Dentists' perspectives, practices, and factors associated with informed consent process for fixed prosthodontic treatment: a cross-sectional study of kampala metropolitan area, Uganda.

BACKGROUND: Dentists have a legal and ethical obligation to obtain informed consent from patients before carrying out treatment. In Uganda, the process of obtaining informed consent in dentistry is not well documented. The aim of the present study was to determine dentists' perspectives and practices regarding informed consent to fixed prosthodontic treatment (FPT) in Kampala Metropolitan, Uganda. METHODS: A quantitative cross-sectional study was conducted among 153 dentists from July to September 2023. Data were collected using a semi-structured self-administered questionnaire that included both closed- and open-ended questions. The questionnaire included items on participants' sociodemographic information, perspectives, and practices about informed consent for FPT. Perspectives were rated using ten items on a five-point Likert scale. The minimum possible total score was 10, and the maximum possible score was 50. Descriptive statistics and Poisson regression were used to summarize and analyze the quantitative data, and the significance level was set at p < 0.05. Open-ended items were analyzed using content analysis. RESULTS: The majority (83.9%) of the participants were general dentists with working experience ranging from 1 to 38 years and a median of 8 years. The majority were familiar with the concept of informed consent and had positive perspectives regarding its use for FPT. The mean score for perspectives was 39.27 (SD, 5.42). However, there were variations in the practices of the dentists. More than three-quarters (87.6%) reported that they always obtained the patient's informed consent before FPT. Less than a third (29.4%) obtained written consent for FPT. About half of the dentists provided information regarding the procedure, benefits, and risks of treatment during the consent process. Bivariate analysis showed that the use of written consent for FPT was significantly (p < 0.05) associated with having a work experience of more than 10 years and having had training involving informed consent after undergraduate studies. CONCLUSION: The present study provides baseline data regarding perspectives and practices regarding informed consent for FPT among dentists in Uganda. It is recommended that regular training courses be developed to highlight the importance of improved informed consent practices for patient protection and to instruct dentists about obtaining valid informed consent. There is a need for future research to streamline guidelines for the informed consent process in dental care in Uganda.

Maternal and infant risk factors and risk indicators associated with early childhood caries in South Africa: a systematic review.

OBJECTIVES: To evaluate the risk factors and risk indicators associated with early childhood caries in South Africa. DESIGN: A systematic review of aetiology was performed. From 1366 papers found, 23 studies met the eligibility criteria and were included. All study designs were included. Healthy children under six who live in South Africa were eligible for the study. The study was registered with PROSPERO, registration number CRD42020216455. DATA EXTRACTION: Eligible studies were selected, and data extracted independently by two reviewers. Published data on socio-economic status, dietary factors, oral hygiene knowledge and practices, breastfeeding and bottle-feeding practices, oral bacterial flora and other risk indicators were collected. Two authors appraised the studies independently using the Joanna Briggs Critical Appraisal tools. DATA ANALYSIS: Heterogeneity was assessed using the I2 statistics, and due to heterogeneity, extracted data were mostly presented narratively. RESULTS: Meta-analysis was performed using random-effects models and concluded that parents of children who had a tertiary education had a 1.77 [1.22-2.57] odds of experiencing dental caries compared to the children of parents with a secondary education. However, the unclear risk of bias of most included cross-sectional studies precluded definitive conclusions. CONCLUSIONS: More high-quality cohort studies need to be performed to evaluate actual risk factors for ECC in a South African setting. Parental/caregiver oral educational knowledge needs promoting before the emergence of their children's teeth. The social determinants of health need to be incorporated in future studies, and suitable targeted interventions need to be developed and implemented to mitigate early childhood caries in South Africa.

Prevalence of early childhood caries in South Africa: a systematic review.

