Dentistry

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An analysis of methods used by African Traditional Health practitioners to treat oral health conditions in Johannesburg, Gauteng.
(2020) Modisha, Mangoedi Kinder Ingridh.; Muslim, Tufayl Ahmed.; Muslim, Tufayl Ahmed.
Background African traditional medicine is widely used in South Africa. African traditional health practitioners treat patients who present with a variety of medical conditions, including oral health conditions. The aim of this study was to determine the knowledge, and practices of African traditional health practitioners regarding oral health conditions. Materials and Methods A cross-sectional survey of 11 African traditional health practitioners who consented to be interviewed in the Johannesburg area was recruited to participate in a structured questionnaire survey, followed by focus group interviews with 10 practitioners. Ethical approval was obtained from the Biomedical Research Ethics Committee (BREC ref. no 451/19). Following the collection of data from the questionnaire administration, a focus group interview was conducted. Data on the knowledge, treatment practices, and post-treatment management of four common oral conditions was collected and analysed. Results Eleven participants who consented to be interviewed, their average age was 44.1 (±8.1) years, with a range of 21-67 years, and a slight majority of female (55.5%, n=6). Ten further participants took part in focus group interviews. African traditional health practitioners were asked a series of questions, in non-dental terminology or language, related to their knowledge (causes); practise (what do you use to treat?, What advise do you give to the patient?); of four common oral health conditions. These are: sores on the lips, sores on the tongue, swollen gums and toothache. Participants reported using a variety of practices such as throwing bones, burning incense, using plants and animal product, as well as commercially manufactured products to treat and manage patients. Conclusion The results of the study reveal that there are vast differences in knowledge, management practices and treatment modalities of African traditional healthcare practitioners. Further research in the knowledge, practises and treatment of oral healthcare practitioners needs to be conducted. Mutual cooperation, collaboration and integrating African traditional health practitioners into primary oral healthcare services need to be urgently prioritised.
Assessment of the educational needs and services available in cleft /lip palate and craniofacial anomalies management in South Africa.
(2020) Ghabrial, Emad.; Butow, K. W.
ABSTRACT Background Since the 1960s, South Africa has been providing multidisciplinary treatment for children with cleft lip and/or palate (CLP) and craniofacial anomalies (CFA) (Marks, 1960). Currently, the standard for best practice (ACPA, 2017) regarding cleft lip/palate and craniofacial anomalies focuses on oral function, improved appearance, and normal speech. Therefore, American cleft palate association recognize the core of the cleft palate team comprises maxillofacial and oral surgeons (MFOS), orthodontists (Orthod), plastic surgeons (PS), and speech-language therapists (SLT). Cleft lip/palate and craniofacial anomalies vary in severity and facial growth patterns, and treatment is complex and lengthy. Therefore, it requires collaboration among different disciplines, with the aim of reaching the treatment goals of good facial growth, aesthetically acceptable appearance, and dental occlusion. Consequently, it becomes increasingly important to provide adequate training for these professionals, to empower them not only to provide efficient treatment, but also to assume leadership roles in this field. This is the first study ever to include all four disciplines. Objectives To obtain information regarding the CLP/CFA academic education of MFOS, Orthod, PS and SLT; the services that those practitioners offer to CLP/CFA patients; and the educational and training needs in this field. Methods A 51-item online survey questionnaire was used to collect quantitative data of a randomised sample of professionals from the four disciplines: MFOS, Orthod, PS and SLT. The study was introduced to the participants by means of a telephone call and they were given the option to record their responses or to send the online questionnaire by email. For the orthodontists, the data was collected during their annual scientific congress by two students using an iPad. Results The questionnaire was completed by 46,3% of MFOS, 41% of Orthod, 46,5% of PS and 18,83% of SLT who are registered on the Medpages database. Although 42,6% of the participating MFOS, 92% of Orthod, 41,6% of PS, and 42,7% of SLT indicated that they provide treatment and intervention for CLP/CFA patients, only a few felt confident to provide such services. The study shows that professionals are treating patients beyond their competence, which could result in poor outcomes and services. Most of the respondents agreed that there is a need to improve CLP/CFA education, and the majority recommended fellowship, sub-speciality training and/or certified courses. The minority suggested continuing-education workshops. Conclusion Most of the professionals who participated in this study provide treatment for both CLP and CFA patients, despite some of them lacking in confidence when treating such cases. The majority agreed that there is a strong need to establish an educational strategy to meet the needs of professionals who treat CLP/CFA patients. The respondents suggested dedicated programmes in the CLP/CFA field. The professionals recommended fellowship, sub-speciality training, certified courses, and continuing-education workshops.
A comparative analysis of oral healthcare policy development between a developed country (Australia) and a developing country (South Africa)
Muslim, Tufayl Ahmed.; Singh, S.
Introduction: Health policy analysis aims to explain the interaction between institutions, interests and ideas in the policy process in order to ensure the best possible health outcomes. Cross-national policy analysis of oral health policies can be undertaken using a conceptual framework, and the results of this analysis could allow for cross-national lessons to be learnt that could be used to improve policy processes. This could result in improved population oral health service delivery and health outcomes. Aim: To undertake a cross-national policy analysis of a developed country (Australia) and a developing country (South Africa) in order to highlight lessons that could be learnt to improve policy development, implementation, reform and service delivery, that could lead to improved oral healthcare policy-making and provision. Objectives: This study sought to develop, and apply, a conceptual framework to undertake a cross-national comparative policy analysis study of a developed country (Australia) and a developing country (South Africa). This developed conceptual framework would need to allow policy analysts to undertake a comprehensive comparative policy analysis that could lead to an understanding and contextualisation of the complex policy environments found in developed and developing countries. Methods: A cross-national policy analysis of oral health policies for the period 2001-2011 was undertaken. A policy analysis conceptual framework was developed and used to comparatively analyse the various constructs, policy influences and policy actors that were involved in oral health policy-making. Data from a desktop literature search, and key stakeholder interviews were comparatively analysed using thematic content analysis, and a Strengths, Weakness, Opportunities and Threats (SWOT) analysis was used to identify lessons in policy development, implementation and reform that could be applied cross-nationally. Thereafter a Systems Dynamic (SD) computer simulation model was constructed and applied cross-nationally to human resources for health forecasting in order to expound the use of SD modelling in policy development and reform. Results: The results revealed that both countries have policy development and implementation structures that are historically embedded within the countries unique social contexts, and offer lessons regarding their strengths and weaknesses that could be applied cross-nationally to improve healthcare policy-making and provision. The results of the document analysis, together with the interviews and literature review, were triangulated and comparatively analysed using the themes outlined in the conceptual framework. These results revealed that a general policy development theory could be formulated and modified to suit local conditions. The need for high-quality valid and reliable data was also highlighted. Another result is the need for the appropriate needs-based and equitable reallocation of resources in order to ensure a feasible and practical oral healthcare system. Conclusions: The lessons offered from the cross-national oral health policy analysis could be adjusted and implemented to both developed and developing countries in order to improve their oral health policy development, implementation and reform structures and processes.
Effectiveness of selected surface disinfectants in the dental clinic – a report from a tertiary training facility in KwaZulu-Natal.
(2016) Deulkar, Swati Ahay.; Singh, Shenuka.; Govender, Thavendran.
