TRAINING NEEDS ASSESSMENT OF STAKEHOLDERS IN THE HEALTH INSURANCE INDUSTRY IN SOUTHWEST REGION OF NIGERIA: IMPLICATIONS FOR UNIVERSAL HEALTH COVERAGE.

Background: The coverage of the social health insurance scheme in Nigeria has been low. The scheme may benefit from personnel training which has been shown to improve organisational performance. Objective: This study, therefore, aimed to assess the training needs of personnel in the health insurance industry in Southwest Nigeria. Methods: This was a cross-sectional survey conducted among personnel of the health insurance industry in Southwest of Nigeria. The survey tool adapted was the Hennessy-Hicks Training Needs Analysis Questionnaire. The tool has been psychometrically tested for validity and reliability. Originally, the tool has 30 items with an allowance for modification without compromising its psychometric properties. The 30 items were grouped into six superordinate categories; management/supervisory, administration, clinical/service delivery assessment, communication/ teamwork, facility financial audit/assessment, and facility infrastructure assessments. Respondents rated each item along two seven-point scales. In the first scale, respondents rated how important (importance rating) the item is to their job while in the second scale, respondents self-rated their current performance level of the item (performance rating). A training need index was generated by subtracting performance rating from the importance rating for each of the six superordinate categories. Results: Training needs for each of the six subcategories ranked by the magnitude of the derived training need index (from highest to lowest) were; clinical/service delivery, facility infrastructure, facility financial audit, management/supervisory skills, communication, and teamwork, and administration. Conclusion: Training need was demonstrated in all six subcategories. Emphasis on the relevant training need of personnel in the health insurance industry in Nigeria is important to improve efficiency and performance.

COMPARATIVE STUDY OF TREATMENT OUTCOME IN APICECTOMIES WITH OR WITHOUT ROOT-END FILLING.

BACKGROUND: High success rate has been reported widely with conventional endodontic. When failure occurs, re-treatment alone or with surgical endodontics is the recommended treatment. OBJECTIVE: To compare the treatment outcome following apicectomy techniques, apicectomy with and without retrograde root - end filling. METHODOS: Fifty three patients presenting with clinical and radiological evidence of pulpal and periapical pathology ≥5mm that will require apicectomy were randomly recruited into the study groups A or B over a period of 12 month. In group A apicectomy was performed without root - end filling and in group B apicectomy was performed with root - end filling. Patients were recalled 12 months and assessed clinically and radiologically. RESULTS: 35 out of 53 recruited patients reported for 12 month re-call visit. Two were excluded because of missing baseline radiographs. 33 patients that reported at 12months recall visit with complete radiographs were used for analysis. Patients age ranged from 16 - 66 years, with those in age group 21 - 30 years predominant, Majority (57.6%) were males. Forty teeth were treated, 14 had root - end filling and 26 without root - end filling. Maxillary incisors were the most frequently apicectomized teeth. 32 (80%) out of 40 apicectomized teeth were successful, 14 (88.5%) out of 26 teeth treated without root end filling were successful, while 9 (64.3%) out of 14 teeth treated with apicectomy with retrofil were successful. CONCLUSION: Though apicectomized teeth without root-end filling had a higher percentage of success it was not statistically significant (p=0.15).

Risk Factors for Apical Periodontitis Sub-Urban Adult Population.

AIMS AND OBJECTIVES: To assess the risk factors of apical periodontitis (AP) in a Nigerian sub-urban adult population and to compare the findings with those previously reported for various population groups. MATERIALS AND METHODS: The study was based on a full mouth radiographic survey of 285 patients. Patients' age ranged from 18-60 years. All teeth were assessed individually and data recorded for caries, fractured / cracked teeth, root fillings, and tooth restorations. The gender, smoking habit, and frequency of dental visit were also recorded. Multiple logistic regression analyses were performed to identify predictors of AP in the individual. RESULTS: The prevalence of AP was 74.4%. The average number of teeth with AP per patient was 2.8 (range 1-5). AP was found to be more prevalent among people 40- 49 years old (87.2%). Primary carious lesions, fractured / cracked teeth, root fillings and coronal fillings were associated with the incidence of AP in the individual. Fractured teeth had a higher risk of developing AP than carious teeth. The presence of root fillings and coronal restorations were also associated with the development of AP. Smoking (OR=3.82; CI=2.17-6.75) and irregular dental visit (OR=6.73; CI=3.75-12.06) were statistically significant risk factors for developing AP. Gender was not a risk factor for AP (OR=0.86; CI=0.50-1.46). CONCLUSION: The prevalence of AP among adult Nigerians is slightly higher than reported figures for many Western societies. Fractured/cracked teeth had a higher risk of developing AP than carious teeth; hence patients with fractured / cracked teeth should seek treatment early to prevent the development of AP.

