A pre and post-test assessment of oral health intervention: caregivers’ knowledge and attitudes at long-term care facilities in the eThekwini district, KwaZulu-Natal.

Oral health remains a neglected aspect of health care among vulnerable populations residing at long-term care facilities. Routine oral health education and training for caregivers have the potential to improve oral health provision. Aims and Objectives To determine the effect of an oral health intervention on caregivers’ knowledge and attitudes. Methods This exploratory study utilised a pre/post-test assessment approach. A total of participated. A pre-test questionnaire was distributed among 145 caregivers from seven long-term care facilities in eThekwini district. An online oral health educational intervention was implemented four weeks later. Six months later, a post-test questionnaire was administered. A Mann-Whitney test and paired sample test were used for statistical analysis. p<0.05 was considered statistically significant. Results Participants (n=19; 13.1%) reported that brushing twice a day and flossing were the two most important dental habits in the pre-intervention phase, compared to 71% (n=103) in the post-intervention phase. Caregivers (n=124; 85.5%) in the pre-intervention phase reported to feel that they should be trained in providing oral health care, compared to 93.8% (n=136) in the post-intervention phase. Conclusion The oral health intervention had a positive effect on caregivers’ knowledge and attitudes. This finding necessitates routine oral health education and training for caregivers

Orthodontic status and treatment need of 13 to 15 year-old children in Kwa-Zulu Natal South Africa: An epidemiology study using the Dental Aesthetic Index (DAI)

The prevalence of malocclusion among school going children in KwaZulu-Natal remains poorly defined despite the known physiological and psychological impact of this dental occurrence. The aim and objectives of this study was to determine the prevalence of malocclusion and possible treatment need in 13-15 year-old school going children in Durban, Kwa-Zulu Natal. This was a descriptive, cross-sectional epidemiological study conducted on 270 school-going children aged 13 to 15 years, in the Umlazi and Pinetown school districts. A two-staged clustered and systematic random sampling technique was used to draw the study sample. Data was collected through an intraoral examination of occlusal status and the malocclusion and orthodontic treatment need was assessed through use of the Dental Aesthetic Index (DAI). Questionnaires were developed to collect information on the learners’ health status and socio demographic profile. The results indicated that 144 (53.3%) of the 270 learners had DAI scores <25 (no abnormality or minor malocclusion not requiring orthodontic treatment); 26 learners (9.6%) had DAI scores of between 26-30 (definite malocclusion requiring elective orthodontic treatment); 59 learners (21.9%) had DAI scores of between 31-35 (severe malocclusion requiring orthodontic treatment); and 41 learners (15.2%) had DAI scores >36 (very severe or handicapping malocclusion requiring mandatory orthodontic treatment). There was an increase in the proportion of malocclusion in older children. The age group of 15 years old had a mean and standard deviation of 30.02+8.9 when compared to the age group 13 years old (27.76+12.17). The association between gender distribution and severity of malocclusion was found to be statistically significant (p=0.01). The present study primarily indicated a significant prevalence of malocclusion in the identified children. Although 53.3% of children did not require treatment, 37.1% presented with severe and handicapping malocclusion. This suggests a definite and mandatory treatment need for this group of children. The study could provide useful baseline epidemiological data that could inform oral health planning on the prevalence of malocclusion and orthodontic treatment need for 13-15 year-old school going children in the identified geographical area

Voluntary Counselling and Testing for HIV in the dental setting: Knowledge, attitudes and practices of oral health care workers in eThekwini district, KwaZulu-Natal

Oral health care workers are frequently at the forefront in recognizing oral manifestations of the Human Immunodeficiency Virus (HIV) and can therefore play a key role in screening and early detection of HIV in dental patients. This study assessed oral health care workers’ knowledge, attitudes and possible practices in Voluntary Counselling and rapid HIV testing (VCT) in the dental workplace in eThekwini district, KwaZulu-Natal so as to determine their understanding and support for these services. This was a cross-sectional, descriptive study. A total of 120 questionnaires were distributed to oral health workers located in private and public dental settings in eThekwini district. One hundred (n=100) completed questionnaires were retrieved, yielding a response rate of 83%. The majority of participants (82%) reported that HIV testing and counselling did not occur in their workplace. Participants (87%) also indicated to have not been trained to perform HIV testing. Sixty-six participants (66%) reported willingness to implement HIV testing in their respective dental workplace. Less than half of the study population (41%) were “unsure” regarding the accuracy of rapid HIV testing. Participants reported inadequate knowledge and practice of VCT. Participants had positive attitudes towards VCT implementation in the dental setting, provided that adequate training and support was available from the Kwa-Zulu-Natal Department of Health. Rapid HIV testing, dental workplace, oral health care workers

