Socio-demographic and behavioural correlates of oral hygiene status and oral health related quality of life, the Limpopo - Arusha school health project (LASH): A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Promoting oral health of adolescents is important for improvement of oral health globally. This study used baseline-data from LASH-project targeting secondary students to; 1) assess frequency of poor oral hygiene status and oral impacts on daily performances, OIDP, by socio-demographic and behavioural characteristics, 2) examine whether socio-economic and behavioural correlates of oral hygiene status and OIDP differed by gender and 3) examine whether socio-demographic disparity in oral health was explained by oral health-related behaviours.</p> <p>Methods</p> <p>Cross-sectional study was conducted in 2009 using one-stage cluster sampling design. Total of 2412 students (mean age 15.2 yr) completed self-administered questionnaires, whereas 1077 (mean age 14.9 yr) underwent dental-examination. Bivariate analyses were conducted using cross-tabulations and chi-square statistics. Multiple variable analyses were conducted using stepwise standardized logistic regression (SLR) with odds ratios and 95% Confidence intervals (CI).</p> <p>Results</p> <p>44.8% presented with fair to poor OHIS and 48.2% reported any OIDP. Older students, those from low socio-economic status families, had parents who couldn't afford dental care and had low educational-level reported oral impacts, poor oral hygiene, irregular toothbrushing, less dental attendance and fewer intakes of sugar-sweetened drinks more frequently than their counterparts. Stepwise logistic regression revealed that reporting any OIDP was independently associated with; older age-groups, parents do not afford dental care, smoking experience, no dental visits and fewer intakes of sugar-sweetened soft drinks. Behavioural factors accounted partly for association between low family SES and OIDP. Low family SES, no dental attendance and smoking experience were most important in males. Low family SES and fewer intakes of sugar-sweetened soft drinks were the most important correlates in females.</p> <p>Socio-behavioural factors associated with higher odds ratios for poor OHIS were; older age, belonging to the poorest household category and having parents who did not afford dental care across both genders.</p> <p>Conclusion</p> <p>Disparities in oral hygiene status and OIDP existed in relation to age, affording dental care, smoking and intake of sugar sweetened soft drinks. Gender differences should be considered in intervention studies, and modifiable behaviours have some relevance in reducing social disparity in oral health.</p

Planning, implementation and evaluation of a school program to promote oral health among Tanzanian adolescents

Background: The global burden of oral disease and risk behavior is concentrated in underprivileged and poor populations. HPS programs are promising methods for promoting health, including oral health. Objective: The present thesis aimed to collect information about the oral health status, oral health behavior, and oral health-related quality of life among school students and to use this information to implement and evaluate an HPS program that was directed at improving oral health, thereby reducing social inequalities among school adolescents in Arusha, northern Tanzania. Methods: The data in survey I (Papers I–IV) were collected in Arusha, from secondary school adolescents aged 12–21 years at baseline in 2009 and during a follow-up in 2011. Oral health education and demonstrations, wall posters, and the provision of toothbrushes were part of the HPS initiative implemented in April 2010, which was evaluated during March–May 2011. The data in Survey II (part of Paper III) were collected during 2005–2006 in Dar es Salaam from 1601 final year primary school pupils aged 12–14 years. Data were collected using a questionnaire and by clinical oral examinations. Results: In Paper I, 49.8% of boys and 46.8% of girls reported at least one OIDP. The corresponding mean OHI-S scores were 1.2 and 1.0, while the OHI-S and OIDP scores varied in the expected direction with socioeconomic status and health-related behaviors of children. Paper II reports differences in the prevalence scores and the overall mean generic Child-OIDP scores among groups with (DMFT less than 0) and without caries (DMFT = 0), and with and without periodontal problems in Arusha and Dar es Salaam. Paper III, principal component analysis of seven health and oral health-related behaviors gave two factors with Eigen value over 1, accounting for 45.8% of the variance. Confirmatory factor analyses, CFA, provided acceptable fit for the hypothesized two-factor model; CFI = 0.97. Paper IV reports the follow-up study in which 727 students were reexamined clinically. The mean number of teeth with caries increased statistically in both groups from the baseline to the follow-up. The mean number of teeth with gingival bleeding decreased (0.5 versus 0.4; p over 0.05) in intervention schools, whereas it increased in control schools. Conclusion: It may be possible to develop the HPS approach further to include oral health in resource-poor sociocultural settings. Overall, the HPS initiative was effective in reducing the gingival bleeding status of adolescents, but not dental caries, calculus, and plaque. Consequences: The challenge for future studies will be to achieve better and more sustainable results. Despite the limited effects of oral health promotion, its integration within HPS initiatives might be beneficial for Tanzanian secondary school students

