Oral health knowledge, behavior, and care seeking among pregnant and recently-delivered women in rural Nepal: a qualitative study

A J Lubon, D J Erchick, S K Khatry, S C LeClerq, N K Agrawal, M A Reynolds, J Katz, L C Mullany, A J Lubon, D J Erchick, S K Khatry, S C LeClerq, N K Agrawal, M A Reynolds, J Katz, L C Mullany

Abstract

Background: Oral health behavior and attitudes of pregnant women in low-income countries are rarely examined, yet should be considered when designing preventative or therapeutic studies to reduce burden of oral diseases. We aimed to understand dental care-seeking behavior, as well as oral health knowledge and attitudes of oral health among pregnant women in rural Nepal.

Methods: Semi-structured in-depth interviews (n = 16) and focus group discussions (3 groups, n = 23) were conducted among pregnant and recently-delivered women in Sarlahi, Nepal. Transcripts were translated from the local language to English then analyzed using a hybrid approach to thematic coding with Atlas.ti version 7.

Results: Women felt confident describing the signs and symptoms of tooth decay and gum disease, but were not knowledgeable about where to receive care for tooth and/or gum pain and relied heavily on the knowledge of their community. Some women used a toothbrush and toothpaste at least once a day to clean their teeth, but many reported the traditional use of a branch of a local shrub or tree as their teeth cleaning instrument. Women suggested a willingness to consider using an oral rinse throughout pregnancy, perceiving that it might have a positive impact on infant health.

Conclusions: Future studies should focus on providing adequate and sustainable resources for pregnant women in Nepal and other low income settings to engage in good oral health behaviors (possibly supported through community-based workers), to maintain dental hygiene, and to access qualified dentists as a means of improving their oral health.

Trial registration: ClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study) and NCT02788786 (Pilot Trial).

Keywords: Dental care seeking behavior; Nepal; Oral health; Oral health behaviors; Periodontal disease; Pregnancy.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was obtained from the Institutional Review Board at the Johns Hopkins Bloomberg School of Public Health (#6297) and from the independent Ethical Review Board of the Nepal Health Research Council (#188/2015). Written consent was obtained from all participants in the study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005;83(9):661–669.
    1. Prasai Dixit L, Shakya A, Shrestha M, Shrestha A. Dental caries prevalence, oral health knowledge and practice among indigenous Chepang school children of Nepal. BMC Oral Health. 2013;13:20. doi: 10.1186/1472-6831-13-20.
    1. Yee R, David J, Lama D. The periodontal health of Nepalese schoolchildren. Community Dent Health. 2009;26(4):250–256.
    1. Knevel RJ, Neupane S, Shressta B, de Mey L. Buddhi Bangara project on oral health promotion: a 3- to 5-year collaborative programme combining support, education and research in Nepal. Int J Dent Hyg. 2008;6(4):337–346. doi: 10.1111/j.1601-5037.2008.00345.x.
    1. Kanal S, Acharya J. Dental caries status and oral health practice among 12-15 year old children in Jorpati, Kathmandu. Nepal Med Coll J. 2014;16(1):84–87.
    1. Thapa P, Aryal KK, Dhimal M, et al. Oral health condition of school children in Nawalparsai district, Nepal. J Nepal Health Counc. 2015;13(29):7–13.
    1. Shrestha N, Acharya J, Sagtani AR, Shrestha R, Shrestha S. Occurrence of dental caries in primary and permanent dentition, oral health status and treatment needs among 12-15 year old school children of Jorpati VDC, Kathmandu. Nepal Med Coll J. 2014;16(2–4):109–114.
    1. Knevel RJM, Gussy MG, Farmer J, Karimi L. Perception of Nepalese dental hygiene and dentistry students towards the dental hygienists profession. Int J Dent Hyg. 2016; 10.1111/idh.12192.
    1. Wagle M, Trovik TA, Basnet P, Acharya G. Do dentists have better oral health compared to general population: a study on oral health status and oral health behavior in Kathmandu, Nepal. BMC Oral Health. 2014;14(23). . Accessed 19 Jan 2017
    1. Knevel RJM, Luciak-Donsberger C. Dental hygiene education in Nepal. Int J Dent Hyg. 2009;7:3–9. doi: 10.1111/j.1601-5037.2008.00338.x.
    1. Thapa P, Aryal KK, Mehata S, et al. Oral hygiene practice and their socio-demographic correlates among Nepalese adult: evidence from non communicable disease risk factors STEPS survey Nepal 2013. BMC Oral Health. 2016;16(105) 10.1186/s12903-016-0294-9.
    1. Ajzen I. The theory of planned behavior. Organ Behav Human Decis Process. 1991;50:179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Buunk-Werkhoven YAB, Dijkstra A, Bink P, van Zanten S, van der Schans CP. Determinants and promotion of oral hygiene behavior in the Caribbean and Nepal. Int Dent J. 2011;61:267–273. doi: 10.1111/j.1875-595X.2011.00071.x.
    1. Prathahini P, Mahendra J. Toll-like receptors: a key marker for periodontal diseases and preterm birth –a contemporary review. J Clin Diagn Res. 2015;9(9):ZE14–ZE17.
    1. Lopez NJ, Uribe S, Martinez B. Effect of periodontal treatment on preterm birth rate: a systematic review of meta-analyses. Periodontol 2000. 2015;67:87–130. doi: 10.1111/prd.12073.
    1. Kim AJ, Lo AJ, Pullin DA, Thornton-Johnson DS, Karimbux NY. Scaling and root planing treatment for periodontitis to reduce preterm birth and low birth weight: a systematic review and meta-analysis of randomized controlled trials. J Periodontol. 2012;83(12):1508–1519. doi: 10.1902/jop.2012.110636.
    1. George A, Shamim S, Johnson M, et al. Periodontal treatment during pregnancy and birth outcomes: a meta-analysis of randomised trials. Int J Evid Based Healthc. 2011;9(2):122–147. doi: 10.1111/j.1744-1609.2011.00210.x.
    1. Boutin A, Demers S, Roberge S, Roy-Morency A, Chandad F, Bujold E. Treatment of periodontal disease and prevention of preterm birth: systematic review and meta-analysis. Am J Perinatol. 2013;30(7):537–544. doi: 10.1055/s-0032-1329687.
    1. Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods. 2006;5(1):80–92. doi: 10.1177/160940690600500107.
    1. Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring conceptualization and operationalization. Qual Quant. 2017; 10.1007/s11135-017-0574-8.
    1. Knevel RJM. Training rural women to improve access to oral health awareness programmes in remote villages in Nepal. Int J Dent Hyg. 2010;8:286–293. doi: 10.1111/j.1601-5037.2010.00481.x.
    1. Lama TP, Khatry SK, Katz J, LeClerq SC, Mullany LC. Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal. J Health Popul Nutr. 2017;36(Supp1):45. doi: 10.1186/s41043-017-0123-z.
    1. Lassi ZS, Middleton PF, Bhutta ZA, Crowther C. Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review and meta-analysis. Glob Health Action. 2016;9:1–13.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe