Factors Influencing Infant Oral Mutilation Practice Among Mothers in Machakos Level 5 Hospital in Machakos County, Kenya

Abstract

Background: Infant Oral Mutilation (IOM) is a dangerous and sometimes fatal traditional practice with a prevalence rate of 60% in the East African Community region. It entails extraction of unerupted primary tooth buds in infants without anesthesia by traditional healers or elders using unsterilized instruments. It has severe immediate and long-term adverse implications for oral and the overall health and wellbeing of infants. Objective: To establish factors influencing IOM practice among mothers of admitted infants in Machakos Level 5 Hospital, Machakos County, Kenya. The null hypothesis of the study was that demographic, economic, sociocultural and health institutional factors did not significantly influence IOM practice among mothers of admitted infants in Machakos Level 5 Hospital. Methods: An analytical cross-sectional study using a mixed-methods study approach was conducted among 60 mothers and 5 traditional healers as key informants from the community. Systematic random sampling method was applied in selection of the mothers while the traditional healers were selected using snowball sampling technique. Data was collected over a period of 8 weeks using a researcher administered semi-structured questionnaire. Traditional healers responded to a researcher administered key informants’ interview guide with an audio-recorded in-depth interview. Quantitative data was analyzed, using SPSS v.25, through descriptive statistics that included percentages, frequencies, means and standard deviation. Association between study variables was evaluated using chi-square test at 95% CI with results presented in tables, graphs and charts. Qualitative data was analyzed using thematic analysis, using NVivo v.12, with findings reported verbatim. Appropriate ethical principles were observed. Results: Low maternal education level was the only demographic factor found to have a significant association with IOM practice among the mothers (p = 0.000). IOM practice among the mothers was not influenced by their socioeconomic status including their occupation (p = 0.285), their partner’s occupation (p = 0.480) or their households’ income level (p = 0.598). The mothers acknowledged that their community traditions and cultural beliefs were central to the practice of IOM (mean = 4.05, SD = 1.489); removal of a child’s milk teeth was a traditional practice deeply entrenched in their cultural beliefs (mean = 4.33, SD = 1.100) and that cultural beliefs were significant drivers of the IOM practice in their community (mean = 4.08, SD = 1.430). A statistically significant association was established between the mothers’ cultural beliefs and traditions with their practice of IOM (p = 0.015). Further, majority (75%, n = 45) of the mothers said that they had never been trained about child’s teething during any of their hospital visits. A statistically significant association was established between IOM practice among the mothers and having not being trained about child’s teething during hospital visits (p = 0.002).

Conclusion: The major drivers of IOM practice among the mothers were community cultural traditions, practices and beliefs that supported the practice, low maternal literacy and the mothers’ lack of training about child’s teething during hospital visits. Recommendation: To the health care workers, efforts are required to educate mothers of the dangers of IOM and particularly its harmful effects on children’s health and overall wellbeing. This would help persuade them against the practice. An investigation of the outcomes of IOM in Machakos County would equally be illuminating