Discriminative ability of the generic and conditionspecific Child-Oral Impacts on Daily Performances (Child-OIDP) by the Limpopo-Arusha School Health (LASH) Project: A cross-sectional study

Background: Generic and condition-specific (CS) oral-health-related quality-of-life (OHRQoL) instruments assess the impacts of general oral conditions and specific oral diseases. Focusing schoolchildren from Arusha and Dar es Salaam, in Tanzania, this study compared the discriminative ability of the generic Child OIDP with respect to dental caries and periodontal problems across the study sites. Secondly, the discriminative ability of the generic-and the CS Child OIDP attributed to dental caries, periodontal problems and malocclusion was compared with respect to various oral conditions as part of a construct validation. Methods: In Arusha, 1077 school children (mean age 14.9 years, range 12-17 years) and 1601 school children in Dar es Salaam (mean age 13.0 years, range 12-14 years) underwent oral clinical examinations and completed the Kiswahili version of the generic and CS Child-OIDP inventories. The discriminative ability was assessed as differences in overall mean and prevalence scores between groups, corresponding effect sizes and odd ratios, OR. Results: The differences in the prevalence scores and the overall mean generic Child-OIDP scores were significant between the groups with (DMFT > 0) and without (DMFT = 0) caries experience and with (simplified oral hygiene index [OHI-S] > 1) and without periodontal problems (OHI-S ≤ 1) in Arusha and Dar es Salaam. In Dar es Salaam, differences in the generic and CS Child-OIDP scores were observed between the groups with and without dental caries, differences in the generic Child-OIDP scores were observed between the groups with and without periodontal problems, and differences in the CS Child-OIDP scores were observed between malocclusion groups. The adjusted OR for the association between dental caries and the CS Child-OIDP score attributed to dental caries was 5.4. The adjusted OR for the association between malocclusion and CS Child-OIDP attributed to malocclusion varied from 8.8 to 2.5. Conclusion: The generic Child-OIDP discriminated equally well between children with and without dental caries and periodontal problems across socio-culturally different study sites. Compared with its generic form, the CS Child-OIDP discriminated most strongly between children with and without dental caries and malocclusion. The CS Child OIDP attributed to dental caries and malocclusion seems to be better suited to support clinical indicators when estimating oral health needs among school children in Tanzania

Assessing association of dental caries with child oral impact on daily performance; a cross-sectional study of adolescents in Copperbelt province, Zambia

Abstract Background Dental caries and child oral impact on daily performance (C-OIDP) have been linked in several studies. However, the studies used caries indices, which limit the ability to examine how C-OIDP prevalence varies across various stages of the dental caries process. Furthermore, cross-cultural differences between Zambia and other African countries where the C-OIDP instrument has been widely used necessitate testing its pychometric properties. This study’s primary aim was to evaluate the association between dental caries and C-OIDP. Secondarily, the study reports the psychometric properties of the C-OIDP index among Zambian adolescents. Methods A cross-sectional study was conducted between February and June 2021 among grade 8–9 adolescents in Copperbelt province, Zambia. A multistage cluster sampling method was used to select participants. Using a pretested self-administered questionnaire, socio-demographics, oral health behaviors, self-reported oral health, and C-OIDP were evaluated. The test-retest and internal consistency reliability of the C-OIDP were evaluated. The Caries Assessment and Treatment Spectrum (CAST) was used to evaluate dental caries. Adjusted odd ratios and 95% confidence intervals were used to evaluate the association between dental caries and C-OIDP after adjusting for confounders identified by a directed acyclic graph. Results Among 1,794 participants, 54.0% were females, while 56.0% were aged 11–14 years. About a quarter (24.6%) had one or more teeth at the pre-morbidity stage, 15.2% at the morbidity, 6.4% at the severe morbidity and 2.7 at the mortality stage. The internal consistency reliability of the C-OIDP Cohen’s Kappa was 0.940, while the Kappa coefficients of the C-OIDP items ranged from 0.960 to 1.00. Participants with severe caries had a high prevalence of C-OIDP, with rates for morbidity, severe morbidity, and mortality stages being 49.3%, 65.3%, and 49.3%, respectively. Oral impacts were 2.6 times (AOR 2.6, 95% CI 2.1–3.4) more likely to be reported by participants with dental caries than those without caries. Conclusions Dental caries was associated with high reporting of C-OIDP, and C-OIDP prevalence was high among participants in the severe stages of the caries process. The English version of the C-OIDP demonstrated adequate psychometric characteristics for assessing OHRQoL among Zambian adolescents