the same belief, another quilombola mother may breastfeed her child¹⁶16 Martins LA. Cuidado ao recém-nascido em comunidade quilombola e a influência intergeracional [dissertação]. Salvador: Universidade Federal da Bahia; 2014. 122 p.,²⁵25 Martins LA, Oliveira RM, Camargo CL, et al. Practice of breastfeeding in quilombola communities in the light of transcultural theory. Rev Bras Enferm. 2020;73(4):e20190191. DOI: https://doi.org/10.1590/0034-7167-2019-0191
https://doi.org/10.1590/0034-7167-2019-0... .

Generations preceding parents reinforce the importance of children “eating what gives them blood”²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p.⁽¹⁾, recommending breastfeeding while relativizing its sufficiency. Thus, rice and bean broths, soups, vegetables, fruits, and foods consumed by other people in the house are introduced¹⁹19 Melo LO. Atenção à saúde da criança quilombola menor de 2 anos: saberes e práticas de cuidado à luz da teoria transcultural [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 105 p.,²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p., while preserving the use of baby food made with milk and added Arrozina®, Cremogema®, or Mucilon®¹⁹19 Melo LO. Atenção à saúde da criança quilombola menor de 2 anos: saberes e práticas de cuidado à luz da teoria transcultural [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 105 p..

Another belief identified is insufficient milk production on the first day after birth, meaning that breastfeeding begins the day after the child is born, and teas are offered as a replacement for colostrum immediately after birth²⁸28 Silva PO, Gubert MB, Silva AKP, et al. Percepções e práticas intergeracionais de mulheres quilombolas sobre aleitamento materno e alimentação infantil, Goiás, Brasil. Cad Saúde Pública. 2021;37(10):e00148720. DOI: https://doi.org/10.1590/0102-311X00148720
https://doi.org/10.1590/0102-311X0014872... . There is also a belief that breastfeeding in the dark contributes to the milk’s quality, as light weakens it²⁵25 Martins LA, Oliveira RM, Camargo CL, et al. Practice of breastfeeding in quilombola communities in the light of transcultural theory. Rev Bras Enferm. 2020;73(4):e20190191. DOI: https://doi.org/10.1590/0034-7167-2019-0191
https://doi.org/10.1590/0034-7167-2019-0... .

Studies¹⁶16 Martins LA. Cuidado ao recém-nascido em comunidade quilombola e a influência intergeracional [dissertação]. Salvador: Universidade Federal da Bahia; 2014. 122 p.,¹⁸18 Ferreira HS, Torres ZMC. Comunidade quilombola na Região Nordeste do Brasil: saúde de mulheres e crianças antes e após sua certificação. Rev Bras Saude Mater Infant. 2015;15(2):219-229. DOI: https://doi.org/10.1590/S1519-38292015000200008
https://doi.org/10.1590/S1519-3829201500... ,¹⁹19 Melo LO. Atenção à saúde da criança quilombola menor de 2 anos: saberes e práticas de cuidado à luz da teoria transcultural [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 105 p.,²⁵25 Martins LA, Oliveira RM, Camargo CL, et al. Practice of breastfeeding in quilombola communities in the light of transcultural theory. Rev Bras Enferm. 2020;73(4):e20190191. DOI: https://doi.org/10.1590/0034-7167-2019-0191
https://doi.org/10.1590/0034-7167-2019-0... ,²⁸28 Silva PO, Gubert MB, Silva AKP, et al. Percepções e práticas intergeracionais de mulheres quilombolas sobre aleitamento materno e alimentação infantil, Goiás, Brasil. Cad Saúde Pública. 2021;37(10):e00148720. DOI: https://doi.org/10.1590/0102-311X00148720
https://doi.org/10.1590/0102-311X0014872... ,²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p.,³¹31 Vasconcelos CVS, Vasconcelos LTS, Lima MRS, et al. Avaliação do consumo alimentar e estado nutricional de crianças menores de dois anos de uma comunidade quilombola. Arq Cienc Saude UNIPAR. 2023;27(1):200-218. DOI: https://doi.org/10.25110/arqsaude.v27i1.2023.9080
https://doi.org/10.25110/arqsaude.v27i1.... have widely indicated that supplements should be introduced, but human milk provision persists beyond the child’s first six months of life¹⁹19 Melo LO. Atenção à saúde da criança quilombola menor de 2 anos: saberes e práticas de cuidado à luz da teoria transcultural [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 105 p.. A study in a quilombola community in the north of the state of Goiás revealed that early weaning (before the child is two years old) is influenced by the eruption of teeth and a new pregnancy of the mother, which can occur 40 days after birth²⁸28 Silva PO, Gubert MB, Silva AKP, et al. Percepções e práticas intergeracionais de mulheres quilombolas sobre aleitamento materno e alimentação infantil, Goiás, Brasil. Cad Saúde Pública. 2021;37(10):e00148720. DOI: https://doi.org/10.1590/0102-311X00148720
https://doi.org/10.1590/0102-311X0014872... . Grandmothers mention aesthetic concerns about their breasts as a reason for early weaning²⁸28 Silva PO, Gubert MB, Silva AKP, et al. Percepções e práticas intergeracionais de mulheres quilombolas sobre aleitamento materno e alimentação infantil, Goiás, Brasil. Cad Saúde Pública. 2021;37(10):e00148720. DOI: https://doi.org/10.1590/0102-311X00148720
https://doi.org/10.1590/0102-311X0014872... .

