Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Dental caries, dental pain and reported oral problems influence people's oral quality of life and thus their perceived need for dental care. So far there is scant information as to the psychosocial impacts of dental diseases and the perceived treatment need in child populations of sub-Saharan Africa.</p> <p>Objectives</p> <p>Focusing on primary school students in Kilwa, Tanzania, a district deprived of dental services and with low fluoride concentration in drinking water, this study aimed to assess the prevalence of dental pain and oral impacts on daily performances (OIDP), and to describe the distribution of OIDP by socio-demographics, dental caries, dental pain and reported oral problems. The relationship of perceived need estimates with OIDP was also investigated.</p> <p>Methods</p> <p>A cross-sectional study was conducted in 2008. A total of 1745 students (mean age 13.8 yr, sd = 1.67) completed an extensive personal interview and under-went clinical examination. The impacts on daily performances were assessed using a Kiswahili version of the Child-OIDP instrument and caries experience was recorded using WHO (1997) criteria.</p> <p>Results</p> <p>A total of 36.2% (41.3% urban and 31.4% rural, p < 0.001) reported at least one OIDP. The prevalence of dental caries was 17.4%, dental pain 36.4%, oral problems 54.1% and perceived need for dental treatment 46.8% in urban students. Corresponding estimates in rural students were 20.8%, 24.4%, 43.3% and 43.8%. Adjusted OR for reporting oral impacts if having dental pain ranged from 2.5 (95% CI 1.8–3.6) (problem smiling) to 4.7 (95% CI 3.4–6.5) (problem sleeping),- if having oral problems, from 1.9 (95% CI 1.3–2.6) (problem sleeping) to 3.8 (95% CI 2.7–5.2) (problem eating) and if having dental caries from 1.5 (95% CI 1.1–2.0) (problem eating) to 2.2 (95% CI 1.5–2.9) (problem sleeping). Students who perceived need for dental care were less likely to be females (OR = 0.8, 95% CI 0.6–0.9) and more likely to have impacts on eating (OR = 1.9, 95% CI 1.4–2.7) and tooth cleaning (OR = 1.6, 95% CI 1.6–2.5).</p> <p>Conclusion</p> <p>Substantial proportions of students suffered from untreated dental caries, oral impacts on daily performances and perceived need for dental care. Dental pain and reported oral problems varied systematically with OIDP across the eight impacts considered. Eating and tooth cleaning problems discriminated between subjects who perceived need for dental treatment and those who did not.</p

Challenges and opportunities for implementing an intersectoral approach in malaria control in Tanzania

Background: Malaria is a complex health problem related to socio-economic and environmental factors that cut across a number of sectors. Establishing intersectoral linkages is important to facilitate joint efforts to address the problem at all levels. The objectives of this study were to explore key sectoral engagements in malaria control policy formulation and implementation, and to determine decision and policy makers’ opinions about different sectoral activities that contribute to malaria transmission and control in Tanzania.Methods: This study included documentary review, self-administered interviews and group discussion. Interviews and group discussions involved key informants at district and national levels. The sectors involved were health, agriculture, environment, livestock, fisheries, education, works, irrigation, water resources, land development, forestry, and community development.Results: Institutions and organizations that were involved in the development of the previous and current National Malaria Strategic Plan (2007-2013 and 2013-2020) were the Ministries of Health and Social Welfare, Prime Minister’s Office of Regional Administration and Local Government, Public universities and non-governmental organizations. All the individuals involved in the development of the plans were either medical or health professionals. According to key informants, sectoral activities identified to contribute to malaria transmission included farming systems, deforestation, fishing, nomadic pastoralism, household water storage, water resource development projects, road and house construction and mining. The lack of intersectoral approaches in malaria control programme included the facts that the Health Sector does not involve other sectors during planning and development of policy guidelines, differences in sectoral mandates and management culture, lack of a national coordinating framework and lack of budget for intersectoral activities.Conclusion: The current strategies for malaria control in Tanzania need to address socio-economic and development activities across sectors and emphasise the need for intersectoral collaboration. It is recommended that the future of malaria control strategies should, therefore, be broad based and intersectoral in planning and implementation

Challenges and Opportunities for Implementing an Intersectoral Approach in Malaria Control in Tanzania