Self-reported oral health status: Perspectives of patients undergoing therapy for cancer of the head and neck region, in the eThekwini District, KZN

There is a dearth of published evidence related to understanding oral health needs for patients undergoing therapy for cancer of the head and neck region in South Africa. This study aimed to assess perceived oral health status of patients undergoing therapy for cancer of the head and neck region, in eTthekwini district, KwaZulu-Natal. This was a cross-sectional case study using quantitative data to determine patients’ perspectives of oral health status and need. The study population comprised 235 voluntary patients (aged between 20-70 years old), undergoing treatment or follow up for cancer therapy of the head and neck region, in a public tertiary referral hospital in the eThekwini district, KwaZulu-Natal. Purposive sampling technique was used for participant selection. The research instrument comprised a combination of two previously validated questionnaires: a core questionnaire (EORTC QLQ-C30, Version 3.0) and the head and neck cancer specific module (EORTC H&N-35). Data was analysed using the statistical package for software sciences (SPSS), version 24. More than half of the study population were male (60%;n= 141). The mean age was 54.38 (SD= 12.30). The results indicate that 14.5% (n=34) were employed, 46.4% (n=109) were unemployed because of cancer and 39.1% (n=92) were unemployed due to other reasons (old age, housewife). Oral cavity cancer was the most common (n=91; 38.7%), followed by laryngeal cancer (n= 53; 22.6%) among all the other head and neck cancers. Males(n=50; 21.3%) were more affected by oral cavity cancer as compared to females (n=41; 17.4%). With reference to treatment, 20.4% (n=48) were on radiotherapy, 28.5% (n=67) were on chemotherapy and 9.8% (n=23) were on CCRT, 17.4% (n=41) had surgery, 8.5% (n=20) were recently diagnosed with cancer of the head and neck and 23.4% (n=55) were on follow up. Oral health-related symptoms were experienced to varying degree by the participants. The majority of participants (n=125; 53.2%) did not report any pain and discomfort. More female participants (n=7; 7.4%) in the age group of 41-60 reported of severedifficulty in swallowing liquids than males of the same age group. Most participants (n=148; 63.0%) had difficulty in swallowing solid foods. Similarly, the majority of participants experienced problems with their teeth (n=162; 69.0%), reported xerostomia (n=159; 67.7%). With reference to trismus, a higher proportion of females (n=27; 28.7%) reported severe trismus compared to male participants (n=33; 23.4%). With reference to increased viscosity of saliva, 34.0% (n=32) of females reported extremely sticky saliva as compared to 29.8% males (n=42)

Isolation of selected possible aerobic bacterial pathogens from dental environmental surfaces after use of disinfectants - A case study at a public dental clinic, in KwaZulu-Natal

Cross infection in the dental clinical environment remains a low priority in conversations around oral health care despite the high risk of exposure to blood and airborne infections. The aim of this study was to determine the presence of selected pathogens after use of disinfectants on specific dental environmental surfaces at a public oral health facility in KwaZulu-Natal. This was a cross-sectional descriptive case study with a non-experimental design. The dental clinical environment was divided into four zones and 9 dental units were systematically selected. Swabs were collected from the 26 identified areas at specific time intervals (7.00, 9.00, 11.00, and 16.00) after the use of chlorine, ethanol (70% in water) and glutaraldehyde (2%) as surface disinfectants. The collected swab samples were cultured in nutrient agar media for two days at 37°C. The colony forming units were then examined and characterized using the MALDI-TOF spectrometer. Out of the 312 samples taken, 262 (84%) were shown to be bacterial culture positive. The most contaminated areas in the dental environment were around the chair area (86.53%) and the area away from the chair (92%). Glutaraldehyde was found to be more effective than chlorine and ethanol. The study suggests an association between the frequency of cleaning, the type of disinfectant used and the bacterial microbial count on the specified dental environmental surfaces at the identified oral health facility