The first foods offered to children reflect the family’s eating habits, such as pumpkin, beans (especially broth), potatoes, soup, cassava, and couscous²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p.. Some foods like fatty meats and beans are considered ‘heavy’ and not recommended for younger children²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p..

A study in Alagoas revealed that children eat, on average, four meals a day, with little variety of food groups and a predominance of cereals (39.3%), meats (13.7%), and milk and dairy products (12.7%). The consumption of fruits (5.4%), vegetables (0.8%), and greens (0.5%) is low, resulting in insufficient intake of zinc, vitamins A and C, folate, and iron¹³13 Leite FM, Ferreira HS, Bezerra MK, et al. Consumo alimentar e estado nutricional de pré-escolares das comunidades remanescentes dos quilombos do estado de Alagoas. Rev Paul Pediatr. 2013;31(4):444-451. DOI: https://doi.org/10.1590/S0103-05822013000400005
https://doi.org/10.1590/S0103-0582201300... . The incidence of anemia in the community studied was 48%¹³13 Leite FM, Ferreira HS, Bezerra MK, et al. Consumo alimentar e estado nutricional de pré-escolares das comunidades remanescentes dos quilombos do estado de Alagoas. Rev Paul Pediatr. 2013;31(4):444-451. DOI: https://doi.org/10.1590/S0103-05822013000400005
https://doi.org/10.1590/S0103-0582201300... .

Another study in Alagoas, before and after the community’s certification as a quilombo remnant, showed a preserved prevalence of overweight in children (9.4%), an increase in vitamin A supplementation and exclusive breastfeeding until six months, and a declining prevalence of anemia of 51.9%¹⁸18 Ferreira HS, Torres ZMC. Comunidade quilombola na Região Nordeste do Brasil: saúde de mulheres e crianças antes e após sua certificação. Rev Bras Saude Mater Infant. 2015;15(2):219-229. DOI: https://doi.org/10.1590/S1519-38292015000200008
https://doi.org/10.1590/S1519-3829201500... .

Overweight-related deviations were identified in a quilombola community in Ceará, where 44.4% of children under two were overweight for their age, and 11.1% were overweight³¹31 Vasconcelos CVS, Vasconcelos LTS, Lima MRS, et al. Avaliação do consumo alimentar e estado nutricional de crianças menores de dois anos de uma comunidade quilombola. Arq Cienc Saude UNIPAR. 2023;27(1):200-218. DOI: https://doi.org/10.25110/arqsaude.v27i1.2023.9080
https://doi.org/10.25110/arqsaude.v27i1.... . Dark green vegetables were absent, and ultra-processed foods were consumed frequently (83%) among children aged six to 23 months, emphasizing instant noodles, sweetened drinks, and stuffed cookies³¹31 Vasconcelos CVS, Vasconcelos LTS, Lima MRS, et al. Avaliação do consumo alimentar e estado nutricional de crianças menores de dois anos de uma comunidade quilombola. Arq Cienc Saude UNIPAR. 2023;27(1):200-218. DOI: https://doi.org/10.25110/arqsaude.v27i1.2023.9080
https://doi.org/10.25110/arqsaude.v27i1.... .