BACKGROUND: The prevalence of Early Childhood Caries (ECC) in South Africa was last determined in 2002 in a national survey. Since then only few scattered studies were conducted across pocketed communities in the country. There appears to be an increasing trend in dental caries prevalence in South Africa. Since South Africa has one of the highest burden of HIV in the world, less focus was spent on Non-Communicable Diseases (NCDs), it was only when HIV patients developed NCD's did the government start evaluating NCDs. However, oral health is still not given enough attention within the health sphere. It is the hope of this systematic review to showcase the extent of dental caries amongst the future leaders of our country. OBJECTIVES: The systematic review presents the prevalence and severity of early childhood caries between age groups and provinces in South Africa from 1975 to 2014. DESIGN: A systematic review of prevalence was performed. SETTINGS AND PARTICIPANTS: All studies performed on children under the age of six who lived in South Africa were eligible to be included. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence of ECC and the dmft scores were the primary and secondary outcome measures. RESULTS: Twenty-one studies were included in the present review. The overall prevalence was 44.94% (95% confidence interval (C.I.) 39.73-50.15%) and the overall dmft score was 2.422 (95% C.I. 2.148-2.696). CONCLUSIONS: The dmft score was the lowest in the Limpopo Province and highest in the Eastern Cape. ECC prevalence increased post-apartheid possibly on account of lifestyle changes due to the exodus from rural to urban and peri-urban areas. Registration The protocol of this systematic review was registered with PROSPERO, CRD42018112161, in November 2018.

Oral Cancer Knowledge, Attitudes, and Practices among Dentists in Khartoum State, Sudan.

The dental professions hold an important responsibility in the control of oral cancer and the early diagnosis highly depends on their knowledge. The present study was developed to assess the knowledge, attitude, and practice of dentists in Khartoum State regarding oral cancer prevention and early detection. An administered questionnaire was structured and sent to all licensed 130 dentists working in public dental clinics in Khartoum State. Responses to the questionnaire were analyzed using descriptive and analytical statistics. Although the majority of the dentists were knowledgeable about the major risk factors of oral cancer, more than half of the dentists reported they do not carry out any special examination to detect oral cancer in age 40 and above in asymptomatic patients. Dentists indicated their lack of training as the main barrier for conducting a comprehensive oral cancer examination. Interestingly, the vast majority of the dentists express their interest to have further oral cancer educational and training sessions. The findings of the present study suggested strongly that educational and training interventions are necessary to enhance preventive measures which may lead to reduce mortality and morbidity from oral cancer.

Social gradient in the cost of oral pain and related dental service utilisation among South African adults.

BACKGROUND: Oral pain affects people's daily activities and quality of life. The burden of oral pain may vary across socio-economic positions. Currently, little is known about the social gradient in the cost of oral pain among South Africans. This study therefore assessed the social gradient in the cost of oral pain and the related dental service utilisation pattern among South African adults. METHODS: Data were obtained from a nationally representative cross-sectional survey of South African adults ≥16 year-old (n = 2651) as part of the South African Social Attitudes Survey conducted by the South African Human Sciences Research Council. The survey included demographic data, individual-level socio-economic position (SEP), self-reported oral health status, past six months' oral pain experience and cost. The area-level SEP was obtained from the 2010 General Household Survey (n = 25,653 households) and the 2010/2011Quarterly Labour Force Survey conducted in South Africa. The composite indices used for individual-level SEP (α = 0.76) and area-level SEP (α = 0.88) were divided into tertiles. Data analysis was done using t-tests and ANOVA. Significance was set at p < 0.05. RESULTS: The prevalence of oral pain among the adult South Africans was 19.4 % (95 % CI = 17.2-21.9). The most commonly reported form of oral pain was 'toothache' (78.9 %). The majority of the wealthiest participants sought care from private dental clinics (64.7 %), or from public dental clinics (19.7 %), while the poorest tended to visit a public dental clinic (45 %) or nurse/general medical practitioner (17.4 %). In the poorest areas, 21 % responded to pain by 'doing nothing'. The individual expenditure for oral pain showed a social gradient from an average of ZAR61.44 spent by those of lowest SEP to ZAR433.83 by the wealthiest (national average ZAR170.92). Average time lost from school/work was two days over the six-month period, but days lost was highest for those living in middle class neighbourhoods (3.41), while those from the richest neighbourhood had lost significantly fewer days from oral pain (0.64). CONCLUSIONS: There is a significant social gradient in the burden of oral pain. Improved access to dental care, possibly through carefully planned universal National Health Insurance (NHI), may reduce oral health disparities in South Africa.

Results of a self-assessment tool to assess the operational characteristics of research ethics committees in low- and middle-income countries.

