Availability, attitudes and costs of selected dental services in a low-income country

ABSTRACT The aim of this study was to determine the availability of selected dental services, attitudes towards such services and economic factors associated with their utilization in a low-income country. Data utilized for this study was collected in two phases. Phase I was a survey of all dental facilities in four selected regions in Tanzania. The survey was administered to officers-in-charge of dental facilities and other dental practitioners working within these facilities. Phase II was a series of cross-sectional studies conducted among outpatients attending four selected regional hospitals in Tanzania. Data was collected using self-administered questionnaires. Dental materials and equipment were inconsistently available and only 3/28 studied dental facilities had all the seven investigated equipment fully functional and in use. The self-rated competency among dental practitioners ranged from 6.4 to 9.8 for all six procedures questioned, but equal scores between cadres were only for tooth extractions (9.7 vs. 9.1 respectively). Competencies for placing restorations were all rated lower by other cadres (p varied from <. 05 to < .001). Most of the patients had a negative overall attitude (-1.99) towards tooth filling treatment although those with previous tooth filling experience had positive attitudes (1.00). The mean willingness-to-pay (WTP) values for tooth filling (7,398 and 7,726 Tshs for anterior and posterior teeth, respectively) were higher (p < 0.001) than for tooth extraction irrespective of tooth type (5,448 and 6,188 Tshs, respectively). Being 45+ years increased the likelihood to offer lower WTP values. More than half (55%) of the patients would experience significant financial impacts as a result of their utilization of dental services. The findings clearly suggest that there are a multitude of factors that influence the observed dental treatment patterns being predominated by tooth extractions in Tanzania. Keywords: Willingness-to-pay, costs, dental services, attitudes, TanzaniaTIIVISTELMÄ Valikoitujen hammashoitopalvelujen saatavuus, niihin liittyvät asenteet ja käytön kustannukset vähävaraisessa maassa Tutkimus selvitti valikoitujen hammashoitopalveluiden saatavuutta sekä niihin liittyviä asenteita ja käyttöön liittyviä taloudellisia tekijöitä vähävaraisessa maassa. Ensin tehtiin kyselytutkimus kaikissa hammashoitopalveluja tarjoavissa yksiköissä neljällä valitulla tansanialaisella hallintoalueella näiden yksiköiden johtajien ja hammashoitoa antavien työntekijöiden keskuudessa. Toiseksi toteutettiin sarja poikkileikkaustutkimuksia kyselyin näiden neljän hallintoalueen avohoitopotilaiden keskuudessa. Kyselyissä selvitettiin valikoitujen hammashoitopalvelujen kustannuksia, hammashoitomateriaalien ja -laitteiden saatavuutta, hammashoidon työntekijöiden kokemia valmiuksia, potilaiden asenteita ja maksuhalukkuutta paikkaushoitoon sekä potilaille hammashoidosta aiheutuviin kustannuksia. Materiaaleja ja laitteita oli vaihtelevasti saatavilla. Vain kolmessa tutkitusta 28 hoitolasta kaikki seitsemän tutkimuksessa tarkasteltua laitetta olivat käytössä ja toimintakunnossa. Hammaslääkärien kokemat valmiudet toimenpiteisiin vaihtelivat (6,4–9,8) ja olivat saman tasoisia muiden ammattiryhmien kanssa vain poistoissa (9,7 vs. 9,1). Paikkausvalmiudet olivat alempia muilla ammattiryhmillä (p <0,05–<0,001). Useimmilla potilailla oli negatiivinen kokonaisasenne (-1,99) paikkaushoitoon. Heillä, joilla oli aiempaa kokemusta paikkaushoidosta, oli positiivinen asenne (1,00). Paikkaushoidon maksuhalukkuuden keskiarvot olivat huomattavasti korkeammat (7398 Tansanian shillinkiä (Tshs) etualueella ja 7726 Tshs taka-alueella) kuin hammaspoistojen maksuhalukkuuden (5448 Tshs etualueella ja 6188 Tshs taka-alueella, p<0,001). Hammashoitopalvelujen käyttö aiheutti yli puolelle (55 %) tutkituista potilaista merkittäviä taloudellisia vaikutuksia. Tulokset osoittavat selvästi, että Tansaniassa monet tekijät vaikuttavat hammashoitopalvelujen tuotantoon, jota hallitsevat hampaiden poistot. Avainsanat: Maksuhalukkuus, kustannukset, hammashoitopalvelut, asenteet, Tansani

Attitudes towards tooth fillings in Tanzanian adults and its association with previous filling experience