Previous generations, especially grandmothers, strongly influence child nutrition. They are concerned with orally transmitting knowledge, practices, and experiences, an aspect valued and appreciated by mothers²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p..

Nursing mothers must consume corn- and cassava-based foods²⁵25 Martins LA, Oliveira RM, Camargo CL, et al. Practice of breastfeeding in quilombola communities in the light of transcultural theory. Rev Bras Enferm. 2020;73(4):e20190191. DOI: https://doi.org/10.1590/0034-7167-2019-0191
https://doi.org/10.1590/0034-7167-2019-0... to increase milk production. Other recommended care for quilombola women after giving birth is drinking rue tea with burnt sugar and cachaça to cleanse the body²⁵25 Martins LA, Oliveira RM, Camargo CL, et al. Practice of breastfeeding in quilombola communities in the light of transcultural theory. Rev Bras Enferm. 2020;73(4):e20190191. DOI: https://doi.org/10.1590/0034-7167-2019-0191
https://doi.org/10.1590/0034-7167-2019-0... , not washing the hair for 40 days, and using their milk to heal cracked nipples²⁹29 Castro ER. “Tem que comer o que dá sangue”: saberes tradicionais e práticas culturais no cuidar e educar de crianças quilombolas [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2021. 158 p..

Discussion

This review highlights care practices structured on traditional values and beliefs to foster the child’s exposure to and incorporation of these elements, contributing to forming and consolidating the quilombola identity³⁴34 Dealdina SS. Mulheres quilombolas: territórios de existências negras femininas. São Paulo: Editora Jandaíra; 2021..

Thus, it is known that quilombolas have a way of interacting that favors sharing. However, regarding child care, the results indicated that sharing is concentrated on women although care is understood as a collective responsibility. Women care for all children, not limited to their biological offspring³⁵35 Silva PC. “Aqui é tudo uma família só”: maternidade e práticas culturais de um grupo de mulheres em uma comunidade quilombola no Alto Jequitinhonha [tese]. Minas Gerais: Universidade Federal de Minas Gerais; 2020. 131 p.. This context could overload women in exercising the ‘maternal’ role, a core that professionals should pay attention to when supporting parenting and child care in this context.

Furthermore, the Quilombo is a dual space of women’s affirmation and empowerment, but also oppression and sexism³⁶36 Fernandes ETBS, Ferreira SL, Ferreira CSB, et al. Autonomy in the reproductive health of quilombolas women and associated factors. Rev Bras Enferm. 2020;73:e20190786. DOI: https://doi.org/10.1590/0034-7167-2019-0786
https://doi.org/10.1590/0034-7167-2019-0... , with intersecting gender issues³⁷37 Soares MRP. Territórios insurgentes: a tecitura. Rev Katálysis. 2021;24(3):522-531. DOI: https://doi.org/10.1590/1982-0259.2021.e79280
https://doi.org/10.1590/1982-0259.2021.e... . They ensure the care of the home and the health of the inhabitants, generate income, and transmit original knowledge³⁴34 Dealdina SS. Mulheres quilombolas: territórios de existências negras femininas. São Paulo: Editora Jandaíra; 2021.,³⁸38 Gomes RF, Oliveira PSD, Silva MLO, et al. Itinerários terapêuticos no cuidado em saúde em comunidades quilombolas. Ciênc saúde coletiva. 2024;29(3):e01602023. DOI: https://doi.org/10.1590/1413-81232024293.0160202
https://doi.org/10.1590/1413-81232024293... under the naturalization of sexism and subordination, but also under the sorority and solidary pain of female peers³⁹39 Pereira AS, Allegretti M, Magalhães L. “Nós, mulheres quilombolas, sabemos a dor uma da outra”: uma investigação sobre sororidade e ocupação. Cad Bras Ter Ocup. 2022;30:e3318. DOI: https://doi.org/10.1590/2526-8910.ctoAO254033181
https://doi.org/10.1590/2526-8910.ctoAO2... . Although boys and girls are taught to perform domestic and territorial tasks, sexist and macho logic reverberates in the community, influencing educational processes and women’s actions³⁵35 Silva PC. “Aqui é tudo uma família só”: maternidade e práticas culturais de um grupo de mulheres em uma comunidade quilombola no Alto Jequitinhonha [tese]. Minas Gerais: Universidade Federal de Minas Gerais; 2020. 131 p..

