The role of dental practitioners in Provider Initiated HIV Counseling and Testing (PITC) for patients attending dental practices in Harare, Zimbabwe.

OBJECTIVE: To assess the role of Zimbabwean dental practitioners in Provider Initiated HIV Counseling and Testing (PITC). DESIGN: A cross-sectional analytic study was conducted. A structured interviewer administered questionnaire was used to collect data from participants. SETTING: Harare private and public dental practices. SUBJECTS: Forty dental practitioners practicing in Harare and two hundred and ninety three patients attending dental practices in Harare were interviewed. MAIN OUTCOME MEASURES: Dental practitioners' practices on HIV counseling and testing for dental patients, acceptability of HIV testing in dental settings and missed opportunities for HIV counseling and testing in dental settings were assessed. RESULTS AND CONCLUSION: Half of the dental practitioners (20) interviewed reported offering HIV counseling to dental patients during their clinical duties. The majority 62% only referred their patients for HIV testing when they presented with oral manifestations of HIV infection. Seventy three percent (29) of practitioners interviewed were not aware of the Ministry of Health and Child Welfare guidelines on HIV counseling and testing. Eighty seven percent (255) of dental patients in this study reported not being counseled nor referred for HIV counseling and testing by their dental practitioner during their dental visits. More than a third (36.5%) of the dental patients experienced repeated missed opportunities for accessing HIV counseling and testing in health settings. The minimal that the dentists may need to be involved with in PITC is counseling their patients and improve referral for care. There is need for continued medical education for dentists on issues related to new HIV interventions or protocols such as PITC.

Exploring opportunities for collaboration between the corporate sector and the dental education community.

The ultimate purpose of both dental industry and dental education is to improve the oral health of the public. This report provides background information on the different roles and objectives of the dental industry and dental education communities, the different operating environment of each sector and also areas of common interest where collaboration will be of mutual benefit. The report addresses five areas for potential collaboration between the dental industry and the dental education communities: 1. Contribution to joint activities. 2. Effectiveness and efficiency. 3. Workforce needs. 4. Middle- and low-income countries. 5. The future of International Federation of Dental Educators and Associations (IFDEA). The traditional areas of support and their limitations that have been provided by industry are outlined in the report and some new approaches for collaboration are considered. Industry-based research has been an important factor in developing new products and technologies and in promoting oral health. However there is a need to facilitate the introduction of these developments at an early stage in the education process. Industry has to operate in an efficient manner to remain competitive and maximise its returns and therefore survive. The academic sector operates in a different environment and under different governance structures; although some trends are noted towards adoption of greater efficiency and financial accountability similar to industry. Opportunities to jointly develop best business practices should be explored. Industry has responded well to the oral health needs of the public through the development of new products and technologies. The education community needs to respond in a similar way by examining different healthcare delivery models worldwide and developing programmes to train members of the dental team to cater for future needs and demands of communities in different regions of the world. The reputation of industry-based scientists and clinicians is high, and their role in contributing to the dental education process in practical ways needs to be explored and further developed. Closer relationships between industry scientists and faculty and students could assist industrys need and desire to develop new technologies for the broader dental care system. The corporate sector can play a key role in the future success of IFDEA by providing support and expertise in developing areas such as regional leadership institutes, a Global Faculty and Network and in collaborating in developing continuing education programmes as well as involvement in its governance. Thirteen recommendations are made in the report. These are considered to be important initial steps in developing the already strong relationship between the education and corporate sectors. Partnership and collaborating more effectively along the lines suggested should, almost certainly, generate mutually beneficial outcomes, whilst serving over the long term to elevate the publics oral health status on a global basis.

Infection control among dental therapists in Zimbabwe.

