Improving the health of Indigenous people globally

Prevalence of temporomandibular joint dysfunction among the indigenous population of India

Purpose

Primary dental care facilities and awareness about temporomandibular disorders are lacking among the indigenous population of Kerala. The aim of the study was to determine the prevalence of temporomandibular joint dysfunction (TMD) disorders among the indigenous populations of Kerala.

Methodology

This cross-sectional study included adults aged 18 years and above, visiting primary health care centre in the tribal hamlet in the town of Kalpetta, Wayanad District, Kerala, India, for reasons other than dental. Axis I and II of Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) was used to screen for TMD. A local language validated screening questionnaire was used. The clinical examination was carried out as per the DC/TMD by a calibrated examiner. The data was processed using SPSS and the frequencies and proportions for signs and symptoms of TMD were estimated.

Results

Among 198 adults screened, 23 (11.6 %) had TMD. Among these 60 % of the adults were aged 31-65 years and predominantly females (86.9 %). 39 % of these patients were dentulous. All affected adults experienced TMD related pain for more than 3 months with 90 % of them experiencing moderate-to-severe pain. Myofascial pain was the most prevalent type. Other findings included moderate anxiety levels in 34.8 % and abnormal oral behaviour and high physical symptoms in 40 % TMD patients.

Conclusion

TMD disorders were prevalent among the indigenous population and remained undiagnosed. The study highlights the need for screening and the availability of basic dental care for the indigenous populations.

Prevalence of periodontal disease among Indigenous and non-Indigenous populations: protocol for systematic review and meta-analysis

BACKGROUND

Indigenous populations globally experience worse oral health than their non-Indigenous counterpart. Globally, the occurrence of periodontal diseases such as gingivitis and chronic periodontitis is high among Indigenous people. This systematic review aims to quantify, at a global level, the prevalence of periodontal disease among Indigenous populations compared to non-Indigenous populations.

METHODS

This review will only consider studies that have reported the prevalence (%) of periodontal disease among Indigenous and compared against non-Indigenous populations. Studies that have no comparative population or data only on one particular population or lack of data on periodontal clinical assessment will be excluded. An electronic search will be conducted using keywords and appropriate MeSH terms across several databases capturing both published and unpublished articles. The search will be conducted from the time of database inception to February 2021. After the initial search, duplicates will be removed, and the remaining titles and abstracts will be assessed for eligibility. The full text of eligible studies will be assessed by two independent reviewers who will also complete the critical appraisals and data extraction. Outcomes measures would be the mean prevalence (%) and standard deviation of periodontal disease among Indigenous and non-Indigenous populations. From the selected studies, we will conduct a random-effects meta-analysis using standardized mean difference as the effect measure. Forest plots will be used for the visualization of differences in the prevalence of periodontitis. A subgroup analysis will be conducted based on the definition of periodontitis, age, publication type, and geographical location. Heterogeneity among studies will be assessed by I² and chi-square test. Egger's test and funnel plots will be used to assess publication bias.

DISCUSSION

Our systematic review and meta-analysis will facilitate an increased understanding of the magnitude of periodontal disease inequalities that exist globally for Indigenous populations through pooled prevalence estimates. The findings will be helpful to design selective targeted preventive and interventional strategies for periodontal disease for reducing oral health inequalities at a global level.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020188531.

Mental health of indigenous people: is Bangladesh paying enough attention?

Indigenous people face numerous challenges to their mental health across the world. We consider the situation in Bangladesh, where those living in the remote hill tracts areas of Eastern Bangladesh experience widespread difficulties. Few seek attention for their problems from professional services, in part because of stigma or a lack of awareness that help could be made available, but also because in these remote areas few resources are available. We make recommendations to improve this situation, which could be implemented with the assistance of primary healthcare services and traditional healers.

Prevalence of dental caries among Indigenous populations compared to non-Indigenous populations: a quantitative systematic review protocol

OBJECTIVE

The objective of this review is to evaluate if the prevalence of dental caries is higher among Indigenous populations compared to non-Indigenous populations.

INTRODUCTION

Globally, Indigenous populations have experienced substantial inequalities in health, including oral health care, when compared to their non-Indigenous counterparts. Indigenous populations experience a higher prevalence of dental caries, but most of this data has been collected from convenience samples not involving non-Indigenous groups. This review will highlight differences in the prevalence of dental caries globally among Indigenous groups compared to non-Indigenous groups.

INCLUSION CRITERIA

The systematic review will include all studies that have compared the prevalence of dental caries (% of decayed teeth>0) and dental caries experience (mean score of decayed, missing, filled teeth) among Indigenous and non-Indigenous populations across all ages.