Prevalence and Severity of Oral Diseases in the Africa and Middle East Region.

This review aims to determine the prevalence and severity of oral health diseases in the Africa and Middle East region (AMER). The profile of oral diseases is not homogeneous across the AMER. There are large disparities between groups. Reliable data are scarce. The prevalence and severity of oral diseases appear to be increasing in the African region, as does associated morbidity. There are substantial differences in inequalities in oral health. Dental caries prevalence is less severe in most African countries than in developed countries, but the high rate of untreated caries reflects the limited resources available and difficulties of access and affordability to essential oral health care services. The prevalence of gingival inflammation is very high in all age groups in several African countries. The prevalence of maxillofacial trauma has increased in many countries, with a wide variation of the incidence and high prevalence of traumatic dental injuries in primary and permanent teeth. Orofacial clefts are among the most common birth defects. Annual incidence of oral cancer is estimated as 25 cases per 100,000 people in Africa. Noma is a major public health problem for the Middle East and North African (MENA) region. Data about human immunodeficiency virus/AIDS are limited, particularly in the MENA region. According to the World Health Organization Regional Committee for Africa report, some fundamental key basic knowledge gaps need to be underlined. They include inequalities in oral health, low priority for oral health, lack of adequate funding, inadequate dental student training, obstacles to medical and dental research, and poor databases. There are very few effective public prevention and oral health promotion programs in the AMER. Universal health coverage is not achievable without scientific research on the effectiveness of health promotion interventions.

Changes in the prevalence of dental caries in primary school children in Lagos State, Nigeria.

OBJECTIVES: To evaluate the changes in the prevalence of dental caries in Lagos State over a 3 years period and the role of age, sex, and playing in the changes observed. MATERIALS AND METHODS: Three primary schools in Lagos State, Nigeria were randomly selected for the study. Six hundred and thirty-three children age 2-12 years, were examined for caries in 2000 while 513 children were examined in 2003. The prevalence of tooth decay and the prevalence of untreated tooth decay were calculated for the two years, that is, 2000 and 2003. Also the degree of unmet treatment need among the population with caries experience was measured. Differences in the prevalence and severity of dental caries in the primary and permanent dentition were assessed. RESULTS: Approximately 18% of children had untreated tooth decay in their primary dentition in 2003: A 26.1% increase from 2000. About 12.0% of the decay, extracted, and filled teeth (deft) index was seen with decayed teeth in 2000 and 16.6% in 2003. Extracted primary teeth decreased from 2.5% in 2000 to 1.5% in 2003. The change in mean deft between 2000 (0.42) and 2003 (0.47) was 11.9%. Over the study period, the overall reduction in the prevalence of dental caries was 34.8% in the permanent dentition. The decline was larger among children aged 5-9 years (62.1%) and among females (75%). CONCLUSION: The study showed no overall changes in caries severity but a decrease in caries prevalence in the permanent dentition over the study period. The largest decline in caries prevalence in the permanent dentition was observed in children aged 5-9 years and females. On the contrary, there was an increase in the caries prevalence in the primary dentition.

Caries incidence in a cohort of primary school students in Lagos State, Nigeria followed up over a 3 years period.

AIM: To describe the progression of dental caries in pupils who had access to an education intervention programme over a three years period. STUDY DESIGN: This was a prospective cohort study. METHODS: A school-based study consisting of 251 children aged 2-10 years old attending three primary schools in Lagos State, Nigeria. Baseline and exit dental examinations were conducted. Study exit examination was conducted 3 years after the baseline. The deft and DMFT index was used to assess caries severity. The key outcome measure recorded in the study was the development of new cavities in any of the previously caries-free teeth. The presence or absence of caries was represented by the change in deft and or DMFT status. STATISTICS: In the analyses, the incidence of new cavities was recorded at both the subject and tooth levels. Incidence rates for the development of new caries were calculated for all children who: were caries-free at recruitment had caries at recruitment were caries-free at recruitment but developed caries during follow up. Relative risk (RR) analysis was also computed for caries-risk estimation. RESULTS: The caries incidence for the study cohort was 9.9%. About 11.0% of children who were caries free at inception of the study developed caries three years later. The cumulative incidence of caries for the cohort of children who were caries-free at the commencement of the study was 105 new cases per 1,000 persons. Of the 40 children who had caries at the inception of the study, 21 (52.5%) developed new caries lesions. The cumulative incidence of caries for the cohort of children who had caries at the commencement of the study was 525 new cases per 1,000 persons. The relative risk of developing caries over a three year period was significantly higher (RR=4.99; 95% CI = 2.88 - 8.64; p< 0.001) in those who had caries at baseline than those who were caries-free at baseline. Caries severity remained stable over the 3 years period. CONCLUSIONS: Caries incidence and severity was low for the study cohort. The relative risk of developing new caries lesion was significantly higher in those with caries when compared with those without caries.

