Navigating the healthcare system in Nairobi City County: perspectives and experiences in the utilization of oral healthcare by caregivers of children with HIV/AIDS.

BACKGROUND: The healthcare system in any republic can cause inequalities in health outcomes if they do not take into account the needs of deprived populations. Children with HIV/AIDS are known to have a high vulnerability to oral diseases; yet, they continue to face limitations in the utilization of oral healthcare. While other determinants of healthcare utilization may co-exist, possible gaps in the oral healthcare system can collectively affect a vulnerable group disproportionately in the utilization of oral healthcare. OBJECTIVE: To explore qualitatively, the perspectives, experiences and attributions of a cohort of caregivers of children with HIV/AIDS and their Health Care Providers (HCPs), on the utilization of oral healthcare within the structure of the oral healthcare system in Nairobi City County (NCC). DESIGN: A cross-sectional explorative mixed methods study design of two hundred and twenty one (221) female caregivers of children with HIV/AIDS and their HCPs using a survey, Focus Group Discussions (FGDs) and In-depth Interviews (IDIs). The study setting was the HIV-Care Facilities (HIV-CCFs) at three large hospitals in NCC. RESULTS: Caregivers mainly utilized independent 'nearby' private dental clinics for oral healthcare services, attributing their selection to cheaper user-fees, proximal service location, and recommendations from social networks. Wait time, opening and closing hours, health workers' attitudes and inferred opportunity costs were perceived as important quality issues in the utilization of oral healthcare. CONCLUSION: The oral healthcare system in NCC does not support the utilization of oral healthcare within the context of providing comprehensive healthcare for children with HIV/AIDS. Absence of 'in-house' oral health services at the HIV- CCFs is viewed as a defining structural barrier.

Prevalence of dental caries and its impact on quality of life (QoL) among HIV-infected children in Kenya.

AIM: To determine the prevalence of dental caries and its impact on QoL among HIV-infected children in Kenya. STUDY DESIGN: Cross-sectional survey of HIV-positive children aged 3-15 years. METHOD: Two hundred and twenty participants were selected by consecutive sampling. Dental examination was undertaken to determine the presence of dental caries among the children using the dmft/DMFT indices. The children's perceived QoL in the domains of oral symptoms, functional limitations, emotional and social wellbeing was assessed using the WHO Simplified Oral Health Questionnaires for children. RESULTS: The overall prevalence of dental caries was 65% whence the prevalence in the deciduous dentition was 50% while that of the permanent dentition was 30.9%. The mean dmft and DMFTscores were 1.75 and 1.08 respectively. Children with high dmft manifested negative impacts on appearance, chewing, biting hard foods and missing school on account of toothache and discomfort, while in the permanent dentition children with high DMFT had a negative impact on biting hard foods. CONCLUSION: A high caries experience had significant negative impacts on the children's QoL, especially in the primary dentition.