Objective: To identify the factors associated with food insecurity among Quilombolas communities in Brazil. Design: An analysis of secondary data assessed in the 2011 Quilombolas Census was performed. The Brazilian Food Insecurity Measurement Scale (Escala Brasileira de Insegurança Alimentar, EBIA) was used to assess household food security status. Sociodemographic conditions and access to social programmes and benefits were also evaluated. Setting: National survey census from recognized Quilombolas Brazilian territories. Subjects: Quilombolas households (n 8846). Results: About half (47·8 %) of the Quilombolas lived in severely food-insecure households, with the North and Northeast regions facing the most critical situation. Households located in North Brazil, whose head of the family had less than 4 years of education, with a monthly per capita income below $US 44, without adequate sanitation and without adequate water supply had the greatest chance of experiencing moderate or severe food insecurity. Households that had access to a water supply programme for dry regions (Programa Cisternas) and an agricultural harvest subsidy programme (Programa Garantia Safra) had less chance of experiencing moderate and severe food insecurity. Households that did not have access to health care (Programa Saúde da Família) had greater chance of suffering from moderate or severe food insecurity. Conclusions: Interventions are urgently needed to strengthen and promote public policies aimed to improve living conditions and food security in Quilombolas communities. Keywords Food security Household food insecurity Quilombolas Social vulnerability Epidemiological surveysFood and nutrition security is the guaranteed right for all to have access to safe, healthy and nutritious foods in adequate amounts, respecting cultural and social preferences (1,2) . The violation of this leads to household food insecurity (HFI), which can range from mild (concerns with food shortage and poor quality of foods due lack of money) to severe (occurrence of hunger) (3) . In Brazil, HFI is measured by national surveys using the Brazilian Food Insecurity Measurement Scale (Escala Brasileira de Insegurança Alimentar, EBIA) (3) . Since 2004 Brazil has generated data on household food security from three National Household Representative Surveys (4) . Analyses of these data have identified black or brown skin colour, low income and education, and poor health as risk factors for HFI (3,4) .In 2004 the prevalence of food insecurity among black and brown individuals was 43·4 % compared with 24·6 % among whites. Between 2004 and 2013 this prevalence decreased but still remained higher among black and brown individuals than whites (33·4 v. 17·2 %, respectively). In 2013 over half (50·7 %) of the Brazilian population self-identified as having black or brown skin (5) , a characteristic associated with illiteracy and low income. Specifically, illiteracy was 11·8 % among black and brown individuals and 5·3 % among whites; furthermore, 14·1 % of the black and ...

We examined the association between household food insecurity and early child development and whether or not maternal depression and anxiety modifies this association. The cross‐sectional study included 468 mother–infant pairs recruited at primary health centers of the Federal District, Brazil. Mothers answered a questionnaire that evaluated early child development (outcome), household food insecurity (independent variable), maternal depression and trait anxiety (effect modifiers). Variables were collected with validated questionnaires for the Brazilian population. Pearson's χ2 test and logistic regression analyses were conducted. Infants who lived in a moderate or severe food insecure household had 2.52 times (95% confidence interval [CI] [1.13, 5.65]) the odds of having early child development delays compared with infants in secure households. Maternal depression and anxiety modified the strength of association between household food insecurity and early child development, which is an innovative finding. Among infants with depressed mothers, those experiencing mild (adjusted odds ratio [aOR] 3.33, 95% CI [1.17, 9.46]) and moderate/severe household food insecurity (aOR 10.13, 95% CI [2.18, 47.10]) had higher odds of having early child development delays, compared with infants in food secure households. Among infants with both anxious and depressed mothers, these associations were even stronger for mild (aOR 4.69, 95% CI [1.41, 15.59]) and moderate/severe household food insecurity (aOR 16.07, 95% CI [2.70, 95.66]). In conclusion, household food insecurity is a risk factor for early child development delays, and this association is modified by maternal depression and anxiety. Future studies should evaluate the impact of intervention packages that address maternal depression and anxiety and household food insecurity on preventing early child development delays.

