Infant Feeding Practices with Oral Health Implications among Suburban Mothers of Tanzania

Background: Behaviours around infants feeding influence both nutritive value and the detrimental effects of the infant feeding. Aim: The study aimed to determine infant feeding practices with implication to child’s oral health and examine the related socio-demographic factors. Materials and Methods: A cross-sectional study among mothers of the infants who were attending RCH clinics in suburban areas of northwest Tanzania. Cluster sampling technique was used to obtain the participants and a structured questionnaire was used to interview the mothers. Frequency distributions and cross-tabulations were used for analysis and reported as proportions and identified differences between the comparative socio-demographic categories. Results: Study involved 213 mother-infant pairs; infants’ mean age was 7.22 ± 3.48 months and 53.1% were female babies. Almost all (94.6 %) the infants were breastfed and 75.3% of infants under six months of age were exclusively breastfeeding. In infants age older than six months, 32.6% of mothers reported to have initiated complementary food before the baby turned six months and that sugar sweetened foods were mostly used (68.1%) complementary foods. Higher proportion of mothers who had secondary school education or beyond (43.4%) reported to have initiated complementary food before the recommended age than their counterparts. Mothers who were employed reported to mostly (74.5%) use sugar sweetened complementary foods as compared to unemployed mothers. Conclusion: Infants of this community were mostly breastfed and initiated complementary feeding earlier than recommended time. Employed mothers and those with secondary education or above tended to have unfavorably infant feeding practices than their comparative groups

Sociodemographics and School Environment Correlates of Clustered Oral and General Health Related Behaviours in Tanzanian Adolescents

Objectives: To identify underlying clusters of general and oral health behaviours and acertain possible factors influencing the existence of the behaviours. Materials and Methods: A cross sectional study was conducted among 4,847 school adolescents aged 11 to 17 years. Data were collected using a structured questionnaire in Kiswahili inquiring about general and oral health related behaviours, socio-demographics and adolescents’ school relationship. Principal component analysis was employed to identify clusters of health behaviour. Frequency distribution for proportions, cross tabulations with chi-square and a two stage binary logistic regression were done. Results: Principal component analysis identified four clusters from twelve health behaviours; hygiene practices, dietary behaviours, cigarette smoking & alcohol consumption and sedentary related behaviours. Girls, OR 0.8 (95% CI 0.7, 0.9); secondary school attendees, OR 0.5 (95% CI 0.4, 0.7) and adolescents with good school relationship OR 0.7 (95% CI 0.6, 0.8) were less likely to smoke or use alcohol. Urban residents were less likely OR 0.8, (95% CI 0.7, 0.9) to report acceptable dietary behaviours. Adolescents whose fathers had secondary education or higher, were in secondary schools and had good school relationship were most likely to have acceptable hygiene behaviours, OR 1.4 (95% CI 1.2, 1.6), 1.6 (95% CI 1.1, 2.2) and 1.4 (95% CI 1.3, 1.7), respectively. Conclusion: Oral and general health behaviours of Tanzanian adolescents factored into four clusters with hygiene behaviours being most practiced and physical exercise the least. The clustered behaviours were influenced by socio-demographics and school environment

Promoting self-regulation in health among vulnerable brazilian children: protocol study

The Health and Education Ministries of Brazil launched the Health in School Program (Programa Saúde na Escola - PSE) in 2007. The purpose of the PSE is two-fold: articulate the actions of the education and health systems to identify risk factors and prevent them; and promote health education in the public elementary school system. In the health field, the self-regulation (SR) construct can contribute to the understanding of life habits which can affect the improvement of individuals' health. This research aims to present a program that promotes SR in health (SRH). This program (PSRH) includes topics on healthy eating and oral health from the PSE; it is grounded on the social cognitive framework and uses story tools to train 5th grade Brazilian students in SRH. The study consists of two phases. In Phase 1, teachers and health professionals participated in a training program on SRH, and in Phase 2, they will be expected to conduct an intervention in class to promote SRH. The participants were randomly assigned into three groups: the Condition I group followed the PSE program, the Condition II group followed the PSRH (i.e., PSE plus the SRH program), and the control group (CG) did not enroll in either of the health promotion programs. For the baseline of the study, the following measures and instruments were applied: Body Mass Index (BMI), Simplified Oral Hygiene Index (OHI-S), Previous Day Food Questionnaire (PFDQ), and Declarative Knowledge for Health Instrument. Data indicated that the majority are eutrophic children, but preliminary outcomes showed high percentages of children that are overweight, obese and severely obese. Moreover, participants in all groups reported high consumption of ultraprocessed foods (e.g., soft drinks, artificial juices, and candies). Oral health data from the CI and CII groups showed a prevalence of regular oral hygiene, while the CG presented good oral hygiene. The implementation of both PSE and PSRH are expected to help reduce health problems in school, as well as the public expenditures with children's health (e.g., Obesity and oral diseases).The intervention program described in this study was funded by Coordination for the Improvement of Higher Education Personnel (Coordenacao de Aperfeicoamento de Pessoal de nivel superior-CAPES), Brazilian Federal agency for the Support and Evaluation of Graduate Education in Public Notice 09/2014, Science without Borders Program/Special Visiting Researcher Program-PVE

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

Assessment of the quality of measures of child oral health-related quality of life

Background Several measures of oral health-related quality of life have been developed for children. The most frequently used are the Child Perceptions Questionnaire (CPQ), the Child Oral Impacts on Daily Performances (C-OIDP) and the Child Oral Health Impact Profile (COHIP). The aim of this study was to assess the methodological quality of the development and testing of these three measures. Methods A systematic search strategy was used to identify eligible studies published up to December 2012, using both MEDLINE and Web of Science. Titles and abstracts were read independently by two investigators and full papers retrieved where the inclusion criteria were met. Data were extracted by two teams of two investigators using a piloted protocol. The data were used to describe the development of the measures and their use against existing criteria. The methodological quality and measurement properties of the measures were assessed using standards proposed by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) group. Results The search strategy yielded 653 papers, of which 417 were duplicates. Following analysis of the abstracts, 119 papers met the inclusion criteria. The majority of papers reported cross-sectional studies (n = 117) with three of longitudinal design. Fifteen studies which had used the original version of the measures in their original language were included in the COSMIN analysis. The most frequently used measure was the CPQ. Reliability and construct validity appear to be adequate for all three measures. Children were not fully involved in item generation which may compromise their content validity. Internal consistency was measured using classic test theory with no evidence of modern psychometric techniques being used to test unidimensionality of the measures included in the COSMIN analysis. Conclusion The three measures evaluated appear to be able to discriminate between groups. CPQ has been most widely tested and several versions are available. COHIP employed a rigorous development strategy but has been tested in fewer populations. C-OIDP is shorter and has been used successfully in epidemiological studies. Further testing using modern psychometric techniques such as item response theory is recommended. Future developments should also focus on the development of measures which can evaluate longitudinal change

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

Parental deceptive information: A case of traditional uvulectomy

Traditional uvulectomy (TU) is a partial or radical removal of the uvula by traditional practitioners. Therapeutic uvulectomy is performed as a remedy for various ailments usually; persistent cough, sore throat, dry throat, vomiting, diarrhea, anorexia, rejection of breast by a child and growth retardation. In Tanzania, TU is done secretly as it is an illegal practice thus often parents do not reveal information of the procedure when complications occur and drive them to seek dental or other medical consultations. A case of deceptive information after traditional uvulectomy is presented