Background: Tooth filling treatment is utilized at low levels in many low and middle-income countries (LMICs), further, little is known about the prevailing attitudes towards such treatment. This study aimed to assess attitudes towards tooth filling among Tanzanian adults and how previous tooth filling experience is associated with these attitudes.Methods: A pretested structured questionnaire was distributed among 1522 out-patients in four regional hospitals in Tanzania in 2015-16. The questionnaire had eight statements on a 6-point Likert scale measuring attitudes towards tooth filling. Responses were analyzed independently and through a constructed attitude sum score. Linear regression analysis was used to assess the association of previous tooth fillings on attitudes towards tooth filling treatment.Results: The respondents were mostly female (57.3%), with a mean age of 33.1 years (SD 11.3). About one third of the respondents (36.4%) had primary level of education. Attitudes towards tooth filling treatment were generally negative. Low levels of education and income were associated with more negative attitudes. A small proportion (11.5%) had a previous tooth filling. Having a previous tooth filling was associated with a more positive attitude towards tooth fillings regardless of socioeconomic status.Conclusions: This study shows that even in areas with limited resources and availability of services, previous experience of tooth fillings is related to more positive attitudes towards restorative treatment, which should be taken into account when planning oral health care programs

Behavioral Adaptations of Nursing Brangus Cows to Virtual Fencing: Insights from a Training Deployment Phase

Virtual fencing systems have emerged as a promising technology for managing the distribution of livestock in extensive grazing environments. This study provides comprehensive documentation of the learning process involving two conditional behavioral mechanisms and the documentation of efficient, effective, and safe animal training for virtual fence applications on nursing Brangus cows. Two hypotheses were examined: (1) animals would learn to avoid restricted zones by increasing their use of containment zones within a virtual fence polygon, and (2) animals would progressively receive fewer audio-electric cues over time and increasingly rely on auditory cues for behavioral modification. Data from GPS coordinates, behavioral metrics derived from the collar data, and cueing events were analyzed to evaluate these hypotheses. The results supported hypothesis 1, revealing that virtual fence activation significantly increased the time spent in containment zones and reduced time in restricted zones compared to when the virtual fence was deactivated. Concurrently, behavioral metrics mirrored these findings, with cows adjusting their daily travel distances, exploration area, and cumulative activity counts in response to the allocation of areas with different virtual fence configurations. Hypothesis 2 was also supported by the results, with a decrease in cueing events over time and increased reliance with animals on audio cueing to avert receiving the mild electric pulse. These outcomes underscore the rapid learning capabilities of groups of nursing cows in responding to virtual fence boundaries

Reproductive health services for populations at high risk of HIV: Performance of a night clinic in Tete province, Mozambique

<p>Abstract</p> <p>Background</p> <p>Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability.</p> <p>Methods</p> <p>In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed.</p> <p>Results</p> <p>An estimated 4,415 FSW work in the area, or 9% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients/month visit the clinic (43% for contraception, 24% for counselling and testing and 23% for STI care). The average clinic running cost is US$ 1408/month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times.</p> <p>Conclusions</p> <p>Size of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV/AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding.</p

SEXUALLY TRANSMITTED DISEASES IN MWANZA, TANZANIA: RISK, BELIEFS, HEALTH CARE SEEKING BEHAVIOUR, AND RESPONSES.

Objective: In Mwanza region, an HIV/STD intervention program has been in progress in the rural population since 1991. The information in this study was gathered to increase understanding about lay concepts of sexually transmitted diseases and to provide information to inform HIV/AIDS/STD interventions. Methods: During a rapid ethnographic survey, 4 investigators conducted more than 100 interviews in 3 rural villages and one roadside settlement with a wide range of key informants including fishers, truck drivers, professional sex workers, STD patients, traditional healers, health care workers, bar attendants, and traders. Results: High-risk transmission sites included bars, guesthouses, periodic markets, and beaches. People at high risk included men with money and/or away from home such as truck drivers, fishers, government officials, and businessmen, and single women who are barmaids, traders, and secondary school students. Despite linguistic differences in typologies, signs and symptoms were similar in many reported STD conditions when compared to the biomedical model. Some common conditions and diseases e.g. schistosomiasis were believed incorrectly to be sexually transmitted. Multiple sources of treatment were sought. Conclusion: The existence of transient social groups with high-risk behaviour is a challenge to the organization and delivery of STD services. Effective interventions will entail cooperation between multiple sectors based on detailed knowledge of local populations and conditions. Interventions should be accompanied by simple research techniques to assist timely assessment

Use of an unmanned aerial vehicle - Mounted video camera to assess feeding behavior of raramuri criollo cows

