Factors Associated with Severe Disease from Malaria, Pneumonia and Diarrhea among Children in Rural Tanzania - a Hospital-Based Cross-Sectional Study.

Mild cases of malaria, pneumonia and diarrhea are readily treatable with complete recovery and with inexpensive and widely available first-line drugs. However, treatment is complicated and expensive, and mortality is higher when children present to the hospital with severe forms of these illnesses. We studied how care seeking behaviours and other factors contributed to severity of malaria, pneumonia and diarrhoea among children less than five years in rural Tanzania. We interviewed consecutive care-takers of children diagnosed with malaria, pneumonia and/or diarrhea at Korogwe and Muheza district hospitals, in north-eastern Tanzania, between July 2009 and January 2010, and compared characteristics of children presenting with severe and those with non-severe disease. A total of 293 children with severe and 190 with non-severe disease were studied. We found persistent associations between severity of disease and caretaker's lack of formal education (OR 6.6; 95% confidence interval (CI) 2.7-15.8) compared to those with post-primary education, middle compared to high socio-economic status (OR 1.9; 95% CI 1.2-3.2), having 4 or more children compared to having one child (OR 2.5; 95% CI 1.4-4.5), having utilized a nearer primary health care (PHC) facility for the same illness compared to having not (OR 5.2; 95% CI 3.0-9.1), and having purchased the first treatment other than paracetamol from local or drug shops compared to when the treatment was obtained from the public hospitals for the first time (OR 3.2; 95% CI 1.9-5.2). The old officially abandoned first line anti-malaria drug Sulfadoxin-pyrimethamine (SP) was found to still be in use for the treatment of malaria and was significantly associated with childrens' presentation to the hospital with severe malaria (OR 12.5; 95% CI 1.6-108.0). Our results indicate that caretakers with no formal education, with lower SES and with many children can be target groups for interventions in order to further reduce child mortality from treatable illnesses. Furthermore, the quality of the available drug shops and PHC facilities need to be closely monitored

Editorial: The "Nylon teeth myth"

No Abstract. Tanzania Dental Journal Vol. 14 (1) 2007: pp. v-v

Dental Anxiety and Its Consequences to Oral Health Care Attendance and Delivery

Dental anxiety has been reported to be a common problem affecting widespread societies, hence a global public health concern. This chapter provides an updated information to dental practitioners, about dental anxiety and its implication to oral health-care attendance and service delivery. It is introduced by defining dental anxiety, providing a summary of prevalence of the problem among children and adults; and its relationship with sociodemography, oral health status, and cultural issues. Causes of dental anxiety and simple ways to diagnose it and management options of dental anxiety for different age groups of populations are summarized to assist dental practitioners during patient management. How dental anxiety influences dental attendance and ultimately impact oral health status of populations; and its relationship with oral health-care delivery are also discussed. Finally, preventive measures both in community and clinical settings are provided and recommendation for dental professionals and other stake holders is outlined

Association of early childhood caries experience with oral hygiene status and oral health practices of preschool children in Tandale, Tanzania

Background: Early Childhood Caries (ECC) has short and long-term effects on children and parents. The short-term effects include higher risk of new lesions, emergency room visits and hospitalization, increased treatment costs and days with restricted activity. The long-term effects are diminished learning ability and delayed physical growth and development.Objectives: To determine the association of ECC with oral hygiene status and oral health practices among children attending informal preschools in Dar es Salaam, Tanzania.Materials and methods: A descriptive cross-sectional study among 297 preschool children and their caregivers. Schools were selected using a stratified random sampling technique while children were conveniently selected. A questionnaire to interview parents inquired on socio-demographic characteristics, oral hygiene practices and dietary habits. Clinical examination for children’s plaque and dental caries scores was conducted. Data was analyzed using SPSS Version 20. Chi square and logistic regression statistical tests were done to determine the association between variables. The level of significance was set at p ≤ 0.05Results: Small proportion of the children brushed their teeth twice per day (24.6%), consumed sugar containing snacks (23.9%) or sugary drinks (20.9%) more than twice per day. Seventy percent had caries with a decayed missing and filled teeth index (dmft) of 4.19(±4.52 SD). Children brushing less than twice a day (p=0.021) and having high plaque scores (p=0.000) were more likely to develop dental caries than their counterparts.Conclusion: Caries experience among preschool children was positively associated with poor oral hygiene status and brushing teeth less than twice per day