OBJECTIVES: To assess the general infection control practices with special reference to the prevention of transmission of HIV/AIDS infection among dental therapists in Zimbabwe. SETTING: Dental therapists practising in Zimbabwe Government Oral Health Clinics. METHODS: A descriptive cross sectional study using a self-administered questionnaire. Questions dealt with infection control practices in the procedure rooms, including barriers to transmission of infection, the practice of disinfection of working surfaces, the use of autoclave, and sterilization of the handpiece. The questionnaire also covered issues of personal protection through the use of protective wear, vaccination against hepatitis B as well as knowledge of one's HIV status. RESULTS: There was a 68% (24/35) response rate. The therapists were predominantly male and they were evenly distributed in the provinces of Zimbabwe. All were trained in Zimbabwe; 91.7% had not been vaccinated against hepatitis B and only 20% (n = 7) had undergone previous HIV testing. Use of gloves was universal; 92% used face masks; 66.7% used protective eyewear; 87.5% wore protective garments; 95% autoclaved/chemoclaved high speed handpieces; 83.3% autoclaved/chemoclaved slow speed handpieces. Barriers to infection control ranged from 22.7% to 40.9% and was attributed to non-availability of gloves and disinfectants. CONCLUSION: The dental therapists seem to practise acceptable infection control methods. There is need to improve upon handpiece sterilization, the use of eyewear and improvement upon supplies for disinfection. Vaccination against hepatitis B virus needs to be encouraged.

Impact of waste disposal on health of a poor urban community in Zimbambwe.

OBJECTIVE: To assess excreta and waste disposal facilities available and their impact on sanitation related diseases in Epworth, an informal settlement on the outskirts of Harare. DESIGN: Descriptive cross-sectional survey. SETTING: This was a community based study of Epworth informal settlement. SUBJECTS: A total of 308 households were interviewed. Participating households were randomly selected from the three communities of Epworth. Secondary medical archival data on diarrhoeal disease prevalence was collected from local clinics and district health offices in the study areas. RESULTS: Only 7% of households were connected to the sewer system. The study revealed that in Zinyengere extension 13% had no toilet facilities, 48% had simple pits and 37% had Blair VIP latrines. In Overspill 2% had no toilet facilities, 28% had simple latrines and 36% had Blair VIP latrines while in New Gada 20% had no toilet facilities, 24% had simple pits and 23% had Blair VIP latrines. Although a significant percentage had latrines (83.2%), over 50% of the population were not satisfied with the toilet facilities they were using. All the respondents expressed dissatisfaction with their domestic waste disposal practices with 46.6% admitting to have indiscriminately dumped waste. According to the community, diarrhoeal diseases were the most prevalent diseases (50%) related to poor sanitation. Health statistics also indicated that diarrhoea was a major problem in this community. CONCLUSION: It is recommended that households and the local authorities concentrate on improving the provision of toilets, water and waste disposal facilities as a way of improving the health state of the community.

Effectiveness of an oral health education programme in primary schools in Zimbabwe after 3.5 years.

UNLABELLED: Many medical and dental professionals in African nations believe that school teachers, through attendance of a short workshop, can be trained to provide oral health education. This increases the number of professionals available and is regarded as an important way forward in improving oral health. OBJECTIVES: The current study assesses the effectiveness of an oral health education programme administered by schoolteachers in a district in Zimbabwe over a period of 3.5 years. METHODS: The experimental group consisted of schools that had sent representatives to a regional workshop on oral health held in 1992. The control group was selected at random from schools not having attended the workshop. A total number of 439 boys and 526 girls were examined in 1992. Follow-up evaluations were carried out in 1993, 1994 and 1996. The dependent variables were plaque accumulation and caries increment in grade 2 and grade 4 children of experimental and control schools. RESULTS: ANOVA test with year of evaluation (1992-94), experiment/control school, age and gender as independent variables showed no statistically significant difference in mean plaque scores in longitudinally examined original grade 2 (P>0.20) and grade 4 children (P=0.06) from experimental and control schools. The mean caries increment score in the experimental and control schools was 0.04 and 0.19, respectively. ANOVA test with fluoride levels and gender as independent variables on caries increment in experimental and control schools did not show a statistically significant difference (P=0.06). CONCLUSION: The one-time training of teachers in aspects of oral health was ineffective in lowering plaque levels over a period of 3.5 years. Considering the low caries increment observed over the study period, the effect of the oral health programme on caries levels in the study group was inconclusive.

Quality of life evaluation in patients with HIV-I infection: the impact of traditional medicine in Zimbabwe.