Malaria is a complex health problem related to socio-economic and environmental factors that cut across a number of sectors. Establishing intersectoral linkages is important to facilitate joint efforts to address the problem at all levels. The objectives of this study were to explore key sectoral engagements in malaria control policy formulation and implementation, and to determine decision and policy makers’ opinions about different sectoral activities that contribute to malaria transmission and control in Tanzania. This study included documentary review, self-administered interviews and group discussion. Interviews and group discussions involved key informants at district and national levels. The sectors involved were health, agriculture, environment, livestock, fisheries, education, works, irrigation, water resources, land development, forestry, and community development. Institutions and organizations that were involved in the development of the previous and current National Malaria Strategic Plan (2007-2013 and 2013-2020) were the Ministries of Health and Social Welfare, Prime Minister’s Office of Regional Administration and Local Government, Public universities and non-governmental organizations. All the individuals involved in the development of the plans were either medical or health professionals. According to key informants, sectoral activities identified to contribute to malaria transmission included farming systems, deforestation, fishing, nomadic pastoralism, household water storage, water resource development projects, road and house construction and mining. The lack of intersectoral approaches in malaria control programme included the facts that the Health Sector does not involve other sectors during planning and development of policy guidelines, differences in sectoral mandates and management culture, lack of a national coordinating framework and lack of budget for intersectoral activities. The current strategies for malaria control in Tanzania need to address socio-economic and development activities across sectors and emphasise the need for intersectoral collaboration. It is recommended that the future of malaria control strategies should, therefore, be broad based and intersectoral in planning and implementation

Self-Reported Occupational Exposure to HIV and Factors Influencing its Management Practice: A Study of Healthcare Workers in Tumbi and Dodoma Hospitals, Tanzania.

Blood borne infectious agents such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immune deficiency virus (HIV) constitute a major occupational hazard for healthcare workers (HCWs). To some degree it is inevitable that HCWs sustain injuries from sharp objects such as needles, scalpels and splintered bone during execution of their duties. However, in Tanzania, there is little or no information on factors that influence the practice of managing occupational exposure to HIV by HCWs. This study was conducted to determine the prevalence of self-reported occupational exposure to HIV among HCWs and explore factors that influence the practice of managing occupational exposure to HIV by HCWs in Tanzania. Self-administered questionnaire was designed to gather information of healthcare workers' occupational exposures in the past 12 months and circumstances in which these injuries occurred. Practice of managing occupational exposure was assessed by the following questions: Nearly half of the HCWs had experienced at least one occupational injury in the past 12 months. Though most of the occupational exposures to HIV were experienced by female nurses, non-medical hospital staff received PEP more frequently than nurses and doctors. Doctors and nurses frequently encountered occupational injuries in surgery room and labor room respectively. HCWs with knowledge on the possibility of HIV transmission and those who knew whom to contact in event of occupational exposure to HIV were less likely to have poor practice of managing occupational exposure. Needle stick injuries and splashes are common among HCWs at Tumbi and Dodoma hospitals. Knowledge of the risk of HIV transmission due to occupational exposure and knowing whom to contact in event of exposure predicted practice of managing the exposure. Thus provision of health education on occupational exposure may strengthen healthcare workers' practices to manage occupational exposure

Estimated Risk of HIV Acquisition and Practice for Preventing Occupational Exposure: A Study of Healthcare Workers at Tumbi and Dodoma Hospitals, Tanzania.

Health care workers (HCWs) are at risk of acquiring human immuno-deficiency virus (HIV) and other infections via exposure to infectious patients' blood and body fluids. The main objective of this study was to estimate the risk of HIV transmission and examine the practices for preventing occupational exposures among HCWs at Tumbi and Dodoma Hospitals in Tanzania. This study was carried out in two hospitals, namely, Tumbi in Coast Region and Dodoma in Dodoma Region. In each facility, hospital records of occupational exposure to HIV infection and its management were reviewed. In addition, practices to prevent occupational exposure to HIV infection among HCWs were observed. The estimated risk of HIV transmission due to needle stick injuries was calculated to be 7 cases per 1,000,000 HCWs-years. Over half of the observed hospital departments did not have guidelines for prevention and management of occupational exposure to HIV infections and lacked well displayed health and safety instructions. Approximately, one-fifth of the hospital departments visited failed to adhere to the instructions pertaining to correlation between waste materials and the corresponding colour coded bag/container/safety box. Seventy four percent of the hospital departments observed did not display instructions for handling infectious materials. Inappropriate use of gloves, lack of health and safety instructions, and lack of use of eye protective glasses were more frequently observed at Dodoma Hospital than at Tumbi Hospital. The poor quality of the hospital records at the two hospitals hampered our effort to characterise the risk of HIV infection acquisition by HCWs. Greater data completeness in hospital records is needed to allow the determination of the actual risk of HIV transmission for HCWs. To further reduce the risk of HIV infection due to occupational exposure, hospitals should be equipped with sufficient personal protective equipment (PPE) and HCWs should be reminded of the importance of adhering to universal precautions

