Impact of the Brazilian Family Health Strategy on child oral health-related quality of life: a cohort study

MORAES, Renita Baldo; SFREDDO, Camila Silveira; ARDENGHI, Thiago Machado

doi:10.1590/1807-3107bor-2021.vol35.0093

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Original Research, Community Dental Health • Braz. oral. res. 35 • 2021 • https://doi.org/10.1590/1807-3107bor-2021.vol35.0093 linkcopy

Impact of the Brazilian Family Health Strategy on child oral health-related quality of life: a cohort study

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Abstract

Most of the Brazilian population is covered by the Family Health Strategy (FHS), however no longitudinal study has assessed the impact of the FHS on child oral health-related quality of life (OHRQoL). The objective of the study was to evaluate the longitudinal impact of the FHS on the OHRQoL. This study followed up 459 children aged 2 to 5 years for 2 years. OHRQoL was assessed by the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) at baseline (April to November 2016) and follow-up (April to December 2018). Children’s parents answered a questionnaire regarding sociodemographic information, FHS service, and dental service. Participants were clinically examined for dental caries. Multilevel Poisson regression was used to assess the associations between FHS variables at baseline and overall/domain-specific of the ECOHIS scores over time. A total of 365 children were reassessed for OHRQoL (follow-up rate: 79.5%). The absence of FHS coverage from the child’s first year of age was associated with higher scores in the family function domain [rate ratio (RR) = 2.42; 95% confidence interval (CI) 1.28–4.58)]. Home visits by the FHS team members were associated with higher psychological domain scores (RR = 1.60; 95%CI 1.01–2.57). Children not covered by the FHS since the first year of age reported worse OHRQoL over time. This fact highlights the importance of an integrated health approach to promote children’s health.

Child; Health Services; Oral Health; Primary Health Care; Quality of Life

Variables	Baseline (T1)	Follow-up (T2)	Dropouts*	p-value
Variables	(n = 459)	(n = 365)	(n = 94)	p-value
Sociodemographic characteristics
Sex [n (%)]	459	365	94	0.66
Girls	230 (50.1)	181 (49.6)	49 (52.1)
Boys	229 (49.9)	184 (50.4)	45 (47.9)
Age (years) [mean (SD)]	3.6 (1.1)	5.5 (1.0)	3.7 (1.1)	0.17
Skin color [n (%)]	446	365	81	0.10
White	354 (79.4)	295 (80.8)	59 (72.8)
Non-white	92 (20.6)	70 (19.2)	22 (27.2)
Maternal education [n (%)]	444	363	81	0.01
≥ 9 years	324 (73.0)	276 (76.0)	48 (59.3)
< 9 years	120 (27.0)	87 (24.0)	33 (40.7)
Household income in R$	2,188.99 (1,484.8)	2,868.10	1,873.22	0.04
[mean (SD)]	2,188.99 (1,484.8)	(2,301.9)	(1,128.9)	0.04
Bolsa Família benefit [n (%)]	444	348	80	0.40
No	359 (80.9)	312 (90.0)	62 (77.5)
Yes	85 (19.1)	36 (10.0)	18 (22.5)
Health service characteristics
FHS since first year of age [n (%)]	451	349	86	< 0.01
Yes	168 (37.3)	120 (32.3)	46 (53.5)
No	283 (62.7)	229 (67.7)	40 (46.5)
Home visit by the FHS team [n (%)]	446	361	81	0.66
No	274 (61.4)	212 (58.7)	48 (59.3)
Yes	172 (38.6)	149 (41.3)	33 (40.7)
Oral health characteristics
Public dental service [n (%)]	452	363	87	0.40
Yes	263 (58.2)	296 (81.5)	54 (62.1)
No	189 (41,8)	67 (18.5)	33 (37.9)
Reason for visiting a dentist [n (%)]	246	274	53	0.17
Check-up/routine	159 (64.6)	158 (57.7)	30 (66.6)
Treatment	87 (35.4)	116 (42.3)	23 (43.4)
Untreated dental caries [mean (SD)]	1.0 (2.1)	1.3 (2.2)	1.5 (2,6)	0.02