METHODS

Initially, articles will be searched in MEDLINE, followed by a more comprehensive search on Scopus, EBSCO (Dentistry and Oral Sciences Sources), Cochrane Database, and OpenGrey. The search will be conducted independently by two reviewers from database inception to September 2020. A reference list will be made identifying all eligible studies. Titles and abstracts will be reviewed, as well as the full text of articles that meet the inclusion criteria. To assess methodological quality, a standardized critical appraisal checklist for studies reporting prevalence will be selected, followed by standardized data extraction using the JBI tool. The results from included studies will be analyzed using JBI SUMARI.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020204311.

Dental Health Inequalities among Indigenous Populations: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to document the disparity in dental caries experiences among indigenous and nonindigenous populations globally by measuring dental caries prevalence and severity. An electronic database (MEDLINE) was initially searched using relevant keywords. This was followed by use of the search string in the following electronic databases: Scopus, EBSCOhost, Cochrane, and Open Grey. Two independent reviewers conducted the study search and screening, quality assessment, and data extraction, which was facilitated using JBI SUMARI software. The primary outcome was the decayed missing filled teeth (DMFT) score and dental caries prevalence. Subgroup analysis was done by country of publication to identify causes of heterogeneity. Forest plots were used with the standardized mean difference (SMD) and publication bias was assessed using the Egger test with funnel plot construction. For the final review, 43 articles were selected and 34 were meta-analyzed. The pooled mean DMFT for both the permanent dentition (SMD = 0.26; 95% CI 0.13-0.39) and deciduous dentition (SMD = 0.67; 95% CI 0.47-0.87) was higher for the Indigenous population than for the general population. Indigenous populations experienced more decayed teeth (SMD = 0.44; 95% CI 0.25-0.62), a slightly higher number of missing teeth (SMD = 0.11< 95% CI -0.05 to 0.26), and lesser filled teeth (SMD = -0.04; 95% CI -0.20 to 0.13) than their nonindigenous counterparts. The prevalence of dental caries (SMD = 0.27; 95% CI 0.13-0.41) was higher among indigenous people. Globally, indigenous populations have a higher caries prevalence and severity than nonindigenous populations. The factors which have led to such inequities need to be examined.

Youth underrepresentation as a barrier to sexual and reproductive healthcare access in Kasulu district, Tanzania: A qualitative thematic analysis

OBJECTIVES

Representation of the key groups in community-level healthcare decisions is a prerequisite for accountable and responsive primary healthcare systems. However, meaningful representation requires both the presence of individuals who represent the key community groups and their capacity to influence the key healthcare plans and decisions. Our study explored how the underrepresentation of the youth in health facility committees, the decentralized community- and facility-level healthcare decision-making forums affects youth access to sexual and reproductive health services.

METHODS

A multisite case study involving focus group discussions, interviews, and meeting observation was conducted in eight primary healthcare facilities in Kasulu, a rural district in Tanzania. Inductive thematic analysis was used to identify the key emerging themes.

RESULTS

Five major themes were identified in connection with youth underrepresentation and limited access to sexual reproductive health as a 'taboo' phenomenon in the communities. These were: numbers do not matter, passive representation, sociopolitical gerontocracy, economic vulnerability, and mistrust and suspicion.

CONCLUSIONS

Gradual emancipatory and transformative efforts are needed to normalize the representation of the youth and their concerns in formal community-level decision-making institutions.

Collection and Reporting of Indigenous Status Information in Cancer Registries Around the World

PURPOSE

Worldwide, Indigenous people often have disproportionally worse health and lower life expectancy than their non-Indigenous counterparts. Despite the impact of cancer on life expectancy, little is known about the burden of cancer for Indigenous people primarily because of the paucity of data. We investigated the collection and reporting of Indigenous status information among a global sample of population-based cancer registries (PBCRs).

PARTICIPANTS AND METHODS

An online survey was e-mailed to eligible registries using set inclusion criteria. Respondents were asked questions on the collection, reporting, and quality assessment of Indigenous status in their registers.

RESULTS

Eighty-three PBCRs from 25 countries were included. Of these, 66% reported that their registry collected Indigenous status data, although the quality of this variable had been assessed in less than half in terms of completeness (38%) and accuracy (47%). Two thirds of PBCRs who collected Indigenous status data (67%), from nine of 25 countries responded that cancer statistics for Indigenous people were reported using registry data. Key barriers to the collection of Indigenous status information included the lack of data collection at the point of care (79%), lack of transfer of Indigenous status to the cancer registry (46%), inadequate information systems (43%), and legislative limitations (32%). Important variations existed among world regions, although the lack of Indigenous status data collection at the point of care was commonly reported across all regions.

CONCLUSION

High-quality data collection is lacking for Indigenous peoples in many countries. To ensure the design and implementation of cancer control activities required to reduce disparities for Indigenous populations, health information systems, including cancer registries, need to be strengthened, and this must be done in dialogue with Indigenous leaders.