Dental care seeking behaviour of children in a rural Nigerian community.

BACKGROUND: There is sparse information about oral health seeking behaviour of children in rural areas of developing countries. The aim of the Study was to determine the dental care seeking-behaviour of children attending the first rural based community oral health centre in Nigeria. METHODS: A retrospective review of records of patients aged 16 years or younger treated at the Primary Oral Health Care Centre in Ibarapa, Nigeria over six years was conducted. Data on sociodemographic characteristics of the patients, pattern of presentation and their oral hygiene practices were collected and processed using SPSS. RESULTS: A total of 239 paediatric patients were seen during the period with a mean age of 9.7 ± 4.4 years and 132 (55.2%) were males. The majority, 225 (94.1%), were presenting for the first time. All the children sought dental care for one problem or the other and the most common reasons for seeking care were: tooth ache in 105 (43.9%), trauma in 30 (12.6%) and perceived unclean mouth in 20 (8.4%) patients. Older children were more likely to seek dental care because of pain (p < 0.00 1), while younger children sought care principally on account of trauma (p < 0.001) and the under 5 years were seen more often for gum ache (p =0.006). The majority, 175 (73.2%), used toothbrush and 182 (76.2%) cleaned their teeth once daily. CONCLUSION: None of the children presented for routine check-up, rather, consultation was as a result of dental problems with toothache being the most common reason.

Dental services and attitudes towards its regular utilization among civil servants in ibadan, Nigeria.

BACKGROUND: Regular utilization of dental services is key to the attainment of optimal oral health state, an integral component of general health and well being needed for effective productivity by working personnel. OBJECTIVE: This study assessed the rate and pattern of dental service utilization among civil servants and their attitudes towards its regular use. METHODOLOGY: A multi-stage sampling technique was used to select participants from the Federal Secretariat in Ibadan, Nigeria. A structured, standardized, pretested and self-administered questionnaire was utilized to elicit responses on dental services and attitudes towards their regular utilization. Responses to knowledge and attitude questions were scored and categorized. Chi-squared test was used to test associations between variables at 5% level of significance. RESULTS: A total of 400 civil servants participated in the study. Their mean age was 44.0 ±7.3years. Many 291(72.8%) were well informed about dental health care and services, but few 156 (39%) had ever utilized it. Of the utilizers, 32 (20.5%) visited within the previous one year period, while others last visited in more than one year period. Few 17 (10.9%) of the utilizers visited for routine dental checks, 103 (66%) for acute pain relief, while the rest had other dental health care needs. The majority 312 (78.0%) showed positive attitude towards regular dental service utilization and this improved with higher educational attainment, improved level of income, being aware of dental services and having ever utilized it (all p<0.05). CONCLUSION: Despite the awareness and positive attitude towards regular dental service use, their utilization rate was relatively low, episodic and problem driven. Appropriate oral health promotion strategies to enhance utilization of preventive dental services are strongly recommended for them.

Oral health practices of adult inhabitants of a traditional community in Ibadan, Nigeria.

BACKGROUND: Although, the association between oral health care practices and sociodemographic characteristics of populations have been documented, information is sparse on sociodemographic indices influencing oral health practices of residents of traditional communities. The study aimed to describe the oral health practices of adult inhabitants of a traditional community in Nigeria. METHODS: A descriptive, cross-sectional study involving adult residents in randomly selected houses in Idikan, Ibadan, Nigeria. Data on their oral health care practices was obtained with the use of structured interviewer administered questionnaires. Data was analysed with SPSS and test of association carried out using Chi square. RESULTS: A total of 390 adult residents participated in the study, of which 56.2% were males. A total of 196 (50.3%) participants used toothbrush solely to clean their teeth, 72 (18.5%) used chewing sticks alone while 119 (30.5%) used both tooth brush and chewing stick. Older residents of the community, those with no formal education and in lower occupational classes were more likely to use chewing stick (p < 0.05). The majority (68.7%) cleaned their teeth once daily, 30% cleaned twice while 1.3% cleaned infrequently. Educational level attained and occupational class were significantly related to frequency of oral hygiene. Nearly all (95.4%) of the participants knew that oral health services are available in most hospitals, yet only 35.9% had ever visited a dental centre with a significantly higher proportion being males (p < 0.05). CONCLUSION: The study showed that the oral health practices of a typical traditional community in Nigeria are highly influenced by socioeconomic considerations.

Attitude and beliefs of some nurses in government hospitals in Ibadan, Nigeria to natal/neonatal teeth in infants.

