Patients' knowledge about dental emergencies, COVID-19 transmission, and required preparations in dental settings

INTRODUCTION

The Coronavirus disease 2019 (COVID-19) pandemics negatively affected the delivery of dental care. The study objective was to assess the knowledge of emergency dental treatments, the transmission routes of COVID-19 in the dental settings, necessary precautions to prevent disease transmission, and the associations between demographic factors and the mentioned domains among Iranian dental patients.

METHODS

This was a cross-sectional study conducted in October 2021. A systematic random sampling approach was used to select 244 participants who had sought services at the dental clinic of Tehran University of Medical Sciences before and during the pandemic. Data was collected using a combination of interviewer-administered and self-administered questionnaire. Three backward stepwise multiple logistic regression analyses were conducted to determine the associations between background factors (age, sex, education level, living status, history of dental visits, history of COVID-19 vaccination, and past COVID-19 infection) and knowledge about emergency dental treatments, knowledge about COVID-19 transmission routes, and knowledge about necessary preparations in dental settings.

RESULTS

The mean (SD) scores for knowledge of emergency dental treatments, COVID-19 transmission routes, and essential preparations in dental settings measured on a 100-point scale were 77 (15.4), 84.2 (12.3), and 93.3 (12.1), respectively. Good knowledge of emergency dental treatments was associated with being under 55 years old (p = 0.03). Good knowledge of COVID-19 transmission routes was associated with living with individuals at a high risk of COVID-19 (p = 0.014) and having received the COVID-19 vaccine (p = 0.013). After adjusting for age, among participants aged 30 years and older, good knowledge of necessary preparations in dental settings was associated with being female (p = 0.012) and having received the COVID-19 vaccine (p = 0.001).

CONCLUSIONS

Patients who sought care at the dental clinic of Tehran University of Medical Sciences had good knowledge about the transmission routes of COVID-19 and the required preparations in dental settings, and limited knowledge about dental emergency treatments.

Healers that hurt: a scoping review of media reports of cases of rape in healthcare settings

BACKGROUND

Sexual assault occurring within healthcare settings represents a significant breach of public trust. This scoping review aimed to highlight the profile of people raped, those who committed the rape within the health facilities, and the legal actions taken to resolved cases.

METHODS

Media-reported data on incidents of rape in healthcare settings were collected. The search was conducted in May and June 2023, focusing on English-language publications with accessible full texts. Reports that lacked information on the survivors or incidents that occurred outside of healthcare settings were excluded. Descriptive statistics were used to summarize the categories of the collected publications, and graphical representations were employed for visualization purposes.

RESULTS

A total of 62 cases were retrieved, originating from Africa (n = 17; 27.4%), Europe (n = 14; 22.6%), Southeast Asia (n = 14; 22.6%), the Americas (n = 11; 17.7%), the Western Pacific Region (n = 5; 8.1%) and Eastern Mediterranean region (n = 1; 1.6%). In addition, 69 individuals were implicated in 59 cases. They were 31 doctors (44.9%), 17 (24.6%) nurses, four (5.8%) nurse/healthcare assistants, three (4.3%) cleaners/ward boy, two (2.9%) traditional medical doctors, and two (2.9%) security guards. Others included six (8.7%) staff members without designations and one (1.4%) ambulance driver. All perpetrators were male, ranging in age from 22 to 67 years. There were 66 victims identified in the 62 cases with age ranging from 2 to 92 years. Except for one case, all victims were female, and all but one case were patients. Most assaults occurred in consulting rooms/clinics (n = 21; 31.8%), 16 (24.2%) happened under sedation, and six (9.1%) were repeatedly raped, Survivors typically reported the cases the police (n = 12; 19.4%), family/friends (n = 11; 17.7%) or to hospital authorities (n = 10; 16.1%). Out of the 69 perpetrators, 19 (30.6%) were imprisoned with sentences ranging from 12 months to an indefinite period and one (1.6%) received a death sentence.

CONCLUSION

The raping of patients by healthcare providers within healthcare settings calls for urgent and extensive measures. Stakeholders in healthcare management need to prioritize raising awareness about the problem, implement robust prevention and reporting strategies, and create healthcare environments that are safe, respectful, and supportive for all individuals seeking care.

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.

METHODS

The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic.

FINDINGS

Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021.

INTERPRETATION

Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.

FUNDING

Bill & Melinda Gates Foundation.

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.

FINDINGS

The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.

INTERPRETATION

Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere.

FUNDING

Bill & Melinda Gates Foundation.

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period.

METHODS

22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.

FINDINGS

Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.

INTERPRETATION

Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic.

FUNDING

Bill & Melinda Gates Foundation.

A pilot study on the global practice of informed consent in paediatric dentistry

Background

Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment-and has specific relevance with SDF/ SF treatments.

Methods

The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared.

Results

Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the "best interest" of the patient.

Conclusion

It is recommended that it is clarified globally when a dentist may act in the "best interest" of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries.

Socio-economic factors associated with post-traumatic stress symptoms among adolescents and young people during the first wave of the COVID-19 pandemic

This study assessed the association between sociodemographic factors and post-traumatic stress symptoms (PTSS) among 18-24-year-olds during the first wave of the COVID-19 pandemic. This was a secondary analysis of data from 4508 individuals collected through an online survey conducted between June and January 2021. PTSS was measured as a dependent variable using the checklist for post-traumatic stress disorder in civilians. Age, birth sex, sexual, level of education, access to emotional and social support, and emotional distress were the independent variables. A multivariate logistic regression analysis was conducted to determine the associations between the dependent and independent variables while controlling for the country related confounding variables. Females (AOR:2.023), sexual minority individuals (AOR:1.868), those who did not disclose their sexual identify (AOR:1.476), those with poor access to emotional and social support (AOR:4.699) and individuals with no formal education (AOR:13.908), and only primary level education (AOR:4.521) had higher odds of PTSS. The study highlights the multifaceted nature of PTSS during the pandemic and suggests the importance of promoting access of young people, especially females, sexual minority individuals and those with low educational status, to emotional/social support to mitigate the probability of PTSS, especially among sexual minority individuals.

Corrigendum: Editorial: Country profile of the epidemiology and clinical management of early childhood caries, volume II

[This corrects the article DOI: 10.3389/fpubh.2023.1201899.].

A scoping review on the links between sustainable development goal 14 and early childhood caries

BACKGROUND

The Sustainable Development Goal (SDG) 14 addresses life below the waters, an important source of protein and contributor to global food security and economic development. Our aim was to explore possible evidence on the links between life below water and early childhood caries (ECC).

METHODS

This scoping review identified articles on the link between life below water and caries according to the PRISMA-ScR guidelines. Three electronic databases (PubMed, Web of Science, and Scopus) were systematically searched in January 2023, using specific search terms. Studies written in English, with full text available, addressing life under water, focusing on dental caries in humans, with results that can be extrapolated to control ECC in children less than 6 years of age were included in the review. Descriptive statistics were used to summarize the retrieved papers and graphical presentation was used for visualization.

RESULTS

There were 224 publications retrieved of which 13 studies, published between 1960 and 2022, were included in the analysis. The papers originated from Asia (7/13), North America (3/13), Europe (1/13), and 2/13 had multi-country authorship. Also, four laboratory studies extracted agents from marine products to determine their efficacy in preventing caries formation and preventing/slowing plaque formation; four letters discussed the caries prevention potential of sea salt as a source of fluoride; and two review articles about the positive effects of extracted marine products for caries prevention. Most (11/13) studies addressed target 14.1 concerned with enriching the marine environment with nutrients and minerals; two addressed target 14.4 focused on ensuring fish stocks are within biologically sustainable levels; two addressed target 14.7 aimed at increasing the economic benefits through sustainable use of marine resources such as fisheries; and one focused on target 14.5 aimed at conserving marine areas by increasing protected areas. In addition, one ecological study assessed the association between the ecosystem and ECC.

CONCLUSIONS

Currently, there is little known about the impact of protection of marine and coastal ecosystem from pollution and ocean acidification on the risk of ECC. Further evidence on possible associations between life below water and ECC management is needed.