Optimal infection control practice forms the cornerstone of quality oral health care delivery in any dental setting. There is very little published evidence on dental infection control practices in South Africa. In addition there is a paucity of evidence that specifically examined the efficacy of commonly used surface disinfectants in oral health clinical settings. The aim of this study was to determine the effectiveness of selected surface disinfectants on specific dental environmental surfaces in an identified public oral health training facility in KwaZulu-Natal. The objectives included the identification and classification of environmental areas that are at risk for cross-contamination in the dental clinic, and comparison of the microbial count at specified times of the day after the use of three surface disinfectants. This was a prevalence (cross-sectional), descriptive research study with a non-experimental design. Data collection included the application of three commonly used surface disinfectants (Chlorine®, Ethanol and Glutaraldehyde) on identified dental environmental surfaces in a public sector dental clinic facility in KwaZulu-Natal. The clinic consists of seventeen dental units that are numbered from one to seventeen. Systematic random sampling technique was used to select selected every second chair for the study (Dental Unit number: number: 1, 3, 5, 7, 9, 11, 13, 15, 17). The dental clinical environment was then divided into four zones: 1): the working area around the dental operator/assistant (chair, head rest, arm rest, foot rest, dental hand pieces, overhead light source, air water syringe tip, spittoon, suction hose, based of dental chair, dental stool, foot control, instrument counter and handle); 2): the area behind chair (wash basin, computer monitor, window, wall, table top, dust bin and taps): 3): the area away from chair (computer processing unit, telephone and floor); and 4): the reception area (patient chairs and reception table top). The swab samples were collected at specific time intervals (7am, 9am, 11am, and at 16.00) using a charcoal swab. Chlorine, Ethanol (70% in water) and Glutaraldehyde (2%) disinfectants were applied separately on the identified nine dental units by using a spray method. Use of the MALDE-TOF spectrometer enabled the mass spectra to be acquired and the bacteria to be identified. Out of the 312 samples taken, 262 (84%) were shown to be bacterial culture positive. More than seven microbial species were identified in which staphylococci, Bacillus species and fungi were present. The most contaminated areas in the dental environment were the area around the chair (86.5 %) and away from chair (92%). The results indicate that Chlorine® was not active against several bacteria because 92% samples had positive growth at the end of the day. Only 56 % of the samples using Ethanol were positive in the morning but the microbial growth increased to 96 % by the end of the day. The use of Glutaraldehyde indicated that 52% of samples were positive at 9 am but that 82% were found to be positive at the end of day. The bacterial survival rate was found to be less with the use of Glutaraldehyde. The study suggests that there was an association between frequency of cleaning, the type of disinfectants used and the microbial count on the specified dental environmental surfaces in the identified oral health facility. The findings therefore indicate that disinfection processes at the identified dental centre are inadequate, sub-optimal and could contribute to the infection chain. There is an urgent need to review the current infection control procedures and protocols, including a review of the type of surface disinfectants used. The frequency of disinfection (damp-dusting and housekeeping) must be reviewed, given the number of patients that are seen on a daily basis. It is also important that simple procedures such as awareness of hand hygiene practices are implemented and prioritized. There should also be dedicated infection control monitoring and evaluation processes.
An exploration of community-based training opportunities for undergraduate dental therapy students at a tertiary institution in KwaZulu-Natal.
(2017) Moodley, Illanavathie.; Singh, Sanil Duleep.
Introduction Dental undergraduate education has received much attention in recent years with a shift from traditional dental school clinical training to community-based clinical training to develop competencies of a new dental graduate (Yip and Smales, 2000). A new dental graduate is competent if he/she can appropriately apply knowledge, clinical skills and professional attitudes in diverse work settings (Yip and Smales, 2000). In a traditional dental school hospital setting, the student gains competency through repetitive completion of clinical procedures and the patient is seen as meeting the educational needs of the student by keeping appointments for set dental procedures (Eriksen et al., 2008). While this type of education leads to mastery in technical skills, it is fragmented, rigid and incentive driven (Eriksen et al., 2008). It does not fully prepare dental professionals to meet the rigors and demands of a diverse work environment, managing multi-cultural communities with a range of oral health care needs (Yoder, 2006). The dental therapist, a mid-level oral health care practitioner, who provides basic preventive and curative dental care, receives a similar type of training. The training includes acquisition of professional knowledge and clinical skills through intense clinical training. Clinical training occurs in a hospital-based, dental school environment. This is a secondary care setting, however, a therapist is expected to work mainly in primary care settings, in diverse communities. This poses a problem for a newly qualified therapist to adjust to a work environment different from the training facility. A strategy that can facilitate the transition from a dental school environment to a work environment is to expose dental therapy students to primary care or community-based settings while in training (Yoder, 2006). Community-based dental education (CBE) is a pedagogical approach that allows a student to develop clinical skills in a community setting so as to contextualise undergraduate training within real world settings for the student dental therapist (Yoder, 2006). Competency is built through acquisition of clinical skills by experience and reflection, and the application of critical and creative thinking in solving clinical problems (Yip and Smales, 2000). In addition, students gain a better understanding of the social, psychological, cultural and economic factors affecting oral health (Yoder, 2006). Traditional dental school training occurs in isolation from other health professionals, yet upon graduation, health professionals are expected to work in collaboration with each other, in a team-based approach, for integrated patient care. Interprofessional learning among other student health professionals is well documented in the literature, however dental student participation is minimal. Thus, to foster dental graduates with skills and ethics and a sense of social responsibility, academic institutions training dental therapy students must create learning opportunities that can facilitate acquisition of these skills and values (Yoder, 2006). The University of KwaZulu-Natal, one of two universities in South Africa, training dental therapists, in line with its mission and vision of being socially accountable, is in the process of reforming health professionals’ education (University of KwaZulu-Natal, 2017b, Essack, 2014). The university calls for all disciplines training health professionals to adopt the Primary Health Care Model (PHCM) to align clinical training to the needs of the health system and for health professionals to be more responsive to the needs of communities (University of KwaZulu-Natal, 2017b, Essack, 2014). This model enforces and facilitates training of health professionals in community health centres, district and regional hospitals within the Department of Health (DoH). However, in expanding the clinical training platforms, it is important to first determine the capacity of various sites to support dental student training. It is also important to create interprofessional community-based learning opportunities and obtain the perspectives of students on integrating community-based education into the curriculum. The purpose of this study is to explore community-based learning opportunities for undergraduate dental therapy student training, test these opportunities, and then develop a framework that can guide curriculum planning and implementation of community-based training. Aim The study aims to strengthen community-based undergraduate dental therapy training at a tertiary institution through an exploration of learning opportunities in the public, private and non-governmental health sectors, using a self-developed conceptual framework to guide this process. Objectives The objectives of the study were to determine the intended role of community-based undergraduate clinical training within the College of Health Sciences through an engagement with relevant academic leaders using semi-structured interviews, to explore opportunities for interdisciplinary community driven initiatives for dental therapy students through focus group discussions with academics from the various disciplines in the School of Health Sciences, to identify support for interdisciplinary community-based clinical training in the public health sector through semi-structured interviews with relevant stakeholders within the KwaZulu-Natal Department of Health, to explore interdisciplinary community-based learning opportunities for dental therapy training through semi-structured interviews with key role players in the non-governmental sector in KwaZulu-Natal, to explore interdisciplinary community-based learning opportunities for dental therapy training through semi-structured interviews with relevant stakeholders in the private health sector, to explore final year dental therapy students’ experiences of community-based training through self-administered questionnaires, to determine the attitudes and perspectives of undergraduate Dental Therapy and Physiotherapy students participating in an interprofessional community-based health education programme through focus group discussions and to develop a conceptual framework to guide data collection and data analysis for community based training for undergraduate dental therapy students. Methods and Materials An in-depth exploratory study design was used to obtain a better understanding of the research phenomenon. The study used predominately qualitative methods to achieve the objectives, however, elements of quantitative methods were also used, to a lesser extent. As there were several objectives to this study, it was conducted in three phases to facilitate the data collection process. An explorative, descriptive study design, with mainly qualitative methods, was used to achieve the objectives in the first phase. To achieve objectives one and two, interviews and focus group discussions were used to collect the data. Four semi-structured interviews were conducted with key role players in the university, including the Dean and Academic leader of Teaching and Learning and two other senior academics, and focus group discussions with a purposively selected sample was used. The sample for the focus group included an academic from each of the eight disciplines, in the School of Health Sciences resulting in a final sample size of 12. To achieve objective three, semi-structured interviews were conducted with the Provincial Head of Oral Health Services and clinical managers of selected clinics and hospitals within the Department of Health to identify potential sites for student training. The sites were selected on the criteria that they had three or more consulting rooms to accommodate a small group of students and provided a full range of dental services within the scope of practice of a dental therapist. The final sample size included six community health centres and twelve hospitals. A data capture sheet was used to record the resources that were available at each site. The final sample size for the interviewees was 19, including the Provincial Manager and the 18 clinical managers from the selected sites. To achieve objectives four and five, semi-structured interviews were conducted with stakeholders within the private and non-governmental sectors involved in organising community-based health care initiatives. To select interviewees, three contacts within the non-governmental sector, known to the researcher, helped to identify further participants through the use of the snowball sampling method. The final sample size was nine, with eight from the non-governmental sector and one from the private sector. In the second phase, a descriptive study design, with elements of action research and qualitative methods was used to achieve objectives six and seven. The final year dental therapy students were exposed to community-based clinical