Socio-demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa district, Tanzania

There is a lack of studies considering social disparity in oral health emanating from adolescents in low-income countries. This study aimed to assess socio-demographic disparities in clinical- and self reported oral health status and a number of oral health behaviors. The extent to which oral health related behaviors might account for socio-demographic disparities in oral health status was also examined. A cross-sectional study was conducted in Kilwa district in 2008. One thousand seven hundred and forty five schoolchildren completed an interview and a full mouth clinical examination. Caries experience was recorded using WHO criteria, whilst type of treatment need was categorized using the ART approach. The majority of students were caries free (79.8%) and presented with a low need for dental treatment (89.3%). Compared to their counterparts in opposite groups, rural residents and those from less poor households presented more frequently with caries experience (DMT>0), high need for dental treatment and poor oral hygiene behavior, but were less likely to report poor oral health status. Stepwise logistic regressions revealed that social and behavioral variables varied systematically with caries experience, high need for dental treatment and poor self reported oral health. Socio-demographic disparities in oral health outcomes persisted after adjusting for oral health behaviors. Socio-demographic disparities in oral health outcomes and oral health behaviors do exist. Socio-demographic disparities in oral health outcomes were marginally accounted for by oral health behaviors. Developing policies and programs targeting both social and individual determinants of oral health should be an urgent public health strategy in Tanzania

A Qualitative Study of Perceived Risk of Occupational Exposure to HIV and Use of Post Exposure Prophylaxis Services Among Health-Care Workers in Tanzania

Background:&nbsp;Occupational exposure to HIV continues to present a risk of HIV infections to health-care workers (HCWs) in low-income countries. Since 2005, policies in Tanzania have been in place to guide the implementation of HIV/AIDS post-exposure prophylaxis (PEP) interventions in the workplace. However, little is known about how frontline HCWs experience and view these interventions. This study aimed to explore how HCWs perceive their HIV infection risk and capture their experiences of workplace HIV/AIDS interventions. &nbsp; Methods:&nbsp;A descriptive qualitative design was used. Medical and nonmedical personnel from 2 hospitals in the Pwani and Dodoma regions of Tanzania participated in the study. We conducted 22 In-depth interviews (IDIs) with HCWs (heads of departments, hospital units, or sections). A content analysis approach was used. &nbsp; Results:&nbsp;The HCWs perceived and reasoned that working in medical wards, incinerator units, dental units, obstetric wards, laundries, laboratories, and mortuaries exposed them to HIV acquisition risk. Many of the medically trained personnel reported that invasive procedures exposed them to some risk of HIV infection. Nonmedical personnel reported to be potentially exposed to HIV infection while incorrectly handling discarded needles and blades (sharps). Although most HCWs expressed awareness about the availability of postexposure prophylaxis (PEP), not all HCWs knew where to report and whom to contact in case of accidents. Ignorance about the implications of exposure to contaminated sharps hindered PEP use among certain cadres. Also, some PEP users were reported to experience side effects, but they were motivated to complete the doses to remain healthy. &nbsp; Conclusion:&nbsp;Occupational exposure to HIV infection remains a significant concern to HCWs, particularly among nonmedical cadres. Despite expressed awareness about infection prevention and control, the reporting channels and the strategies to promote recognition of the importance of using PEP services after exposure need to be strengthened

Biosocial Determinants of Persistent Schistosomiasis among Schoolchildren in Tanzania despite Repeated Treatment

Schistosomiasis is a parasitic disease endemic to Tanzania and other countries of the global south, which is currently being addressed through preventive chemotherapy campaigns. However, there is growing recognition that chemotherapy strategies will need to be supplemented to sustainably control and eventually eliminate the disease. There remains a need to understand the factors contributing to continued transmission in order to ensure the effective configuration and implementation of supplemented programs. We conducted a cross-sectional questionnaire, to evaluate the biosocial determinants facilitating the persistence of schistosomiasis, among 1704 Tanzanian schoolchildren residing in two districts undergoing a preventive chemotherapeutic program: Rufiji and Mkuranga. A meta-analysis was carried out to select the diagnostic questions that provided a likelihood for predicting infection status. We found that self-reported schistosomiasis continues to persist among the schoolchildren, despite multiple rounds of drug administration.Using mixed effects logistic regression modeling, we found biosocial factors, including gender, socio-economic status, and water, sanitation, and hygiene (WASH)-related variables, were associated with this continued schistosomiasis presence. These findings highlight the significant role that social factors may play in the persistence of disease transmission despite multiple treatments, and support the need not only for including integrated technical measures, such as WASH, but also addressing issues of poverty and gender when designing effective and sustainable schistosomiasis control programs