Maternal factors associated with early childhood caries among 3-5-year-old children with low socio-economic status in Trishal, Bangladesh

Introduction

Early Childhood Caries (ECC) is more prevalent in nations where a larger portion of the population resides below the poverty line. This study aimed to evaluate the connections between maternal awareness, attitudes, practices related to oral health, and the occurrence of ECC among children aged 3-5 years in Bangladesh, a low-middle income country with high level of poverty.

Methods

This cross-sectional study recruited mother-child pairs with a focus on children aged 3-5 years from low socioeconomic backgrounds in Trishal, Bangladesh. Data collected included maternal oral health knowledge, attitudes, and behaviors. Clinical examinations were conducted to check for dental plaque on the upper central incisors' labial surfaces. ECC was identified using the ICDAS II index criteria. Associations between maternal oral health knowledge, attitudes, behaviors, and children's plaque score and caries status were analyzed using multivariable logistic regression, and adjusting for confounding variables (child's age, gender, mother's age, education, and number of children).

Results

Among 532 mother-child pairs, 491 (93.2%) mothers were unaware of the role of fluoride in preventing caries, while 516 (97%) recognized the importance of using fluoridated toothpaste during brushing. Additionally, 520 (97.7%) mothers reported not knowing how to brush their child's teeth, and 87 (16.4%) brushed their children's teeth twice daily. Visible dental plaque was observed in 420 (78.9%) children, and 321 (60.3%) had ECC. Higher plaque score increased the odds of ECC in the study population (AOR: 5.617, 95% CI: 3.511-8.987).

Conclusions

Mothers of preschool children with low socioeconomic status were poorly aware of caries preventive behaviors and had suboptimal oral health practices for their children. The plaque score was the only oral health factor that seems to increase the risk for ECC among children with low socio-economic status in Bangladesh. It is imperative to prioritize support and interventions aimed at improving oral hygiene practices to reduce ECC risk in this population.

A scoping review linking early childhood caries to violence, neglect, internally displaced, migrant and refugee status

BACKGROUND

The aim of the scoping review was to identify and synthesize the available literature concerning the relationship between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC) as it relates to the United Nation's Sustainable Development Goal 16 (SDG 16).

METHODS

Data regarding the links between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC), and the associations between ECC and maternal and child exposure to physical and sexual abuse, insecurity, crime, exploitation, torture, and displacement were extracted. The search was carried out in January 2023 across three databases (PubMed, Web of Science, and Scopus). Only publications in English with accessible full texts were included. Descriptive statistics were utilized to summarize the categories of the retrieved papers, and graphical representation was employed for visualization purposes. The relationships between the publications and each of the 10 targets of Sustainable Development Goal 16 (SDG 16) were also assessed.

RESULTS

Forty-five studies were reviewed. Most studies (42.2%) originated from the Americas Regions, while no studies were identified from the Africa Region. A significant portion (46.7%) of the papers focused on abuse, violence, and neglect as risk factors for ECC. Migrants, refugees, and IDPs were the most investigated populations (44.4%). Only one study specifically focused on IDPs and migrants respectively. The prevalence of untreated caries was higher among migrants, refugees, and IDPs compared to the host community, ECC was more prevalent among children who experienced abuse, neglect, or were in protective care. The was no clear direction on the associations between ECC and intimate partner violence, adverse childhood experiences, and wars. In terms of the SDGs, the reviewed publications addressed four targets (SDG16.1, SDG16.2, SDG16.3, and SDG16.5) out of the ten targets outlined in SDG 16.

CONCLUSION

There is available evidence regarding the connections between ECC and war, refugees, migration, violence, and neglect, as outlined in SDG 16. Future studies are needed to investigate how forced movements directly affects ECC status, how disruptions of peace and stability is a risk factor for ECC, and the associations between ECC and other indicators related to SDG 16 targets.

Associations between maternal mental health, child dental anxiety, and oral health of 6- to 12-year-olds in Nigeria

Maternal mental health affects their children's oral health. This study assessed the associations between maternal mental health and dental anxiety level, dental caries experience, oral hygiene, and gingival status among 6- to 12-year-old children in Nigeria. This was a cross-sectional study that recruited mother-child dyad participants through a household survey conducted in Ile-Ife, Nigeria. Data collected included the independent (maternal mental health risk, depressive symptoms, and child's dental anxiety), and dependent (caries experience, oral hygiene status, and gingival health status) variables. Multivariate logistic regression analysis was conducted to determine the associations between dependent and independent variables after adjusting for confounders (mothers' age, child's age, sex, and socioeconomic status). Statistical significance was set at p < 0.05. Of the 1411 mothers recruited, 1248 (88.4%) had low mental health risk, and 896 (63.5%) had mild depressive symptoms. As for the children, 53 (3.8%) had caries, 745 (52.8%) had moderate to high dental anxiety, 953 (63.0%) had gingivitis and 36 (2.6%) had poor oral hygiene. The maternal mental health risk was not significantly associated with the child's caries experience (AOR: 1.012; 95%CI: 0.860-1.190; p = 0.886), poor oral hygiene (AOR:1.037; 95%CI: 0.975-1.104; p=0.250), and moderate/severe gingivitis (AOR:0.887; 95%CI: 0.764-1.030; p = 0.115). Maternal depression status was not significantly associated with the child's caries experience (AOR: 0.910; 95%CI: 0.802-1.033; p = 0.145), poor oral hygiene (AOR: 1.016; 95%CI: 0.976-1.057; p = 0.439), and moderate/severe gingivitis (AOR: 0.963; 95%CI: 0.861-1.077; p = 0.509). Maternal mental health risk and depression do not seem to be risk factors for schoolchildren's oral health in Nigeria. Further studies are needed to understand these findings.

A cross-sectional study on resilience, anxiety, depression, and psychoactive substance use among heterosexual and sexual minority adolescents in Nigeria

BACKGROUND

Mental health-related problems predispose alcohol and other psychoactive substances use as coping strategies. We assessed associations between resilience and anxiety symptoms, depressive symptoms, problematic alcohol, and multiple psychoactive substance use among sexual minority and heterosexual adolescents in Nigeria.

METHODS

This was a secondary analysis of a subset of data generated through an online cross-sectional study conducted between 16th and 31st of October 2020. Data extracted for adolescents in Nigeria age 13-19 years were: dependent variables (alcohol use using the CAGE test, multiple psychoactive substance use, depressive symptoms using the Patient Health Questionnaire-9, and anxiety symptoms using the Generalized Anxiety Disorder-7 measure); independent variables (resilience using the Connor-Davidson resilience scale and sexual identity), and confounding factors (age and sex). Associations between dependent and independent variables were determined using multivariable logistic regression analyses after controlling for confounders.

RESULTS

Of the 1419 adolescent participants, 593 (42%) were sexual minority individuals, 533 (37.6%) had high depressive symptoms, 381 (26.8%) had high anxiety symptoms, 177 (12.5%) had problematic alcohol use and 389 (27.4%) used multiple psychoactive substances. Resilience was significantly associated with lower odds of anxiety (AOR:0.96, 95% CI: 0.94-0.97, p < 0.001) and depressive (AOR:0.94, 95% CI: 0.92-0.96, p < 0.001) symptoms, problematic alcohol use (AOR:0.97, 95% CI: 0.95-0.99, p = 0.002), and multiple psychoactive substance use (AOR:0.95, 95% CI: 0.93-0.96, p < 0.001). Sexual minority adolescents had significantly higher odds of anxiety (AOR:4.14, 95% CI: 3.16-5.40, p < 0.001) and depressive symptoms (AOR:4.79; 95% CI: 3.73-6.15, p < 0.001), problematic alcohol use (AOR:2.48, 95% CI: 1.76-3.49, p < 0.001), and multiple psychoactive substance use (AOR:5.69, 95% CI: 4.34-7.47, p < 0.001).

CONCLUSION

Sexual minority adolescents and adolescents with low resilience have a higher need for interventions to reduce the risk of anxiety, depression, and the use of alcohol and other psychoactive substances.

Risk indicators for oral ulcers among people living with HIV during the first wave of the pandemic: a cross sectional study

BACKGROUND

Little is currently known about HIV-related parameters that may increase the risk for oral ulcers during the COVID-19 pandemic. This study aimed to overcome this gap in research by assessing the associations between HIV viral load, antiretroviral adherence profile, co-morbidity status, SARS-CoV-2 infection and oral ulcers among people living with HIV (PLHIV).