OBJECTIVES: To evaluate the impact of phytotherapy (traditional medicine) in persons with HIV infection and to assess the quality of life of those persons with respect to HIV disease progression, including sociodemographic characteristics. DESIGN: A community based open label non-intervention and uncontrolled cohort study. SETTING: Blair Research Institute Clinic. SUBJECTS: A total of 105 HIV infected persons at various stages of HIV infection. Seventy-nine percent were on phytotherapy (PT) and 21% on conventional medical care (CMC). MAIN OUTCOME MEASURES: (a) Assessment of quality of life of HIV infected persons on phytotherapy using the WHOQol instrument, and (b) assessment of quality of life of those persons in relation to the HIV disease progression using CD4 cell counts and viral load as measure of disease progression. METHODS: We interviewed 105 patients with various stages of HIV-I infection in a community based cohort study from June 1996 to May 1998, in Harare. The 96 (91.4%) asymptomatic and six (8.6%) symptomatic patients underwent regular physical examinations and had blood drawn for laboratory tests at the baseline afterwards at three month intervals over a period of two years. RESULTS: The mean (s.d.) age was 34.9 (7.3) years; 64.4% were women and 60.3% were married. In multi variate analyses, age was significantly correlated with the level of independence domains (p = 0.032), whereas, gender was significantly correlated with social relationships' domains (p = 0.034). The type of treatment received was significantly correlated with spiritual domains (p = 0.045). Proportions of scores on five domains measuring different aspects of quality of life for patients on phytotherapy were much lower than those on conventional therapy (p < 0.0001, for all variables). CONCLUSION: Our data support the role of phytotherapy in improving the quality of life of HIV-I infected patients, yet its pharmacological basis is unknown. The WHOQol instrument is a good measure of quality of life for patients with HIV infection.

Alcohol consumption in HIV-I infected persons: a study of immunological markers, Harare, Zimbabwe.

OBJECTIVE: To examine the effect of alcohol use in relation to the age, gender and plasma levels of HIV-I RNA and CD4 cells count in HIV-I infected persons as a prognostic indicator for the disease progression to AIDS. DESIGN: A community based cohort study. SETTING: The study was conducted at the Blair Research Institute Clinic from June 1996 to May 1998. SUBJECT: We interviewed 105 volunteers, at a baseline and then followed them up on a three monthly basis. They underwent physical examinations and had blood drawn for laboratory tests. AUDIT Core was used to gain an indication of how much dependence there was on alcohol by patients in relation to demographic and immunological variables. MAIN OUTCOME MEASURES: Frequency of alcohol use and HIV-I disease progression to AIDS using viral loads and CD4 cells counts as measures of immune impairment. RESULTS: The volunteers had a mean (s d) age of 34.9 (7.3) years. Prevalence of alcohol use was 30.5% (n = 34.95% CI = 21.7 to 39.3). Most of the patients with CD4 cells count less than 200 mm3 did not use alcohol (p = 0.023) by the six months follow ups. There were no significant mean differences between users and nonusers of alcohol regarding the levels of both plasma viremia and CD4 cells count. CONCLUSION: Our finding is consistent with previous findings that found no relationship between alcohol use in persons with HIV-I infection and progression of disease to AIDS.

ART restorations and glass ionomer sealants in Zimbabwe: survival after 3 years.

Atraumatic restorative treatment (ART) consists of removing demineralised tooth tissues with hand instruments only, restoring the prepared cavity and sealing the adjacent pits and fissures with an adhesive filling material. This relatively painless, no-handpiece, minimal intervention approach to controlling dental caries is described. ART was applied in an oral health care programme in Zimbabwe that was carried out amongst secondary school students from 1994 to 1997. A new glass ionomer (Fuji IX) was used as the restorative and sealant material. Sealants were placed in high caries risk students using the 'press-finger' technique. A total of 297 one-surface ART restorations and 95 glass ionomer sealants were placed in 142 and 66 students, respectively. After 3 years, the lost-to-follow-up percentages for one-surface ART restorations and glass ionomer sealants were 30.6% and 30.5%, respectively. Actuarial (life table) analysis resulted in 3-year survival rates of one-surface ART restorations of 88.3% (95% CI: 92.4%-84.2%), ranging from 94.3% to 65.4% per operator. A total of 28 ART restorations placed in 25 students failed. Reasons for failure related to the material and the operator (11 restorations or 5.3% each), and to caries adjacent to the restoration (one restoration or 0.5%). Reasons for failure were not recorded for five restorations (2.3%). Sealants were placed on surfaces diagnosed as early enamel lesions. After 3 years, 71.4% (95% CI: 81.7%-61.1%) of the fully and partially retained sealants survived with a range of 100% to 55.6% per operator. Of the sealed surfaces 96.3% (95% CI: 100%-92.2%) survived 3 years without developing caries. Experienced operators placed better ART restorations than inexperienced operators. This study has demonstrated that ART with a glass ionomer restorative material and sealants provided high quality preventive and restorative dental care to this student population. ART has become one of the treatment modalities available to oral health workers in managing dental caries.