The feeling of belonging to the Quilombo and its causes has cultural, historical, and social representations that connect territory and existence, perpetuating the struggle and resistance. This construction is manifested in childcare actions, highlighting the promotion and permission of free and autonomous exploration of the Quilombo and its surroundings.

To this end, interactions with the territory and all its components are valued. Free play is emphasized, and children are exposed to the inhabitants’ oral interventions to share traditions and stories, fostering child-territory, child-culture, and child-belonging relationships. Mothers encourage children to participate in community activities, hoping these practices will be passed on to future generations⁴⁰40 Silva PC, Eiterer CL, Miranda SA. Maternidade e práticas culturais no quilombo. Rev Vozes dos Vales [Internet]. 2020 [acesso em 2024 jun 26];9(18)11-15. Disponível em: http://site.ufvjm.edu.br/revistamultidisciplinar/files/2020/10/Paula.pdf
http://site.ufvjm.edu.br/revistamultidis... .

The results of this review have shown that constructing the quilombola identity is a structuring factor in child care. It occurs based on and in close relationship with the territory, seeking to fight for and guarantee the right to preserve the symbolic and ethnic relationship established by ancestors⁹9 Salomão FV, Castro CV. A Identidade Quilombola: Territorialidade Étnica e Proteção Jurídica. CPPG-DirUFRGS. 2018;13(1)236-255. DOI: https://doi.org/10.22456/2317-8558.73034
https://doi.org/10.22456/2317-8558.73034... . Legal recognition of the quilombola territory implies committing to the particularities of these communities, as shown in the results of one of the studies in this review¹⁸18 Ferreira HS, Torres ZMC. Comunidade quilombola na Região Nordeste do Brasil: saúde de mulheres e crianças antes e após sua certificação. Rev Bras Saude Mater Infant. 2015;15(2):219-229. DOI: https://doi.org/10.1590/S1519-38292015000200008
https://doi.org/10.1590/S1519-3829201500... .

Traditional knowledge, transmitted orally, especially by older women, reinforces the resistance and affirmation of quilombolas⁵5 Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome (BR). Censo 2022: População quilombola é de 1,3 milhão, indica recorte inédito do censo. Serviços e Informações do Brasil [Internet]. 2023 jul 27 [acesso em 2024 jun 26]. Disponível em: https://www.gov.br/pt-br/noticias/assistencia-social/2023/07/populacao-quilombola-e-de-l-3-milhao-indica-recorte-inedito-do-censo
https://www.gov.br/pt-br/noticias/assist... ,⁶6 Alves HJ, Soares MRP, Costa RRS, et al. Saúde da Família, territórios quilombolas e a defesa da vida. Trab educ saúde. 2023;21:e02209219. DOI: https://doi.org/10.1590/1981-7746-ojs2209
https://doi.org/10.1590/1981-7746-ojs220... and is found in childcare practices⁴⁰40 Silva PC, Eiterer CL, Miranda SA. Maternidade e práticas culturais no quilombo. Rev Vozes dos Vales [Internet]. 2020 [acesso em 2024 jun 26];9(18)11-15. Disponível em: http://site.ufvjm.edu.br/revistamultidisciplinar/files/2020/10/Paula.pdf
http://site.ufvjm.edu.br/revistamultidis... , as evidenced in the results of this study. Knowledge and traditions are circulated in the community from an early age, ensuring their functionality and survival⁶6 Alves HJ, Soares MRP, Costa RRS, et al. Saúde da Família, territórios quilombolas e a defesa da vida. Trab educ saúde. 2023;21:e02209219. DOI: https://doi.org/10.1590/1981-7746-ojs2209
https://doi.org/10.1590/1981-7746-ojs220... . This symbolic process begins in early childhood and already reveals manifestations, as evidenced by the behavior of quilombola children vis-à-vis non-quilombola peers³⁰30 Gocks C. Vicissitudes do brincar e do aprender em uma escola rural do 4º distrito de Pelotas/RS – Brasil [dissertação]. Pelotas: Universidade Federal de Pelotas; 2021. 90 p..