METHODS

This was a secondary analysis of data generated from 21,206 to 18 years and above, recruited from 152 countries through an online survey between July and December 2020. Data were extracted for 874 people who reported living with HIV. The dependent variable was reporting having oral ulcer. The independent variables were the viral load, adherence to antiretroviral treatment and a history of SARS-CoV-2 infection. The confounding variables were age at last birthday and sex at birth. A multivariable logistic regression analysis was conducted to determine the associations between the dependent and independent variables after adjusting for the confounding variables.

RESULTS

Of the 874 participants, 99 (11.3%) reported having oral ulcers during the first wave of the COVID-19 pandemic. The odds of PLHIV having oral ulcers during the first wave of the COVID-19 pandemic was significantly higher for people who did not know their viral load than those who had undetectable viral load (AOR: 2.036; 95% CI: 1.204-3.443; p = 0.008); and people who did not adhere to the use of antiretroviral treatment than those who adhered (AOR: 4.113; 95% CI: 2.567-6.589; p < 0.001). Also, PLHIV who had SARS-CoV-2 infection had significantly higher odds of having oral ulcers than those who did not have the infection (AOR: 14.556; 95% CI: 4.500-47.078; p < 0.001). PLHIV who had co-morbidities had non-significantly higher odds of having oral ulcers than those without co-morbidities (AOR: 1.170; 95% CI: 0.656-2.085; p = 0.595).

CONCLUSION

Oral ulcers may be an indicator of poor adherence to antiretroviral therapy and unsuppressed viral load among PLHIV. It may also be an indicator of SARS-CoV-2 infection and a signal to take prompt and critical care of affected individuals because of the risk for severe COVID-19 for these individuals.

Socioeconomic inequality, health inequity and well-being of transgender people during the COVID-19 pandemic in Nigeria

BACKGROUND

We aimed to explore socioeconomic inequality, health inequity, and the well-being of transgender people during the COVID-19 crisis in Nigeria.

METHODS

Between June and December 2021, a cross-sectional survey was conducted collaboratively with community-based organisations in Nigeria. Participants living with or at risk of HIV were recruited voluntarily, online and face-to-face, using a combination of venue-based and snowball sampling. We assessed the association between gender identity (transgender and vulnerable cisgender women), and (i) socioeconomic inequality measured with socioeconomic status, social status, economic vulnerability, macrosocial vulnerability; (ii) health inequity measured with self-assessment of health, recency of HIV test, access to HIV and sexual and reproductive health services, gender-affirming care, financial and non-financial barriers to accessing health services; and (iii) well-being, measured with gender-based violence, mental health, psychoeconomic preferences. We used multivariable logistic regressions and controlled for interactions and confounders.

RESULTS

There were 4072 participants; 62% were under 30, and 47% reported living with HIV. One in ten (11.9%; n = 485) was transgender, and 56.5% reported living with HIV. Compared to vulnerable cisgender women, the results showed significantly higher odds (aOR:3.80) of disruption in accessing HIV services in transgender participants; gender-based violence (aOR:2.63); severe (aOR:2.28) symptoms of anxiety and depression. Among the barriers to accessing health and HIV services, transgender had three-time higher odds of reporting additional non-official fees compared to vulnerable cisgender women. The disclosure of their gender identity or sexual orientation was the most important non-financial barrier to accessing health services (aOR:3.16). Transgender participants faced higher housing insecurity (aOR: 1.35) and lower odds of using drugs (aOR:0.48). Importantly, they are more likely to have performed a recent HIV test and less likely to not know their HIV status (aOR:0.38) compared to vulnerable cisgender women.

CONCLUSIONS

Socioeconomic inequality, health and well-being inequity in transgender people appear to be exacerbated by the COVID-19 pandemic in Nigeria. Interventions are necessary to mitigate socioeconomic challenges, address structural inequality, and ensure equitable access to health services to meet the Sustainable Development Goals for transgender people.

Associations between mental health challenges, sexual activity, alcohol consumption, use of other psychoactive substances and use of COVID-19 preventive measures during the first wave of the COVID-19 pandemic by adults in Nigeria

BACKGROUND

The aims of this study were to assess: 1) the associations among sexual activity, alcohol consumption, use of other psychoactive substances and mental health during the COVID-19 pandemic; and 2) the associations between COVID-19 preventive measures, alcohol consumption and use of psychoactive substances.

METHODS

This was a secondary analysis of data collected from adults in Nigeria between July and December 2020. The variables extracted included change in sexual activity, alcohol consumption and use of other psychoactive substances, COVID-19 preventive behaviors (wearing face masks, washing hands, physical distancing), anxiety, depression, post-traumatic stress disorder (PTSD) and sociodemographic variables (age, sex, education, HIV status, employment status). Multivariable logistic regressions were conducted. A model was run to regress depression, anxiety, PTSD, increased alcohol consumption, and increased use of other psychoactive substances, on increased sexual activity. In separate models, anxiety, depression, and PTSD were regressed on increased alcohol consumption and on increased use of other psychoactive substances. Finally, three models were constructed to determine the associations between increased alcohol consumption and increased use of other psychoactive substances on three separate COVID-19 preventive behaviors. All models were adjusted for sociodemographic variables.

RESULTS

Increased alcohol consumption (AOR:2.19) and increased use of other psychoactive substances (AOR: 3.71) were significantly associated with higher odds of increased sexual activity. Depression was associated with significantly higher odds of increased alcohol consumption (AOR:1.71) and increased use of other psychoactive substances (AOR:3.21). Increased alcohol consumption was associated with significantly lower odds of physical distancing (AOR:0.59).

CONCLUSION

There was a complex inter-relationship between mental health, sexual health, increased use of psychoactive substances. The consumption of alcohol also affected compliance with physical distancing. Further studies are needed to understand the observed relationships.

A scoping review on the association of early childhood caries and maternal gender inequality

AIM

The objective of this scoping review is to present current evidence regarding the association between early childhood caries (ECC) and maternal-related gender inequality.

METHODS

Two independent reviewers performed a comprehensive literature search using three databases: EMBASE, PubMed, and Web of Science. Literature published in English from 2012 to 2022 was included in the search and was restricted to only primary research by using the following key terms: "dental caries", "tooth decay", "gender", "sex", "preschool", "toddler," and "infant". The included studies were limited to those reporting an association between ECC and maternal aspects related to gender inequality. Titles and abstracts were screened, and irrelevant publications were excluded. The full text of the remaining papers was retrieved and used to perform the review. The critical appraisal of selected studies was guided by the Joanna Briggs Institute (JBI) Critical Appraisal Tools.

RESULTS

Among 1,103 studies from the three databases, 425 articles were identified based on publication years between 2012 and 2022. After full-text screening, five articles were included in the qualitative analysis for this review. No published study was found regarding a direct association between ECC and maternal gender inequality at the level of individuals. Five included studies reported on the association between ECC and potential maternal-gender-related inequality factors, including the mother's education level (n = 4), employment status (n = 1), and age (n = 1). Regarding the quality of the included studies, out of five, two studies met all JBI criteria, while three partially met the criteria.

CONCLUSIONS

Based on the findings of this scoping review, evidence demonstrating an association between gender inequality and ECC is currently limited.

A multi-country survey of the socio-demographic factors associated with adherence to COVID-19 preventive measures during the first wave of the COVID-19 pandemic

BACKGROUND

Health behaviours are influenced by individual characteristics including age, gender, education and economic level. This study aimed to assess the associations between individual-level determinants and adherence to COVID-19 preventive measures.

METHODS

We performed secondary analyses of international data collected using an online survey during the first wave of the COVID-19 pandemic between June and December 2020. The dependent variables were self-reported adherence to COVID-19 preventive measures (wearing of face masks, frequent washing/sanitizing of hands, physical distancing, working remotely). The independent variables were age, sex at birth (female vs male), having a chronic disease related elevated risk for severe COVID-19 (none/little, might be at increased risk, at increased risk), educational level completed (no formal education, primary, secondary vs college/university) and employment status (retiree, students, not employed vs employed). Four multivariate logistic regression analyses were conducted to determine the associations between the dependent variables and independent variables. Interaction terms with country-income level were tested in regressions to explore its moderating effect.