PURPOSE: Many research ethics committees (RECs) have been established in low- and middle-income countries (LMICs) in response to increased research in these countries. How well these RECs are functioning remains largely unknown. Our objective was to assess the usefulness of a self-assessment tool in obtaining benchmarking data on the extent to which RECs are in compliance with recognised international standards. METHODS: REC chairs from several LMICs (Egypt, South Africa and India) were asked to complete an online self-assessment tool for RECs with a maximum score of 200. Individual responses were collected anonymously. RESULTS: The aggregate mean score was 137.4±35.8 (∼70% of maximum score); mean scores were significantly associated with the presence of a budget (p<0.001), but not with duration of existence, frequency of meetings, or the presence of national guidelines. As a group, RECs achieved more than 80% of the maximum score for the following domains: submission processes and documents received, recording of meeting minutes, criteria for ethical review and criteria for informed consent. RECs achieved less than 80% of the maximum score for the following domains: institutional commitment, policies and procedures of the REC, membership composition and training, policies and procedures for protocol review, elements of a decision letter and criteria for continuing review. CONCLUSIONS: This study highlights areas where RECs from LMICs can improve to be in compliance with recommended international standards for RECs. The self-assessment tool provides valuable benchmarking data for RECs and can serve as a quality improvement method to help RECs enhance their operations.

Adapting a community of practice model to design an innovative ethics curriculum in healthcare.

The focus of healthcare ethics within the framework of ethical principles and philosophical foundations has always, in recent times, been the community, namely, the healthcare provider, the patient or, in research, the study participant. An initiative is thus described whereby a community of practice (CoP) model was developed around health ethics in health research, education and clinical care. The ethics curriculum was redesigned to include several components that are integrated and all embracing, namely, health research ethics, healthcare ethics, health personnel education in ethics and global and public health ethics. A CoP is a group who share a common interest and a desire to learn from and contribute to the community with their variety of experiences. The CoP is dynamic and organic, generating knowledge that can be translated into effective healthcare delivery and ethical research. It requires the collaboration and social presence of active participants such as community members, healthcare professionals and educators, ethicists and policy makers to benefit the community by developing approaches that adapt to and resonate with the community and its healthcare needs. Philosophical principles constitute the foundation or underpinning of this innovative curriculum. Recommendations are presented that will continue to guide the consolidation and sustainability of the CoP.

Health and human rights a South African perspective.

General statements of basic entitlements are established as a guide for potential laws and regulations protecting human rights. Human rights are those claimed to belong to every individual regardless of nationality or position within society. The historical evolution of human rights relative to health in the Republic of South Africa is discussed.

Redefining the non-communicable disease framework to a 6 × 6 approach: incorporating oral diseases and sugars.

The WHO Global Oral Health Status Report, published in 2022, highlighted the alarming state of oral health worldwide and called for urgent action by integrating oral health into non-communicable diseases (NCDs) and universal health coverage initiatives. 3·5 billion people have oral diseases, surpassing all other NCDs combined. The detrimental role of sugars as a risk factor for oral diseases and other NCDs has also been well documented. Despite the evidence, oral diseases and sugars are not part of the current NCD framing, which focuses on five diseases and five risk factors (ie, 5 × 5). Oral diseases and sugars remain sidelined, disproportionately affecting poor and disadvantaged populations. In this Viewpoint, we advocate for the integration of oral diseases and sugars into the current approach towards the prevention and control of NCDs. An expanded 6 × 6 framework would recognise growing evidence and would reiterate the need to strengthen action, resource allocation, and policy development for NCDs. We present the evidence and rationale for, and benefits of, an expanded NCD framework and detail recommendations to guide efforts towards improved priority, investment, and equitable health outcomes for NCDs, including oral health.

Methods of payment for oral health care in Yaoundé.

