Oral health in an urban slum, Nigeria: residents' perceptions, practices and care-seeking experiences.

BACKGROUND/INTRODUCTION: One of the key recommendations for the new WHO global strategy for oral health is inclusion of disadvantaged populations and their engagement in policy dialogues such that their needs and views are addressed in policy decisions. OBJECTIVES: This study explored oral health perceptions, practices and care-seeking experiences of slum residents in Ibadan, Nigeria. METHOD: Focus group discussions (FGD) were conducted with family health-decision makers in an urban slum site. Oral health perceptions, practices, and care-seeking experiences were discussed. FGDs were recorded, transcribed, and translated. ATLAS.ti qualitative research software was deployed for analysis using thematic analysis. RESULTS: Six FGD sessions, divided by gender and age, were conducted between September-October 2019, (N = total 58 participants, aged 25 to 59 years). Common dental ailments mentioned were dental pain, tooth sensitivity, bleeding gums, tooth decay, mouth odor, gum disease, and tooth fracture. Perceived causes of dental conditions included poor dental hygiene and habits, sugary diets, ignorance, and supernatural forces. Mouth cleaning was mostly done once daily using toothbrush and paste. Other cleaning tools were ground glass, wood ash, charcoal, "epa Ijebu" (a dentrifice), and "orin ata" (a type of chewing stick). Remedies for relieving dental pain included over-the-counter medicines, warm salted water, gin, tobacco (snuff/powdered), cow urine/dung, battery fluid, and various mixtures/ concoctions. Visits to the dentists were mentioned by a few but this was usually as last resort. Main barriers to accessing care from dental care facilities were unaffordability of service charges and fear of extreme treatment measures (extraction). Suggested measures to improve timely access to dental health care included reducing/subsidizing costs of treatments and medications, offering non-extraction treatment options, and oral health education programmes. CONCLUSION: The slum residents experience various forms of dental ailments mostly pain-related. The residents perceived formal dental clinics as unaffordable, thereby engaging in self-care remedies and harmful oral health practices before seeking professional help. Policymakers and decision-makers may leverage this empirical evidence for the people's education on early dental care and address challenges to affordable, available, and acceptable oral healthcare services among slum residents to improve access to care facilities.

Tooth adornment among siblings living in an urban slum in Nigeria: Health implications for a vulnerable population.

Tooth jewelry boosts the appearance and confidence of wearers. However, its use may carry adverse health consequences. This paper creates awareness about a practice not previously reported in Nigeria, to prevent negative health consequences while appropriate measures are taken to quantify and describe the determinants and plan appropriate interventions.

Prevalence and determinants of oral health conditions and treatment needs among slum and non-slum urban residents: Evidence from Nigeria.

Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compared findings with non-slum urban residents in Ibadan, Nigeria. The Multistage sampling was used to select adult (≥18-years) residents from a slum and a non-slum urban sites. Information sought from participants included dietary habits, oral hygiene practices, and the use of dental services. Oral examinations were performed in line with WHO guidelines. Associations were examined using logistic regression. Mediation analysis was undertaken using generalized structural equation modeling. The sample comprised 678 slum and 679 non-slum residents. Median age in slum vs non-slum was 45 (IQR:32-50) versus 38 (IQR:29-50) years. Male: female ratio was 1:2 in both sites. Prevalence of oral diseases (slum vs non-slum sites): dental caries (27% vs 23%), gingival bleeding (75% vs 53%) and periodontal pocket (23% vs 16%). The odds of having dental caries were 21% higher for the slum dwellers compared to non-slum residents (OR = 1.21, 95% CI:0.94 to 1.56); and 50% higher for periodontal pocket (OR = 1.50, 95%CI: 1.13 to 1.98), after adjusting for age and sex. There was little evidence that tooth cleaning frequency mediated the relationship between place of residence and caries (OR = 0.95, 95%CI: 0.87 to 1.03 [indirect effect], 38% mediated) or periodontal pocket (OR = 0.95, 95%CI: 0.86 to 1.04, 15% mediated). Thirty-five percent and 27% of residents in the slum and non-slum sites respectively required the "prompt and urgent" levels of treatment need. Oral diseases prevalence in both settings are high and the prevalence was generally higher in the slum with correspondingly higher levels of prompt and urgent treatment needs. Participants may benefit from targeted therapeutic and health promotion intervention services.

Associations of Government-Mandated Closures and Restrictions With Aggregate Mobility Trends and SARS-CoV-2 Infections in Nigeria.