RESULTS

Out of 16,866 respondents, 12,634 (74.9%) wore masks or face coverings, 12,336 (73.1%) washed or sanitized their hands frequently, 11,464 (68.0%) reported adherence to physical distancing and 5,646 (33.5%) worked remotely. In adjusted analyses, increased age, college/university education, employment, and having risks for severe COVID-19 were associated with significantly higher odds of adhering to COVID-19 preventive measures. Retirees and students had lower odds of adhering to COVID-19 prevention measures than employed individuals. Males had significantly lower odds of wearing face masks (AOR: 0.901), frequent washing/sanitizing hands (AOR: 0.774) and working remotely (AOR: 0.875) compared to females. Country-income level generally moderated the above relationships such that the associations disappeared in lower income countries.

CONCLUSION

The study findings suggest that the individual socio-demographic factors-age, sex, employment status, education status and having a chronic disease - influence adherence to COVID-19 preventive measures. Findings further reiterate the need for health education and health promotion campaigns on preventive health measures to focus on subpopulations, such as younger males, students and retirees, that require targeted or unique messaging.

Social media information and its association with the adoption of COVID-19 preventive measures in four Latin American countries

Objective

The study aimed to assess the association between adherence to COVID-19 preventive measures and access to media information related to COVID-19.

Methods

A multi-country, cross-sectional study using an online survey was conducted from June to December 2020. The sample included 1,457 participants from Argentina, Brazil, Chile, and Mexico. The outcome variable was self-reported adherence to preventive measures (handwashing, social distancing, self-isolation, use of face masks, and working from home). The explanatory variable was self-report of following media information related to COVID-19 (watching or reading the news, following social media coverage). Multivariable logistic regression analyses were conducted to determine the associations.

Results

Following information on social media was positively associated with higher odds of practicing social distancing (AOR=5.39; 95%CI: 3.93-7.30), self-isolation (AOR=1.44; 95%CI: 1.08-1.92), use of face masks (AOR=16.84; 95%CI: 10.03-28.27), handwashing (AOR=6.95; CI 95%: 4.98-9.71), and working from home (AOR=1.85; 95% CI: 1.43-2.41). Differences in the use of social media for COVID-19 information were observed among the four countries.

Conclusion

Following social media was positively associated with adherence to COVID-19 preventive measures in Latin America. Social media may be effectively used for COVID-19 behaviour modification in Latin America.

Teledentistry from research to practice: a tale of nineteen countries

Aim

The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries.

Methods

Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe.

Results

Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries.

Conclusion

Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.

Association between maternal decision-making and mental health and the nutritional status of children under 6 years of age in sub-urban Nigeria

BACKGROUND

We assessed the association between decision-making power and mental health status of mothers and the nutritional status of their children less than 6 years old in Ile-Ife, Nigeria.

METHODS

This was a secondary data analysis of 1549 mother-child dyads collected through a household survey conducted between December 2019 and January 2020. The independent variables were maternal decision-making and mental health status (general anxiety, depressive symptoms, parental stress). The dependent variable was the child's nutritional status (thinness, stunting, underweight and overweight). Confounders were maternal income, age, and education status, and the child's age and sex. The associations between the dependent and independent variables were determined using multivariable binary logistic regression analysis after adjusting for confounders. The adjusted odds ratios (AORs) were determined.

RESULTS

Children of mothers with mild general anxiety had lower odds of stunting than children of mothers with normal anxiety (AOR: 0.72; p = 0.034). Mothers who did not make decisions on children's access to health care (AOR: 0.65; p < 0.001) had children with lower odds of being thin than those whose mothers made decisions on their access to health care. Children of mothers with clinically significant parenting stress levels (AOR: 0.75; p = 0.033), severe depressive symptoms (AOR: 0.70; p = 0.041) and who were not decision makers on the access of their children to health care (AOR: 0.79; p = 0.035) had lower odds of underweight.

CONCLUSIONS

Maternal decision-making status and mental health status were associated with the nutritional status of children less than 6 years in a sub-urban community in Nigeria. Further studies are needed to understand how maternal mental health is associated with the nutritional status of Nigerian preschool children.

Associations between depression, fear of COVID-19 infection and students' self-care measures used during the first wave of the pandemic

BACKGROUND

COVID-19 lockdown resulted in the closure of schools with associated problems. The aim of this study was to determine the associations between depression, fear of contracting COVID-19 infection and the use of self-care measures by college students during the first wave of the COVID-19 pandemic.

METHODS

This was a cross-sectional study that collected data from undergraduate and postgraduate college students 18 years and older from 152 countries between June and December 2020. Study participants were recruited through crowdsourcing using various social media platforms including Facebook, Twitter, and Instagram, WhatsApp groups and emails to participants in the collaborators' networks. The dependent variables were fear of contracting COVID-19 and depression while the independent variable was students' self-care measures. Multivariable logistic regression models were conducted to assess the associations between the dependent and independent variables.

RESULTS

Of the 2840 respondents, 1305 (46.0%) had fears of contracting COVID-19 and 599 (21.1%) reported depression. The most common self-care measures were phone calls with friends/family (60.1%) and video chat (52.8%). Learning a new skill was significantly associated with higher odds of fear of contracting COVID-19 (AOR = 1.669) and lower odds of having depression (AOR = 0.684). Talking to friends/family through video chat (AOR = 0.809) was significantly associated with lower odds of feeling depressed while spending time with pets (AOR = 1.470) and taking breaks from the news/social media (AOR = 1.242) were significantly associated with higher odds of feeling depressed. Students from lower middle-income countries (AOR = 0.330) had significantly lower odds of feeling depressed than students from low-income countries.

CONCLUSION

Self-care strategies involving social interactions were associated with less depression. Coping strategies with more cognitive demands may significantly reduce the risk of fear of COVID-19. Special attention needs to be given to students in low-income countries who have higher odds of depression during the pandemic than students from other countries.

A multi-country study of the associations between HIV vulnerability status, perception of COVID-19 related stigma and post-traumatic stress symptoms during the first wave of the pandemic

BACKGROUND

This study investigated the associations between COVID-19 related stigma and post-traumatic stress symptoms (PTSS); and the associations between PTSS and COVID-19 related stigma, HIV status, COVID-19 status and key HIV population status.

METHODS

This was a secondary analysis of data of 12,355 study participants generated through an online survey that recruited adults from 152 countries between July and December 2020. The dependent variables were COVID-19-related stigma and PTSS. The independent variables were HIV status (positive/negative), transaction sex (yes/no), use of psychoactive drugs (yes/no), and vulnerability status (transaction sex workers, people who use psychoactive drugs, living with HIV, and COVID-19 status). The confounding variables were age, sex at birth (male/female), level of education, sexual minority individuals (yes/no) and country income level. Multivariable logistic regression analyses were conducted to determine associations between the dependent and independent variables after adjusting for confounders.

RESULTS

There were 835 (6.8%) participants who experienced COVID-19 related stigma during the pandemic and 3,824 (31.0%) participants reported PTSS. Respondents who were living with HIV (AOR: 1.979; 95%CI: 1.522-2.573), tested positive for COVID-19 (AOR: 3.369; 95%CI: 2.692-4.217), engaged in transactional sex (AOR: 1.428; 95%CI: 1.060-1.922) and used psychoactive drugs (AOR: 1.364; 95%CI: 1.053-1.767) had significantly higher odds of experiencing COVID-19 related stigma. Individuals with vulnerability status (AOR:4.610; 95%CI: 1.590-13.368) and who experienced COVID-19 related stigma (AOR: 2.218; 95%CI: 1.920-2.561) had significantly higher odds of PTSS.

CONCLUSION

Individuals with vulnerability status may be at increased risk for COVID-19 related stigma. Key and vulnerable populations who were living with HIV and who experienced stigma may be at a higher risk of experiencing PTSS. Populations at risk for PTSS should be routinely screened and provided adequate support when they contract COVID-19 to reduce the risk for poor mental health during COVID-19 outbreaks and during future health crisis with similar magnitude as the COVID-19 pandemic.