OS033. Correlates of maternal health outcomes associated with a low-costintervention in secondary facilities across Kano state, Nigeria.

INTRODUCTION: Nigeria has one of the highest rates of maternal mortality in the world. Eclampsia is a major contributor to the deaths especially in Northern Nigeria where the culture of teenage marriage is common. Kano is the state with the highest population in Nigeria. Despite its effectiveness, magnesium sulphate was been used to treat eclampsia and severe preclampsia in only one of 35 general hospitals inthe state as at 2007. OBJECTIVES: In 2008, magnesium sulphate was introduced in 10 General Hospitals in Kano state of Northern Nigeria in a Population Council project funded by the MacArthur Foundation. The aim of the study was to determine if the maternal outcomes improved. METHODS: Doctors and midwives from the 10 hospitals were trained on the use of magnesium sulphate. The trained health workers later conducted step down trainings at their health facilities. Magnesium sulphate, treatment protocol, patella hammer and calcium gluconate were then supplied to the hospitals. Data was collected through structured data forms. The data was analysed using SPSS. RESULTS: Within a year of the project, 1045 patients with severe preeclampsia and eclampsia were treated. The case fatality rate for severe preeclampsia and eclampsia fell from 20.9% (95% CI 18.7-23.2) recorded before the project to 2.3% (95%CI 1.5-3.5) after the project. The perinatal mortality rate in those that received magnesium sulphate was 12.3% (CI 10.4-14.5) while the 5min APGAR score for 72.9% of the babies was 7 or more. CONCLUSION: Training of health workers on updated evidence based interventions and providing an enabling environment for their practice are key components to the attainment of the Millennium Development Goals in developing countries.

Pulp stones: a review.

Pulp stones are a frequent finding on bitewing and periapical radiographs but receive relatively little attention in textbooks. A review of the literature was therefore performed, initially using the PubMed database and beginning the search with 'pulp calcifications' and 'pulp stones'. Each term provided more than 400 references, many of which related to pulp calcification in general rather than pulp stones, and focussed largely on the problems these changes presented to clinicians. A manual search using references from this source was carried out. Contemporary textbooks in endodontology were also consulted, and an historic perspective gained from a number of older books and references. The factors involved in the development of the pulp stones are largely unknown. Further research may determine the reasons for their formation, but with current endodontic instruments and techniques this is unlikely to alter their relevance to clinicians.

Signs and symptoms of temporomandibular disorders in Nigerian adult patients with and without occlusal tooth wear.

OBJECTIVES: The purpose of this study was to investigate the prevalence of signs and symptoms of temporomandibular disorders in Nigerian patients with and without occlusal tooth wear, and to relate the signs and symptoms with the severity of occlusal tooth wear. METHODS: One hundred and fifty patients with occlusal tooth wear, and 100 control subjects participated in this study (mean age 40.8 +/- 12.2 years, range 18-65 years). Exclusion criteria included patients and subjects with more than one missing opposing pair of premolars or molars, restorations covering the entire incisal edge, canine cusps and occlusal surfaces of premolars and molars. The severity of occlusal wear was assessed using the tooth wear index (TWI) designed by Smith and Knight (1984). Chi-square test was used to compare the differences in signs and symptoms of TMD. P < 0.05 was defined as significant. RESULTS: Although more females reported pain than males the difference was not statistically significant (p = 0.05). Except for impaired range of movement, tooth wear patients and controls differ significantly with respect to the variables; pain report, pain on palpation, TMJ sound and deviation on opening (p < 0.001). Patients with mean occlusal TWI score of > or =3 differ significantly from those with TWI score < or =2 with respect to pain on palpation and TMJ sound (p < 0.001). CONCLUSIONS: Posterior occlusal wear (mean TWI scores of 3 or 4) was significantly associated with pain on palpation and TMJ sound. Hence there may be a clinically relevant risk of TMD among Nigerian patients with occlusal tooth wear.

Dental caries in 12-year-old suburban Nigerian school children.