Payment for dental services is one of the key determinants of treatment options, access to health care, and treatment decisions. The ability to pay for services directly affects the quality of life of an individual and also their accessibility to oral health services. The aim of the present study was to identify the different methods of payment used to obtain oral health care in Yaoundé, Cameroon This was a cross-sectional descriptive study carried out in selected dental clinics in Yaoundé using convenient sampling between January 2021 and June 2021. Data was collected using a structured questionnaire. A total of 377 patients aged 8 to 83 years made up of 194 (51.46%) females and 183 (48.54%) males participated in the study. There is no government-assisted package for oral health care in Cameroon and more than two-thirds (66.84%) made direct payments or paid out of pocket without a refund from any insurance company. More than half 147 (58.33%) of the study population did not complete the planned dental care due to insufficient funds. Direct payments covered treatments such as scaling, restorations, root canal therapy, and dental extractions while prostheses (dentures, crowns, bridges, and implants) were only afforded by very few patients. The reasons for the inability to pay for dental services included financial difficulties 107 (72.97%) and lack of time 36 (24.49%). Only half 36 (50%) of the participants employed in the formal sector had access to health insurance and treatments like scaling, dental prosthesis, orthodontics, and dental implants were rarely provided by an insurance company. These procedures were considered to be very expensive with fluctuating prices and were viewed as being for aesthetic purposes. The majority 67 (93.06%) of payments through insurance reported being reimbursed aftercare. Two-thirds of 48 (71.64%) of the insured participants said it was difficult to get reimbursed due to the administrative bottlenecks and as such some preferred to pay out of pocket despite being insured. Late consultations encountered led to caries complications with 105 (52.24%) pulpitis. In general, financial difficulty was reported by 97 (48.26%) as the main reason for not being able to afford dental care. Oral diseases present a huge burden for children and adults due to the high cost of treatment limiting their accessibility and treatment options. There is a need to create compulsory health insurance to enhance greater access to oral health services to encourage the population to seek dental care timeously.

The proposed need for integrated maternal and child oral health policy: A case of South Africa.

The high oral disease burden among children in South Africa, specifically early childhood caries, has received scant attention despite the fact that it is a public health concern that negatively impacts the overall well-being and quality of life of the child. While South Africa has a number of well documented policies that focus on oral health in general and maternal and prenatal health, none specifically addresses the oral health of children under the age of six years. The integration of oral health in maternal and child health care in South Africa could lead to an improved oral health quality of life and better oral health outcomes for mothers and children to address the high prevalence of childhood caries and unmet treatment needs for this population. While the integration of oral health care into primary healthcare is recognised as crucial and affordable, it however continues to be neglected. In South Africa, oral health disparities are attributed to the unequal distribution of oral health services, and policies that govern oral, maternal and child health seem to work in parallel with one another. Integrating oral health into interventions for primary health care delivery is a cost-effective way to improve the health of disadvantaged groups. Considering that maternal oral health predicts children's oral health and primary health care teams regularly see under-6-year-olds, this primary care setting is ideal for integration of these services. Despite growing interest in an integrated oral health and primary care system, there is little literature on oral health integration models. Improving the oral health of vulnerable populations requires integrating oral health into primary care and implementing interdisciplinary public health programs. The development of an Integrated Maternal and Child Oral Health policy would play a critical role in advancing integration; however, such a policy should be designed with both implementation and translation in mind for it to be successfully followed through. Such a policy should be comprehensive and contextual, aimed at increasing access to oral health services for women and children and reduce the oral disease burden. This paper proposes and describes the possible content and objectives of such a policy that will enhance effective leadership and accountability and strengthen health system delivery platforms for quality maternal and child oral health services along the continuum of healthcare. Furthermore, it will illustrate the importance of a policy that aims to promote coordinated, relevant, trans-multi-disciplinary and inter-sectoral community engagement to improve pregnancy and oral health outcomes, and importantly, establish a sustainable and contextual surveillance system for maternal and child oral health.

Occurrence of dental emergency events in Primary Health Care services.

The aim of this study was to describe the occurrence of dental emergency and its association with individual factors and primary health care services. A follow-up study was conducted with data extracted from an exploratory study about the classification of dental care needs over time according to a care framework. There were included 1831 patients of five services. The outcome was the occurrence of dental emergency analyzed according to sex, age, skin color, service and maximum waiting time for dental care. A multivariate analysis with Poisson regression was used to estimate weighted prevalence ratio (PR) with 95% Confidence Intervals (CI) and survival analysis was conducted. The prevalence of dental emergency was 12.6%, varying according to age (13-19: PRa =1.79 (95%CI: 1.0-3.21); 20-65:PRa = 2.71 (95%CI: 1.73-4.26); Over 65: PRa = 2.51 (95%CI: 1.41-4.46)) and Primary Health Care service (FHS 2: PRa = 2.20 (95%CI: 1.37-3.53),FHS 3: PRa = 1.43 (95%CI: 0.90-2.27); FHS 4: PRa = 3.25 (95%CI: 2.15-4.92),FHS 5: PRa = 2.49 (95%CI: 1.56-3.97)) For 231 cases classified as emergency, the failure rate was 7.4%. For 214 cases of emergency, the non-continuity after appointment rate was 53.7%. The incidence of dental emergency was 8.3% and recurrence was 7.2%. Considering all 262 emergency cases attended, the resolution rate was 93.5% and most cases (n = 252, 96.1%) received care within one day. The results point to high effectiveness in emergency dental care within Primary Health Care services. There are indications of the need for improvements in retention and continuity of care.