We determined the feasibility of using unmanned aerial vehicle (UAV) video monitoring to predict intake of discrete food items of rangeland-raised Raramuri Criollo non-nursing beef cows. Thirty-five cows were released into a 405-m2 rectangular dry lot, either in pairs (pilot tests) or individually (experiment tests), that contained 12 food bowls arranged in an open semicircle and placed approximately 1 m apart. Four bowls containing either long alfalfa hay (AH, 200 g), long Sudangrass hay (SH, 200 g), or cottonseed cake (CC, 50 g) were alternated (CC, AH, SH) using the same sequence in all tests. Video footage of all arena tests was acquired with a three dimensional Robotics Y6 Multi-copter fitted with a two-axis brushless gimbal and a GoPro Hero 3 Silver Digital Camera. Video files were processed to extract a total of 4 893 two-second-interval still images that were viewed to determine cow feeding activity. Cows that were naïve to the sound of the UAV fed as frequently (P > 0.05) as their adapted counterparts during 12-min pilot tests. Significant positive correlations (r=0.68-0.91; < 0.05) between video-derived feeding frequency estimates and amount of AH, SH, and CC consumed per bowl were observed during the individual 4-min experiment tests. Our results suggest that UAV video monitoring could be a useful tool to monitor feeding behavior of rangeland cows. © 2016 The Society for Range Management. Published by Elsevier Inc. All rights reserved.The Rangeland Ecology & Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information

Dental Caries Pattern Amongst Tanzanian Children: National Oral Health Survey

Background: Dental caries in young children and adolescents is a public oral health challenge in countries with developing economies and economic transition. This study presents a demographic pattern of dental caries in primary and permanent dentition of 5-, 12-, and 15-year-old Tanzanians based on the 2020 National Oral Health Survey findings. Methods: This is a cross-section study based on data from Tanzania's 5th National Oral Health Survey. Data on dental caries and basic demographics were collected employing World Health Organization Oral Health Survey protocols. Analysis was done using the SPSS computer programme version 23, and proportions and mean dental caries experiences in Decayed extracted filled teeth in primary dentition/Decayed Missing Filled Teeth in permanent dentition were summarised and chi-square statistics and binary logistic regression assessed the differences and determined the association between dental caries and the selected demographic characteristics. Results: The survey included 2187 participants; 42.4% were from rural areas and 50.7% were female. Overall caries prevalence was 17%, specifically 43.2%, 20.5%, and 25.5% amongst 5-, 12- and 15-year-olds, respectively. Decayed teeth components were 98.4%, 89.8%, and 91.4% amongst 5-, 12-, and 15-year-olds, respectively. Overall mean (SD) DMFT amongst 12- and 15-year-olds were 0.40 (0.27) and 0.59 (1.35), respectively. Urban participants had significantly lower odds of dental caries experience (odds ratio, 0.62, 95% confidence interval 0.45–0.84) compared with rural participants, whilst the 15-year-olds had higher odds of dental caries experience than the 12-year-olds. Conclusion: Dental caries prevalence in primary dentition was high. The proportion of decayed teeth components of def/DMFT was the highest compared with that of missing and filled teeth components. Older adolescents and those from rural areas had higher odds of dental caries experience

Are integrated HIV services less stigmatizing than stand-alone models of care? A comparative case study from Swaziland.

INTRODUCTION: Integrating HIV with primary health services has the potential to reduce HIV-related stigma through delivering care in settings disassociated with HIV. This study investigated the relationship between integrated care and felt stigma. The study design was a comparative case study of four models of HIV care in Swaziland, ranging from fully integrated to fully stand-alone HIV care. METHODS: An exit survey (N=602) measured differences in felt stigma across model of care; the primary outcome "perception of HIV status exposure through clinic attendance" was analyzed using multivariable logistic regression. In-depth interviews (N=22) explored whether and how measured differences in stigma experiences were related to service integration. RESULTS: There were significant differences in perceived status exposure across models of care. After adjustment for potential confounding between sites, those at a partially integrated site and a partially stand-alone site had greater odds of perceived status exposure than those at the fully stand-alone site (aOR 3.33, 95% CI 1.98-5.60; and aOR 11.84, 95% CI 6.89-20.36, respectively). There was no difference between the fully stand-alone and the fully integrated clinic. Qualitative data suggested that many clients at HIV-only sites felt greater confidentiality knowing that those around them were positive, and support was gained from other HIV care clients. Confidentiality was maintained in various ways, even in stand-alone sites, through separate waiting areas for HIV testing and HIV treatment, and careful clinic and room labelling. CONCLUSIONS: The relationship between model of care and stigma was complex, and the hypothesis that stigma is higher at stand-alone sites did not hold true in this high prevalence setting. Policy-makers should ensure that service integration does not increase stigma, in particular within partially integrated models of care