Evaluation of the Nigerian national antiretroviral (ARV) treatment training programme

There is an understanding that greater availability of HIV treatment for the 40.3 million people currently infected with HIV is a humanitarian imperative that could prolong the lives of millions, restore economic productivity, and stabilise societies in some of the world's hardest-hit regions. The Nigerian government recognises that the country has the third highest burden of infection, with people living with HIV estimated to total 4.0 million, and so in 2002 commenced the implementation of one of Africa's largest antiretroviral (ARV) treatment programmes. A successful ARV programme requires that all components of a functional management system be put in place for effective and efficient functioning. This would include logistics, human resources, financial planning, and monitoring and evaluation systems, as well as sustainable institutional capacities. The Nigerian national ARV treatment training programme was conceived to meet the human resource needs in hospitals providing ARV therapy. This paper reports on the evaluation of the training programme. It examines knowledge and skills gained, and utilisation thereof. Recommendations are made for improved training effectiveness and for specific national policy on training, to meet the demand for scaling up therapy to the thousands who need ARV.

Effect of psychological management techniques on specific item score change during the management of dental fear in children

The aim of the study is to determine how specific fear inducing items contribute to the overall dental fear level in Nigerian children. In addition, it looks at the specific changes that psychological management produces on each item and how variables like age, gender and type of treatment received contribute to these specific changes observed. The dental fear level of 75 children, who were attending the dental clinic for the first time were assessed pre and post-treatment using the short form of the dental subscale of the child fear survey schedule. During treatment, the children were managed using various forms of psychological management strategies. The effect of age and the gender of the children on the dental fear level were analyzed. The effect of the type of treatment received, categorized into either invasive or non-invasive, on the dental fear level was also determined. Results showed that with the use of psychological management strategies, dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009). However, no statistically significant dijfference was noted in the dental fear scores based on age, gender and type of treatment received. On the other hand, the aggregate scores for each of the possible fear inducing items highlighted in the psychometric scale varied and so did the effectiveness of psychological techniques in significantly reducing dental fear scores for each of the items. Age, gender and type of treatment did have significant effect on the fear level changes that occur with specific items. It was concluded that although a significant change occurred in the dental fear level score of the child post management with psychological techniques, this does not necessarily translate to significant changes in the scores for each fear inducing item assessed by the psychometric scale. Age, gender and the type of treatment the child received also influence the change that could occur for each item. The dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009).

Oral health-care workers and HIV infection control practices in Nigeria

The first case of HIV infection was reported in Nigeria in 1986. Since then, the prevalence has risen from less than 0.1% in 1987 to 5.8% in 2002, and an estimated 3.6 million Nigerians now live with HIV/AIDS. More than 40 oral manifestations of HIV infection have been recorded and between 70% and 90% of persons with HIV infection will have at least one oral manifestation at sometime during the course of their disease. Oral health-care workers (OHCWS) are expected to play active roles in the prevention and control of HIV/AIDS. In this study, a one-day workshop was organized for 64 oral health workers in Ile-Ife, Nigeria, focusing on the epidemiology of HIV/AIDS, the oral manifestations, control and prevention of HIV in a dental environment, oral care of the infected patient and the ethical, legal and social aspects of HIV/AIDS. Participants' knowledge and practices of infection control were assessed with an infection control checklist administered pre- and post-workshop. Sixty (90.8%) respondents believed that HIV/AIDS was not yet a problem in Nigeria, and 58 (90.6%) believed that drugs have been developed which can cure HIV infection and AIDS. The men complied more with waste disposal regulations than women (P = 0.010). Twenty-nine of 58 (50.0%) did not discard gloves which were torn, cut or punctured. Seven (12.1%) did not change gloves between patients' treatment. Conscious efforts should be made to train OHCWS on all aspects of HIV/AIDS prevention and care. It must never be assumed that adequate information will be acquired through tangential sources.

Retrospective survey of antibiotic prescriptions in dentistry

OBJECTIVE

To evaluate dentists' prescription writing patterns and their appreciation of the characteristics of antibiotics.

DESIGN

Evaluation of drug prescriptions written over a six-month period.

SETTING

Dental Hospital, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

SUBJECTS

Retrospective analysis of 313 prescriptions written by dentists attending to outpatient dental patients.

RESULTS

The total number of drugs on one prescription ranged from one to seven with Penicillins being the most commonly prescribed drug. Some prescriptions were found to be incorrect with regards to dose, frequency, and duration. Instructions as to the best time of administering drugs with regards to meals were not stated in any prescription.

CONCLUSION

Improvement through continuing education is desired on the part of prescribers to ensure a good standard of care and avoid practices that may increase antimicrobial resistance. Drug information services including side effects and drug interactions for professionals and consumers at the hospital is highly desirable.

