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

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.

摘要 巴西绝大多数人口均纳入家庭健康战略（Family Health Strategy, FHS）的覆盖范围，但目前尚无纵向研究评估该战略对儿童口腔健康相关生活质量（oral health-related quality of life, OHRQoL）的影响。本研究旨在评估家庭健康战略对儿童口腔健康相关生活质量的纵向影响。本研究对459名2~5岁的儿童开展了为期2年的随访。研究分别于基线阶段（2016年4月至11月）与随访阶段（2018年4月至12月），采用巴西版幼儿口腔健康影响量表（Early Childhood Oral Health Impact Scale, ECOHIS）对儿童的口腔健康相关生活质量进行评估。儿童家长填写了涵盖社会人口学信息、家庭健康战略服务及牙科服务相关内容的调查问卷。研究对象接受了龋齿临床检查。采用多水平泊松回归分析，评估基线时家庭健康战略相关变量与随访期间幼儿口腔健康影响量表总分及各维度得分之间的关联。最终共有365名儿童完成了口腔健康相关生活质量的再次评估，随访保留率为79.5%。儿童自出生起未被家庭健康战略覆盖，与家庭功能维度得分升高存在关联[率比（rate ratio, RR）=2.42，95%置信区间（confidence interval, CI）=1.28~4.58]。家庭健康战略团队成员的上门家访服务，与心理维度得分升高存在关联（RR=1.60，95%CI=1.01~2.57）。自出生起未纳入家庭健康战略覆盖范围的儿童，其随访期间的口腔健康相关生活质量更差。该研究结果凸显了整合式卫生服务模式对促进儿童健康的重要意义。