An investigation of early childhood caries in the lower socio-economic areas surrounding Tygerberg Oral Health Centre in order to plan a community appropriate intervention strategy

Mohamed, Nadia (2014-12)

Thesis (PhD)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: The long waiting lists for general anaesthesia and sedation services for children with Early Childhood Caries (ECC) at the Tygerberg Oral Health Centre highlighted the problem of ECC in this area. This was confirmed by a retrospective study of patient records at the Centre. ECC is largely caused by a combination of lifestyle factors, especially feeding and oral hygiene practices. Socio-economic status and parental factors such as education and employment have also been shown to play a role in the development of ECC. In order to address this problem, a study was designed to determine the prevalence of ECC in children from the lower socio-economic communities which drain to the Tygerberg Oral Health Centre and assess the knowledge of the caregivers of these children. A total of 659 children were examined at crèches and schools as well as community health clinics. The children examined at the clinics accompanied others and did not have any health reason for the visit themselves. As the aetiology is largely behaviour-driven and children are dependent on their caregivers to meet their basic needs, 366 caregivers attending the community health clinics with their children, were interviewed to determine their practices and knowledge of oral health. A total of 83 health care workers at these clinics were also interviewed to assess their knowledge of oral health matters and determine the role that they can play in the prevention of this disease. A cross-sectional community survey was carried out by means of clinical assessments and structured interviews with the aid of questionnaires. The survey was divided into 3 parts: 1. Prevalence of ECC amongst the children 2. Knowledge of the caregivers about oral health care 3. Knowledge of health care workers at the clinics in these communities about ECC The prevalence study revealed that 71.6% of children in the study population presented with caries. This is extremely high and highlights the need for serious interventions. Parents/ caregivers were shown to be ill-informed regarding their children’s oral health care needs which include dietary and oral hygiene practices as well as how this disease can be prevented. It is clear that caregivers need to be educated regarding feeding practices, weaning time, dietary content and the importance of basic oral health. The importance of preserving the primary dentition and regular dental attendance also needs to be emphasized in this community where dental health does not seem to be a priority. Health care workers such as nurses who come into contact with children from an early age would be the ideal vehicle to impart this information. However, as revealed from the results of this study, there is a serious lack of knowledge amongst these professionals regarding oral health matters. Time and resources therefore have to be invested to improve their knowledge and lessen their load so that more emphasis can be placed on prevention. Small changes can make a big difference towards addressing the burden of this disease on the health care system.

AFRIKAANSE OPSOMMING: Die lang waglyste vir algemene narkose en sedasiedienste vir kinders met Vroeë Kinderkaries (VKK) by die Tygerberg Mondgesondheid Sentrum het die probleem van VKK in die area uitgelig. Dit is bevestig deur 'n retrospektiewe studie van pasiënterekords by die Sentrum. VKK word grootliks veroorsaak deur 'n kombinasie van lewenstyl- faktore, veral voeding en mondhigiëne praktyke. Daar is ook aangetoon dat sosio-ekonomiese status en ouerlike faktore soos opvoeding en werkstatus 'n rol speel in die ontwikkeling van VKK. In 'n poging om hierdie probleem aan te spreek is 'n studie onderneem om die prevalensie van VKK in kinders van laer sosio-ekonomiese gemeenskappe wat van die Tygerberg Mondgesondheid Sentrum gebruikmaak te bepaal. Die kennis van mondgesondheid van die vernaamste toesighouers van die kinders in die studie is ook bepaal. 'n Totaal van 659 kinders is by crèches en skole sowel as gemeenskapsklinieke ondersoek. Die kinders wat by die klinieke ondersoek is, het nie self 'n gesondheidsrede vir die besoek gehad nie maar het saam met ander mense gekom. Die etiologie van VKK word hoofsaaklik deur gedrag gedryf en kinders is van hulle toesighouers afhanklik vir hulle basiese behoeftes. Dus is 366 toesighouers wat gemeenskapsklinieke besoek het ondervra oor hulle praktyke en kennis rakende mondgesondheid. 'n Totaal van 83 gesondheidswerkers by die klinieke is ook ondervra oor hulle kennis van mondgesondheid om die rol wat hulle kan speel in die voorkoming van hierdie siekte te ondersoek. 'n Dwarsdeursnit gemeenskaps-opname is uitgevoer deur middel van kliniese ondesoeke en gestruktureerde onderhoude met behulp van vraelyste. Die opname is in drie dele aangepak: 1. Prevalensie van VKK onder die kinders 2. Kennis van die toesighouers oor mondgesondheidsorg 3. Kennis van gesondheidsorgwerkers by die klinieke in hierdie gemeenskappe oor VKK Die prevalensiestudie het getoon dat 71% van kinders in die studiepopulasie karies gehad het. Dit is baie hoog en het die behoefte aan ernstige ingryping beklemtoon. Ouers/ toesighouers het geblyk om baie swak ingelig te wees oor hulle kinders se mondgesondheid-behoeftes wat dieet- en mondhigiëne praktyke ingesluit het, asook hoe die siekte voorkom kan word. Dit is duidelik dat versorgers onderrig moet word oor voedingspraktyke, die beste tyd vir soog, dieetinhoud en die belang van basiese mondgesondheid. Die belang van die behoud van primêre dentisie en gereelde tandsorgafsprake behoort ook in hierdie geneemskappe beklemtoon te word, gesien in die lig van die lae prioriteit wat hierdie gemeenskappe op mondgesondheid plaas. Gesondheidsorgwerkers soos verpleegpersoneel wat reeds in kontak kom met hierdie kinders op 'n jong ouderdom is die ideale persone om sulke inligting te versprei. Dit het egter uit die studie geblyk dat daar 'n ernstige gebrek aan kennis by hierdie professionele persone bestaan oor mondgesondheid. Tyd en hulpbronne sal belê moet word en hulle werkslading verlig moet word om hulle kennis te verbeter sodat meer klem op voorkoming gelê kan word. Klein veranderinge kan 'n groot verskil maak om hierdie siektelas op die gesondheidsorgstelsel te verlig.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/95833
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