Differences in adoption of COVID-19 pandemic related preventive behaviour by viral load suppression status among people living with HIV during the first wave of the pandemic

BACKGROUND

Adherence to antiretroviral therapy and COVID-19 preventive behaviours among people living with HIV during the pandemic has received little attention in the literature. To address this gap in knowledge, the present study assessed the associations between viral load, adherence to antiretroviral therapy and the use of COVID-19 prevention strategies during the first wave of the COVID-19 pandemic. This was a secondary analysis of data generated through an online survey recruiting participants from 152 countries. Complete data from 680 respondents living with HIV were extracted for this analysis.

RESULTS

The findings suggest that detectable viral load was associated with lower odds of wearing facemasks (AOR: 0.44; 95% CI:0.28-0.69; p < 0.01) and washing hands as often as recommended (AOR: 0.64; 95% CI: 0.42-0.97; p = 0.03). Also, adherence to the use of antiretroviral drugs was associated with lower odds of working remotely (AOR: 0.60; 95% CI: 0.38-0.94; p = 0.02). We found a complex relationship between HIV positive status biological parameters and adherence to COVID-19 preventive measures that may be partly explained by risk-taking behaviours. Further studies are needed to understand the reasons for the study findings.

An International Investigation of Molar Incisor Hypomineralisation (iMIH) and Its Association with Dental Anomalies: Development of a Protocol

BACKGROUND

Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations.

METHODS

Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7-16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics.

CONCLUSION

This large-scale study has the potential to improve understanding about MIH with benefits for patient management.

Relationship Between Types of Information, Dental Anxiety, and Postoperative Pain Following Third Molar Surgery: A Randomized Study

PURPOSE

Third molar (M3) extraction is an anxiety-provoking procedure. Information mode delivery may affect patients' anxiety level and postoperative sequelae. This study determined the relationship between information types, dental anxiety, and postoperative pain following mandibular M3 extraction.

METHODS

Patients (aged 18 to 35 years) requiring M3 extraction under local anesthesia were recruited into this prospective randomized study conducted in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. Patients were randomized to two groups; verbal or audiovisual depending on M3 extraction information received. Primary outcome variable (difference in anxiety between groups) was assessed with State-Trait Anxiety Inventory (STAI-S) and Modified Dental Anxiety Scale(MDAS). Pain recorded on postoperative days (PODs) 1, 3, and 7 using the Visual Analog Scale was the secondary outcome. Other covariables include biodata, impaction types, and difficulty indices. Data analysis was descriptive and bivariate using IBM/SPSS for Windows, version 23 (SPSS, Chicago, IL USA) with significance set at P < .05.

RESULTS

Ninety patients referred for M3 extraction met the inclusion criteria, 45 patients in each group. The audiovisual group had significant increase in anxiety preoperatively measured by STAI-S (P = .002) and MDAS (P = .009) when compared with the verbal group. No significant differences in the STAI-S (P = .16) and MDAS (P = .216) scores were recorded at POD7. The progressive reduction in pain in both groups was not significant at POD7 (P = .746).

CONCLUSIONS

Preoperative verbal information allayed anxiety compared to real life audiovisual information in M3 patients. These findings will provide a baseline reference data for subsequent research in our environment.

Psychosocial Factors Associated with Memory Complaints during the First Wave of the COVID-19 Pandemic: A Multi-Country Survey

This study assessed the associations between psychosocial factors (social isolation, social support, financial support and emotional distress) and memory complaints during the COVID-19 pandemic. This was a secondary analysis of data extracted from the dataset of participants recruited from 151 countries for a COVID-19 related mental health and wellness study between June and December 2020. The dependent variable was memory complaint, measured using the Memory Complaint Questionnaire. The independent variables were perception of social isolation, social support, financial support, emotional distress and history of SARS-CoV-19 infection. Confounding variables were age, sex at birth, level of education, employment status, HIV status and country-income level. Multivariable logistic regression was used to determine the associations between the dependent and independent variables after adjusting for the confounders. Of the 14825 participants whose data was extracted, 2460 (16.6%) had memory complaints. Participants who felt socially isolated (AOR: 1.422; 95% CI: 1.286-1.571), emotionally distressed (AOR: 2.042; 95% CI: 1.850-2.253) and with history of SARS-CoV-19 infection (AOR: 1.369; 95% CI: 1.139-1.646) had significantly higher odds of memory complaints. Participants who perceived they had social and financial support had significantly lower odds of memory complaints (AOR: 0.655; 95% CI: 0.571-0.751). Future management of pandemics like the COVID-19 should promote access to social and financial support and reduce the risk of social isolation and emotional distress.

A multi-country survey on access to healthcare and treatment services among individuals with critical medical care needs during the first wave of the pandemic

BACKGROUND

Healthcare services were significantly interrupted during the early phase of the COVID-19 pandemic. The aim of the present study was to determine the associations between sociodemographic factors and healthcare access during the first wave of the COVID-19 pandemic among individuals with critical care needs.

METHODS

This was a secondary analysis of the data of 5,156 participants recruited from 152 countries during the first wave of the COVID-19 pandemic. The dependent variables were self-reported difficulty of access to health care, challenges with obtaining medication, and the use of alternative medical services. The independent variables were age at last birthday; sex at birth, level of education, employment status and the macro-social vulnerability status. The confounding variable was the country income level. Three multivariable logistic regression analyses were conducted to determine the associations between the dependent variables and the independent variables after adjusting for the confounder.

RESULTS

Difficulty accessing health care services and obtaining medications was experienced by 1922 (37.3%) and 3746 (72.7%) participants respectively. Also, 1433 (27.8%) used alternative medical care. Retirees (AOR:1.59), unemployed (AOR:1.198), people living with HIV (AOR:2.36) and at increased risk of COVID-19 (AOR:2.10), people who used drugs (AOR:1.83) and transacted sex (AOR:1.971) had significantly higher odds for reporting difficulty with access to health care. Males (AOR:1.23), respondents with secondary level of education (AOR:1.39), retirees (AOR:2.19), unemployed (AOR:1.47), people living with HIV (AOR:2.46), people who used drugs (AOR:1.79), transacted sex (AOR:2.71) and those who might be (AOR: 1.66) and were at (AOR: 2.3) increased risk of severe COVID-19 had significantly higher odds for reporting difficulty with access to medications. People who used drugs (AOR:2.093) transacted sex (AOR:1.639), who might be (AOR: 1.211) and were at (AOR: 1.511) increased risk of severe COVID-19, and who had difficulty accessing usual healthcare (AOR: 9.047) and obtaining medications (AOR:2.16) had significantly higher odds of reporting alternative medical care use. People living with HIV (AOR:0.562) had significantly lower odds of using alternative medical care.

CONCLUSION

We identified populations who had challenges with access to healthcare and obtaining medications used alternative medical care except for people living with HIV. Priority attention should be given to alternative medical care use during future health pandemics.

COVID-19 self-testing in Nigeria: Stakeholders' opinions and perspectives on its value for case detection

BACKGROUND

COVID-19 testing coverage is limited in Nigeria. Access to rapid SARS-CoV-2 antigen-detection self-testing kits may help improve the detection of asymptomatic and mildly symptomatic cases and increase the country's low rate of SARS-CoV-2 testing. Before implementing self-testing in Nigeria, assessing the population's perceptions regarding this approach is imperative. In mid-2021, an exploratory cross-sectional qualitative research was conducted to investigate stakeholders' values and preferences for SARS-CoV-2 self-testing in Nigeria.

METHODS

In-person and online semi-structured interviews and focus group discussions with healthcare workers, representatives of civil society, and potential implementors of self-testing delivery programs were used to explore values and perceptions around access to conventional provider-initiated COVID-19 testing. Topics included the public's values in relation to SARS-CoV-2 self-testing, the safe and effective use of SARS-CoV-2 self-testing, and likely actions upon receiving a positive SARS-CoV-2 self-test result. A thematic analysis approach was applied.

RESULTS

The 58 informants (29 female) reported that Nigeria has limited availability of conventional provider-delivered SARS-CoV-2 testing. While just a few informants were familiar with SARS-CoV-2 self-testing, they generally supported using self-testing as an approach that they felt could assist with early case detection and improve access to testing. Concerns relating to the use of self-testing mainly related to the ability of low-literate individuals to use and interpret the self-tests, the affordability of self-tests, equity of access, and the availability of healthcare system support for those who self-test positive.

