Doctoral Degrees (Health Systems and Public Health)

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Browsing Doctoral Degrees (Health Systems and Public Health) by browse.metadata.advisor "Chikte, Usuf M. E."

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    Minimising mechanical prosthodontic interventions for adult patients with a shortened dental arch in South Africa
    (Stellenbosch : Stellenbosch University, 2017-12) Khan, Saadika; Chikte, Usuf M. E.; Omar, Ridwaan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY : Background: A large body of high-end evidence suggests that shortened or posteriorly reduced dental arches (SDA or PRDA) are adequate for oral function. Such a finding has positive implications for patients from resource-constrained communities. Indeed, in the context of South Africa (SA), the SDA or PRDA concept has been embedded within its oral health policies since 1994, although no context-specific evidence appears to have informed this policy. The SDA concept, considered as a non-interventionist therapeutic approach, may be seen as a significant evidence-based primary healthcare solution for the underprivileged and underresourced majority of SA, when applied appropriately. The cost of current prosthodontics interventions, including removable, fixed or implantretained prostheses are very high and not within the reach of the underprivileged majority. These prosthodontic appliances are not constructed at public health clinics and patients may only obtain these from dental teaching institutions and private practitioners. From a human rights perspective, evidence-based research should guide practitioners and their practices as it can ensure patients’ right of access to healthcare and the appropriate use of beneficial evidence whilst eliminating harmful ones. This stance has been made more explicit within the amended National Oral Health Strategy of SA. Objectives: To determine the effectiveness (viz. oral function, patient satisfaction and OHRQoL) of a SDA or PRDA compared to a complete dental arch, with a view to minimizing expensive prosthodontic interventions for the South African partially dentate adult community. Methods: A step-wise approach in study designs was implemented amongst a South African cohort. A systematic review, followed by an overview of systematic reviews was conducted to guide researchers with the literature, and in turn provide a scaffold for the cross-sectional questionnaires and cross-sectional clinical study for this cohort. Studies were conducted among dental practitioners, clinical teachers, and dental students to determine what was currently taught and clinically practiced. A randomized controlled trial was subsequently conducted to determine patient satisfaction and quality of life with a SDA or PRDA. Results: Studies conducted were from the top-end of the hierarchical evidence pyramid; thus their results are expected to have evidence of strong reliability and validity with respect to the benefits of the SDA or PRDA. The generalizability of outcomes obtained related to settings, subject, intervention, results and costs which were acceptable for this cohort. Aspects of knowledge translation (KT) such as diffusion (creating awareness of the SDA concept) and dissemination (publishing and conference presentations of the different research studies) were fulfilled. Conclusions: This step-wise research approach highlighted the absence of the implementation aspect of KT, namely the application of the SDA or PRDA concept to clinical practice. The implication of this on the potential to positively impact patients’ treatment costs, satisfaction and oral health-related quality of life within the SA context, is noteworthy. The evidence obtained and presented strongly questions the current non evidence-based aspects of prosthodontic curricula such as rehabilitation to complete arch status at the largest dental teaching institution in Africa. Moreover, the efficiency of the system is based on informed healthcare policies, emphasizing the need for evidence-based research both at an institutional and private practice level. Additionally, the contextual evidence derived from the research performed towards the present PhD highlighted key areas that may be grouped into important human rights, academic and economic aspects of all those who are impacted.