Identified factors in child-dentist relationship important for the management of dental anxiety in Nigerian children

AIM

To investigate the effects and interrelationship between dental anxiety and dentist's experience, dentist's behaviour, type of treatment received and the behaviour of Nigerian children during treatment.

METHODS

Pre- and post-dental treatment anxiety levels of 69 child patients, who were attending the dental clinic to receive dental treatment for the first time, were assessed using the DFSS-SF. The dentist's and child's behaviour during treatment procedures were unobtrusively observed and recorded. The pre- treatment anxiety levels were classified as high (HAC) and low (LAC), while those of the dentists who managed the children were categorized as experience or inexperienced. The interrelationship between a child's dental anxiety level, dentist's behaviour during child management, dentist's experience and the type of treatment the child received were analysed.

RESULTS

The anxiety level of the children decreased significantly post-treatment when experienced dentists managed the child in comparison to inexperienced dentists (Z=3.22, p<0.02). The dentist's behaviour did not significantly affect the anxiety level of the child. However, physical contact was used more frequently with HAC than LAC (z=2.27;p<0.023). There was no association between a child's behaviour in the dental chair and their anxiety level (chi(2)=0.08, p<0.93). Also, the more invasive the procedure, the less the tendency for a noted decrease in anxiety level of a child post-treatment, though this was statistically insignificant (z=1.34; p<0.44).

CONCLUSION

The dentist's behaviour played no role in changing the anxiety level of a child nor did it have any influence on anxiety-related behaviour of a child. However, the experience of the dentist was a very significant factor for effecting a decrease in the dental anxiety level change for children.

Effect of information on dental anxiety and behaviour ratings in children

AIM

To establish the effect of information received about dental care on the anxiety level of the child prior to receiving any form of dental treatment and on their behaviour during dental treatment.

METHODS

Eighty-four healthy child patients at their first dental visit, between the ages of 8 and 13 years attending a paediatric dental clinic in Nigeria participated in the study. Information on their dental anxiety level was collected using the Dental Subscale of the Child Fear Survey Schedule. The children were asked to identify their source and type of dental information received. The information given was later categorised into positive or negative for analysis purposes. The children's behaviour during dental treatment was assessed using Venham's clinical ratings of anxiety and cooperative behaviour. The mean dental anxiety scores, as well as the mean Venham behavioural ratings, of those that had received information on dental treatment were compared with those that had never received any information.

RESULTS

Previously received information did not appear to have any significant impact on the measures of the dental anxiety level of these children neither was there a statistically significant association between information received and behaviour of the child in the dental chair.

CONCLUSION

Past information may play only a minor role in affecting dental anxiety levels and behaviour of the child during dental treatment.

The epidemiology, etiology, and pathophysiology of acute necrotizing ulcerative gingivitis associated with malnutrition

Acute Necrotizing Ulcerative Gingitivitis (ANUG) is a distinct and specific disease. This disease entity has been described as far back as the days of Hippocrates and is known by many synonyms. With the advent of antibiotics and with improved nutritional status, the incidence has decreased and even become extinct in developed countries. However, with the increasing incidence of severe immunodeficiency states such as seen in Acquired Immunodeficiency Syndrome (AIDS) the lesion has once more, become a well recognized and often encountered clinical entity in developed countries. In developing countries, however, the condition is still a commonly diagnosed clinical lesion because of the persistently poor nutritional status. Because of the current campaign for increased focus on global health issues, ANUG, a lesion of significant interest for the developing countries where malnutrition is high and for developing countries because of the AIDS, a global pandemic has resurfaced as a topic for discussions and study. This literature review will provide a better understanding of the epidemiology, etiology, and pathophysiology of ANUG associated with malnutrition.

The modulating effect of culture on the expression of dental anxiety in children: a literature review

The experience of anxiety is a universal human phenomenon. Studies have shown a world-wide variation in the prevalence of dental anxiety with estimates ranging between 3% and 43%. The aetiology of dental anxiety is multifactorial, with factors acting in synergy to affect its expression. For children, age and gender play fundamental roles in its expression. However, these two factors are modulated by other variables such as culture which may influence the context in which anxiety is experienced, the interpretation of its meaning and responses to it. The modulating effect of culture in synergy with other variables may be one of the reasons why reports on dental anxiety have varied from region to region. This paper attempts to identify the interrelating roles of culture, age and gender, and how these relationships may affect variability in the expression and measurement of dental anxiety in children.