training and their perspectives of the experiences were obtained using self-administered questionnaires. A total of 32 out of 36 final year students participated in the study. In addition, students from the Disciplines of Dentistry and Physiotherapy participated in an interprofessional activity, and their views on the collaboration, were also obtained using focus group discussions. Two focus groups discussion were facilitated separately for the students, the first with six dental therapy students and the second with five physiotherapy students. In addition a third focus group discussion was held with the academic and clinical staff at the community health centre, including two academics (one from each discipline, accompanying the students), three dental clinical staff and one physiotherapy clinical staff, giving a final sample size of six. This was conducted to obtain their perspectives of the student collaboration. Five patients, randomly selected, were also interviewed, for their opinion of a student intervention. The third phase involved developing a framework for interprofessional community-based training for dental therapy students using the data collected from phase 1 and 2. In the data analysis process, the qualitative and quantitative data were analysed separately. The interviews and focus group discussion were first transcribed verbatim and then cleaned. The transcripts were read several times to identify codes. Several codes were generated and linked together in axial coding, which were then selected and collated into large themes and sub-themes. The quantitative data obtained from the data capture sheets of the site inspections were analysed using quantitative analysis through a variety of statistical techniques. The data from each sheet was extracted and captured using Excel software. All the information was collated to form a comprehensive list of available resources. A descriptive statistical method was used to comprehend the data which was presented in the form of tables and graphs. The study was conducted following the ethical guidelines of the university. Ethics approval (HSS/1060/015D) for the study was obtained before commencing the study. Results Four main themes arose from the data analysis which were aligned to objectives one to seven. These themes included: benefits of community-based training, challenges experienced, learning opportunities for community-based training and the perceived barriers to implementation. The study findings indicated that there were several benefits. The academics participating in the study believed that CBE was beneficial to students, the institution, the health system and communities. They believed that students could improve proficiency and critical reasoning by being exposed to many patients. They could also learn to connect theory to practice. Academics in the study perceived that CBE was a means for the institution to implement its goal of high impact community engagement. Benefits to the health system included building sustainable partnerships, making health care more accessible to communities and aligning the health professionals training to the needs of the health system which could make them easily employable. They also believed that communities could benefit through improved service delivery and access to services that were not previously available. Student participating in the study believed that being exposed to community-based training improved their clinical skills and self-confidence. The dental therapy students, participating in the study, reported that they benefitted from collaborating with the physiotherapy students. They perceived a better understanding of the role of the other professional, the value of peer learning and a team approach to patient education and care. The results of the study showed that there were also several challenges to community-based training. These challenges were both internal and external, with the main internal challenge being an absence of a clear operational plan for implementation of CBE at discipline level and across disciplines. Other internal challenges included a lack of support from college leaders, cooperation of other academics and funding. External challenges stemmed from the training sites, such as clinical supervisors not having a clear understanding of their roles and responsibilities in student training and the lack of communication between the two institutions. The study showed that there were several opportunities for community-based training in the public, private and non-governmental sectors. Opportunities within the Department of Health included students training at nearby community health centres which could create real life learning situations where students spend a set time, on a continual basis, treating patients as they would in a workplace. The decentralised sites offered a sustained exposure over two weeks of work experience that could allow a student the opportunity to provide more comprehensive management of a patient through a follow-up appointment system. The non-governmental and private sectors offered many learning opportunities for students through their innovative means of service delivery such as a mobile health bus, a shipping container turned into a mobile clinic and classrooms in schools converted into makeshift clinics. In addition, there were also many interprofessional community-based learning opportunities for students such as integrating oral health into general health educational talks in school and clinic settings, joining existing community projects and being part of the rehabilitation team for stroke patients. The results of the study noted that barriers did exist in the implementation of interprofessional community-based programmes. Academics in the study sample, cited finding a common time on timetables to implement interprofessional activities and funding to be their main barriers, while clinical managers perceived clinical space to accommodate large numbers of students as their main barrier. In addition to the overall themes provided, the results were discussed in relation to each objective. Objective one intended to determine the role of CBE in student clinical training. The academics, participating in the interviews and focus group discussions in the study, recognised that CBE was a valuable pedagogical approach in contextualising clinical training in settings that match the health system. They perceived CBE as being beneficial at various levels; to students, the institution, the health system and communities. However, they believed that the biggest challenge was that there was no clear guidelines on how this process had be made operational and implemented at individual and across disciplines. Objective two explored opportunities for interdisciplinary community driven initiatives for dental therapy students. Findings linked to objective two showed that academics in the focus group discussions believed that students learning in an interprofessional manner had many benefits, such as an improved understanding of the scope of practice of other professionals so that could learn to refer patients appropriately in the future to provide an integrated patient care delivery. The study further indicated that there were several interprofessional learning opportunities for dental therapy students in various settings such as schools and primary health care centres. However, barriers to collaboration as identified by the focus group participants, were a mismatch in student numbers in trying to arrange equal opportunities for all students and time-table scheduling for interprofessional activities. The results related to objective three demonstrated that the sites within the DoH could provide conducive environments for contextual student learning. The site inspection of the 18 dental clinics within the DoH revealed that the clinics in general, provided the services within the scope of the dental therapist with the exception of three, not offering restorative procedures and one, not offering scaling and polishing. They also had the necessary consumables and equipment to provide these services. The only service lacking in some of the clinics was radiography as only 61% of the clinics had an x-ray machine. The clinical managers in the study sample believed that students could benefit from learning in a real world setting. They perceived that students could master dental procedures and participate in school health programs and mobile services. They perceived that students working in such an environment facilitated their transition into the work environment. The main problem, they perceived were that students might slow down the clinicians’ work progress. The study findings in relation to objectives four and five revealed that there were many private sector and NGO community-driven projects which could provide meaningful learning opportunities for student training. Study participants indicated that students participating in their projects could benefit by adapting to different environments and working with limited resources. They believed that students could learn to treat a patient with respect and empathy, irrespective of their social, economic and cultural background and gain a deeper understanding of societal needs that could inspire volunteerism and altruism. The results of objective six showed that the dental therapy students participating in the study, believed that working in community settings improved their clinical skills and increased their self-confidence. They perceived a better understanding of the social determinants of health, social inequalities, and diversity in cultures. The main challenge experienced, was the language barrier that hindered effective communication with patients. The findings of the study in relation to objective seven demonstrated students’ openness and readiness to participate in interprofessional activities. The dental therapy and physiotherapy student participants of the study indicated that they derived several benefits of the collaborative learning experience such as respect for the other professional, an improved understanding of the role of the other professional and appropriate referral patterns. The last objective was to develop a conceptual framework for community-based training for undergraduate dental therapy students. The framework was guided by combining the formal theory obtained from literature and the empirical research findings of objectives one to seven of the study. It comprised of five components; the education system, selection of sites, student engagement, graduate competencies and the health system. The framework had a strong theoretical foundation and demonstrated the value of informed research before implementing curricula changes and new teaching pedagogies. It further demonstrated the importance of obtaining students’ input in decision making processes involving curriculum development. The framework showed the potential of being transdisciplinary as it could be used by other disciplines in the School of Health Sciences and other universities in South Africa training dental therapists, to guide community-based planning and implementation. However, it was limited only to the context of interprofessional community-based clinical training without exploring learning opportunities for a common interprofessional, classroom-based, theoretical foundational component for community-based education. Conclusion This study showed that there were several opportunities for community-based training for undergraduate dental therapy students in the public, private and NGO sectors. By taking students out of a closed university, hospital-based training centre and placing them in community settings, clinical training is contextualised in real world settings. The study reported many benefits of community-based training that could lead to the overall professional and personal development of a dental therapy student, and were reported from both the students’ and academics’ perspectives. These benefits prepared them for the work environment that they would soon enter. Barriers in the implementation of interprofessional community-based programmes were also noted and this needed to be addressed for the successful implementation of community-based training. This study also demonstrated that there was a need for a deeper engagement with theory and practice in making changes to the learning process of students and to curriculum development. The framework that was developed offered a structure for the planning and implementation of community-based training. It demonstrated the importance of student and academic engagement before adopting this pedagogical approach. It emphasised the roles and responsibilities of the education and health systems, and through this collaboration with each other, could produce relevant health professionals, including oral health care professionals, who could competently provide care to patients in diverse communities. This study also initiates exploration of further engagement for opportunities in community-based training involving multiple disciplines.
