RESUMO
OBJECTIVES: Inequalities have been reported between high, middle and low socioeconomic position (SEP) children. However, the effect of contextual and individual SEP on existing inequalities among socioeconomically deprived children varies between local contexts. The aim of this study was to assess the impact of contextual and individual SEP on individual caries experience among socioeconomically deprived children in Chile. METHODS: Cross-sectional multilevel analysis of data from the 2015 electronic register of the National Board of School Aid and Scholarships (JUNAEB) of Chile. The contextual variables were the municipality Human Development Index (HDI) and rurality index. Individual variables included gender, living in extreme poverty and school grade. Multilevel negative binomial models assessed their impact on DMFT/dmft. RESULTS: 112,429 children in 255 municipalities were included. Overall, contextual SEP (HDI) was not associated with caries experience in the primary or permanent dentition. Individual SEP (living in extreme poverty) was associated with caries experience in both dentitions. The proportion of children living in extreme poverty with caries experience in the primary teeth was 17% higher than children not living in extreme poverty (PR 1.17; 95% CI 1.15-1.19), while for children with permanent teeth it was 9% higher (PR 1.09; 95% CI 1.08-1.11). CONCLUSION: These findings could support the development of health strategies focused on individual SEP to efficiently reduce oral health inequalities among socioeconomically deprived children.
Assuntos
Cárie Dentária , Criança , Estudos Transversais , Índice CPO , Cárie Dentária/epidemiologia , Humanos , Análise Multinível , Saúde Bucal , Pobreza , Prevalência , Fatores SocioeconômicosRESUMO
OBJECTIVE: To assess the effectiveness of a dental caries prevention programme on the permanent dentition of Chilean rural schoolchildren using fluoridated powdered milk and milk derivatives. BASIC RESEARCH DESIGN: The fluoridated products were delivered to 35,000 schoolchildren in the rural areas of the Ninth Region in Chile using the standard School Feeding Programme (PAE). The daily fluoride dose from milk fluoridated products was estimated at 0.65 mg/day, during approximately 200 schooldays/year. Cross-sectional samples of schoolchildren aged 6, 9 and 12 years from study communities and from positive control communities (ongoing APF-gel programme) were examined at the start of the study in November 1999 and after 36 months. RESULTS: No significant differences were found for the DMFT and dmft indices among 6-year-olds in the study and positive control groups either at baseline or 36 months later. Significant reductions (range 24-27%) were observed in the DMFT index in 9 and 12-years-olds of the study communities when clinical data at baseline, in the absence of a fluoridated preventive programme, were compared to those obtained after 36 months of receiving fluoridated milk products. Upon the follow-up examination, the DMFT indices of schoolchildren aged 9 and 12 years old receiving fluoridated milk were not significantly different from those of the positive control comparison group of the APF-Gel programme. CONCLUSIONS: Considering the relative costs and technical difficulties involved in both caries preventive programmes, it appears that in rural Chilean communities, fluoridation of powdered milk and milk derivatives is an effective alternative caries prevention programme in areas where either water fluoridation or other community delivered programmes are difficult to apply.
Assuntos
Cariostáticos/administração & dosagem , Cárie Dentária/prevenção & controle , Fluoretos/administração & dosagem , Leite , Saúde da População Rural , Fluoreto de Fosfato Acidulado/uso terapêutico , Animais , Cariostáticos/análise , Cariostáticos/uso terapêutico , Criança , Chile , Estudos de Coortes , Estudos Transversais , Índice CPO , Fluoretos/análise , Fluoretos/uso terapêutico , Fluoretos Tópicos/uso terapêutico , Seguimentos , Serviços de Alimentação , Humanos , Cremes Dentais/uso terapêutico , Abastecimento de Água/análiseRESUMO
OBJECTIVE: This paper assesses the cost-effectiveness of a community dental caries prevention programme, targeting pre-school children living in non-fluoridated rural areas of Chile. BASIC RESEARCH DESIGN: The results of a community trial to measure the effects of using fluoridated powdered milk and milk-cereal to prevent dental caries, together with the cost of running the programmeme, were used to determine its cost-effectiveness when compared to the status-quo alternative. In the experimental community, fluoridated milk products were given to approximately 1,000 children aged between six months and six years, using the standard National Complementary Feeding Programme available in Chile. The control group received the milk products only. Dental caries status was recorded at the beginning and end of the programme in both communities using WHO criteria. The costs that would be incurred by such a programme, using a societal perspective, were identified and measured. RESULTS: Children who received fluoridated products had significantly lower mean levels of dental caries than those who had not. This improvement was achieved with a yearly cost of RCH (1999) $1,839.75 per child (1 US$ = RCH (1999) $527.70). On average, this programme resulted in a net societal savings of RCH (1999) $2,695.61 per diseased tooth averted after four years when compared to the control group. CONCLUSIONS: While the analysis has inherent limitations as a result of its reliance on a range of assumptions, the findings suggest that there are important health and economic benefits to be gained from the use of fluoridated milk products in non-fluoridated rural communities in Chile.
Assuntos
Cariostáticos/administração & dosagem , Laticínios , Cárie Dentária/prevenção & controle , Fluoretos/administração & dosagem , Serviços de Alimentação , Saúde da População Rural , Criança , Pré-Escolar , Chile , Estudos de Coortes , Redução de Custos , Análise Custo-Benefício , Índice CPO , Assistência Odontológica/economia , Cárie Dentária/economia , Restauração Dentária Permanente/economia , Custos de Cuidados de Saúde , Humanos , Lactente , Perda de Dente/economia , Perda de Dente/prevenção & controleRESUMO
In recent years health education practitioners have been looking for ways to extend the social psychological analysis of human behavior with approaches that focus on the cultural and social context of human behavior. In this article the value of the 'thick description' approach, borrowed from anthropology, is explored by examples from the Caribbean and South Africa. It demonstrates that an anthropological approach has much to offer as a basis for sound interventions for understanding human behavior. However, although an anthropological approach offers valuable starting points for interventions, its broad scope exceeds the traditional goals of health education (changing health beliefs, health counseling). Interventions will not aim at informing individuals, but at improving cultures. They may concern the change of basic cultural and social structures such as gender roles. To limit the risk of ethnocentrism, adequate ways need to be developed to make optimal use of the information thick description offers, while avoiding ethnocentrism. The article ends with a discussion concerning the assets of a dialogical approach towards health promotion. A dialogue between health promoters and their target population may help solve the problem of ethnocentrism in broadly scoped interventions.