Eruption of the first deciduous teeth in children has shown much variation and occasionally may erupt prematurely at birth or within one month of life. Myths about natal/neonatal teeth abound in the Nigerian culture. Nurses are health care providers who are in constant close contact with patients and can be invaluable in helping to dispel these associated myths. However, to provide correct information they should be adequately equipped to do so. The aim of this study thus, was to assess the attitudes and beliefs of some nurses in Ibadan, Nigeria to natal/neonatal teeth in infants. A cross sectional survey was conducted among 380 nurses in the teaching, general and local government hospitals and clinics in Ibadan, Nigeria. Results revealed that 41.3% of the respondents would express shock and surprise if they assisted in delivering a baby with natal teeth. Half of the respondents (49.7%) felt that natal/neonatal teeth will be a great source of embarrassment to the family while a smaller proportion (11.8%), believed it was a curse (p = 0.01). On the advice the respondents would give to the mothers, more than a th (39.7%), would recommend immediate extraction of the teeth. A further 42 (11.1%) nurses were of the opinion that spiritual cleansing should be carried out prior to extraction. A greater proportion of the older nurses would advice immediate extraction of the teeth (p = 0.031). Regarding the perceived effect of natal/neonatal teeth on the children, (7.4%), (12.6%) and (29.2%) of the respondents believed that the children will behave strangely, will possess spiritual authority and be victims of stigmatization later in life respectively. This study has revealed that knowledge gaps about natal/neonatal teeth exist among the nurses in Ibadan, Nigeria. Health education programmes targeted at nurses are essential to correct these beliefs.

Effectiveness of an oral health care training workshop for school teachers: a pilot study.

BACKGROUND: School teachers play key roles in imparting appropriate and up-to-date knowledge to pupils and students. However, most teachers in developing countries like Nigeria have poor knowledge and motivation about oral health which may be due to inadequate training in the area of oral health. This might be one of the reasons for the poor oral hygiene among them and their students. OBJECTIVES: To evaluate the effectiveness of an oral health care training programme organized for teachers in Eruwa, Oyo state, Nigeria. METHODS: An intervention study was conducted among 40 school teachers who attended a two day oral health training workshop at Eruwa, headquarters of Ibarapa East Local Government Area. Training methods included lectures and demonstrations on aetiology, clinical features, treatment and prevention of common oral diseases. Pre- and post- evaluation written tests were administered to the participants to assess the effectiveness of the training. The knowledge scores were rated as poor, fair and good knowledge scoring <50.0%, 50.0-60.0% and > 60.0% respectively. Frequencies, percentages and means of relevant variables were generated. Paired t-test was used to compare means at P<0.05. RESULT: The mean age of the teachers was 40.13 ±7.24 years. There were 16 (40.0%) males and 24 (60.0%) females. Twenty (50.0%) of the participants had poor pre-training knowledge as compared to 7 (17.5%) after the training. Thirteen (32.5%) had fair pre-training knowledge as compared to 17 (42.5%) post training. Only (2.5%) of the participants had good pre-training knowledge as compared to 18 (45.0%) post training. The mean scores of the pre- and post-evaluation tests were 31.70 ±11.31 and 48.20 ±11.16 respectively. There was a statistically significant difference between the mean scores of the pre and post evaluations P<0.05. CONCLUSIONS: The training workshop improved the knowledge of school teachers regarding oral health.

Survival rates of two atraumatic restorative treatment (ART) types in occlusal carious permanent teeth after two years.

OBJECTIVE: To compare survival rates of Atraumatic Restorative Treatment (ART) restorations placed with and without conditioners in occlusal cariouspermanent teeth after two years. MATERIAL AND METHODS: The study was an experimental study among children, mean age 13.1 +/- 3.0 years. Two types of ART restorations were randomly placed on 186 occlusal carious permanent teeth on contralateral sides using split mouth design. Ethical clearance to conduct the study was obtained from the UI/UCH Review Committee. ART was performed using GC Fuji IX GP and teeth that were conditioned with GC Dentine Conditioner. Time taken to place restorations and average material cost were recorded. Follow-up of subjects to evaluate integrity of restorations was conducted at 6 monthly intervals by one independent examiner. Proportions and percentages were generated; student t-test was used to compare means. Cumulative survival rates were determined by the coded scores and standard criteria for evaluating ART restorations. RESULTS: There was no significant difference in the mean time for placing ART restorations with or without conditioners and in the cumulative survival rates of both treatment types after 2 years (p > 0.05). CONCLUSION: ART restorations placed without tooth conditioners can achieve similar result as those placed with conditioners.

Traditional and emerging oral health practices in parts of Nigeria.