Traditional practices in childcare include blessings, teas, and herbal medicines, which promote development and intervene in cases of illness⁵5 Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome (BR). Censo 2022: População quilombola é de 1,3 milhão, indica recorte inédito do censo. Serviços e Informações do Brasil [Internet]. 2023 jul 27 [acesso em 2024 jun 26]. Disponível em: https://www.gov.br/pt-br/noticias/assistencia-social/2023/07/populacao-quilombola-e-de-l-3-milhao-indica-recorte-inedito-do-censo
https://www.gov.br/pt-br/noticias/assist... ,⁴⁰40 Silva PC, Eiterer CL, Miranda SA. Maternidade e práticas culturais no quilombo. Rev Vozes dos Vales [Internet]. 2020 [acesso em 2024 jun 26];9(18)11-15. Disponível em: http://site.ufvjm.edu.br/revistamultidisciplinar/files/2020/10/Paula.pdf
http://site.ufvjm.edu.br/revistamultidis... . When widely adopted in childcare, this popular knowledge is preserved intergenerationally, as revealed by the findings of this review³⁸38 Gomes RF, Oliveira PSD, Silva MLO, et al. Itinerários terapêuticos no cuidado em saúde em comunidades quilombolas. Ciênc saúde coletiva. 2024;29(3):e01602023. DOI: https://doi.org/10.1590/1413-81232024293.0160202
https://doi.org/10.1590/1413-81232024293... .

By focusing on the relationship between quilombolas and health services, the findings of this study highlighted weaknesses. Furthermore, difficult access has been identified, primarily due to geographical issues, impacting the right to health³⁸38 Gomes RF, Oliveira PSD, Silva MLO, et al. Itinerários terapêuticos no cuidado em saúde em comunidades quilombolas. Ciênc saúde coletiva. 2024;29(3):e01602023. DOI: https://doi.org/10.1590/1413-81232024293.0160202
https://doi.org/10.1590/1413-81232024293... ,⁴¹41 Durand MK, Heidemann ITSB. Quilombola women and Paulo Freire’s research itinerary. Texto Contexto – Enferm. 2020;29:e20180270. DOI: https://doi.org/10.1590/1980-265X-TCE-2018-0270
https://doi.org/10.1590/1980-265X-TCE-20... . However, the review data revealed dissatisfaction with care, long waiting times, and brief appointments²²22 Oliveira EF, Camargo CL, Gomes NP, et al. Factors related to quilombola attendance to child follow-up appointments. Rev Bras Enferm. 2019;72:9-16. DOI: https://doi.org/10.1590/0034-7167-2017-0605
https://doi.org/10.1590/0034-7167-2017-0... , exacerbating the weaknesses in guaranteeing the right to health. Some recommendations for health teams to regularly travel to quilombos to monitor child development and support childcare are known. However, a recent study revealed that medical care only occurred once a month in improvised locations³⁸38 Gomes RF, Oliveira PSD, Silva MLO, et al. Itinerários terapêuticos no cuidado em saúde em comunidades quilombolas. Ciênc saúde coletiva. 2024;29(3):e01602023. DOI: https://doi.org/10.1590/1413-81232024293.0160202
https://doi.org/10.1590/1413-81232024293... .