Exploring oral antibiotic prescription patterns for the management of dental conditions at two public health institutions in Pietermaritzburg, KwaZulu-Natal.
(2020) Ramnarain, Prishana.; Singh, Shenuka.
Introduction: Oral antibiotics are typically prescribed for the management of dental conditions such as acute odontogenic and non-odontogenic infections, and as prophylaxis for patients such as those with infective endocarditis or placement of joint prosthesis. While these measures are intended to limit the spread of possible infection that could occur as a result of oral surgical procedures, very little is known about antibiotic prescription practices and trends for dental purposes, specifically in the public sector in KwaZulu-Natal. Study Aim and Objectives: The aim of this study was to determine patterns of oral antibiotic prescription for the management of dental conditions at public health facilities in the Pietermaritzburg complex so as to create practitioner awareness of the need for the judicious use of antibiotics. The study objectives were to determine patterns of oral antibiotic prescription for dental patients at the identified public health institutions; understand dental and medical practitioners‘ knowledge, attitudes and practices related to antibiotic prescription for dental conditions; and ascertain public health pharmacists‘ perspectives on these patterns of oral antibiotic prescription. Method: This study was divided into 3 phases and a combination of quantitative and qualitative data was collected. The research sites comprised two purposively selected public sector hospitals located in the Pietermaritzburg complex of UMgungundlovu district (Institution A and B respectively). In Phase 1, data collection comprised a retrospective clinical record review to determine oral antibiotic prescription patterns for dental purposes (n=720) at the two identified research sites during the period March 2012- July 2018. For Phase 2, a cross sectional study design was used. Purposive sampling was used to select the study sample comprising medical and dental practitioners (Group 1, n=123) and pharmacists (Group 2, n=25). A separate self-administered questionnaire was developed for each group. The questionnaires comprised open and closed ended questions that were designed to assess the identified health care workers‘ knowledge, attitudes and practices related to oral antibiotic prescriptions or dispensing for dental use; perceptions of therapeutic duplication of antibiotics, availability of laboratory information and recommendations for the improvement of oral antibiotic prescriptions. A Likert scale format was used to elicit responses such as 1 (Strongly agree), 2 (Agree), 3 (Not sure), 4 (Disagree), 5 (Strongly Disagree). For Phase 3, the qualitative data was derived from focus group discussions held with purposively selected health care practitioners at each institution (Institutions A and B). The study sample included health care practitioners (medical and dental practitioners) and pharmacists, involved in prescribing or dispensing oral antibiotics for dental purposes. Two focus-group discussions (FGDs) comprising six people per group at each research site, were set up. The quantitative data was analyzed using the Statistical Package for Social Sciences software (SPSS Version 25 R). Univariate descriptive statistics such as frequency and mean distribution and inferential techniques such as Pearson‘s Chi-Square test were conducted to determine a possible relationship between the independent and dependent variables. A p-value of 0.05 was established as being significant. The internal consistency of the questionnaire, according to the Cronbach alpha score, was 0.68. Validity of the questionnaire was maintained. The qualitative data (obtained from the focus group discussions) were analyzed using thematic analysis. All emergent themes were further analyzed to gain a better understanding of participants‘ perspectives related to oral antibiotic prescriptions for dental conditions. Credibility, conformability, transferability and dependability of the collected data were maintained to enhance rigor and trustworthiness in the qualitative component of the study. Results: The results of the retrospective chart review indicated that dental abscesses (n=479; 66%) were the most common dental condition for which oral antibiotic therapy was prescribed. There were inconsistencies in the pattern of oral antibiotic prescription for dental conditions between the two public health care institutions. At Institution A, antibiotic therapy was prescribed for dental conditions such as trismus (n=13; 6%), soft palate swelling (n=9; 4%), fibrous epulis (n=6; 3%) and acute herpes (n=2; 1%). Interestingly, oral antibiotics were not prescribed at Institution B for the same dental conditions. Antibiotic therapy was prescribed for eruption pain (n=4; 1%) and in cases where patients did not bring their inhaler for asthma treatment (pump) (n=3; 1%) at Institution B. For the self-administered questionnaire, the response rate for Group 1 (medical and dental practitioners was 77.5% (n=93). The response rate for Group 2 (pharmacists) was 92% (n=23). The majority of participants in this study (n=72, 77.4%) indicated awareness of an Antibiotic Stewardship Programme in their respective institutions yet 42 participants (45%) were not sure on whether the programme was active. More than half of the study participants (n=60, 64.5%) indicated referring to the Standard Treatment Guidelines „some times‟ when prescribing antibiotics. The majority of participants (n=72, 77.4%) indicated that they would prescribe antibiotics for orofacial swellings. Almost 33 participants (35.4%) stated that they would prescribe antibiotics for irreversible pulpitis. Almost 31 participants (88.9%) from Institution A and 40 (75%) from Institution B indicated prescription of antibiotics for pericoronitis. Similarly, 27 participants (76.9%) Institution A and 14 (72.1%) from Institution B would prescribe antibiotics for periodontitis. The majority of participants (n=80, 86%) agreed that there was need to improve antibiotic prescription processes. With regards to the prescription of oral antibiotics as prophylaxis for the prevention of infections such as infective endocarditis, the following responses were obtained. Almost 13% of respondents from Institution A reported prescribing PEN VK 250mg daily followed by Penicillins, Augmentin, Benzyl Penicillin, Clindamycin and Kefazol while 23% of respondents from Institution B indicated prescribing Amoxicillin 2g stat dose one hour before a dental procedure followed by Pen VK, Penicillin, Clindamycin, Benzyl Penicillin oral and intravenous, Benzatime Penicillin, Penicillin G and Vancomycin. More than two thirds of study participants in Group 2 (n=18; 78%) perceived a correlation between the dental condition and the antibiotic prescribed thereof. Participants (n=17; 73.9%) also believed that oral antibiotics were sometimes prescribed without any clinical indication. The following themes emerged from qualitative data analysis (focus group discussions): inconsistencies in antibiotic coverage for dental-related clinical management between the two sites. There was no consensus among research participants on the need for diagnosis laboratory testing to improve antibiotics prescription. However, all participants agreed that there is a need to improve antibiotic prescription in their various hospitals. Discussion: Overall the results of the study indicated inconsistencies in antibiotic prescriptions for dental conditions. This suggests that over and under prescribing may be occurring in the identified clinical settings. The most common dental infection in this study, requiring antibiotic therapy was dental abscesses (66%). While the recommended treatment of choice for the management of periapical abscess, periodontitis abscess and localized dentoalveolar abscess is incision and drainage (Kuriyama et al. 2005), Lalloo et al. suggested that practitioners might be following some personal or ad-hoc criteria in selecting when to prescribe antibiotics or not (Lalloo et al. 2017). Peric et al. also reported that antibiotics were prescribed as a precaution because of ‗uncertainty concerning the diagnosis, patient‘s expectations, unavailability of dental services and in short- term cases where there is insufficient time for doing any treatment‘ (Peric et al. 2015:111). Participants in this study also prescribed antibiotics for the treatment of alveolitis (dry socket) (15%). This finding is supported by a previous study done in England, Kuwait and Turkey where almost half of the study population (dentists) reported that they would prescribe antibiotics for dry socket treatment (Dar-odeh et al. 2010). Antibiotics were also prescribed for systemic conditions (10%) in this study. This finding is consistent with previous reviews that concluded patients with low immunity may be at higher risk of infection (Sidana et al. 2017). Interestingly, a pattern of antibiotic prescription emerged based on the clinical site where the respondent was located. According to Standard Treatment Guidelines 2018, the prescribed regimen should be as follows: Amoxil, oral, 2g one hour before the procedure. Respondents from Institution B appeared to adhere to the Standard Treatment Guidelines. This difference in prescription pattern for the same health condition, which was dependent on the clinical site, was an interesting observation. Additionally, only 65% of respondents referred to the Standard Treatment Guidelines. In contrast, a previous study reported that only 45% of practitioners adhered to the Standard Treatment Guidelines and Essential Medicines List in Primary Health Care settings in South Africa (Gasson 2018). In a recent South African study, it was also reported that dentists were aware of the treatment guidelines but few followed the recommendations for antibiotic prophylaxis (Mthethwa et al. 2018). More research is thus required to further understand these differences across clinical settings. On the other hand 78% of pharmacists perceived a correlation between the dental condition and the antibiotic prescribed for the dental condition. This is a significant finding as a previous study has shown that when the treatment guidelines are adhered to, the resistant micro-organisms reduce in numbers (Ntsekhe et al. 2011). Gutierrez et al. therefore, highlight the need for professional agreement and consensus building with regards to the conditions for antibiotic prescriptions (Gutierrez et al. 2006). Such efforts are also needed in a South African context to facilitate practitioner consensus building and ensure consistency in antibiotic prescription. Antimicrobial Stewardship and infection and prevention control teams could provide opportunities to augment prescribing practices and streamline this process (South African National Department of Health 2015). Additionally, there is need for continuing professional development so as to better equip health practitioners with updated knowledge on antibiotic prescription for dental conditions (Rocha-Periera, Lafferty, Nathwani 2015; Lee et al. 2015). Conclusion: The results indicated that health care practitioners reported inconsistent knowledge, attitudes and practices related to antibiotic prescription patterns. The study showed that there was inconsistency in antibiotic therapy prescription for dental conditions at the two public health institutions. There is a need for consensus building among health professionals and better guidance for antibiotic prescription in the management of dental conditions.