CONCLUSION

Although the Nigerian public perceive multiple benefits associated with access to SARS-CoV-2 self-testing, the perceived inefficiency of the national health service delivery system may limit the access of users of the kits to psychosocial and clinical support. Nevertheless, in Nigeria, where COVID-19 vaccine coverage is low and the risk of further waves of COVID-19 is high, self-testing may assist in the prompt detection of cases and contribute to halting the spread of the virus.

Moderating effects of resilience and self-esteem on associations between self-reported oral health problems, quality of oral health, and mental health among adolescents and adults in Nigeria

BACKGROUND

There is an intersection between oral and mental health though the studies on these intersections are few. This study investigated associations between self-reported oral health problems, quality of oral health, and depression and general anxiety among adolescents and adults in Nigeria; and analysed the moderating effects of resilience and self-esteem on these associations.

METHODS

In this secondary analysis, data were extracted from the database of an online survey conducted among participants 13 years and older and living in Nigeria about their self-reported psychological wellbeing. The data was collected between September and October 2020. Dependent variables were self-reported presence of oral health problems (yes/no) and self-reported quality of oral health (using a five-item scale ranging from "very good" to "very poor"). Independent variables were depressive and anxiety symptoms. Moderating factors evaluated were resilience and self-esteem. Multivariable logistic regression analysis was used to determine the associations between the dependent and independent variables after adjusting for confounders (age, sex, employment status and educational status). A path analysis was conducted to determine the moderating effects of self-esteem and resilience on associations between dependent and independent variables.

RESULTS

We extracted data for 2,757 adolescents and adults aged 13 to 62 years, of which 2,062 (74.8%) reported having oral health problems and 925 (33.6%) reported poor quality of oral health. Higher levels of depressive symptoms were significantly associated with higher odds of oral health problems (AOR: 1.07; 95% CI: 1.04-1.10; p<0.001). Higher levels of depressive symptoms (AOR: 1.05; 95% CI: 1.03-1.07; p<0.001), and higher levels of anxiety symptoms (AOR: 1.07; 95% CI: 1.04-1.11; p<0.001) were significantly associated with poor quality of oral health. Resilience significantly moderated the association between anxiety symptoms and oral health problems (AOR = -0.004; 95% CI: -0.006 --0.001; p = 0.002).

CONCLUSION

Depression may be a risk indicator for self-reported oral health problems, while depression and anxiety appear to be risk indicators for self-reported poor quality of oral health. These factors could be included as confounders in future studies on oral health problems and quality of oral health among adolescents and adults in Nigeria.

Gender differences in dentistry and oral sciences research productivity by researchers in Nigeria

Background

The aim of the study was to assess gender differences in the productivity, impact, collaboration pattern and author position of dentistry and oral sciences researchers in Nigeria.

Methods

We examined the Web of Science (WoS) publication records of dentistry and oral sciences researchers to assess gender differences in productivity, impact, collaboration and authorship pattern (first authorship, last authorship and corresponding author). The analysis included the number of publications in journals ranked based on their quartile rating amongst the journals in the subject area (Q1-Q4). Chi square was used to make gender comparisons. Significance was set at >5%.

Results

413 unique authors published 1,222 articles on dentistry and oral sciences between 2012 and 2021. The number of WoS documents per female author was significantly higher than that per male author (3.7 vs. 2.6, p = 0.03). A non-significantly higher percentage of females authored papers in Q2 and Q3 journals and a higher percentage of males authored papers in Q4 journals. The number of citations per female author (25.0 vs. 14.9, p = 0.04) and the percentage of females listed as first authors (26.6% vs. 20.5%, p = 0.048) were statistically greater than men. The percentage of males listed as last authors was statistically greater than females (23.6% vs. 17.7%, p = 0.04). The correlation between the percentage of papers with researchers listed as first authors and that listed as last authors was not significant for males (p = 0.06) but was significant for females (p = 0.002). A non-significantly greater percentage of females were listed as corresponding authors (26.4% vs. 20.6%) and males were listed as international (27.4% vs. 25.1%) and domestic collaborators (46.8% vs. 44.7%). Also, there was no statistically significant gender difference in the proportion of articles published in open access journals (52.5% vs. 52.0%).

Conclusion

Though there were significant gender differences in the productivity, impact, and collaboration profile of dentistry and oral sciences researchers in Nigeria, the higher female research productivity and impact may be driven by cultural gender nuances that needs to be explored further.

A qualitative insight into researchers' perceptions of gender inequality in medical and dental research institutions in Nigeria

OBJECTIVE

The aim of the study was to gain a qualitative insight into scientific researchers' perceptions of gender inequality inside Nigerian research institutions through an investigation of how gender equality is enacted in medical and dental research institutions in Nigeria.

METHODS

This descriptive and cross-sectional qualitative study probed decision-making around navigating gender inequity and explored opinions about how a supportive environment for female medical and dental researchers could be established. Data were collected through semi-structured telephone interviews with 54 scientific researchers across 17 medical and dental academic institutions in Nigeria between March and July 2022. Data were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Three core themes emerged: institutionalized male dominance in research institutions; changing narratives on gender equalities in research and academic enterprise; and women driving the conscience for change in research institutions. Female medical and dental researchers' perceived gender equality was challenging mainstream androcentric values in knowledge production within the medical and dental field; and queries the entrenchment of patriarchal values that promote a low number of female medical and dental trainees, fewer female research outputs, and few women in senior/managerial positions in the medical fields.

CONCLUSION

Despite the general view that change is occurring, a great deal remains to be done to facilitate the creation of a supportive environment for female medical and dental researchers in Nigeria.

Is oral rehydration therapy associated with early childhood caries in children resident in Ile-Ife, Osun State, Nigeria?

BACKGROUND

Oral rehydration therapy may increase the risk of early childhood caries (ECC) because of reduced pH in the oral environment.

AIM

To investigate associations between the use of oral rehydration therapy and the prevalence and severity of ECC in children resident in the Ife Central Local Government Area of Osun State, Nigeria.

DESIGN

This observational study assessed the prevalence and severity of caries, using the International Caries Detection and Assessment System (ICDAS) II index. The outcome variables were the prevalence and severity of ECC. The explanatory variable was the use of oral rehydration solution for the management of diarrhea in the 12 months preceding the study. A multivariable logistic regression analysis was conducted to determine associations between the explanatory and outcome variables.

RESULTS

Only 217 (14%) of the 1564 children had used oral rehydration solution for the management of diarrhea. Seventy-three (4.7%) children had ECC. The use of oral rehydration solution was not significantly associated with the prevalence and severity of ECC.

CONCLUSION

The study findings suggest that the use of oral rehydration therapy in the management of diarrhea may not be a risk factor for ECC in communities with low prevalence and severity of ECC and high prevalence of gastroenteritis.

The Nigerian Dentist: Emerging Trends in Caries Management

BACKGROUND

Fundamental to effective caries management, are measures that eliminate caries risk factors and increase caries protective factors. These include the use of appropriate and effective caries assessment, diagnostic and teaching methods.

OBJECTIVES

To assess the use of current caries management protocols and teaching methods/techniques among Nigerian Dentists.

METHODS

A pre-tested self-administered questionnaire was used. Only dentists of Nigerian descent and practicing in Nigeria were assessed. The questionnaire inquired about diagnostic tools, assessment and teaching methods used by the Dentists in caries management.

RESULTS

More than half of the participants reported use of visual (86.3%), tactile method (76.2%) and periapical radiographs (66.2%) at all times for caries diagnosis. More than three quarters had never used electrical conductance, fibre-optic, CAMBRA, ICDAS, laser fluorescence or bacteria count in caries assessment and diagnosis. Among the 38.4% of the respondents who taught courses on cariology, didactic method and demonstration were the commonest methods used, while use of games was the least used. Didactic method was used more by those that had practiced for 10 years and more. This relationship was statistically significant (p= 0.05).