Oral health care for patients undergoing therapy for head and neck cancer in KwaZulu-Natal, South Africa - A qualitative study

BACKGROUND: There is limited published evidence in KwaZulu-Natal on access to oral health care for patients undergoing cancer therapy in the head and neck region. OBJECTIVES: This study aimed to assess patients' oral health-related perceptions, practices and needs during cancer therapy. METHODS: This was a descriptive case study. A semi-structured face-to-face interview was conducted with volunteers (n=12) undergoing cancer therapy in head and neck region. Purposive sampling was used to select study participants who were recruited from a public tertiary central referral hospital in KwaZulu-Natal. A semi-structured interview was also conducted with the eThekwini district coordinator for oral health services to gain better insight into oral health service delivery for patients with special needs. RESULTS: The results indicated that oral health care in the sample population was not prioritised. Some of the emergent themes included: participants' knowledge and oral health self-care practices, support for participants to cope with head and neck cancer, barriers in accessing facility-based oral health care (poor access to dental services, failure of the local clinic to provide appropriate care), lack of referral by oncology care practitioners for patients to access dental care, and existing gaps in oral health service delivery The reported non-existence of a specific oral health policy to address cancer and the absence of a risk factor intervention program highlighted some of the shortcomings for quality oral health service delivery in this population group. CONCLUSION: The results indicated that oral health care is important for patients undergoing cancer therapy. There is an urgent need for oral health planning in the province to take into account the specific oral health needs of this vulnerable population

Prevalence of dental caries among learners with disabilities attending special education schools in the eThekwini District, KwaZulu-Natal

IntroductionIndividuals with special healthcare needs may have poororal health as a result of systemic and structural issues that make it more difficult to maintain optimal oral healthstatus. As such, these individuals may require specialised, multidisciplinary oral healthcare. Furthermore, determiningthe severity of oral conditions among these people isnecessary to establish the number of people affected and the services required to improve oral healthcare for these affected populations. Aims and objectivesTo determine the prevalence of dental caries among learnerswith disabilities attending special schools education in theeThekwini district, using DMFT/dmft and PUFA/pufa indices.DesignA cross-sectional descriptive study design.MethodsA proportional stratified random sampling method was usedto select learners from 22 special schools in the eThekwinidistrict (n=435). The sample was divided into subgroups known as strata (schools) and a systematic sampling technique was used in each school. The learners were further categorised according to the classification of Special Health Care according to the Individuals with Disabilities Education Act (IDEA). Data collection comprised an intraoral examination to determine the prevalence of dental caries (using the DMFT/dmft index) and the extent of untreated dental caries using the PUFA/pufa index. ResultsOut of the 488 students in the special schools approached, 435 consented to participate in the study giving a response ate of 89.14%. The prevalence of dental caries in the permanent and primary dentition was 53.6% and 22.5% respectively. The overall D (decayed) component recorded in permanent teeth was 740 (88%), the F (filled) component was 30 (4%) and M (missing) component was 77 (9%). Females had higher mean DMFT and PUFA scores while males had higher dmft and pufa scores. The DMFT and dmft scores recorded were highest in the 18-20 years age group at 3.70 ± 3.83 and the 6-8 years age group at 4.31 ± 4.00 respectively. The relationship between the DMFT and dmft scores and participants’ age was seen as statistically significant, as these increased with age (p <0.001). The highest caries prevalence was found in the intellectual disability group (46.4%; n=393). The “untreated caries to PUFA ratio” was 2.5 to 1, indicating that 26% of the D + d component (in DMFT/dmft) had progressed mainly to pulpal involvement. The PUFA/pufa scores were higher in the 12- 14 years age group at 0.46 ± 1.33 and 6-8 years age group at 2.06 ± 3.45 respectively when compared to the other age groups in the study sample.ConclusionThe high number of dental caries recorded in the permanent and primary dentition and the low number of restored teeth in the study sample highlight the need for promotive, preventive and restorative oral healthcare programmes within this population

Students’ knowledge, attitudes and practices related to infection control in undergraduate dental clinical training during COVID-19 A report from one South African university