Maternal perception of child's nutritional status has a potential impact on the identification, prevention, and treatment of childhood overweight. Thus, the aim of this study was to evaluate the prevalence of misperception and factors associated with maternal perception of the nutritional status of first- to third-grade elementary school students from private schools in the Federal District, Brazil. This cross-sectional study was conducted with 554 mother-child pairs. Children's nutritional status was assessed by measuring their weight and height. The mothers completed an online questionnaire about sociodemographic data, maternal nutritional status, maternal perception of her own nutritional status (silhouette scale for female adults), and maternal perception of child's nutritional status (silhouette scale for children). Only 30.0% of the mothers were successful in choosing the most appropriate silhouette to represent child's nutritional status. Highly educated mothers (Adjusted OR = 1.51) and mothers of male children (Adjusted OR = 2.53) or of non-overweight children (Adjusted OR = 1.65) were more likely to underestimate child's nutritional status. Conversely, mothers below 35 years of age (Adjusted OR = 1.85) and mothers of female children (Adjusted OR = 2.24) or of overweight children (Adjusted OR = 1.94) were more likely to overestimate child's nutritional status. There was a high prevalence of misperception, which shows the need for interventions for children that take into account the relevance of mother's role and the adequate recognition of child's nutritional status.

The Nurturing Care Framework (NCF) calls for establishing a global monitoring and accountability systems for early childhood development (ECD). Major gaps to build low‐cost and large‐scale ECD monitoring systems at the local level remain. In this manuscript, we describe the process of selecting nurturing care indicators at the municipal level from existing routine information systems to develop the Brazilian Early Childhood Friendly Index (IMAPI). Three methodological steps developed through a participatory decision‐making process were followed. First, a literature review identified potential indicators to translate the NCF domains. Four technical panels composed of stakeholders from federal, state and municipal levels were consulted to identify data sources, their availability at the municipal level and the strengths and weakness of each potential indicator. Second, national and international ECD experts participated in two surveys to score, following a SMART approach, the expected performance of each nurturing care indicator. This information was used to develop analytical weights for each indicator. Third, informed by strengths and weaknesses pointed out in the previous steps, the IMAPI team reached consensus on 31 nurturing care indicators across the five NCF domains (Good health [n = 14], Adequate nutrition [4], Responsive caregiving [1], Opportunities for early learning [7] and Security and safety [4]). IMAPI represents the first attempt to select nurturing care indicators at the municipal level using data from existing routine information systems.

Providing an enabling nurturing care environment for early childhood development (ECD) that cuts across the five domains of the Nurturing Care Framework (i.e., good health, adequate nutrition, opportunities for early learning, security and safety and responsive caregiving) has become a global priority. Brazil is home to approximately 18.5 million children under 5 years of age, of which 13% are at risk of poor development due to socio‐economic inequalities. We explored whether the Early Childhood Friendly Municipal Index (IMAPI) can detect inequities in nurturing care ECD environments across the 5570 Brazilian municipalities. We examined the validity of the IMAPI scores and conducted descriptive analyses for assessing sociodemographic inequities by nurturing care domains and between and within regions. The strong correlations between school achievement (positive) and socially vulnerable children (negative) confirmed the IMAPI as a multidimensional nurturing care indicator. Low IMAPI scores were more frequent in the North (72.7%) and Northeast (63.3%) regions and in small (47.7%) and medium (43.3%) size municipalities. Conversely, high IMAPI scores were more frequent in the more prosperous South (52.9%) and Southeast (41.2%) regions and in metropolitan areas (41.2%). The security and safety domain had the lowest mean differences (MDs) among Brazilian regions (MD = 5) and population size (MD = 3). Between‐region analyses confirmed inequities between the North/Northeast and South/Southeast. The biggest within‐region inequity gaps were found in the Northeast (from −22 to 15) and the North (−21 to 19). The IMAPI distinguished the nurturing care ECD environments across Brazilian municipalities and can inform equitable and intersectoral multilevel decision making.