Variables	Baseline (T1)				Follow-up (T2)
	Number of items	Mean (SD)	Possible range	Observed range	Number of items	Mean (SD)	Possible range	Observed range
	Number of items	ECOHIS Scores	Possible range	Observed range	Number of items	ECOHIS Scores	Possible range	Observed range
Overall ECOHIS	13	2.6 (4.2)	0-52	0-44	13	2.9 (4.5)	0–52	0–36
Child impact section
Symptoms	1	0.5 (0.9)	0-4	0-4	1	0.6 (0.9)	0–4	0–4
Functional	4	0.6 (1.4)	0-16	0-14	4	0.7 (1.4)	0–16	0–11
Psychological	2	0.6 (1.1)	0-8	0-6	2	0.4 (1.0)	0–8	0–8
Self-image/social interaction	2	0.1 (0.6)	0-8	0-7	2	0.2 (0.9)	0–-8	0–8
Family impact section
Parental distress	2	0.6 (1.4)	0-8	0-8	2	0.7 (1.6)	0–8	0–8
Family function	2	0.2 (0.7)	0-8	0-7	2	0.2 (0.8)	0–8	0–8

Variables	Child section				Family section		Overall ECOHIS
	Symptoms	Function	Psychological	Self-image/ social interaction	Parent distress	Family function	RR (95% CI)
	RR (95% CI)	RR (95% CI)	RR (95% CI)	RR (95% CI)	RR (95% CI)	RR (95% CI)	RR (95% CI)
Sociodemographic characteristics
Sex	p = 0.25	p = 0.22	p = 0.77	p = 0.92	p = 0.89	p = 0.14	p = 0.65
Girls	1	1	1	1	1	1	1
Boys	1.16 (0.89-1.51)	1.26 (0.86–1.83)	1.05 (0.74-1.49)	0.95 (0.39-2.28)	0.96 (0.57-1.61)	1.53 (0.86-2.75)	1.06 (0.82-1.34)
Age	p < 0.01	p = 0.02	p = 0.34	p < 0.01	p = 0.02	p = 0.07	p < 0.01
	1.21 (1.07–1.37)	1.23 (1.03–1.47)	0.92 (0.78-1.08)	2.22 (1.40-3.51)	1.34 (1.05-1.72)	1.29 (0.98-1.70)	1.17 (1.05-1.32)
Skin color	p = 0.11	p = 0.01	p = 0.86	p = 0.11	p < 0.01	p = 0.53	p = 0.09
White	1	1	1	1	1	1	1
Non-white	1.28 (0.94–1.75)	1.75 (1.12–2.73)	0.96 (0.61-1.49)	2.28 (0.82-6.33)	2.23 (1.22-4.07)	0.78 (0.37-1.66)	1.28 (0.96-1.73)
Maternal education	p = 0.01	p = 0.03	p = 0.23	p = 0.43	p = 0.27	p = 0.82	p = 0.06
9 years	1	1	1	1	1	1	1
< 9 years	1.43 (1.08–1.89)	1.58 (1.04–2.39)	1.27 (0.86-1.87)	1.47 (0.56-3.84)	1.37 (0.77-2.44)	0.92 (0.47-1.79)	1.30 (0.99-1.70)
Household income	p = 0.73	p = 0.06	p = 0.02	p = 0.05	p = 0.50	p = 0.73	p = 0.21
Household income	1.00 (0.99–1.00)	0.99 (0.99–1.00)	0.99 (0.99-1.00)	0.99 (0.99-1.00)	0.99 (0.99-1.00	0.99 (0.99-1.00)	0.99 (0.99-0.00)
Bolsa Família benefit	p = 0.04	p < 0.01	p < 0.01	p = 0.03	p = 0.15	p = 0.83	p = 0.02
No	1	1	1	1	1	1	1
Yes	1.38 (1.01–1.89)	2.02 (1.30–3.14)	1.74 (1.15-2.63)	3.05 (1.09-8.49)	1.59 (0.84-3.00)	0.92 (0.43-1.94)	1.42 (1.05-1.92)
Health service characteristics
FHS since first year of age	p = 0.64	p = 0.57	p = 0.16	p = 0.42	p = 0.62	p = 0.04	P = 0.99
Yes	1	1	1	1	1	1	1
No	0.93 (0.71–1.22)	0.89 (0.60–1.31)	0.77 (0.54-1.10)	0.69 (0.28-1.68)	1.14 (0.66-1.96)	1.92 (1.02-3.60)	0.99 (0.77-1.28)
Home visit by the FHS team	p = 0.58	p = 0.13	p = 0.04	p = 0.88	p = 0.51	p = 0.07	p = 0.54
No	1	1	1	1	1	1	1
Yes	1.07 (0.82–1.40)	1.34 (0.91–1.97)	1.44 (1.01-2.05)	1.07 (0.43-2.61)	1.19 (0.70-2.02)	0.56 (0.30-1.03)	1.08 (0.84-1.39)
Oral health characteristics
Public dental service	p = 0.27	p = 0.03	p = 0.02	p = 0.03	p = 0.33	p = 0.24	p = 0.01
Yes	1	1	1	1	1	1	1
No	1.15 (0.89–1.50)	1.52 (1.04–2.22)	1.54 (1.08-2.18)	2.58 (1.07-6.19)	1.29 (0.76-2.18)	1.41 (0.79-2.51)	1.38 (1.08-1.76)
Reason of visiting a dentist	p < 0.01	p < 0.01	p < 0.01	p < 0.01	p < 0.01	p < 0.01	p < 0.01
Check-up/routine	1	1	1	1	1	1	1
Treatment	2.28 (1.69–3.07)	2.75 (1.78–4.23)	2.31 (1.45-3.66)	5.52 (1.73-17.6)	3.50 (1.92-6.37)	2.58 (1.44-4.61)	2.41 (1.82-3.19)
Untreated dental caries	p < 0.01	p < 0.01	p < 0.01	p = 0.02	p < 0.01	p = 0.01	p < 0.01
Untreated dental caries	1.15 (1.09–1.21)	1.18 (1.0–1.27)	1.11 (1.03-1.19)	1.25 (1.041.49)	1.47 (1.34-1.62)	1.16 (1.03-1.31)	1.20 (1.15-1.27)

