Determinants of the Utilization of Oral Healthcare Among Female Caregivers of Children With Hiv/aids in Nairobi City County, Kenya

Abstract

This thesis presents the findings of a study on determinants of the utilization of oral healthcare among caregivers of children with HIV/AIDS in Nairobi City County. The central problem of the study were the issues associated with the utilization of oral healthcare for children with HIV/AIDS, who suffer a preponderance of oral manifestations, and whose need for oral healthcare may be greater than the general population. The study was concerned that, despite the problem of high prevalence of dental caries being noted among children with HIV/AIDS, for a variety of reasons, these children continue to face limited access to oral healthcare. The general objective of the study, therefore, was to explore the ways in which individual and societal factors influence female caregivers in utilizing oral healthcare for children with HIV/AIDS in Nairobi City County. Specifically, the study sought to determine the influence of caregivers’ oral health perceptions and cultural beliefs, the impact of socioeconomic factors, and the significance of structural factors in the utilization of oral healthcare. The study was guided by the health services utilization model. The study was hospital-based and was both exploratory and cross-sectional by design. It was carried out among 221 female caregivers of children with HIV/AIDS attending the HIV-care clinics at Getrude Children’s Hospital, Kenyatta National Hospital, and Mbagathi County Referral Hospital. The findings of the study indicate that, one, caregivers have prevailing perceptions and cultural beliefs about oral health and illness management which are holistic and woven into the social and cultural fabric of their daily lives and influence the utilization of oral healthcare. Two, the socio-economic circumstances of the caregivers such as low income levels and lack of social health insurance have a compounding effect on the low utilization of oral healthcare for children with HIV/AIDS. Finally, structural factors and characteristics of the healthcare system are significant in selecting an oral health provider; caregivers weigh out cheaper options on user-costs and prices of care, geographic service location, health workers attitudes, and waiting time at the respective health facility. It can, therefore, be concluded that a caregiver’s decision to utilize oral healthcare is a composite of perceptions and cultural beliefs on oral health and dental illnesses, effect of contextual societal factors, and innate characteristics of the healthcare system. The study found that caregiver’s measures of oral health needs are based on individual conceptions of oral health and perceptions of severity of disease and this is threatened by limited oral health literacy and lack of basic oral health information. Additionally, the caregivers perceive the cost of services and access to oral healthcare to be prohibitive and this, coupled with low enrollment with social health insurance, constitutes major barriers to the timely utilization of oral healthcare for children with HIV/AIDS. The study, therefore, recommends that, one, the National government considers greater subsidy on social health insurance for low-income earners and pro-poor payments, to enable those in the informal sector with irregular incomes benefit from public health insurance. Two, the County government establishes satellite dental health facilities closer to the people to reduce the distances of travel to regulated oral healthcare providers. Finally, there is need for collaborative research and development of innovative models that support oral health services for children with HIV/AIDS within the context of their caregivers’ cultural construction and comprehensive healthcare.