Exploring oral health care for patients undergoing cancer therapy of the head and neck region: a case study in the eThekwini District, KwaZulu-Natal.
(2017) Bauluck-Nujoo, Bibi Saleenna.; Singh, Shenuka.
Oral health care is paramount for patients with head and neck cancer. There is currently no published evidence to ascertain these patients’ access to oral health care. The extent to which oral health planning in the province takes into account the specific oral health needs of patients with head and neck cancer is not known so far. Aim: The aim of this study was to assess the perceptions and oral health practices of patients undergoing therapy for cancer of the head and neck region, in the Ethekwini District, KwaZuluNatal, so as to inform oral health planning of the needs for this population. Method: This was a cross-sectional, descriptive and exploratory study using both quantitative and qualitative data to determine the perceptions and oral health practices of patients with head and neck cancer. The study population for the quantitative component of the study, consisted of purposively selected patients with head and neck cancer (n=235) from a public tertiary central referral hospital in the Ethekwini District, KwaZulu-Natal (KZN). Data collection included the use of two previously validated questionnaires that was combined, namely, The EORTC QLQC30 and the EORTC QLQ- H&N35. These combined questionnaires included both single and multiple item scales to assess self-reported treatment side effects and oral health–related symptoms (Aaronson et al., 1993). There were eleven single item questions (such as mouth opening, dry mouth, sticky saliva, teeth problems, feeling ill, cough, pain killers, nutritional supplements, use of feeding tube, weight loss/gain) and seven multiple item questions on pain, swallowing, sexuality, social contact, social eating, speech and senses (Aaronson et al., 1993; Sherman et al., 2000; López-Jornet et al., 2012). The quantitative data collected was captured in Microsoft excel spreadsheet and imported onto Statistical Package for Social Sciences software (SPSS) version 24 for analysis. The demographic details for the participants were calculated using descriptive statistics (mean, frequency, percentages, standard deviation). Pearson Chi-Square test was used to assess possible relationships between the independent and dependent variables. The p-value was set to less than 5% (p< 0.05) to be significant. For the qualitative component of the study, structured interviews were conducted with twelve voluntary patients (n=12) undergoing cancer therapy for the head and neck region. The purpose of the interview was to gain a better understanding of oral health-related challenges and opportunities facing these patients. The interview schedule comprised demographic questions related to the date of diagnosis, duration and type of treatment and past and present habits. Other questions included participant’s knowledge of oral health care in relation to one’s overall well-being, oral health self-care practices, perceived barriers and opportunities to access oral health care, and familial support. Another semi-structured interview was conducted with the Ethekwini oral health district coordinator using purposive sampling technique. The interview schedule comprised questions related to oral health strategies in place to support patients with head and neck cancer and the extent to which oral health care is covered in district health policy and planning for these patients. Other questions included the existent institutional support for oral health promotion activities such as risk factor intervention programmes or strategies to improve oral health awareness. Data analysis of the qualitative data incuded content analysis using a thematic process by following the steps described by Braun and Clarke (2006). The audio-recorded interviews were first transcribed verbatim and a data clean-up process was applied (Braun and Clarke, 2006; Theron, 2015). The narrative from each interview transcript was then coded and analysed based on the conventional thematic content analysis approach (Braun and Clarke, 2006; Theron, 2015). A code guide was developed to guide and support the coding process. Open nodes were generated in the open coding phase (Pateman et al., 2015). This form of coding thus allowed for inductive reasoning of the emergent themes (Theron, 2015). Results: The results from the quantitative component of the study indicated that head and neck cancer was most common among participants in the 61-70 (n=86; 36.6%) age group. Oral cavity cancer was most common type of cancer reported (n=91; 38.7%), followed by laryngeal cancer (n= 53; 22.6%). Males (n=50; 21.3%) were more affected by oral cavity cancer as compared to females (n=41; 17.4%). With regards to employment, 14.5% (n=34) of participants were employed, while 46.4% (n=109) were unemployed because of cancer and 39.1% (n=92) were unemployed due to other reasons (old age, housewife). With respect to treatment, 20.4% of participants (n=48) were on radiotherapy, 28.5% (n=67) on chemotherapy and 9.8% (n=23) were on concurrent chemoradiotherapy, while 17.4% of participants (n=41) had already undergone surgery. Only 8.5% of participants (n=20) were recently diagnosed with cancer of the head and neck while 23.4% (n=55) were on follow up programme. There were noted differences in the self-reported severity and extent of oral complications in relation to the participants’ perceived oral health status. Xerostomia was found to be more common with increasing age. Pain in the jaw was experienced by 46.8% of participants while the majority of participants (n=125; 53.2%) did not report any pain in the jaw. Among those who perceived intra-oral discomfort, 13.8% females (n=13) and 7.8% males (n=11) experienced severe intraoral related pain and discomfort. More female participants (n=7; 7.4%) in the age group of 41- 60 reported severe difficulty in swallowing liquids than males of the same age group. Male participants who perceived severe difficulty to swallow liquids were all in the age group of 51- 70 years. Among those (n=100; 42.6%) who perceived difficulty to swallow pureed food, slightly more females (n=13; 13.8%) perceived severe difficulty in swallowing pureed foods than males (n=17; 12.1%, p=0.034). Most of the 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%) and reported xerostomia (n=159; 67.7%). A higher proportion of females (n=27; 28.7%) reported severe trismus as compared to male participants (n=33; 23.4%). Sticky saliva (increased viscosity in salivary flow) was reported by 34.0% (n=32) females and 29.8% males (n=42). Dysgeusia (altered sense of taste) was also reported by the majority of participants (n=131; 55.7%), among whom 22.3% females (n=21) reported severe dysgeusia as compared to 19.1% males (n=27). The majority of participants (n=138; 58.7%) perceived difficulty to eat, with 35.1% females among them (n=33) reporting of severe problem in eating as compared to 23.4% males (n=33). With reference to the qualitative data, six themes emanated from both interviews namely, knowledge and practices in oral health care, barriers in accessing oral health care, support for oral health care (includes both familial and institutional support), perceived opportunities to access oral health care, perceived precautions for outdoor activity and identified shortcomings in oral health service delivery at district level. Participants generally agreed that oral health was important for their overall well-being, with the exception of one participant. The reported oral hygiene practices included toothbrushing, mouthwash and dental floss. With reference to the perceived barriers, a lack of dental services in some areas of the province which consequently led to the need to travel long distances to access the nearest dental facility, was reiterated by some participants. The co-existence of other diseases in addition to cancer was perceived by one participant as being challenging to seek oral health services. The time taken by hospital staff to diagnose dental pathology was also seen as a barrier to access oral health care. Additionally, the fact that medical personnel fell short of informing patients about oral complications arising with chemotherapy was perceived as a shortcoming. Financial instability and failure of the local dental clinic to provide basic oral health care were reported to hamper access to oral health care. With regards to support, most participants reported that they had support, whether financially or morally from their families, with the exception of one participant who did not get any form of familial support. One interviewee reported that support was obtained through prayer. Participants also indicated the need to use protective clothing, hats and sunscreen. As for professional support, the oral health district coordinator reported that there was no specific support for oral health promotion activities from a policy perspective for head and neck cancer patients. However, he narrated that the pathway of referral patterns to oral and maxillofacial surgeons, ENT or oncology in cases of suspected malignancies was a form of oral health-related support for patients. Furthermore, he indicated that the district has many dental facilities with good infrastructure to offer services, such as oral prophylactic treatment and prosthetic services. Some of the opportunities perceived by head and neck cancer participants for improving oral health self-care practice included access to a dental hygienist, comprehensive explanation of the benefits and complications of cancer therapy, and clear referral patterns for further oral health management. Among the shortcomings identified to deliver oral health services at the district level was the absence of a specific oral health policy formulated for head and neck cancer patients and risk factor intervention programs. Conclusion: The results indicate that patients with cancer of the head and neck region reported limited access to professional oral health care. Oral health promotion services in the district, should take into account the specific needs for patients with cancer of the head and neck cancer region. There is an urgent need to prioritise oral health care for this vulnerable population in district oral health planning efforts.