BACKGROUND: Dental caries is one of the commonest oral diseases in children. Despite this fact, not much attention has been given to studies on this issue among suburban Nigerian children. OBJECTIVE: To investigate the prevalence of dental caries, dental attendance and oral health behaviours among the 12- year-old suburban Nigerian children. SUBJECTS AND METHODS: Four hundred and two schoolchildren (349 boys, 153 girls) from both private and public schools age 12-year-old participated in the study in 2003. One examiner was calibrated and performed the screening procedures using standard method of WHO diagnostic criteria. RESULTS: The prevalence of caries was 13.9 % and mean DMFT was 0.14. The decayed component accounted for 77.2 % of the DMFT while filling and missing teeth accounted for 15.8% and 7% respectively. Over 85 % of the children examined were caries free. Seventy seven per cent of the teeth affected by caries were untreated. The probability of having caries experience DMFT> 0 was significantly associated with the type of school and regular sweet consumption p < 0.05. The children who had not visited the dentist had higher caries prevalence than other children. This was statistically significant p < 0.05. Dental attendance was generally poor in both public (90.6%) and private (83.1%) school children. CONCLUSION: The findings in this study for the caries prevalence in 12 year-old suburban Nigerian schoolchildren was as low as in developed countries of central Europe and lower than the global standard according to WHO references for the year 2000.

Dental care needs and demands in patients attending the dental hospital of the Obafemi Awolowo University Teaching Hospital's Complex Ile-Ife, Nigeria.

BACKGROUND: To compare the pattern of need and demand for dental care in settings where services are paid for through government sponsored insurance programs and out of pocket by individuals. METHODS: Study consisted of first visit patients attending the Dental Hospital. The assessment of normative treatment needs was done. The tooth based treatment needs were assessed by the WHO basic methods and the periodontal needs were assessed by the periodontal need systems PTNS. RESULTS: More males had sought treatment than females. In both sexes, most of the patients demanding treatment belonged to the 17-34 year age group. There was no statistically significant difference between age groups (P = 0.65). 55.4, 8.1 and 1.4 percents sought care for toothache, caries without concomitant pain and dental check-up respectively. Oral surgical care was considered necessary for the main complaint in 50.1% of cases. However, the age group 17-34 year old needed more restorative care than periodontal and the > 65 age group requested more extractions. CONCLUSION: The expressed need or demand for dental care falls short of the normative need. It should therefore be the aspiration of appropriate government ministry and health care providers to attempt converting normative needs into demand for care.

Prosthetic parameters among dental patients in Ile-Ife, Nigeria.

The purpose of this study was to determine the Rest Vertical Dimension (RVD), Occlusal Vertical Dimension (OVD), Freeway Space (FWS) and their importance in the fabrication of dental prostheses. These prosthetic parameters were determined in 310 dentate patients attending the Dental Hospital of the Obafemi Awolowo University Teaching Hospitals' Complex Ile-Ife. The MMO was obtained by measuring inter-incisal distance. RVD and OVD were derived using Willis gauge. The FWS was taken as 'RVD minus OVD'. Of the 310 attendees, twenty-seven (8.7%) were denture wearers. There was no statistically significant difference between the genders with regards to the use of dentures (P = 0.17). The mean values (+/- standard deviation) for MMO was found to be 50.5 +/- 7.9 mm (range 18.0 to 70.0 mm). The RVD was 73.0 +/- 8.4 mm (range 50.0 to 94.0 mm) and OVD was 69.8 +/- 8.2 mm (range 47.0 t 92.0 mm). The mean FWS was 3.3 +/- 1.4 mm (range 1 to 9 mm). Following the loss of most of the posterior teeth or in a state of complete edentulism, the face profile appears squashed and the vertical dimensions are altered. To provide an efficient and functional prosthesis, the facial dimensions have to be restored to or near pre-edentulous state. The establishment of values for these facial dimensions in given population will assist in the provision of satisfactory prosthesis.

Non-carious cervical lesions in a Nigerian population: abrasion or abfraction?

OBJECTIVES: To determine the proportion of non-carious cervical lesions (NCCL) that were either abrasion or abfraction like and to test the validity of the assumption that right-handed patients cause more abrasion on the cervical surfaces of teeth on the left side of the mouth. SETTING: Ile-lfe, Southwestern Nigeria. PARTICIPANTS: 106 first time patients diagnosed as having any form of NCCL. DESIGN: Patients were subjected to intra-oral examination followed by the administration of a questionnaire. The cervical lesions were examined and scored using the tooth wear index designed by Smith & Knight 1984. NCCL was diagnosed as abrasion or abfraction like based on established clinical features plus positive history of possible associated aetiological factors. OUTCOME MEASURES: Abrasion and abfraction like lesions. RESULTS: Abrasion was the diagnosis in 630 (62.3%) of the 1,012 tooth sites with NCCL that had no associated occlusal surface wear facet. This constituted about two-thirds of the NCCL. Three hundred and eighty two (37.7%) of the NCCL occurred in association with an occlusal surface wear facet and presented the typical wedge shaped defects with sharp margins characteristic of abfraction. These abfraction like lesions constituted about one-third of the NCCL. 50.8% of abrasive NCCL in right-handed brushers were located on the left side of the mouth. CONCLUSIONS: About one-third of NCCL in the present study presents an abfraction component, and two-thirds abrasion. Although, right-handed brushers had more severe lesions on the opposite side of the mouth, the difference was not statistically significant.

