Factors Associated With Practices Of Health Care Workers Towards Integrating Oral Health Into Primary Health Care In Imenti North District, Kenya

Abstract

Background

The prevalence of oral health diseases is on the rise in Kenya. The ratio of oral health care personnel to the population is however very low. Preventive dentistry remains is therefore key to reverse this trend. Integration of oral health into primary health care would utilize the non-oral health care providers to achieve the primary goal of preventive dentistry. Key to this integration is the knowledge, attitude and practices of health workers on their roles.

Methods

This was a cross sectional study among medical doctors, nurses and clinical officers in Imenti North district, Kenya. A self-administered questionnaire was used to assess their knowledge, attitude and practices on the three roles in integration, that is, diagnosis, oral health education and referral. A total of 214 participants took part in the study. Analysis for association was done using Chi square, odds ratio, Fishers exact test and logistic regression.

Results

Overall, 88.8% of interviewees had adequate knowledge on their role towards integration. There was relatively a lower score in health education (70.1%) than on diagnosis (82.7%) and referral (79.9%). Majority (83.6%) of the respondents had positive attitude towards their roles. There was generally poor dental screening practice with only 12% of the respondents carrying out screening on all their patients. A high percentage (65.4%) of the respondents offered oral health education while 95.5% referred patients with dental problems.

There was a significant positive association between dental training (p=0.049) or having a copy of the referral guidelines (p=0.019) and dental screening. Multivariate analysis using logistic regression showed a significant association between having a copy of referral guidelines (p= 0.040) and dental screening. Barriers identified with dental screening included lack of equipment, poor attitude and lack of experience. Availability of a dentist and distance to a referral facility were key determinants of referral practices.

Conclusion

Social demographic characteristics do not influence provision of oral health services by non-oral health care providers. Provision of resources and equipment including referral guidelines on oral health, face masks and tongue depressors influenced provision of oral health services. Similarly, availability of a dentist influenced the decision to refer patients who had suspected dental diseases. Adequate knowledge by health workers on their role did not always result in provision of oral health services mainly due to lack of hands on experience. While attitude of health workers towards their role in integration of oral had no statistical significant association with provision of oral health services, positive attitude was linked with willingness to be trained in oral health and provide dental services. Recommendation

Health care providers in Imenti North district should provide resources and equipment, train in- service health care workers in oral health and provide on-job skills training to health care workers to convert knowledge in oral health into practice. The number of facilities offering dental services should be increased to encourage referral by health care workers.