A framework for integrated school oral health promotion within the Health Promoting Schools Initiative in KwaZulu-Natal.
(2015) Reddy, Moganavelli.; Singh, Shenuka.
Introduction: Schools can provide a perfect setting for the implementation of health and oral health promotion activities. However, a change in focus was needed at schools from the traditional topic-based approach to health education to a more holistic approach to health and oral health promotion. The Health Promoting School Initiative provides an integrated, holistic, collaborative and co-ordinated approach to health. This initiative can therefore provide a platform for the integration of oral health promotion activities within health promotion activities at these schools. However, the extent to which oral health promotion is incorporated into health promotion activities and whether oral health, promotion programmes have been implemented at these schools is unclear in South Africa. Aim: This study set out to develop a framework to use a systematic approach to critically assess the viability of including oral health promotion elements within the Health Promoting School Initiative to establish the appropriateness of this mechanism for school-based oral health service delivery. Methods This study was explorative and since the integration of oral health promotion into the school programme is multifaceted, a combination of both qualitative and quantitative data was collected. It was conducted in three phases. Qualitative data was obtained through in depth interviews and self administered questionnaires in the first phase of the study. The second phase of the study comprised of the implementation of an intervention based on the findings in the first phase of the study. The third phase of the study obtained qualitative data using focus group discussions. A situational analysis was conducted in the first phase of the study. All policy documents, strategic plans and reports from the national and provincial departments of health and education that were relevant to oral health were reviewed in this study. The purpose of this was to ascertain priorities and strategies for oral health promotion at schools. Quantitative data was obtained using the World Health Organization Decayed Missing Filled Teeth (WHO DMFT) Tool to determine dental needs of the learners. A self administered questionnaire and data capture sheet was also included. Quantitative data were quantified according to codes, and verified. The data was analysed with SPSS version 21.0. Inferential techniques used for data analysis included correlations and chi-square test values which were interpreted using p-values. The transcription obtained from interviews in Phase 1 and focus group discussions in Phase 3, and qualitative responses to the questionnaire were analysed separately. Responses from interviews and focus group discussions were first transcribed verbatim and organised according to the questions. The raw data was then checked and verified for quality purposes. Triangulation was used for evaluation of the data. Thematic data analysis using inductive and iterative techniques was used for qualitative data. Open coding, axial coding and selective coding was used to analyse the data. Objectives: 1. To identify current policies or priorities for health promotion and oral health promotion in policies, strategic plans and annual reports of the Department of Health and Department of Education. 2. To conduct a situational analysis of existing services and an epidemiological profile to determine unmet oral health needs of six year old learners at the selected Health Promoting Schools in KwaZulu-Natal using a questionnaire, interview schedule, data capture sheet and the WHO DMFT Tool. 3. To determine the presence or absence of school based oral health promotion programmes at the selected schools using a questionnaire and interview schedule. 4. To introduce oral health promotion programmes in schools where there are no or interrupted oral health service delivery to determine the feasibility of these programmes. 5. To determine the opportunities and barriers for the incorporation of oral health promotion within the Health Promoting School Initiative through focus group discussions. 6. To compare this programme to schools that have existing oral health promotion programmes. Results and Discussion: The results obtained in the three phases of the study were integrated, discussed and then coherently presented in this chapter. The qualitative and quantitative data obtained from Appendices 1, 2, 3, 4 and 5 are described and discussed in accordance with objectives 1, 2 and 5 of the study. The inextricable link between these objectives is demonstrated appropriately throughout the analysis. Four salient themes emanated from the data. These themes were aligned to objectives 1, 2 and 5 of the study. The data are presented as categories that are linked into a framework of consistent behaviour, connections and consequences that are relevant to a particular phenomenon. The framework used to guide this study provided a systematic and negotiated approach to the planning, implementation and review of the oral health promotion intervention to achieve the desired goals in an appropriate period of time. The framework also provided a multi-level approach for oral health care delivery that included macro, meso and micro influences. The framework identified critical areas for assessment for those involved in planning and implementing integrated school health programmes. Potential target areas for oral health promotion interventions were also identified. Processes that advocate and encourage social cohesion, partnership development and resource sharing were also identified. Process evaluation investigated how well the planned intervention had been implemented. It also identified the factors that facilitated or impeded the implementation. In this study, 27% of the six year old children were caries-free giving a caries rate of 73%. The mean dmft for the study sample was 3.65. The average dmft per school ranged from a high of 6.8 to a low of 1.1 with both these extremes recorded in the rural districts. Overall 94% of the learners required some type of treatment with the majority (90%) requiring preventive care. The Unmet Treatment Need (UTN) was 97%. Although the Health Promoting School Initiative was chosen because it provides a supportive environment to improve health, several barriers were present for the successful integration of oral health promotion into this initiative. The study findings indicated an absence of oral health promotion initiatives in the curriculum. Educators also noted that they were restricted to what was prescribed in the curriculum and therefore found it difficult to include oral health promotion as suggested by the researcher. Additionally, almost 70% of study participants (educators) lacked knowledge and skills in oral health promotion. This resulted in a lack of confidence in the implementation of an oral health promotion programme. The study findings also noted a lack of in-service training provided in oral health promotion to educators. These factors therefore impacted on the integration of oral health promotion into the school programme. It was further noted that if oral health promotion activities such as tooth brushing and fluoride rinses are included in the school programme, this would have implications in terms of time management for educators as these activities would encroach upon their teaching time. Sustainability of these activities would also be a problem as a result of inadequate resources, funding, knowledge and supporting structures. The study findings indicate that the barriers identified in this study are similar to what has been reported more than ten years ago. This implies that although the Department of Health in collaboration with the Department of Education has adopted the Health Promoting School Initiative, they have not provided the necessary resources to sustain these programmes. It was therefore suggested that a multilayered approach to health and oral health promotion be implemented as opposed to a blanket programme so that a greater mix of available strategies could be considered from district to district. Although there were many limitations to this programme some benefits were identified. All (100%) participants identified the importance of the inclusion of oral health promotion into the curriculum, especially in rural areas. Educators at two schools (15%) were of the opinion that oral health education should be reinforced in the curriculum by introducing examples and activities. Some educators (46%) also felt that this programme was of benefit to them as it had created awareness to oral health. This therefore empowered educators to take control of the programme by creating awareness to the importance of oral health and providing guidance on the implementation of the programme. Conclusions and Recommendations: The aim was achieved by developing and using a conceptual framework to integrate oral health promotion within the context of the Health Promoting Schools Initiative. This framework provided a systematic and negotiated approach for the planning, implementation and review of the oral health promotion intervention based on the needs of the six year old learners at the identified schools. The strength of this framework was underpinned in its multi-level approach to ensure quality of oral health care delivery. The limitations of this framework were that it was not tested for effectiveness to bring about behaviour change as this was a long term goal. Additionally, the cost-effectiveness of this framework was not