Testing a consensus conference method by discussing the management of traumatic dental injuries in Tanzania

Objectives: To test the recommended consensus conference methods in Tanzania by discussing the management of traumatic dental injuries, and to reach consensus on the feasibility of the treatment modalities of traumatic dental injuries recommended in western countries in theTanzanian situation.Study participants: Fifteen dentists as representatives of the profession and two lay people as representative of potential consumers.Interventions: Presentation of treatment modalities for traumatic dental injuries recommended in western countries.Main outcome measure: Consensus on the feasibility of the recommended treatment modalities of traumatic dental injuries in the Tanzanian situation.Results: For most types of injuries, consensus on the feasibility of the recommended treatment methods for Tanzania was reached immediately. More time was spent to discuss management of some injuries where the members felt that the recommended managementregimes for these injuries are not feasible in the current Tanzanian situation. Panel members made three recommendations. First, parents and teachers should be provided with guidelines or instructions about self-care following trauma. Second, teaching on the management oftraumatic dental injuries at training institutions should be emphasised and third, dental practitioners at dental clinics in the country should get continuing education about the management of traumatic dental injuries.Conclusion: The methods for achieving consensus were useful in the Tanzanian dental situation, therefore it is recommended that the methods be adopted to reach consensus on other oral health issues

Accessing Oral Healthcare within a Context of Economic Transition

In many low-mid income settings, accessibility of health services remains inadequate and inequitable. These observed disparities in accessibility are particularly evident for oral healthcare services. The access to oral healthcare is influenced by the responsiveness of the health system, including availability of human resources for health, oral health facilities’ infrastructure, geographical distribution, equipment and materials as well as community’s awareness and affordability of the provided services. The evolution of oral healthcare access in Tanzania; from the early post-colonial phases of independence to current transition that the country is undergoing from low to a low-mid income economy is presented. The major health policies’ transition from “Free Healthcare” services to “Cost-sharing” and ultimately to “Health Insurance” are presented within the context of their influence towards oral healthcare access

Diseases and conditions falsely linked with “nylon teeth” myth: a cross sectional study of Tanzanian adults

Background: Different communities associate children’s ailments with their developmental milestones and they have beliefs on a variety of causes of the ailments. The objective of this study was to determine the diseases and conditions falsely linked with “nylon teeth” myth among Tanzanian adults.Methods: A cross sectional cluster study was conducted in five zones of Tanzania. A total of 200 individuals from each region stratified by age and sex were targeted. Study subjects included adults of child bearing age, elders, health care workers, teachers and traditional healers. A structured questionnaire was used to inquire for the demographic characteristics of the participants as well as diseases and conditions falsely linked with the nylon teeth myth.Results: A total of 1,359 people participated in the study. Of the total participants, 262 (19.3%) reported nylon teeth myth to exist in their locality. The main symptoms that were falsely linked with nylon teeth myth were diarrhoea (83.5%), long standing fevers (81.2%) and difficult in sucking (76.7%). Respondents less likely to falsely link nylon teeth myth with various diseases and conditions were residents in southern regions. They linked nylon teeth myth with diarrhoea (OR=0.29, CI=0.14-0.63), fevers (OR=0.38, CI=0.18-0.80), cough (OR=0.38, CI=0.16-0.94), stunting (OR=0.24, CI=0.10-0.58), excessive crying (OR=0.19, CI=0.09-0.40) and difficult sucking (OR=0.35 CI=0.17-0.70). Males linked the myth with stunting (OR=0.57, CI= 0.34-0.98) and excessive crying (OR 0.431, CI=0.24-0.78). The more educated respondents linked the myth with long standing cough (OR=2.068, CI=1.11-3.84) and stunting (OR=2.07, CI=1.10-3.76). The health care workers less likely linked nylon teeth with excessive crying (OR=0.37, CI=0.15-0.96) and difficult sucking (OR=0.29, CI=0.11-0.81).Conclusion: Diarrhoea, fevers and difficult in sucking were the symptoms most frequently linked with nylon teeth myth. Linking of the symptoms and the myth was more common among respondents from northern regions, non – medics, males and the more educated ones. Educational and behavioural change intervention against the diseases frequently falsely linked with nylon teeth myth is recommended to control the myth.