Importance: To prepare for future coronavirus disease 2019 (COVID-19) waves, Nigerian policy makers need insights into community spread of COVID-19 and changes in rates of infection associated with government-mandated closures and restrictions. Objectives: To measure the association of closures and restrictions with aggregate mobility and the association of mobility with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and to characterize community spread of COVID-19. Design, Setting, and Participants: This cross-sectional study used aggregated anonymized mobility data from smartphone users in Nigeria who opted to provide location history (from a pool of up to 40 million individuals) collected between February 27 and July 21, 2020. The analyzed data included daily counts of confirmed SARS-CoV-2 infections and daily changes in aggregate mobility across 6 categories: retail and recreation, grocery and pharmacy, parks, transit stations, workplaces, and residential. Closures and restrictions were initiated on March 30, 2020, and partially eased on May 4, 2020. Main Outcomes and Measures: Interrupted time series were used to measure associations of closures and restrictions with aggregate mobility. Negative binomial regression was used to evaluate associations between confirmed SARS-CoV-2 infections and mobility categories. Averted infections were estimated by subtracting cumulative confirmed infections from estimated infections assuming no closures and restrictions. Results: Closures and restrictions had negative associations with mean change in daily aggregate mobility in retail and recreation (-46.87 [95% CI, -55.98 to -37.76] percentage points; P < .001), grocery and pharmacy (-28.95 [95% CI, -40.12 to -17.77] percentage points; P < .001), parks (-43.59 [95% CI, -49.89 to -37.30] percentage points; P < .001), transit stations (-47.44 [95% CI, -56.70 to -38.19] percentage points; P < .001), and workplaces (-53.07 [95% CI, -67.75 to -38.39] percentage points; P < .001) and a positive association with mobility in residential areas (24.10 [95% CI, 19.14 to 29.05] percentage points; P < .001). Most of these changes reversed after closures and restrictions were partially eased (retail and recreation: 14.63 [95% CI, 10.95 to 18.30] percentage points; P < .001; grocery and pharmacy: 15.29 [95% CI, 10.90 to 19.67] percentage points; P < .001; parks: 6.48 [95% CI, 3.98 to 8.99] percentage points; P < .001; transit stations: 17.93 [95% CI, 14.03 to 21.83] percentage points; P < .001; residential: -5.59 [95% CI, -9.08 to -2.09] percentage points; P = .002). Additionally, every percentage point increase in aggregate mobility was associated with higher incidences of SARS-CoV-2 infection in residential areas (incidence rate ratio [IRR], 1.03 [95% CI, 1.00 to 1.07]; P = .04), transit stations (IRR, 1.02 [95% CI, 1.00 to 1.03]; P = .008), and workplaces (IRR, 1.01 [95% CI, 1.00 to 1.02]; P = .04). Lastly, closures and restrictions may have been associated with averting up to 5.8 million SARS-CoV-2 infections over the study period. Conclusions and Relevance: In this cross-sectional study, closures and restrictions had significant associations with aggregate mobility and were associated with decreased SARS-CoV-2 infections. These findings suggest that future anticontagion measures need better infection control and contact tracing in residential areas, transit stations, and workplaces.

Dental education in the rural community: a Nigerian experience.

At the University of Ibadan, Ibadan, Nigeria, dental students are prepared not only to provide skilled care to individual patients, but also to assume responsibility for the community as a whole. In establishing the rural posting program for dental students, it was planned that all fifth year dental students would undertake a rural posting at Igboora, approximately 80 km from Ibadan, the capital of Oyo State. During this 6 week immersion experience students learn about living in a rural area where they provide community oral health services. This report provides recommendations for initiating, sustaining and expanding rural dental education programs.

Improvised source of water coolant for ultrasonic scaler: an appropriate technology in underserved communities.

Traditionally dental plaque, calculus and stains have been removed by scaling and polishing manually with hand instruments such as curettes, chisels, hoes and scalers. However, ultrasonic scaling is becoming the preferred method of initial periodontal treatment and maintenance, due to improved patient and operator comfort. Ultrasonic scaling can be performed effectively using pipe-borne water as coolant. However, such a water supply is unavailable in many rural dental clinics, especially in underserved communities in Nigeria. This article reports on an improvised source of water coolant, designed and fabricated to make modern, easy and effective plaque control available to people in communities where there is no pipe-borne water. The device will improve operator efficiency in tooth cleaning and patient compliance with treatment. Due to its simple design but effective function, the device is ideal for use in Nigeria's primary healthcare delivery program, offering enhanced preventive and curative services to remote, rural and semi-urban populations. In doing so oral health can be improved with a reduction in the incidence of oral diseases.

Determinants of good oral hygiene among pregnant women in ibadan, South-Western Nigeria.

BACKGROUND AND OBJECTIVES: The need to attain and maintain good oral hygiene among pregnant women cannot be over emphasized as periodontal diseases in pregnancy have been linked with poor pregnancy outcomes. This study assessed the variables that affect oral hygiene status among pregnant women in a south-western Nigerian locality. METHODOLOGY: Four hundred and five pregnant Nigerian women were assessed for their oral hygiene status using the Oral Hygiene Index-Simplified. Demographic and pregnancy statistics were also obtained and the relationships between these and oral hygiene status were determined. RESULTS: The mean age was 25.35 ± 5.02 years. Most of the women (96.0%) had never visited a dentist or any other oral health care provider and only 12.5% of those who had been attended by dental care givers have ever had professional dental cleaning. The oral hygiene status appeared to worsen as parity increased (p=0.047) while the use of the toothbrush and paste was associated with good oral hygiene (p=0.007). Higher education was associated with use of the tooth brush and paste (p=0.046) and good oral hygiene (p= 0.001). CONCLUSION: The positive effect of education on oral hygiene practices is highlighted in this study. However there is still need for proper health enlightenment in this population with regards to use of the available oral health care facilities.