Variables	Child section				Family section		Overall ECOHIS
	Symptoms	Function	Psychological	Self-image/ social interaction	Parent distress	Family function	RR (95%CI)
	RR^a (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)
Sociodemographic characteristics
Sex	**	**	**	**	**	**	**
Girls
Boys
Age	1.21 (1.07–1.37)	1.25 (1.05–1.49)	**	2.42 (1.54–3.81)	1.33 (1.05–1.68)	**	1.19 (1.06–1.33)
Skin color	**	**	**	**		**	**
White					1
Non-white					2.16 (1.23–3.80)
Maternal education		**	**	**	**	**	**
9 years	1
< 9 years	1.41 (1.08–1.87)
Household income	**	**	**	**	**	**	**
Bolsa Família benefit	**	1		1			1
No		1.98 (1.29–3.06)		3.12 (1.18–8.27)			1.40 (1.04–188)
Yes
Health service characteristics
FHS since first year of age	**	**	**	**	**		**
Yes						1
No						2.42 (1.28–4.58)
Home visit by the FHS team	**	**		**	**	**	**
No			1
Yes			1.60 (1.01–2.57)
Oral health characteristics
Public dental service
Yes	**	1	1	**	**	**	1
No		1.67 (1.05–2.67)	2.83 (1.23–6.54)				1.32 (1.02–1.70)
Reason of visiting a dentist				**	**
Check-up/routine	1	1	1			1	1
Treatment	1.75 (1.29–2.41)	1.83 (1.18–2.87)	2.08 (1.31–3.30)			2.87 (1.61–5.12)	1.68 (1.27–2.23)
Untreated dental caries	1.08 (1.03–1.14)	1.11 (1.02–1.20)		1.24 (1.05–1.47)	1.47 (1.33–1.62)		1.13 (1.08–1.19)

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Sociedade Brasileira de Pesquisa Odontológica - SBPqO Av. Prof. Lineu Prestes, 2227, 05508-000 São Paulo SP - Brazil, Tel. (55 11) 3044-2393/(55 11) 9-7557-1244 - São Paulo - SP - Brazil
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[TFN1] ^*Difference between participants followed up and dropouts. Chi-square test for categorical variables and Mann-Whitney test for continuous variables. T1: baseline; T2: Follow-up; SD: standard deviation; R$: Real (US$1.0 is equivalent to R$5.0 approximately); FHS: Family Health Strategy.