CONCLUSION

Majority of Nigerian Dentists still depend solely on traditional methods of teaching, assessment and diagnosis of dental caries. Modern caries assessment, diagnostic techniques and teaching methods are needed to improve caries management in order to promote early treatment, which is often preventive.

Associations between mental health and HIV status among sexual minority and heterosexual adolescents in Nigeria

BACKGROUND

We aimed to determine associations between the mental health status of adolescents by self-reported sexual identity; and to determine associations between the mental health status of sexual minority adolescents living with and without HIV.

METHODS

This cross-sectional study collected data from Nigerians aged 13-19 years old using an online survey. We collected information on dependent (sexual identity) and independent (presence of depressive symptoms, generalised anxiety disorder, suicidal attempt/ideation, HIV status) study variables. A multivariate regression model determined associations between the dependent and independent variables. A second multivariate regression model was developed to establish associations between HIV status among sexual minority individuals and the dependent variables. All models were adjusted for age, sex assigned at birth and education level.

RESULTS

Among 1247 respondents living in Nigeria, 497 (39.9%) identified as sexual minority individuals. Compared with their heterosexual peers, sexual minority adolescents had significantly higher odds of reporting depressive symptoms (adjusted OR (AOR): 5.54; 95% CI: 4.10 to 7.47; p<0.001), high general anxiety (AOR: 3.56; 95% CI: 2.64 to 4.79; p<0.001) and history of suicidal attempt/ideation (AOR: 2.95; 95% CI: 2.20 to 3.94; p<0.001). Sexual minority adolescents living with HIV had significantly higher odds of high general anxiety (AOR: 2.42; 95% CI: 1.21 to 4.84; p=0.013), while those with unknown HIV status had significantly higher odds of depressive symptoms (AOR: 3.82, 95% CI: 2.78 to 5.27; p<0.001), high general anxiety (AOR: 3.09; 95% CI: 2.29 to 4.17; p<0.001) and suicidal attempt/ideation (AOR: 1.65; 95% CI: 1.22 to 2.24; p=0.001).

CONCLUSION

Sexual minority adolescents reported poorer mental health status than heterosexual adolescents. Although there was no significant difference in the mental health status of sexual minority adolescents living and not living with HIV, sexual minority adolescents with unknown HIV status reported worse mental health than their HIV-negative peers. Sexual minority adolescents in Nigeria need comprehensive rights-based care that improves access to mental health services, and those with unknown HIV status may need both HIV and mental health screening and care.

Whose rights are being violated when receiving HIV and sexual and reproductive health services in Nigeria?

Background

In Nigeria, vulnerability status may increase the risk for the violation of human rights while receiving health care. The present study determined the proportion and profile of people who reported rights violation while accessing HIV and sexual and reproductive health (SRH) services.

Methods

This was a cross sectional study with data collected between February and March 2021. The dependent variables were patients’ rights to autonomy: right to privacy and confidentiality of medical records; right to be treated with respect, regardless of gender, race, religion, ethnicity, allegations of crime, disability or economic circumstances; right to decline or consent to participation in medical research, experimental procedures or clinical trials; right to quality care in accordance to prevailing standards; and right to complain and express dissatisfaction regarding services received. The independent variables were sexual identity (heterosexual/straight, gay, lesbian, bisexual, queer), HIV status (positive, negative, do not know), living with disability (yes/no), and access point to HIV services (public or donor funded/private). Five multivariate regression models were developed to determine associations between the dependent and independent variable after adjusting for age, education level (no formal education, primary, secondary, tertiary), sex (male, female, intersex), marital status (single, married, separated/divorced, cohabiting) and gender identity (male, female, transgender).

Results

Complete data from 2119 study participants were analysed. Transgender individuals had significantly higher odds of experiencing violation of their rights to privacy and confidentiality of medical records (AOR:1.70), right to be treated with respect (AOR:1.71), right to complain and express dissatisfaction regarding services received (AOR:1.57) and right to decline consent to participate in medical research, experimental research, experimental procedures or clinical trials (AOR:1.81) compared to individuals who were males.

Conclusion

A high proportion of recipients of HIV and SRH services in Nigeria reported rights violations. Transgender individuals appear to have higher risk and those in spousal relationships have lower risk for rights violations. Studies are needed to learn how to improve rights-based HIV and SRH service delivery in Nigeria especially for transgender individuals.

Fear of contagion, emotional stress and coping strategies used by adults during the first wave of the COVID-19 pandemic in Nigeria

BACKGROUND

The COVID-19 pandemic has induced high levels of stress. The aim of the study was to assess the relationship between emotional stress (COVID-19 related fear, anger, frustration, and loneliness) and the use of coping strategies among adults in Nigeria during the COVID-19 pandemic.

METHODS

Data from adults aged 18 years and above were collected through an online survey from July to December 2020. The dependent variables were COVID-19 related fear (fear of infection and infecting others with COVID-19), anger, frustration, and loneliness. The independent variables were coping strategies (use of phones to communicate with family and others, video conferencing, indoor exercises, outdoor exercises, meditation/mindfulness practices, engaging in creative activities, learning a new skill, following media coverage related to COVID-19) and alcohol consumption. Five logistic regression models were developed to identify the factors associated with each dependent variables. All models were adjusted for sociodemographic variables (age, sex at birth, and the highest level of education).

RESULTS

Respondents who consumed alcohol, followed media coverage for COVID-19 related information, and who spoke with friends or family on the phone had higher odds of having fear of contracting COVID-19 or transmitting infection to others, and of feeling angry, frustrated, or lonely (p < 0.05). Respondents who exercised outdoors (AOR: 0.69) or learned a new skill (AOR: 0.79) had significantly lower odds of having fear of contracting COVID-19. Respondents who practiced meditation or mindfulness (AOR: 1.47) had significantly higher odds of feeling angry. Those who spoke with friends and family on the phone (AOR: 1.32) and exercised indoors (AOR: 1.23) had significantly higher odds of feeling frustrated. Those who did video conferencing (AOR: 1.41), exercised outdoors (AOR: 1.32) and engaged with creative activities (AOR: 1.25) had higher odds of feeling lonely.

CONCLUSION

Despite the significant association between emotional stress and use of coping strategies among adults in Nigeria during the COVID-19 pandemic, it appears that coping strategies were used to ameliorate rather than prevent emotional stress. Learning new skills and exercising outdoors were used to ameliorate the fear of contracting COVID-19 in older respondents.

Unemployment and expenditure on health and education as mediators of the association between toothbrushing and global income inequalities

Objective

The study assessed the association of country-level income inequalities with the percentage of schoolchildren toothbrushing-at-least-twice-daily; and the mediating effect of country-level unemployment rate and governmental expenditure on health and education (EH&E).

Methods

This was an ecological study. The dependent variable was country-level toothbrushing-at-least-twice-daily among 11-15-year-old schoolchildren. Data for the period 2009 to 2019 were extracted from two global surveys about schoolchildren’s health and from manuscripts identified through a systematic search of three databases. The independent variable was country-level income inequalities measured by the Gini coefficient (GC) extracted from the Sustainable Development Report 2021. The mediators were the unemployment rate and EH&E. We stratified the sample by the level of GC and assessed the correlation between the dependent and independent variables in each stratum. Linear regression was used to assess the relations between the dependent and independent variables, and mediation path analysis was used to quantify the direct, indirect, and total effects.

Results

Data were available for 127 countries. The mean (SD) percentage of children who brushed-at-least-twice-daily was 67.3 (16.1), the mean (SD) GC = 41.4 (8.2), unemployment rate = 7.5 (4.7) and EH&E = 8.4 (3.3). The percentage of children brushing at-least-twice-daily had weak and non-significant correlation with GC that was positive in countries with the least inequality and negative for countries with higher levels of inequality. A greater percentage of schoolchildren brushing-at-least-twice-daily was significantly associated with higher GC (B = 0.76, 95%CI: 0.33, 1.18), greater EH&E (B = 1.67, 95%CI: 0.69, 2.64) and lower unemployment rate (B=-1.03, 95%CI: -1.71, -0.35). GC had a significant direct positive effect (B = 0.76, 95%CI: 0.33, 1.18), a significant indirect negative effect through unemployment and EH&E (B=-0.47, 95%CI: -0.79, -0.24) and a non-significant total positive effect (B = 0.29, 95%CI: -0.09, 0.67) on the percentage of schoolchildren brushing-at-least-twice-daily.

