Improving maternal and child healthcare through professional training in quilombola communities, Brazil: a controlled interrupted time-series study

Despite Brazil’s upper-middle-income status, maternal and child health indicators remain below expectations, with wide disparities across population groups. Quilombola communities, in particular, face persistent barriers to healthcare access and utilization. Training frontline primary healthcare workers on the rights of women and children offers a cost-effective, scalable strategy to improve outcomes during the critical first 1,000 days of life. This study evaluated a community-based intervention to enhance healthcare professionals’ knowledge of maternal and child health rights in a quilombola community in Maranhão, Brazil. A quasi-experimental, controlled interrupted time series design compared two municipalities: Alcântara (intervention) and Guimarães (control). An active learning, rights-focused educational program was delivered. Ten maternal and child health indicators were analysed using monthly SISAB data (2014–2023), with Prais–Winsten regression and ARIMA models. Twelve months post-intervention, Alcântara showed increased antenatal visits by community health agents (Xreg = 64.92; 95% CI: 34.33–95.51; p < 0.001), complementary breastfeeding (Xreg = 10.62; 95% CI: 5.01–16.23; p < 0.001), and full vaccination coverage in children under two (Xreg = 30.33; 95% CI: 8.61–52.04; p = 0.006). A reduction in health education activities for pregnant women was also observed (Xreg = − 3.25; 95% CI: −5.94 to − 0.56; p = 0.01). All indicators declined in the control municipality. A low-cost, rights-based educational intervention using active learning improved key maternal and child health indicators in a socioeconomically vulnerable quilombola population. These findings support the role of rights-focused training for community health workers in advancing health equity.