Given the above, advances in health care, its policies, and guiding documents regarding the singularities of quilombos and their population are urgently needed. Primary health care does not adjust its work processes to the particularities of quilombola territories, resulting in insufficient and disjointed reception of social determinants³³33 Souza LN, Nogueira LMV, Rodrigues ILA, et al. Práticas de cuidado em saúde com crianças quilombolas: percepção dos cuidadores. Esc Anna Nery. 2023;27:e20220166. DOI: https://doi.org/10.1590/2177-9465-EAN-2022-0166pt
https://doi.org/10.1590/2177-9465-EAN-20... ,⁴¹41 Durand MK, Heidemann ITSB. Quilombola women and Paulo Freire’s research itinerary. Texto Contexto – Enferm. 2020;29:e20180270. DOI: https://doi.org/10.1590/1980-265X-TCE-2018-0270
https://doi.org/10.1590/1980-265X-TCE-20... . Substandard living conditions, such as low income and education, lack of services, social facilities and leisure spaces, and infrastructure and mobility issues, directly affect early childhood and children’s long-term development potential. Studies that explore quilombolas’ perceptions of the impact of these issues on children’s health and their care practices are recommended.

Regarding dietary practices, the review results revealed that breastfeeding management was influenced by quilombola beliefs, such as the tendency to consider human milk insufficient and requiring supplementation. These practices and outcomes do not align with national recommendations for exclusive breastfeeding up to six months of age⁴4 Ministério da Saúde (BR), Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. Política Nacional de Atenção Integral à Saúde da Criança: orientações para implementação [Internet]. Brasília, DF: MS; 2018 [acesso em 2024 jun 5]. Disponível em: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2018/07/Pol%C3%ADtica-Nacional-de-Aten%C3%A7%C3%A3o-Integral-%C3%A0-Sa%C3%BAde-da-Crian%C3%A7a-PNAISC-Vers%C3%A3o-Eletr%C3%B4nica.pdf
https://portaldeboaspraticas.iff.fiocruz... ,¹⁶16 Martins LA. Cuidado ao recém-nascido em comunidade quilombola e a influência intergeracional [dissertação]. Salvador: Universidade Federal da Bahia; 2014. 122 p.,⁴²42 Ministério da Saúde (BR). Estratégia nacional para promoção do aleitamento materno e alimentação complementar saudável no Sistema Único de Saúde. Brasília, DF: MS; 2015. and lack support conducted under a culturally congruent approach. Professional positions guided by this perspective favor thematizing beliefs, such as interpreting the child’s nighttime crying as hunger due to insufficient human milk and perceiving colostrum as ‘thin’, with the offer of teas and thickeners⁴⁴44 Müller MR, Lima RC, Ortega F. Repensando a competência cultural nas práticas de saúde no Brasil: por um cuidado culturalmente sensível. Saude Soc. 2023;32(3):e210731pt. DOI: https://doi.org/10.1590/S0104-12902023210731pt
https://doi.org/10.1590/S0104-1290202321... . Furthermore, intending to nourish the child well, quilombolas adopt human breastfeeding until two years of age⁴²42 Ministério da Saúde (BR). Estratégia nacional para promoção do aleitamento materno e alimentação complementar saudável no Sistema Único de Saúde. Brasília, DF: MS; 2015.,⁴³43 Lima LTB. Aleitamento materno e população quilombola: uma revisão integrativa [trabalho de conclusão de curso]. Caicó: Universidade Federal do Rio Grande do Norte; 2023. 23 p., which is a point that can be worked on by the professional to promote exclusive breastfeeding.

Transforming beliefs requires a longitudinal dialogue, which is hindered by health professionals’ prescriptive relationships. Culturally sensitive care practices involve recognizing cultural diversity and a dialogue between professional and popular knowledge for a more holistic care approach⁴⁴44 Müller MR, Lima RC, Ortega F. Repensando a competência cultural nas práticas de saúde no Brasil: por um cuidado culturalmente sensível. Saude Soc. 2023;32(3):e210731pt. DOI: https://doi.org/10.1590/S0104-12902023210731pt
https://doi.org/10.1590/S0104-1290202321... .