investigated. Although current policies and strategic plans (100%) in South Africa and KwaZulu-Natal have prioritised primary prevention and promotion, integrated approach and the common risk factor approach, study findings indicate that not all these strategies have been translated into practice. This therefore suggests that current oral health services are inconsistent and fragmented. Currently there is inequality and inequity in the delivery of oral health services in schools. Strategies for oral health promotion have not been translated into practice indicating that oral health services are currently not properly aligned. Lack of collaboration between the Department of Health and Department of Education has resulted in a lack of coordination between the Health Promoting Schools Initiative and School Health Services in terms of policy and guidelines with education policies and guidelines. It was established from research findings that oral health promotion is not incorporated into general health promotion in the school curriculum. Current water supplies and sanitation are still inadequate (50%) in rural schools. Although most(71.4%) of the schools in the rural areas have access to a community clinic, resources are limited and poor road conditions and transport prevent attendance at these clinics. The majority (87%) of the schools currently have limited control over what is being sold at their tuck shops and by vendors. There is also a lack of support from the Department of Education in terms of funding for oral health promotion programmes. An increase in the prevalence of dental caries suggests that this has not been adequately addressed in KwaZulu-Natal. The decrease in fillings suggests that there is a decrease in oral health service provision for restorative procedures. There is therefore a need for improvement in oral health service delivery. As a result of the current focus being on policy formulation and not the translation of policy into sustainable programmes, it was recommended that there was a need for multiple stakeholder involvement in policy monitoring with specific strategies for implementation and evaluation of oral health promotion activities. There was also a need to ensure stakeholder involvement in the development of oral health learning material at school level. More research needs to be done to explore the mechanism to support and address inequity in oral health promotion related service delivery at schools and to test the adaptability of the framework in other health related settings both provincially and nationally.
An investigation of the knowledge and attitudes of emergency care practitioners in the management of common orofacial traumas.
(2017) Reddy, Lucy.; Moodley, Illanavathie.
Introduction: Some of the worst injuries suffered by patients are facial scars and disfigurement (Zadik, 2007). Whilst certain scars on a patient may be covered by clothing or other methods, facial scars, disfigurement and loss of function remain obvious to victims of serious vehicle accidents, sports injuries or other miscellaneous activities (Levin and Zadik, 2012 et al., Zadik, 2007). It is essential to provide timeous and appropriate treatment in cases of orofacial trauma, and this prehospital care is usually provided by first responders such as emergency care practitioners (Pozner et al., 2004). However; there is inadequate knowledge in the management of orofacial trauma amongst emergency care practitioners (ECPs). Moreover, orofacial trauma is often not included in medical courses and first aid trainings or in first-aid text books and manuals (Levin and Zadik, 2012 et al., Zadik, 2007). Research on an international level in regards to orofacial trauma and the knowledge of ECPs in managing orofacial trauma is substantial. However, in South Africa, there is paucity of epidemiological studies in the field of oral and facial trauma, and in an understanding of the knowledge of emergency care practitioners in the management of these conditions. Improved knowledge and treatment protocols could assist emergency care practitioners to improve in the management of casualties that present with orofacial trauma. Aim: The aim of the study is to determine the knowledge and attitudes of ECPs of the eThekwini District of KwaZulu-Natal, South Africa in the management of patients presenting with common traumatic orofacial injuries and medical emergencies in order to identify any gaps in their training regarding management of these injuries. Methods: This was an exploratory, descriptive study using both quantitative and qualitative methods. The advantage of using mixed methods is that it allows for triangulation of the literature and results, thus strengthening the reliability and validity of the study. The study was conducted in two phases, with each phase having a different data collection tool and process. In phase 1 the research participants, being a random sample of 288 Emergency Care Practitioners were given a self-administered questionnaire to complete. The questions were designed to elicit the required information, and simultaneously allow the research participants to forward any other information or comments that they may have wanted to. In phase 2 of the study, an interview was conducted with the relevant ECPs using a structured interview schedule. A list of seven questions was posed to these participants, and they had the opportunity to provide additional input. Results: The results revealed that there were poor levels of education, training, and understanding of the emergency medical management of common orofacial traumas by ECPs. There was poor initial training, with a significant portion of the participants (44.9%, p 0.233) having not received any training at all in the management of orofacial traumas. There was also a significant majority (78.3%, < 0.001) having no further education and training. Most ECPs indicated a desire to receive such training. Conclusions: The study suggests that there is inadequate knowledge, education and training levels of ECPs abilities to appropriately manage common orofacial emergencies. There is a need for a curriculum review to include basic and advanced training and education that would equip ECPs to deal with these emergencies.
Knowledge, attitudes and practices concerning oral health care among undergraduate students in the Life Sciences Department at the Central University of Technology, Free State.
(2020) Mbele-Kokela, Feziwe Flora.; Moodley, Rajeshree.
Background Problems with oral health can, in many ways, affect the quality of life. Bad oral health can prevent positive feelings from being expressed by students, influencing their social experiences and how they feel about themselves. Adults’ periodontal wellbeing influences their smiling habits and their quality of life linked to smiles. Bad periodontal health can also prevent positive feelings from being expressed by adults, which may, in turn, influence their self-concept and social interactions. Objectives The aim and objectives of this study were to determine the students’ knowledge, attitudes and practices regarding oral health care among undergraduate students in the Life Sciences Department at the Central University of Technology, Free State. Methods This descriptive study design used quantitative and qualitative methods conducted among undergraduate students in the Faculty of Health and Environmental Sciences, Department of Life Sciences at the Central University of Technology (CUT). Data were collected using an online survey questionnaire. Data were summarised and aggregated using numerical formats, and the responses related to the KAP of students were numerically coded, which helped to interpret the results. The minimum proportional response rate that was required was (n=156), where purposive sampling was used calculated with 95% confidence level. Results A total of (n=220) participants completed the questionnaire. Overall, 28.4% (n=62) were males and 70.2% (n=153) were females with 1.4% (n=3) classifying themselves as other (p<0.001). The questionnaire assessed oral health care knowledge, dental attitudes and oral health care practices (i.e. frequency of tooth brushing, use of dental floss and dental visits). Of the participants, it was noted that significantly more males smoked compared to the other two groupings. Out of (n=220) participants, 26.6% (n=58) smoked. Habits were also structured around the participant’s sugar intake. In this study, over 80%; (n=187) of the participants agreed that they loved sugar. More than 63% (n=138) participants confirmed brushing their teeth twice a day, and 31% (n=68) brushed once a day. The findings in this research further suggested that participants did not use oral hygiene strategies such as dental floss. Results suggested that more 56.4% (n=123) did not floss. The participants were asked ‘what is plaque?’ 41% (n=91) stated it was a layer of bacteria in the teeth while other participants 14%; (n=8) stated it was dirt on the teeth. A few of the participants, 37.9% (n=77), stated that they did not know what plaque was. Nearly 32% (n=72) of the participants did not understand how the state of one’s general health could affect their oral health. They indicated that they did not know the relationship between the two. In comparison, only 44.5% (n=98) had an idea. Conclusion It was found that oral health education was not covered in the disciplines researched in our study. We also found that variations in the source of dental information were correlated with oral health behaviour in university students. The study, therefore, concluded that oral health care knowledge, attitudes and practices are affected by education.
