"It was pain. That's it. It was pain." Lack of oral health care among otherwise healthy young adults living with HIV in South Africa: A qualitative study

Utilization of dental health services and its associated factors among adult population in Ernakulam district, Kerala, India: A mixed-method analysis

Background

There exists a high burden of oral diseases. Yet, the utilization of oral health care remains low. Understanding how, when, and why/why not individuals utilize dental healthcare resources is essential for planning health services and developing policies as it reflects the population's oral health needs, helps allocate resources efficiently, and formulate policies that are tailored to address their needs.

Objectives

To assess the utilization of dental health services and its associated factors along with barriers and facilitators among adults residing in Ernakulam district, Kerala, using the Anderson healthcare model for healthcare utilization.

Methods

A mixed-method study was conducted among adults aged 18 years and above in urban and rural wards of Ernakulam district using the cluster sampling method. Univariate and multivariate analysis were used for the quantitative part, and thematic analysis was used for the qualitative aspect. The total sample size was 544.

Results

The dental healthcare utilization was 15.4 ± 2.9 % among the study participants. Age and education were associated with dental healthcare utilization. The level of education, pain, and self-consciousness of oral diseases were independent predictors. Barriers identified were negative attitudes, financial restraints, and difficulty in access, while facilitators were trust in service providers, availability of services, and a positive attitude.

Conclusion

Utilization was poor despite the perceived need for oral health care. This was affected by several personal and system-level facilitators and barriers.

Perceived oral health interventions by medical providers in Gugulethu, South Africa

Introduction

The purpose of this study was to explore factors that impact patients’ ability to access high quality, expeditious oral health care by understanding medical professionals’ knowledge of oral health, the care they provide to patients presenting with oral health complaints, and their perceptions of potential interventions to improve oral health care delivery.

Methods

We conducted in depth qualitative interviews, which were analyzed using an inductive content analytical approach. The study was conducted in Gugulethu, a community located outside of Cape Town, South Africa. Local public sector health services provided free-of-charge are the main source of primary health and dental care for this population. Participants included the following medical providers: doctors, clinical nurse practitioners, professional nurses, and health promoters.

Results

Identified themes fell within the three broad subject areas: oral health knowledge, patient care, and potential interventions. Themes within oral health knowledge included (1) personal responsibility for hygiene, (2) routine oral health care, (3) lack of knowledge among medical professionals, (4) poverty, and (5) an oral-systemic connection. Participants cited both ‘clinical care knowledge’ and/or ‘uncertainty’ about patient care for oral health complaints. Participants independently suggested interventions in three broad areas: (1) education, (2) expanded provider roles, and (3) colocation of services.

Conclusions

Our findings suggest that a variety of interventions, ranging from high to low resource investment, may impact access to and utilization of oral health services and thereby result in improved patient care. Future studies should develop and evaluate the suggested interventions in a range of care settings.

Prevalence of Oral Mucosal Lesions and Relation to Serum Cotinine Levels-Findings from a Cross-Sectional Study in South Africa

Oral mucosal lesions (OML) can decrease oral health-related quality of life and some have the potential to become malignant. The aim of the present study was to report the prevalence of OML in relation to age, sex, and serum cotinine levels in a population with mixed ancestry from South Africa. This study is part of the Cape Town Vascular and Metabolic Health (VHM) study, conducted between 2014-2016. Trained dental examiners assessed the oral mucosa for the presence of OML according to WHO criteria. In total, 1976 individuals were included in the study, being 1496 females (75.7%) and 480 males (24.3%) with average age of 49.5 years (SD = 15.3). In total, 262 lesions were detected in 252 participants (overall prevalence of 13%). Males had higher prevalence than females (14% vs. 9%, p = 0.008). Participants aged 25-34 had the highest prevalence rates (21%). Participants who had cotinine ≥15 ng/mL had higher prevalence of OML as compared to those with <15 ng/mL (15% vs. 5%, p < 0.001). Most common lesions were nicotine stomatitis (33%) and leukoplakia (19%). Age, male sex, and higher cotinine levels were associated with increased prevalence of OML.