Assessment Of Level Of Oral Health Education And Status For People Living With Hiv And Aids At Mbagathi District Hospital Comprehensive Care Centre Nairobi, Kenya

Abstract

Background: The aim of oral health education programmes is to strengthen disease prevention and oral health promotion worldwide. It is very important particularly among those who are living with chronic ailments some of which are precursors to oral health diseases and the vulnerable in the communities. The outcome of an effective oral health education programme is improved oral health knowledge, hygiene, and positive attitude and practices. The overall result is improved oral health status and decreased oral diseases particularly dental caries and periodontal diseases. Human Immunodeficiency Virus (HIV) is a chronic infection which leads to reduction in the body’s immune response thereby exposing the affected individuals to a higher risk of opportunistic infections. Previous studies have shown that PLWHIV and AIDS have higher prevalence and severity of oral diseases compared to their healthier counterparts. The incidence increases particularly when the oral hygiene practices are poor. Increased oral health knowledge will lead to improved oral health practices and attitude change with ultimate resultant in better oral health and general health, in particular among those living with chronic conditions. Provision of oral health education regularly and effectively is one way of attaining good oral health in particular among those who live with chronic illnesses and even the entire population at large. Objectives: To assess the level of oral health education and oral health status among PLWHIV and AIDS at Mbagathi District Hospital Comprehensive Care Clinic (CCC), Nairobi Kenya. Design: This was a descriptive cross-sectional study. Study Area: Mbagathi District Hospital CCC, Nairobi, Kenya. Subjects: The study participants were PLWHIV and AIDS attending a CCC. A sample of 246 subjects was derived using the prevalence of oral disease quoted in a study among PLWHIV and AIDS. Sampling method: Systematic sampling method was employed. Instruments: Questionnaires and clinical oral examinations. Tools: Modified World Health Organization (WHO) oral health assessment questionnaires to determine level of oral health knowledge. This was also used to measure the level of oral health education provided either at the CCC or any other source. An oral examination was carried out to determine oral health status. Data analysis: Descriptive statistics were used to summarise the data. Frequencies of all the variables were generated and used for checking outliers. The level of oral health education was determined from knowledge, attitude and practices on oral health. Oral health status was determined through oral health examinations. Student’s t-test and Fisher’s –F test were used in analyzing the data. Simple linear regression test was used to determine the correlation between gingival bleeding and other related variables. Significance level was denoted at 5% level. Results: Level of oral health education: Knowledge on, food stuffs and their effect on teeth, tooth brushing and use of toothpaste was 91.1% among the study participants. Other additional information such as why or when and what to use for tooth brushing besides toothpaste was 18.3%. Knowledge on the causes of gingival bleeding and their prevention among the study participants was 10%, even though bleeding gums was perceived as unhealthy. Formal education had a direct relationship on the level of oral health information. The information on whether oral health had an impact on general health was 18.9%. Effect of HIV infection on oral health was 10%. Regular visits to the dentist for normal dental check-ups were 18.9%. Regular use of antiseptic mouth wash was 12.2%. Sources of oral health information varied widely from seminars, parents, print media and schools. Pain was the commonest complain and also the reason for visiting the dentist among the study participants. Treatment modalities for pain relief varied from visiting dentist, self-administered treatment through use of homemade remedies and visiting general health worker at the nearest health facility. Oral health status: The older age groups had higher mean plaque score 0.73 compared to younger age groups with a mean 0.12. Those with secondary level of education and above were found to have better plaque score 0.16 and 0.33 compared to those with no education 0.40 and with primary level 0.38. With regard to gingival inflammation and other personal characteristics, plaque score impacted gingival inflammation more than the others. Other oral mucosal lesions were commonly discolouration of the palate and ulcerations on the mucosa and the lips. Caries experience (DMFT) was related to gender, age and level of formal education of the participants. Overall DMFT was 3.59. Conclusion: The current study revealed minimal knowledge on oral health conditions and causes or prevention of oral disease. This resulted in poor oral health practices among PLWHIV and AIDS at Mbagathi District Hospital CCC. Lack of strict oral hygiene practices was common among the study participants. Poor oral health seeking behaviours and failure to recognise impact of oral health on general health was eminent. A high caries experience (DMFT) and failure to seek oral health care appropriately was also noted. This may be as a result of lack of effective oral health education and promotion regularly among PLWHIV and AIDS. Recommendations: There is need for regular promotion of oral health through oral health education tailored to improve oral health knowledge, attitude and practices among PLWHIV and AIDS by the health care providers at the CCC. Inclusion of oral health education in training packages for the health workers to be considered by NASCOP. The Impact of HIV and AIDS on oral health and the resultant impact of oral health on general health should be emphasized. Proper oral health care should be through oral health education to ensure good oral hygiene practices and reduction in oral diseases. Oral health seeking behaviour and practices should be improved among PLWHIV and AIDS. Use of simple home made remedies like warm salt water as antiseptic mouth gurgle and use of available tooth stick (mswaki) to brush teeth properly should be encouraged among those who cannot afford toothpaste and tooth brush. Other methods of providing oral health education such as electronic media, radio, and teachers/schools should be considered for effective oral health promotion. Use of bill boards and brails for the deaf and visually impaired should be considered. More visits to the dentist should be encouraged for regular dental check ups, early diagnosis and effective treatment. There should be more resource allocation for prevention of oral diseases instead of the current trend where more resources are provided for curative purposes. Routine oral health education among PLWHIV and AIDS at Mbagthi District Hospital CCC may lead to improvement of oral knowledge and practices.