OBJECTIVE: The purpose of this study was to document the beliefs and perceptions and emerging oral health care practices in parts of Nigeria. METHODS: A descriptive study, based in four different locations that were selected to reflect urban-rural and geographical spread, was conducted. Focus group discussions and in-depth interviews were conducted among representative groups and significant gatekeepers in the study areas. The discussions focused on oral health problems frequently encountered in the communities, their dietary and snacking habits as well as the dental remedies commonly employed by the people for prophylactic and therapeutic purposes. RESULTS: It was revealed that in both rural and urban low- to- middle socio-economic classes, periodontitis was the commonest dental problem in adults, while dental caries in children appeared to be also a cause for concern especially in northern Nigeria and the urban south. Most adults ate the local staple carbohydrate diets, however large quantities of cariogenic snacks were reported to be consumed. Chewing sticks and locally prepared toothpastes ranked prominent among the tooth cleaning implements, but many in the cities used toothbrushes. Various dental care remedies were employed ranging from warm saline wash to herbal preparations, antibiotics and battery water. In communities studied, the belief in ill defined "worms" as causative agents of all oral health problems was very firm. Consultation with traditional oral healthcare practitioners was a practice commonly observed in all study sites. CONCLUSION: This study has highlighted specific areas for intervention in disease prevention and oral health promotion in Nigeria.

Gender and ethnic differences in onchocercal skin disease in Oyo State, Nigeria.

During preparation for a study on the effects of ivermectin treatment on onchocercal skin disease in the Ifeloju Local Government Area of Oyo State, Nigeria, 1032 adults aged 20 years and older were examined for skin lesions and palpable nodules. It was found that for 4 types of skin lesions, acute papular onchodermatitis (APOD), chronic papular onchodermatitis (CPOD), lichenified onchodermatitis (LOD) and depigmentation (leopard skin), as well as for subcutaneous nodules, females had a significantly higher prevalence than males. Although the area is inhabited primarily by the Yoruba people, the study also included some of the cattle-herding Fulani ethnic group. The reactive skin lesions, APOD, CPOD and LOD, were found to be more common among the Fulani, although there were no significant differences in leopard skin and nodules between both groups. While there is need for further research on both immunological and behavioural factors that may lead to these differences in disease. The need to achieve equity in health programming by ensuring that women and ethnic minorities receive full disease control services is of more immediate concern.

Ethnic diversity and disease surveillance: Guinea worm among the Fulani in a predominantly Yoruba district of Nigeria.

Guinea-worm eradication has been progressing internationally and efforts at case containment have begun in most endemic countries. Case containment rests on the assumption that in previous phases of eradication most if not all endemic settlements have been identified. Experiences in the predominantly Yoruba communities of Ifeloju Local Government Area (LGA) in Oyo State, Nigeria, however, have shown that the settlements of ethnic minority groups may be overlooked during initial case searches and subsequent programmes of village-based reporting. The migrant cattle-herding Fulani are found throughout the savannah and sahel regions of West Africa. Nearly 3000 live in 60 settlements in Ifeloju. An intensive case search identified 57 cases in 15 settlements. The assumption that village-based health workers (VBHWs) in neighbouring Yoruba farm hamlets would identify cases in the Fulani settlements, known as gaa, proved false. Only 5 endemic gaa were located next to a Yoruba hamlet that had a VBHW, and even then the VBHW did not identify and report the cases in the gaa. Efforts to recruit VBHWs for each endemic gaa are recommended, but only after LGA staff improve the poor relationship between themselves and the Fulani, whom they view as outsiders. The results also imply the need for Guinea worm eradication staff in neighbouring LGAs, states and countries to search actively for the disease among their minority populations.

The role of community health workers in the management of essential drugs.

The ability to provide essential drugs not only fulfills part of the primary health care (PHC) duties of the community health worker (CHW), but also helps legitimize the role of the CHW in the community. Essential drugs are often routed through relatively inefficient government structures before reaching the CHW, thus creating problems of regular supplies and timely distribution. Few examples are said to exist where CHWs take charge of essential drug programs to the fullest: planning, purchasing, and maintaining their own stocks. An association of CHWs in Idere Nigeria has been doing just that since 1986-87. Self-assessment of this scheme was stimulated by several factors including rising wholesale prices and subsequent community member reluctance to pay for medicines. In addition, the local government had begun its own CHW training in line with national PHC guidelines and priorities. It became possible to examine the two systems side by side. The main variable used to determine system functioning was whether CHWs had replenished their village drug box stocks in the previous year. Among five factors tested, group (Idere CHW association member or local government trainee) sex, age, residence (town or hamlet), and perceived willingness to pay by villagers, only group was shown to be significantly associated with stock replenishment purchases. Most (63%) of the independent Idere group had replenished their stocks compared to 35 percent of local government CHWs. Cultural factors such as elders' predisposition to provide free service to those in need were also identified. The Idere association used this information to suggest ways of improving supervision, support, and purchasing so as to strengthen their service to the community.