The challenges of oral-based diagnostics in extending the role of dentistry as a health care profession: property rights, privacy, and informed consent.

Saliva may be a legal and ethical counterpart of other bodily fluids in diagnostic testing to blood and urine, with regard to its role in diagnostic testing. Two paradigms that have been proposed in the literature to address these challenges are reviewed in this paper. The first is centered on ownership and property rights to saliva, including financial compensation from commercially developed products using saliva. The commodification of saliva as property is also discussed. The second paradigm is related to privacy and the potential for genetic discrimination, given the unwarranted disclosure of confidential information. The management of saliva specimens from dental patients and research participants will also require the implementation of innovative approaches to obtain informed consent.

Risk Indicators for Early Childhood Caries in South Africa: Protocol for a Systematic Review.

BACKGROUND: Early childhood caries (ECC) is a common disorder characterized by the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces of primary teeth in children 71 months old or younger. South Africa has a diverse population in terms of culture, education, income, and occupation. This diversity is due to the consequences of historical racial discrimination, poverty, unemployment, lack of accessibility to health services, and quality of education. These factors make South Africa unique, and the disease and risk profiles for this country differ from those of other countries at similar stages of development. For these reasons, it is important to identify the unique maternal and infant risk factors for ECC in the South African context. OBJECTIVE: The purpose of this study is to determine the risk factors associated with the incidence and prevalence of ECC in South Africa in children under the age of 6 years. METHODS: All cross-sectional and cohort studies documenting risk factors associated with the prevalence and incidence of dental disease and severity (decayed, missing, and filled scores) will be included. We will search 7 databases for eligible studies, and those included will be based on prespecified inclusion criteria. Only studies conducted with South African children who are aged 6 years and younger in which dental caries risk factors are documented will be included. There is no restriction on the time or language of publication. Included articles will be scrutinized for quality by using a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be performed. RESULTS: The literature search was conducted in November 2020. CONCLUSIONS: The results of this study will provide a framework to inform medical and dental personnel to highlight mothers and infants at risk of developing ECC. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020216455; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216455. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26701.

Prevalence of Early Childhood Caries in South Africa: Protocol for a Systematic Review.

BACKGROUND: Young children are at the highest risk of developing dental caries as they have a lack of autonomy over their diet and oral hygiene practices. Dental caries develops over time due to demineralization of tooth substance (enamel), which results from acid production during sugar metabolism by bacteria. Early onset of dental caries often results in asymptomatic presentation, but if left untreated, it can result in severe pain, infection, and dentoalveolar abscesses. Early childhood caries (ECC) is defined as dental caries in children aged 6 years and younger and is a significant public health problem in South Africa. According to the Global Burden of Disease study, untreated dental caries of primary teeth affects 532 million children. Untreated dental caries has many detrimental effects which can affect the physical development and reduce the quality of life of affected children. Furthermore, long-term untreated dental caries can result in school absenteeism, low BMI, and poor educational outcomes. OBJECTIVE: The purpose of this study was to determine the prevalence and severity of ECC in South Africa in children under the age of 6 years. METHODS: All cross-sectional studies documenting the prevalence and severity of dental disease (decayed, missing, and filled teeth scores) will be included. Various databases will be searched for eligible studies. Only studies conducted on South African children aged 6 years and under will be included. There will be no restriction on the time or language of publication. The quality of all eligible studies will be analyzed by a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be conducted. RESULTS: The protocol is registered with PROSPERO. The literature search was initially conducted in November 2018 and was repeated in November 2020. CONCLUSIONS: The results of this study will be used to advise stakeholders of the prevalence and severity of dental disease in children under 6 years of age in South Africa. TRIAL REGISTRATION: PROSPERO CRD42018112161. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/25795.

Perceptions of intimidation and bullying in dental schools: a multi-national study.

