The association between area level socio-economic position and oral health-related quality of life in the South African adult population

Objective: To investigate the association between arealevel socio-economic position (SEP) and oral health-related quality of life (OHRQoL). Methods: Data collected from a nationally representative sample of the South African population ?16 years old (n=3,003) included demographics, individual-level SEP measures and self-reported oral health status. OHRQoL was measured using the Oral Health Impact Profile-14 (OHIP-14). The General Household Survey (n=25,653 households) and Quarterly Labour Force Surveys (n~30,000 households/ quarter) were used to determine area-level SEP. Data analysis included a random-effect negative binomial regression model and Blinder-Oaxaca decomposition analysis. Results: Area-level deprivation was associated with more negative oral impacts, independent of an individual's SEP. Other significant predictors of oral impacts included having experienced oral pain and reporting previous dental visits. Area differences in dental attendance contributed the most (37.5%) to the observed gap in OHRQoL, explained by differences in area-level SEP, whereas individual-level SEP contributed the least (18.8%). In the more affluent areas, satisfaction with life in general and individuals' SEP were significantly positively associated with OHRQoL.DHE

The role of socio-economic position on satisfaction with oral health services among South African adults : a structural equation model

OBJECTIVE : To investigate how differences in socio-economic position (SEP) influence satisfaction with dental services among South Africans. METHODS : Data collected from a nationally representative sample of the South African population ≥16 years old (n=3,112) included socio-demographics, health insurance enrolment, past-year dental visit and facility type (public or private), satisfaction and reason(s) for dissatisfaction with the dental services received. Using structural equation modelling, a pathway to satisfaction with dental services was tested using a number of model fit statistics. RESULT : Of the 15.1% (n=540) who had visited a dentist in the past-year, 54.1% (n=312) were satisfied with the services received. Reasons for dissatisfaction included long waiting time (33.1%), painful procedure (13%) and rude staff (10.4%). Being of higher SEP was associated with reporting using private facility. Those who visited public facilities were more likely to have encountered a long waiting time, which in turn was associated with being more likely to report treatment as having been painful and reporting dissatisfaction. Long waiting times had the greatest direct effect on dental service dissatisfaction (β = -0.31). CONCLUSION : Improving waiting time is likely to be the major factor to help reduce socio-economic disparities in the quality of dental services experienced by South Africans.http://www.sada.co.zaam2017Dental Management Science

Piloting the community service attitudes scale in a South African context with matching qualitative data

INTRODUCTION : There is a need to measure the social accountability of dental students following service learning (SL) exposure. OBJECTIVES : To pilot the Community Service Attitudes Scale (CSAS) and to test its reliability in a South African context while matching CSAS findings with students’ perceptions of their SL experience. METHODS : Final year dental students at Sefako Makgatho University anonymously completed a modified version of the CSAS and submitted written reflections before and after SL exposure. Students also participated in two focus group discussions after exposure. Before and after CSAS data were statistically compared using t-tests. Qualitative data from the focus groups and reflective essays were matched against the findings of the CSAS. RESULTS : Students (n=41, 76% CSAS response rate) generally displayed positive attitudes towards communities in need, both before and after exposure (no statistical difference). The CSAS internal consistency was excellent (α = 0.96). Qualitative findings suggested a need for stakeholders’ involvement in the procurement of SL resources and in meeting community needs. There was tension between SL and quota-driven dental training. CONCLUSION : The CSAS showed good reliability and appears a useful tool to measure social accountability in South Africa. The qualitative findings need further investigation.http://www.sada.co.zaam2017Dental Management Science

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Early-phase dental students' motivations and expectations concerning the study and profession of dentistry

This study investigated the career choice and aspirations of early phase dental students in the four dental schools in South Africa, namely the University of the Western Cape (UWC), University of the Witwatersrand (Wits), University of Limpopo (Medunsa) and University of Pretoria (UP). Willing participants completed a self-administered questionnaire (n=184). Motivations for entering a dentistry programme were similar across race and university, with wanting a secure job most often stated as an important factor. For a third of respondents, dentistry was not a first choice. Amongst the White students, it was a first choice for 82% compared with 59% amongst Black Africans. Expected income five-years after graduation also differed significantly across race and university, with White and UP students expecting to earn considerably higher than the others. About 36% of students were concerned about the levels of personal debt related to studying, with the White and Asian students less concerned. Those who expected lower levels of income from the profession were more concerned about personal debts. Most students planned to enter general dental practice (GDP) after community service, almost all White and Wits students expressed this intention, compared with only 35% of Black Africans and 39% of Medunsa students. Orthodontics and Maxillofacial & Oral Surgery were the most popular specialities of choice. The professional attribute "Has a friendly manner and good relationship with patients" was ranked high most often. In conclusion, career advice may not need to be tailored differently for the different racial groups. There is however a need for further investigations on how to address the concerns of financial security which may be realised by the practice of dentistry, and in particular the racial disparities observed in expectations of the profession. This study further highlights the need for government financial assistance for students from under-represented groups.R Lalloo, OA Ayo-Yusuf, V Yengopa

Establishing a Health Promotion and Development Foundation in South Africa

South Africa has a ‘quadruple burden of disease’. One way to reduce this burden, and address the social determinants of health and social inequity, could be through health promotion interventions driven by an independent Health Promotion and Development Foundation (HPDF). This could provide a framework to integrate health promotion and social development into all government and civil society programmes. On priority issues, the HPDF would mobilise resources, allocate funding, develop capacity, and monitor and evaluate health promotion and development work. Emphasis would be on reducing the effects of poverty, inequity and unequal development on disease rates and wellbeing. The HPDF could also decrease the burden on the proposed National Health Insurance (NHI) system. We reflect on such foundations in other countries, and propose a structure for South Africa’s HPDF and a dedicated funding stream to support its activities. In particular, an additional 2% levy on alcohol and tobacco products is proposed to be utilised to fund the HPDF.DHE

Establishing a health promotion and development foundation in South Africa

South Africa has a 'quadruple burden of disease'. One way to reduce this burden, and address the social determinants of health and social inequity, could be through health promotion interventions driven by an independent Health Promotion and Development Foundation (HPDF). This could provide a framework to integrate health promotion and social development into all government and civil society programmes. On priority issues, the HPDF would mobilise resources, allocate funding, develop capacity, and monitor and evaluate health promotion and development work. Emphasis would be on reducing the effects of poverty, inequity and unequal development on disease rates and wellbeing. The HPDF could also decrease the burden on the proposed National Health Insurance (NHI) system. We reflect on such foundations in other countries, and propose a structure for South Africa's HPDF and a dedicated funding stream to support its activities. In particular, an additional 2% levy on alcohol and tobacco products is proposed to be utilised to fund the HPDF.

IARC perspective on oral cancer prevention

An expert panel review of strategies for preventing oral cancer report that the use of tobacco (both smoking and smokeless), areca nut exposure, and heavy alcohol consumption are major contributors to this illness