Knowledge, attitudes and practices of exit-level Health Sciences students at a selected University in Durban, South Africa, towards the consumption of sugar-containing beverages following the introduction of the Sugar Tax in South Africa.
(2021) Samuels, Lavern.; Muslim, Tufayl Ahmed.
Introduction South Africa has the highest prevalence of lifestyle-related diseases, such as diabetes, dental caries, and obesity-related diseases. Many of these diseases are expensive and difficult to treat and place a burden on the healthcare system. If sugar-consumption can be decreased, then the prevalence of these diseases can be reduced, resulting in financial savings and reduced disease burden. Consequently, there will be a reduction in the number of healthcare workers needed, and the costs of delivering healthcare to the population. The sugar tax was implemented in South Africa to directly raise revenue for the State that could be utilised to prevent and treat lifestyle-related diseases and indirectly increase the price of food products containing sugar to reduce sugar consumption. It was envisaged that this reduced sugar consumption would reduce obesity and in diseases that have sugar as a causative agent. Healthcare professionals can play a critical role in advising patients on reducing sugar intake, especially with reduced consumption of sugar-sweetened beverages. Aim and objectives This study aimed to determine the knowledge, attitudes and practices of knowledge, attitudes and practices of exit-level health sciences students at a selected University in Durban, South Africa, towards consuming sugar-containing beverages following the introduction of a sugar tax. Methods Gatekeeper permission was obtained from the Durban University of Technology and final ethical approval from the University of KwaZulu-Natal. Online information sheets about the study were made available to 150 final-year students in the health sciences professions and informed consent was obtained. An online questionnaire was administered to the participants. It included questions around participants sociodemographic profile, knowledge of the sugar tax and SSBs, attitudes towards the sugar tax and SSBs, and perceptions of their practices relating to dietary advice and the sugar tax. Qualitative data were analysed using NVivo, and quantitative data using the Statistical Package for the Social Sciences (SPSS) (version 25) SPSS. Results The study population consisted of a young population with the mean age being 23.6 years. Most participants (60.4%, n=40, p.101707 – not significant), left the purchasing and food-choice decisions to their parents. Most participants (n=39, 59%) reported that they had changed their SSBs consumption habits. Most (78.2%, n=51) participants were not aware of the sugar tax's purpose and its introduction. Participants were mostly positive 61% (n=40) on their attitudes towards the merit of the implementation of a sugar tax, but 21 participants (32%) had a negative view of this tax, citing reasons such as that “even with an increase of the sugar beverages price, consumption will not decline.” The sugar tax theme is an excessive burden placed on an already over-taxed society. A violation of personal and constitutional rights was reported by 27% (n=18) of the participants who supported the sugar industries anti-sugar tax stance. Only 24% (n=16) believed they had not received sufficient education and training around sugar consumption containing beverages. Participants reported having had minimal training, lacking in-depth knowledge of the current literature about SSBs consumption. Conclusion This study raises several important questions regarding nutritional training among the various cadres of health sciences students at universities and technology universities. According to the results, it appears that there is a need for curriculum reform that would lead to improved training in diet and nutrition advice content. This is so that future health professionals will be more aware of the current trends and practices about diet and nutrition, thus offering their clients/patients holistic health management and treatment course of care. Extensive curriculum reform and redesign should occur, in that extensive training and education be given to all Health Sciences students and future healthcare workers about the ill effects of excessive sugar consumption, and that they are trained in being able to render dietary counselling and advice to their prospective patients.
Parental knowledge, attitudes and perceptions of dental caries and dental sealants as a preventive strategy of dental caries.
Nair, Brenton Ganesh.; Singh, S.
Introduction: Children’s oral health care should be a public health priority and parental knowledge, attitudes and perceptions (KAPs) are likely to play a role in achieving and maintaining a desired level of oral health in children. Aims and Objectives: The aim of the study was to understand parents role and the use of dental sealants in Grade 1 learners’ oral preventive health in the Chatsworth Circuit of the uMlazi District, KwaZulu-Natal. The objectives of the study were to establish parental knowledge, attitudes and perceptions of Grade 1 learners towards dental caries through the use of a self-administered questionnaire, to determine parental self-oral health care practices (and consequent influence on the child) through the use of a self-administered questionnaire, to assess parental knowledge, attitudes and perceptions towards dental sealants as a preventive strategy for dental caries through the use of a questionnaire and group focus discussions, to determine the relationship between gender, parental age, level of education and socio-economic status on knowledge, attitudes and perceptions towards dental sealants and dental caries through statistical tests of association and compared to the literature review, and lastly to determine the current oral health promotive strategies implemented by the KwaZulu-Natal (KZN) Department of Health through a review of the available policy documents and statistical records. Methods: The study participants were the parents (ɳ=295) of grade one learners aged between five and six years old who attended schools in the Chatsworth Circuit of the uMlazi education district. From a sample population of 50 schools, twelve schools were selected from an ordered list, using systematic sampling technique. Information was obtained using a self-administered questionnaire that included questions on demographic data, oral health behaviour and knowledge patterns, income and education status, and knowledge of oral health prevention practices. Further data was obtained by conducting focus group interviews at five schools with 10 participants in each group. Ethical approval was obtained from the Humanities and Social Sciences Research Ethics Committee at the University of KwaZulu-Natal (Reference: HSS/0327/013M) and gatekeeper permission was obtained from the relevant sections in the Department of Education and the Department of Health in the eThekwini District, KwaZulu-Natal. All participants were assured of confidentiality. Privacy and confidentiality were maintained and participant anonymity was guaranteed through the use of codes. Results: Although the majority of respondents understood the role of diet and self-care practices such as tooth-brushing in the prevention of dental caries, almost 80% of these respondents did not floss or use a mouthwash (70%). Similar scores were reported by respondents for their children’s oral health care practices. The study participants (74%) did not perceive dental caries in deciduous teeth as being important precursors for caries in adult teeth. The results indicate that 65% of respondents were aware of dental sealants. However only 67% of participants were willing to have sealant placements performed on their children. A significant number (33%) of respondents were uncertain or unwilling to have this procedure done. The association between the participants’ level of education and the child’s self-care practice was of statistical significance (p=0.002). Almost two-thirds of the respondents (77%) had at most a high school education and about 43% of the respondents were dependent on the social welfare system (p=.003). The results indicate that extractions is the most frequent clinical procedure with almost 192 722 procedures carried out in the eThekwini District, KwaZulu-Natal in 2011. The results further indicate that 75% (ɳ=295) of the participants experienced difficulties in accessing facility-based oral health care due to transport problems. Discussion: The results of this study reveal gaps in parents’ knowledge, attitudes and perceptions towards dental caries, oral hygiene practices, diet and nutrition, and dental sealants. The study findings further reiterate that parental attitudes and perceptions does appear to influence children’s attitudes and perceptions towards oral health self- care. This is reflected in the statistical significance between the participant’s level of education and the child’s self-care practice. Income also appears to play a role in determining attitudes towards oral health self-care practices. More research needs to be conducted to unravel the reasons for parents not wanting to have sealant placements done on their children despite knowledge of its known benefits. This study thus supports the premise that perceived parental knowledge of oral health self-care does not necessarily translate into practice. It is also important to note that oral health service delivery in the public sector is still curative driven with very little focus on prevention and promotion of optimal oral health care. The low number of dental sealant placements provides further evidence that there is a mismatch between oral health policy priorities and oral health service delivery. Conclusion: The study therefore concludes that parental knowledge, attitudes and perceptions towards dental caries could be influenced by education and income. Knowledge and awareness of the value of dental sealants did not necessarily translate into support for this procedure as a preventive strategy for dental caries. The literature provides supportive evidence for parental involvement in oral health promotion decision-making but the factors that influence this decision making, must be considered. More research needs to be conducted to further investigate strategies to improve parental involvement in oral health promotion decision making, specifically in the area of children’s oral health care.
Voluntary counselling and testing for HIV in the dental clinical setting: knowledge, attitudes, perceptions and practices of oral health care workers in the eThekwini District, Durban, South Africa.
(2018) Balwanth, Sonam.; Singh, Shenuka.
Abstract available in pdf.

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