OBJECTIVES: To determine first year dental students' perceptions of intimidation by instructors and bullying by fellow students. METHODS: Data were collected through a cross-sectional survey of first year dental students from seven dental schools representing five countries; one each from Romania, South Africa, Australia and the U.S.A., and three from Malaysia. Self-report questionnaires were administered to participants at least six months after they had commenced their dental degree course during 2005-6. RESULTS: Over a third (34.6%) reported that they had been intimidated or badly treated by their tutors/instructors and 17% reported that they had been bullied or badly treated by their fellow students in the recent past. There were statistically significant differences in reports of intimidation by instructors between the different dental schools. Intimidation by instructors was associated with a history of medication use for stress, anxiety and depression, and perceived stress in the past month. There were no statistically significant variations in reports of bullying by fellow students between different dental schools. Bullying by fellow students was associated with dieting to lose weight, self-reported general health and perceived stress. CONCLUSIONS: This multi-national study highlights that intimidation and bullying is prevalent within dental teaching and training environments. Future research is needed to explore their impact on students' wellbeing and academic progress as well as on patient care. CLINICAL IMPLICATIONS: Dentists are the best recruiters for the profession. If the dental school experience is a negative one it can have significant impact on the future of the profession

A Framework for Equity Access to Primary Dental Care.

The objective of this study was to demonstrate face validity with a novel resource allocation framework designed to maximize equity into dental booking systems. The study was carried out in 2014. Eleven experts in primary dental care practice in Southern Brazil participated, using a three-round consensus group technique. First, the experts reached consensus on the items to be included in a 5-level diagnostic scale. They identified 21 clinical conditions and categorized them according to the oral health intervention required. Then, they described workload and activity standards for dental staff to carry out health promotion, oral disease prevention, dental treatment, dental rehabilitation, and urgent dental care. Finally, they agreed upon a set of wait times for primary dental care, establishing maximum waits from 2 to 365 days, according to the diagnostic classification. The framework demonstrated potential ability to promote more equitable access to primary dental services, since equal diagnostic classifications share the same waiting times for the dental care they require.

Traumatic dental injuries of permanent incisors in 11- to 13-year-old South African schoolchildren.

Traumatic dental injuries (TDI) are common in children. There are few data on prevalence of TDI in South African populations. We assessed the prevalence and causes of TDI to anterior teeth in 11- to 13-year-old South African schoolchildren through a cross-sectional study, using a random cluster sampling method. Oral examinations were performed by calibrated examiners following training for TDI to anterior permanent incisor teeth (eight teeth) using a modified version of Ellis's classification. Of the study population of 2610 children aged 11-13 years old from 26 primary schools, 1665 children participated. The response rate was 64%. More than two-thirds (64.4%) were 12 years old. One hundred and six children had a TDI (6.4%). After adjusting for the effect of age and socio-economic status, boys had an almost 2.5 (95% CI: 1.59, 3.69) times higher probability of having a traumatic dental injury than girls. The highest prevalence was in 12 year olds and in the high socio-economic status group. Most of the children had trauma to one tooth. Enamel fracture was the main type of TDI (69.1%). The majority of the TDIs were untreated (85.4%). Homes and schools were the most common places where TDIs occurred, while only 5.7% occurred on a street, road or pavement. Falls were the main cause of TDIs. Sport was the second most common cause and the third most common cause was collision with objects. The present study indicates that the prevalence of TDIs in schoolchildren is not as high as has been reported in other countries. The prevalence of TDIs in this population was relatively low.

Social, psychological and health concerns among people living with HIV/AIDS in Nigeria.

PURPOSE: The aim of the present study was to identify the concerns and the influence of demographic factors on the social, psychological and health concerns of people living with HIV/AIDS (PLWHA) in a Nigerian population. MATERIALS AND METHODS: A questionnaire survey was conducted among 141 consenting PLWHA in the Ife-Ijesa zone, Osun State, Nigeria. A 22-item questionnaire elicited information on PLWHA's concerns about social, psychological and health issues. RESULTS: The main social concern was that of 'Feeling very lonely', whereas the major psychological concern was that of 'Lack of interest in things'. The most common health concern reported was 'Gradually getting thinner', whereas 'No cure for AIDS' was the least. 'Getting tired easily' was also a highly rated concern. Males had statistically significant fewer social concerns than females. Unemployed PLWHA had fewer social, health and psychological concerns when compared with the employed. There was a statistically significant relationship between age and health concerns (P < 0.05). CONCLUSIONS: PLWHA in the present study reported that they were concerned about social, psychological and health issues, despite the fact that they were attending support group meetings. Efforts on care should not only focus on health and medical issues but also on social and psychological issues.