Factors influencing the use of behavioral management techniques during child management by dentists

Dental anxiety develops from a vicious cycle of bodily arousal from dental stimuli, cognitive interpretation and ineffective coping all working in a runaway feedback loop. Behavioral management strategies (BMT) aim at cognitive reorientation, which results in better compliance with instruction. This paper therefore tried to find out possible factors that influence the effective use of BMT during child dental management during treatment by dental operators in Nigeria. The levels of anxiety pre and post treatment were assessed using the short form of the dental version of the Child Fear Survey Schedule. Also, the type of treatment given to the child, the types and number of behavioral strategies employed during dental management as well as the gender and age of the child were noted. The professional status of the attending dental operator was also noted. Prior to the commencement of the study, the five students in the final year, who were to attend to the children in this study received one week training on the psychological management of dental anxiety in children. Results obtained from the dental operators were compared. The type of treatment received by the child did not significantly affect the dental anxiety score. The number of techniques combined by house officers and senior registrars were significantly higher than would be expected by chance (chi2=16.030, P=0.0001 and chi2=9.000, P=0.0001 respectively). Combination of techniques was also more frequent during invasive procedures and when dental anxiety levels were high. Combining techniques also tended to decrease dental anxiety more significantly than otherwise. Training has a role to play in the basic and efficient use in the management of the child dental patient. The training of dentists should thus entail the full spectrum (content and instructional effectiveness) of all psychological techniques.

Dental anxiety in a subpopulation of African children: parents ability to predict and its relation to general anxiety and behaviour in the dental chair

AIM

This was to investigate the ability of Nigerian parents to predict their child's dental anxiety level and the relationship between the child's dental anxiety, general anxiety and behaviour in the dental chair.

METHODS

A group of 53 mothers and 35 fathers and their respective children completed schedules that measured general and dental anxiety. The child's behaviour on the dental chair was also assessed. The child's self report of dental anxiety and general anxiety was compared with that of the parents. Dental anxiety ratings by the children and parents were correlated with the behaviour assessment of the dentist. Statistical significance was determined at <0.05.

RESULTS

There was no statistically significant difference between the parent's assessment of their child's dental anxiety level and the child's self report (t=0.389; p=0.689). However, the mothers were able to rate their child's dental anxiety level better than the fathers (r=0.497 and p<0.001 for mothers, r=-0.049 and p=0.789 for fathers). Also there was a moderate correlation between the child's self reported dental anxiety and general anxiety levels (r=0.58, p<0.05) and a low correlation between the clinical behaviour ratings and the child's self reported dental anxiety level (r=0.10, p>0.05).

CONCLUSION

The Nigerian mothers could be relied upon to make objective assessment of their child's dental anxiety. General anxiety appears to play a significant role in dental anxiety development in Nigerian children who appear to behave well in the dental chair despite their reported dental anxiety levels.

The effect of psychological management on dental anxiety in children

The aim of this study was to determine the effect of using of psychological management techniques on the level of anxiety in Nigerian children during dental management. The Short Form of the Dental Anxiety Survey Schedule was administered to 81 children who were attending a suburban dental clinic for the first time. This schedule was re-administered again two weeks later when they came for a follow up visit. The age of the patients was recorded. The types as well as number of psychological techniques employed during treatment were also noted. The overall mean dental anxiety level of the children decrease from an average of 15.23 +/- 5.03 before treatment to 13.40 + 4.13 after treatment (p < 0.001). However, the mean dental anxiety score in children in whom no psychological technique was employed during treatment increased after treatment. On the other hand, there was also a statistically significant decrease in the mean dental anxiety level of children treated using either a single psychological technique or combined psychological techniques after treatment. Better results were obtained when combined psychological techniques where used than when only a single technique was used. It was concluded that psychological techniques used in the management of dental anxiety in children are highly effective in decreasing dental anxiety levels. Better results are obtained when a number of techniques are combined effectively.

The effect of sociodemographic factors on dental anxiety in children seen in a suburban Nigerian hospital

OBJECTIVE

This paper attempts to determine the sociodemographic factors that relate to dental anxiety in suburban African children.

METHODS

A short form of the Dental subscale of the Child Fear Survey schedule (DFSS_SF) was administered to 81 patients (first time attendees at the clinic) between the ages of eight and 13 years. The psychometric scale was used after determining its reliability and validity to ensure that it was culturally appropriate. Age, gender, sociodemographic status were also recorded. The dental anxiety score distribution, its threshold level as well as the relationship between the sociodemographic variables and patients' anxiety were determined.

RESULTS

There was no statistically significant association between age (P = 0.856), gender (P = 0.124), socio-economic status of the children (P= 0.12) and level of dental anxiety. However, a statistically significant relationship did exist between the type of school the child attended and the anxiety level (P = 0.009). Also, 18 (14.8%) of the children were found to have high anxiety levels.

CONCLUSIONS

Further studies involving larger non-clinic samples are needed to examine the issues raised by the findings of this study.