The COVID-19 pandemic has highlighted the need for renewed conversations in infection control in the context of dental undergraduate learning. This study set out to examine dental therapy and oral hygiene students’ knowledge, attitudes and practices related to infection control.This quantitative survey was conducted at one dental training site in South Africa. The study population comprised 156 full time enrolled students that was stratified into Year 1 (n=55), Year 2 (n=54) and Year 3 (n=47). An online, self-administered questionnaire with closed and open-ended questions was used to collect information. Data were analyzed using SPSS version 25.0 (IBM Corp., USA) and thematic analysis. The response rate for the study was 70.5% (n=111).Almost all participants (n=104) strongly agreed/agreed that COVID-19 is transmitted mainly through infected droplets. Most participants (Year 1: n=24, 22.5%; Year 2: n=28, 26.2%; Year 3: 22, 31.2%) strongly disagreed / disagreed that younger people were less susceptible to contracting COVID-19 disease. While 23 first (21.5%) and 16 second-year students (14.9%) strongly agreed/agreed that personal protective gear was sufficient protection against COVID-19, about 16 third-year students (14%) were unsure or disagreed. Almost all participants (n=105, 98.1%) strongly agreed/agreed to washing or sanitizing their hands regularly. The emergent themes from qualitative data analysis included: better access to resources and more coordinated planning for clinical and classroom-based learning. There were inconsistencies in participants’ knowledge and attitudes towards infection control. There is a need for ongoing awareness of infection control in both clinical and class-room based learning

It’s all about trust : reflections of researchers on the complexity and controversy surrounding biobanking in South Africa

CITATION: Moodley, K. & Singh, S. 2016. It’s all about trust: reflections of researchers on the complexity and controversy surrounding biobanking in South Africa. BMC Medical Ethics, 17:57, doi:10.1186/s12910-016-0140-2.The original publication is available at https://bmcmedethics.biomedcentral.comENGLISH SUMMARY : Background: Biobanks are precariously situated at the intersection of science, genetics, genomics, society, ethics, the law and politics. This multi-disciplinarity has given rise to a new discourse in health research involving diverse stakeholders. Each stakeholder is embedded in a unique context and articulates his/her biobanking activities differently. To researchers, biobanks carry enormous transformative potential in terms of advancing scientific discovery and knowledge. However, in the context of power asymmetries in Africa and a distrust in science born out of historical exploitation, researchers must balance the scientific imperative of collecting, storing and sharing high quality biological samples with obligations to donors/participants, communities, international collaborators, regulatory and ethics authorities. To date, researcher perspectives on biobanking in South Africa have not been explored and documented. Methods: In-depth qualitative interviews were conducted with a purposive sample of 21 researchers – 8 in the Western Cape, 3 in Gauteng and 10 in Kwa-Zulu Natal. Interviews lasted approximately 40–60 min and were audiotaped with consent. Thematic analysis of the transcribed interviews was conducted by the co-authors. Results: Researchers articulated serious concerns over standardised regulatory approaches that failed to consider the heterogeneity of biobanks. Given that biobanks differ considerably, guidelines and RECs need to stratify risk accordingly and governance processes and structures must be flexible. While RECs were regarded as an important component of the governance structure researchers expressed concern about their expertise in biobanking. Operational management of biobanks was regarded as an ethical imperative and a pre-requisite to building trust during consent processes. While broad general consent was preferred, tiered consent was thought to be more consistent with respect for autonomy and building trust. Material Transfer Agreements (MTAs) were often lacking when biosamples were exported and this was perceived to impact negatively on trust. On the other hand, researchers believed that authentic community engagement would help to build trust. Conclusion: Building trust will best be achieved via a system of governance structures and processes that precede the establishment of a biobank and monitor progress from the point of sample collection through to future use, including export. Such governance structures must be robust and must include comprehensive national legislation, policy and contextualised guidelines. Currently such governance infrastructure appears to be lacking in many African countries including South Africa. Capacity development of all stakeholders including REC members will enhance expeditious and efficient review of biobanking protocols which in turn will reinforce trust in the researcher-donor relationship. Science translation and community engagement in biobanking is integral to the success of biobanking in South Africa.https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-016-0140-2Publisher's versio