Studies in quilombola communities in Maranhão/Brazil have identified a high prevalence of child malnutrition associated with environmental and income factors⁴⁵45 Silveira VNC, Padilha LL, Frota MTBA. Desnutrição e fatores associados em crianças quilombolas menores de 60 meses em dois municípios do estado do Maranhão, Brasil. Ciênc saúde coletiva. 2020;25(7):2583-2594. DOI: https://doi.org/10.1590/1413-81232020257.21482018
https://doi.org/10.1590/1413-81232020257... , and the results of the present study add cultural determinants. Maternal short stature was associated with child stunting, suggesting a cycle of chronic malnutrition across generations⁴⁵45 Silveira VNC, Padilha LL, Frota MTBA. Desnutrição e fatores associados em crianças quilombolas menores de 60 meses em dois municípios do estado do Maranhão, Brasil. Ciênc saúde coletiva. 2020;25(7):2583-2594. DOI: https://doi.org/10.1590/1413-81232020257.21482018
https://doi.org/10.1590/1413-81232020257... .

Childhood malnutrition is prevalent in the Brazilian North and Northeast, which include many quilombola territories. It is essential to develop quantitative, qualitative, and participative studies that address nutritional issues among quilombola children and generate evidence to address this problem. Early childhood feeding practices directly affect health and nutritional problems.

Given the above, we underscore that culturally and socially sensitive care practices must value context and collaborative care in the healthcare fabric, recognize social inequalities, and promote comprehensive and equitable care⁴⁶46 Souza LB, Chaveiro EF. Territory, environment and way of life: conflicts between agribusiness and the Quilombola community of Morro de São João, Tocantins. Soc Nat. 2019;31(1):1-18. DOI: https://doi.org/10.14393/SN-v31nl-2019-42482
https://doi.org/10.14393/SN-v31nl-2019-4... . The Brazilian government is responsible for intervening in stalled policies, such as those promoting equity for Black people and other vulnerable groups⁴⁶46 Souza LB, Chaveiro EF. Territory, environment and way of life: conflicts between agribusiness and the Quilombola community of Morro de São João, Tocantins. Soc Nat. 2019;31(1):1-18. DOI: https://doi.org/10.14393/SN-v31nl-2019-42482
https://doi.org/10.14393/SN-v31nl-2019-4... .

A limitation of this study was the difficulty with specific descriptors for values, practices, and beliefs in caring relationships. Attempts to use descriptors such as ‘childcare’ or ‘parent-child relationships’ resulted in studies with a different focus than intended, and the term ‘parenting practices’ is not recognized as a descriptor in national and international databases. This search limiting factor may have restricted the scope of the results obtained. Another limitation is that the studies’ were primarily qualitative, which favors some evidence about practices and beliefs related to childcare but does not allow for statements about outcomes and variables derived from this care, such as growth and developmental achievements.

Additionally, except for one study, the review did not find evidence from the male perspective, which suggests the need to develop research that explores this angle in addition to the community’s view as a group. Furthermore, despite having identified the location of the Quilombo, when brought to the primary study, the description did not allow for statements about the plurality of ways of being quilombola and childcare practices.

Final considerations

Most of the studies in this review are from recent years and use a qualitative approach, emphasizing ethnographies. Increasing visibility and considering the quilombola childhood’s particularities and the care practices that promote them is imperative. There is an urgent need to renew the ways of caring and confront structural racism and the violation of rights in this context. The Brazilian State standardizes childhood and denies diversity, erasing cultural and social specificities.

The studies show that promoting the quilombola identity is an important guide for childcare practices. Moreover, traditional beliefs, practices, and knowledge were highlighted, outlining care related to nutrition, health promotion, and management of health problems. The relationship with health services was identified as weak and lacking support. Therefore, professional backing in this context requires a culturally sensitive and respectful stance, focusing on the rights, protection, and promotion of quilombola children without denying their struggle and resistance.

The imposing care model, which supports parenting practices, needs to be renewed in its approach under policies structured from a cultural perspective.

References

Publication Dates

History