Root malformation in mandibular premolars: an endodontic difficulty-report of two cases.

Much of the literature is concerned with variation in root canal morphology rather than variation in root morphology. The present communication reports two rare cases of patients with aberrant root morphology in all their mandibular premolars examined. The role of intra-oral preoperative radiographs of diagnostic value is emphasized, without which unexpected complications during endodontic treatment or extraction may occur. Failure of endodontic treatment as a result of the inability to negotiate and instrument one of the canals in the aberrant root is an important difficulty that may be encountered with such variant teeth.

Follow-up study of apicectomised anterior teeth.

A retrospective study was carried out on anterior teeth which had undergone apicectomy between 1995 and 1997. More maxillary teeth were treated (94.7%) than mandibular teeth (5.3%). Radicular cyst was the most frequently diagnosed reason for the treatment (47.3%), followed by chronic apical infection/granuloma (44.0%). The overall success rate was 71.9%, while treatment outcome was doubtful in 14.0% of the apicectomised teeth. The presence of pre- or postoperative signs and symptoms did not have any statistically significant effect on the treatment outcome. A higher percentage of roots with retrograde amalgam fillings healed successfully than roots with orthograde fillings, but the difference was not statistically significant (P > 0.05). More lesions classified histopathologically as radicular cysts healed successfully than those classified as granulomas (Fisher exact test, 2-tailed P value = 1.0).

A survey of amalgam restorations in a south-western Nigerian population.

The present survey assessed the proportion of replacement restorations in comparison with new restorations because of primary caries in a setting where the caries experience had been reported to be low but probably on the increase. Also the relative importance of the main reasons for the replacements among other things was established. A total of 488 amalgam restorations were surveyed. About 25% of all restorations were replacements of failed restorations. The main reason for the replacement was bulk amalgam fracture, which accounted for 47.1% of all restorations. These show a reversal of what had been reported in settings where the caries experience was high but now is on the decrease. The importance of bitewing radiograph of all failed restorations was emphasized in order to minimize under or over treatment. The median age of failed restorations was 5.0 years. More than half (60.3%) of replaced restorations had failed during the first 5 years of use.

Patients' attitudes to wearing of gloves by dentists in Nigeria.

OBJECTIVE: To evaluate patient's attitudes to the use of gloves by dentists. DESIGN: This consisted of a four-item questionnaire administered to 445 consecutive patients attending our dental clinic. SETTING: . Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria. SUBJECTS: Four hundred and forty five patients above the age of fifteen years attending the dental clinic for the first time. RESULTS: Majority of the patients were in the 20-30 year age group and over 93% had formal education. Most of the respondents (88.8%) stated that glove wearing was essential and over 63% considered that glove wearing protected both the operator and the patient. Whilst about one-third of respondents would attend for treatment when gloves were not worn, 81.3% felt that gloves should be changed after each patient. There were statistically significant differences (p<0.05) in responses in relation to age-groups and educational attainment, however no sex differences (p>0.05) were reported. CONCLUSION: This survey showed a high level of awareness by patients on the use of gloves by dentists. It also found that age-groups and levels of educational attainment influenced patients attitude to glove use.

A survey of cases of cancrum oris seen in Ile-Ife, Nigeria.

AIM: To review the records of child patients with cancrum oris who presented at a teaching hospital in Nigeria. SETTING: Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. SAMPLE AND METHODS: The study was carried out through review of records of child patients diagnosed as having cancrum oris or post-cancrum oris defects between 1982 and 1996. Age, gender, site distribution, treatment and its outcome were recorded. RESULTS: One hundred and forty-two cases were diagnosed during the study period. Mean age was 4.65 years (range 2-16 years). The maxillary quadrants were affected more often than the mandibular. Seventeen patients completed treatment satisfactorily, but 55 failed to do so. All patients had evidence of malnutrition. CONCLUSIONS: The findings of this and other studies demonstrate the need for major initiatives to address the underlying causes of cancrum oris and to promote the utilization of health care.