Three-year survival of one-surface ART restorations and glass-ionomer sealants in a school oral health programme in Zimbabwe.

An oral health care programme in secondary schools using the atraumatic restorative treatment (ART) approach for dental caries was started in 1993. Glass ionomer (restorative type II, 1) was used as the restorative and sealant material. Sealants were placed using the 'press-finger' technique. Results after 3 years revealed a survival percentage for one-surface ART restorations of 85.3 (95% CL: 89.7-80.9%), which ranged from 96.1 to 69.3% per operator. Failures were related to 'unacceptable marginal defects' (8.1%), 'falling out' (6.1%) and 'excessive wear' (2.5%). Of the 33 failed one-surface ART restorations, 17 were material-related, 7 had caries and no information was available for 9 restorations. Sealants were placed only on surfaces diagnosed as early enamel lesions and on some small dentinal lesions. After 3 years, 50.1% (95% CL: 55.1-45.1%) of the fully and partially retained sealants survived with a range of 68.5-25.9% per operator. Regardless of the low rate of retention, the sealed surfaces had a 4 times lower chance of developing caries than unsealed surfaces with early enamel lesions over the 3-year period. The retention of sealants and the survival of one-surface ART restorations were influenced by an operator effect. The mean treatment time for one-surface ART restorations without chairside assistance was 22.1 min (range per operator of 19.8-23.6 min), whilst the mean time for placing sealants was 9.3 min (range per operator of 8.2-10.8 min). It is concluded that the ART approach and the use of glass-ionomer sealants have made preventive and restorative dental care available for this student population and further that ART seems to be appropriate for population groups currently not receiving preventive and restorative dental care.

Oral health status among secondary school students in Harare, Zimbabwe.

In 1993 a demonstration oral care programme to evaluate the ART procedure for dental caries under field conditions began among secondary school students in Greater Harare. The programme was preceded by an oral epidemiological survey. Of the 569 students examined, with a mean age of 13.9 years, 58.7 per cent were caries free. The mean DMFS and DMFT scores were 1.4 and 1.1, respectively. Very few missing and filled teeth were observed. Excluding those with pulp involvement, small dentinal lesions which could not be penetrated with an excavator at the time of examination, constituted 49 per cent of the mean DMFS score. 84 per cent of dentinal lesions needing treatment were judged to be treatable using the ART procedure. Using the index of Green and Vermillion (1964), the mean plaque score was 5.6 with substantial variation observed between the schools. Calculus was observed among 89.5 per cent of the students examined. 18 per cent of them had a central diastema in the maxilla. Crowding or spacing in the upper and lower anterior region of the jaws was observed in 67.5 per cent and 60.5 per cent of the students, respectively. 15.8 per cent were dissatisfied with the position of their teeth whilst 15 per cent indicated that they would like to undergo corrective treatment. It was concluded that these secondary students lack preventive and curative oral care and that the vast majority of the dentinal lesions observed could be treated using the ART procedure.

Atraumatic restorative treatment and glass-ionomer sealants in a school oral health programme in Zimbabwe: evaluation after 1 year.

An oral health care programme in secondary schools using the atraumatic restorative treatment (ART) technique for dental caries was started in 1993. Glass-ionomer was used as the restorative and sealant material. Sealants were placed using the "press finger' technique. Results after 1 year revealed a survival percentage for one-surface ART restorations of 93.4 whilst the complete and partial retention percentages for sealants were 60.3 and 13.4, respectively. No caries was observed in teeth restored using ART, and only 0.8% of surfaces diagnosed as having early enamel lesions at the start of the programme and sealed consequently had progressed into active dentinal lesions after 1 year. The sealant retention percentage and the survival percentage of ART restorations were influenced by an operator effect. The majority of restorations were carried out without administering local anaesthesia. The mean treatment time for one-surface ART restorations was 22.1 min (range per operator of 19.8-23.6 min), whilst the mean time for placing sealants was 9.4 min (range per operator of 8.2-10.8 min). Post-operative sensitivity was reported for 6% of the teeth restored. 95% of the students were satisfied with ART as a treatment modality. It is concluded that ART may in part be the answer to the unavailability of restorative care for many population groups globally.