Conclusion

Unemployment and EH&E mediated the association between income inequality and toothbrushing. Country-level factors may indirectly impact toothbrushing.

A multi-country study on the impact of sex and age on oral features of COVID-19 infection in adolescents and young adults

Background

Oral diseases are features of COVID-19 infection. There is, however, little known about oral diseases associated with COVID-19 in adolescents and young adults (AYA). Therefore, the aim of this study was to assess oral lesions’ association with COVID-19 infection in AYA; and to identify if sex and age will modify these associations.

Methodology

Data was collected for this cross-sectional study between August 2020 and January 2021 from 11-to-23 years old participants in 43-countries using an electronic validated questionnaire developed in five languages. Data collected included information on the dependent variables (the presence of oral conditions- gingival inflammation, dry mouth, change in taste and oral ulcers), independent variable (COVID-19 infection) and confounders (age, sex, history of medical problems and parents’ educational level). Multilevel binary logistic regression was used for analysis.

Results

Complete data were available for 7164 AYA, with 7.5% reporting a history of COVID-19 infection. A significantly higher percentage of participants with a history of COVID-19 infection than those without COVID-19 infection reported having dry mouth (10.6% vs 7.3%, AOR = 1.31) and taste changes (11.1% vs 2.7%, AOR = 4.11). There was a significant effect modification in the association between COVID-19 infection and the presence of dry mouth and change in taste by age and sex (P = 0.02 and < 0.001).

Conclusion

COVID-19 infection was associated with dry mouth and change in taste among AYA and the strength of this association differed by age and sex. These oral conditions may help serve as an index for suspicion of COVID-19 infection in AYA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02515-5.

Is self-reported depression, HIV status, COVID-19 health risk profile and SARS-CoV-2 exposure associated with difficulty in adhering to COVID-19 prevention measures among residents in West Africa?

BACKGROUND

The aim of this study was to determine whether self-reported depression, coronavirus disease of 2019 (COVID-19) health risk profile, HIV status, and SARS-CoV-2 exposure were associated with the use of COVID-19 prevention measures.

METHODS

This survey collected data electronically between June 29 and December 31, 2020 from a convenient sample of 5050 adults 18 years and above living in 12 West African countries. The dependent variables were: social distancing, working remotely, difficulty obtaining face masks and difficulty washing hands often. The independent variables were self-reported depression, having a health risk for COVID-19 (high, moderate and little/no risk), living with HIV and COVID-19 status (SARS-CoV-2 positive tests, having COVID-19 symptoms but not getting tested, having a close friend who tested positive for SARS-CoV-2 and knowing someone who died from COVID-19). Four binary logistic regression models were developed to model the associations between the dependent and independent variables, adjusting for socio-demographic variables (age, gender, educational status, employment status and living status).

RESULTS

There were 2412 (47.8%) male participants and the mean (standard deviation) age was 36.94 (11.47) years. Respondents who reported depression had higher odds of working remotely (AOR: 1.341), and having difficulty obtaining face masks (AOR: 1.923;) and washing hands often (AOR: 1.263). People living with HIV had significantly lower odds of having difficulty washing hands often (AOR: 0.483). Respondents with moderate health risk for COVID-19 had significantly higher odds of social distancing (AOR: 1.144) and those with high health risk had difficulty obtaining face masks (AOR: 1.910). Respondents who had a close friend who tested positive for SARS-CoV-2 (AOR: 1.132) and knew someone who died of COVID-19 (AOR: 1.094) had significantly higher odds of social distancing. Those who tested positive for SARS-CoV-2 had significantly lower odds of social distancing (AOR: 0.629) and working remotely (AOR: 0.713). Those who had symptoms of COVID-19 but did not get tested had significantly lower odds of social distancing (AOR: 0.783) but significantly higher odds of working remotely (AOR: 1.277).

CONCLUSIONS

The study signifies a disparity in the access to and use of COVID-19 preventative measures that is allied to the health and COVID-19 status of residents in West Africa. Present findings point to risk compensation behaviours in explaining this outcome.

Risk indicators for dental caries, and gingivitis among 6-11-year-old children in Nigeria: a household-based survey

Background

There is little is known about the factors associated with caries experience and gingivitis among 6–11-year-old children in Nigeria. The aim of the study was to determine the prevalence and preventive oral health behaviors associated with caries and gingivitis among 6–11-year-old children in Nigeria.

Methods

A cross-sectional questionnaire-based survey was conducted in Ile-Ife, Nigeria. The dependent variables were caries and gingivitis. The dmft/DMFT index was used to assess dental caries experience (present or absent) and caries severity. The gingival index was used to assess the prevalence (present or absent) and severity of gingivitis (healthy gingiva/mild gingivitis versus moderate/severe gingivitis). The independent variables were preventive oral health behaviors (frequency of daily tooth brushing, frequency of consumption of refined carbohydrates in-between-meals, use of fluoridated toothpaste, and use of dental floss, history of dental service utilization). A series of logistic regression analysis models were constructed to determine the associations between the dependent and independent variables after adjusting for confounders (age, sex, and socioeconomic status).

Results

There were 69 (5.2%) children with caries. The mean (standard deviation) dmft was 0.08 (0.457) and the mean DMFT was 0.02 (0.159). There were 839 (63.3%) children with gingivitis with a mean (SD) gingival index score of 0.503 (0.453). Children who seldom or never used fluoride toothpaste had significantly higher odds of developing moderate to severe gingivitis (AOR; 1.671; 95% CI: 1.003–2.786; p = 0.049). Children with middle socio-economic status had significantly lower odds of developing moderate to severe gingivitis (AOR: 0.573; 95%CI: 0.330–0.994; p = 0.048). There were no risk indicators identified for caries.

Conclusion

The prevalence of dental caries was low while the prevalence of gingivitis was high in the study population. The daily used of fluoridated toothpaste seem to reduce the risk for moderate/severe gingivitis. Further studies are needed to understand these findings.

Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18: a geospatial modelling study

BACKGROUND

More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels.

METHODS

We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution.

FINDINGS

Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000-257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution.

INTERPRETATION

Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution.

FUNDING

Bill & Melinda Gates Foundation.

Age-specific associations with dental caries in HIV-infected, exposed but uninfected and HIV-unexposed uninfected children in Nigeria

Background

HIV infection and its management confer a substantial health burden to affected individuals and have been associated with increased risk of oral and dental diseases. In this study, we sought to quantify HIV-associated differences in the prevalence and severity of dental caries in the primary and permanent dentition of 4–11-year-old Nigerian Children.

Methods

We used clinical, laboratory, demographic, and behavioral data obtained from an ongoing cohort study of age-matched HIV-infected (HI, n = 181), HIV-exposed-but-uninfected (HEU, n = 177), and HIV-unexposed-and-uninfected (HUU, n = 186) children. Measures of dental caries experience (i.e., prevalence and severity) were based on dmft/DMFT indices recorded by trained and calibrated clinical examiners. Differences in primary and permanent dentition caries experience between HI, HEU, and HUU were estimated using multivariable logistic and negative binomial regression modeling.

Results

HI children had significantly higher caries experience (33%) compared to HEU (15%) and HUU (22%) children. This difference persisted in fully adjusted analyses [odds ratio (OR) = 1.6; 95% confidence interval (CI) = 1.0–2.6], was most pronounced in the permanent dentition (OR = 3.4; 95% CI = 1.2–9.5), and mirrored differences in caries severity. While molars were predominantly affected in both primary and permanent dentitions, caries lesion patterns differed between dentitions. Caries severity was significantly associated with hypoplastic primary teeth, gingival inflammation, and lower CD4 counts.

Conclusions

We found that the higher prevalence and severity of dental caries among HI children was driven by increased burden of permanent dentition caries compared to their uninfected counterparts. The dentition-specific associations identified in this study highlight the need to design and implement age-specific caries prevention strategies. These may include intensified oral hygiene regimens aimed at mitigating the cariogenic impact of hyposalivation among HI children. Similarly, the long-lasting impacts of developmental defects of the enamel in the primary and permanent dentitions must not be ignored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02421-w.