Reliability and validity of a short form of the dental subscale of the child fear survey schedule used in a Nigerian children population

This study sought to establish the reliability and validity of a short form of the Dental Subscale of the Child Fear Survey Schedule (DFSS-SF). The schedule was administered twice to 23 children who had not attended a dental clinic for dental treatment before. The second administration was done two weeks after the first. They had no preknowledge of the second administration of the schedule. The children's behaviour during treatment was also assessed using the Frankl's scale. An additional assessment was also made using the dichotomy "anxious" or "not anxious". Analysis of the reliability was done using the Cronbach's coefficient alphas as well as the Pearson product-moment coefficient. The overall coefficient alphas for the DFSS-SF was 0.82 (p < 0.0001). A test retest correlation of 0.73 (p < 0.0001) was obtained. On comparison of the DFSS-SF with the Frankl's scale, a significant difference was found in the psychometric scores of the children grouped as anxious and no anxious. Also, on comparison of the DFSS-SF with the dichotomy scale, a highly significant difference between the two was observed (p = 0.005). A good negative correlation was found between the second administration of the DFSS-SF and Frankl's scale (r = -0.54; p = < 0.01). The DFSS-SF is a reliable and valid instrument for measuring dental anxiety in Nigerian children. However the study needs to be replicated on a larger number of children.

Seminars on controversial issues. A review of the pharmacological approach to the management of dental anxiety in children

This paper aims to review the existing literature on the pharmacology of a number of sedative drugs used in the management of dental anxiety in the conscious child patient. Pharmacological agents may be used as a complement to behavioural techniques to assist in the management of anxiety in some paediatric dental patients. Their use may also be especially indicated in children with disabilities. These agents are usually sedative in action and do not, in themselves, eliminate anxiety but merely enhance patient acceptance by reducing arousal and modifying anticipation of danger. The agents used are varied and diverse and include nitrous oxide, benzodiazepines and narcotics. Nitrous oxide has proved to be of particular value but carries a degree of risk for the operating staff. Amongst the benzodiazepines, Midazolam has been used more frequently in recent years. It may be given by a variety of routes, including intra-nasally. Dentists who employ sedative agents and techniques should be familiar with the pharmacology of the agents selected, be cognisant of the risks and benefits of the technique employed and be able to manage any adverse events that may arise through their use.

Parental anxiety as a possible predisposing factor to child dental anxiety in patients seen in a suburban dental hospital in Nigeria

INTRODUCTION

The aim of this study was to determine the relationship between parents' anxiety level and that of the child patient.

METHODS

The Short Form of the Dental Anxiety Survey Schedule was administered to 81 children who were attending the dental clinic for the first time. The Dental Anxiety Scale was also used to collect relevant information from the parents.

RESULTS

There was no statistically significant correlation between the anxiety level of the mother (r = -0.02, P = 0.82) or the father (r = -0.59, P = 0.62) and that of their child. However, bivariate analysis showed a closer association between the anxiety levels of the mother and the child (P = 0.055) compared to that between the father and the child (P = 0.475) although this was again found not to be statistically significant.

CONCLUSION

Assessment and management of the anxiety level of the mother may be needed in some cases, both to manage the child effectively and to break the cycle of dental care anxiety in families.

Caring for the people living with HIV/AIDS and AIDS orphans in Osun State: a rapid survey report

The aim of the study is to obtain the views and opinions of People Living with HIV/AIDS (PLWHAS), community leaders and other stake holders (care providers and AIDS orphans), so as to assess the role of Non-Governmental Organisations in the control of HIV infection with the purpose of making appropriate recommendations for policy formulation on issues related to the health and care of PLWHAs. A qualitative research was carried out using in-depth interview method with a questionnaires as a guide. In all, 12 seropositives, 13 community leaders and 34 AIDS orphans were interviewed. Results indicate that there was a lack of networking between the six Non-Governmental Organisations working in the state in relation to HIV/AID. Also, none of these PLWHAs had concrete plans for the future of their children, though they all expressed some form of anxiety about their children's future. The burden of care of AIDS orphans often fall on the maternal family members. Top on the list of the problem of AIDS orphans was their poor education due to financial difficulties. There is the need for the government to provide, support, encourage and monitor the activities of the Non-Governmental Organisations and network with them so as to maximise the benefits that can be obtained from the role they play in HIV/AIDS management.

Aetiology of dental anxiety in children: a review of the literature

Dental anxiety has long been identified as a factor that affects the effective provision and acceptance of dental treatments by patients. For children, this becomes a handicap especially when they have not developed an ability to cope with the problem. This paper reviews factors that have been identified as aetiological factors for dental anxiety in children. Also a note has been made on a possible concomitant factor to other identified aetiological factors in Nigerian children though there is the need for more studies in the country on this subject. An understanding of the various aetiological factors in dental anxiety would help in the child-patient management with there being the possibility of a multidisciplinary approach to this multidimensional problem.