Tài liệu Status and effective intervention of oral and dental diseases of mong pupils in primary schools in yen bai province

MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY NGUYEN NGOC NGHIA STATUS AND EFFECTIVE INTERVENTION OF ORAL DISEASE IN MONG PRIMARY SCHOOL PUPILS IN YEN BAI PROVINCE SPECIALITY: SOCIOLOGY HYGIENE AND HEALTH ORGANIZATION Code number: 62.72.01.64 SUMMARY OF MEDICINE DOCTORAL THESIS THAI NGUYEN, 2014 The dissertation was completed at UNIVERSITY OF MEDICINE AND PHARMACY THAI NGUYEN UNIVERSITY SUPERVISOR Asso. Prof. Trinh Đinh Hai. PhD Critic 1: ............................................................................... Critic 2:................................................................................ Critic 3:................................................................................ The dissertation will be defended nationally to the Evaluation Committee at University of Medicine and Pharmacy, Thai Nguyen University at …………… on ……………, 201 The dissertation is available for reference at: - The library of Thai Nguyen University of Medicine and Pharmacy - Learing resource centre of Thai Nguyen University - The National Medical Library 1 BACKGROUND Oral and dental disease are common diseases, having about 80 % of the world population, all ages, all walks of life. According to the World Health Organization (WHO) currently has approximately 5 billion people worldwide suffer from periodontal disease, focused primarily in Asia and Latin America, in the developed countries accounted for 60-90 % children of school age have oral disease. Caries is a matter of the Governments of the countries concerned launched several measures to solve. BRM is the cause of tooth loss, reduction or loss of strength chewable adult as well as children. In Vietnam, according to oral health survey in 2000, the national rate was 84,9 % milk tooth decay, permanent tooth decay in children 6-8 years old was 25,4 %, this rate increase by age and up to 69 % at ages 15-17. The rate of gingivitis was 45% and that needs dental treatment are huge and urgent. Yen Bai is a mountainous province faces many difficulties in health care. The rate of dental disease primary pupils above 70 %. Over the years, Yen Bai has no solutions, no specific pattern to reduce the incidence of dental disease in a sustainable way down. The research question here is that interventions to enhance oral health for Mong primary school pupils in Yen Bai province. We studied the subject: "Status and effective intervention of oral diseases in Mong primary school pupils in Yen Bai province" with the following objectives: 1. Describe the current status of oral diseases in Mong primary school puples in Yen Bai province 2011. 2. Analyze of some factors related to oral and dental disease of Mong primary school pupils. 3. Evaluate the effectiveness of preventive intervention for oral and dental disease in Mong primary pupils. 2 THE NEW SCIENTIFIC FINDINGS OF THESIS 1. The study identified that the rate of dental disease in Mong primary school pupils in two mountainous districts in Yen Bai province is 71,4 % of which tooth decay accounts for 69,6 % and gingivitis accounts for 50,1 %. 2. Model of community mobilization on taking care of dental health for Mong primary school pupils are interested by community. In this model, coordination among commune health centers, village health staff, school teachers, schools and community leaders are very closed and effective. Interventions has helped teachers and health workers make a better monitoring and management of pupils’ health at the schools; it has also enhanced awareness of parents and community in prevention of dental diseases at home. Supervision activities have helped communal leaders and involved stakeholders in evaluation of the intervention and adjust the intervention plan timely in accordance with the real local situation. Intervention model has affected parent’s behaviors and Mong people community. This is a basis for them to give up habits which harm the pupils’ dental health. 3. Dissertation deeply studied Mong’s customs and habits of dental health care for pupils. As the fact that, Mong people do not pay much attention to their health. There are a lot of old customs and habits that harm their health. 4. After intervention, knowledge, attitude and practice of pupils increased respectively 36,9 %, 42,9 %, 68,3 %. Knowledge, attitude and practice of teachers and pupil’s parents changed significantly, the teacher increased respectively 74,9 %, 61,6 %, 76,8 %, the pupil’s parents increased respectively 47,5 %, 31,2 %, 35,1 %. Efficiency of intervention for tooth decay: milk tooth; permanent tooth and gingivitis achieved respectively 7,2 %, 10,6 % and 34,4 %. Efficiency of intervention for periodontal disease (bleeding gums, tartar) achieved 31,7 %. 3 STRUCTURE OF THE THESIS The thesis 127 pages long, including the following sections: - Background: 02 Page - Chapter 1: Overview 35 Page - Chapter 2: Subjects and Methodology 21 pages - Chapter 3: Results of the study 39 pages - Chapter 4: Discussion 28 pages - Conclusion: 2 pages The research results are presented in 47 tables, 04 charts, 04 figure, 02 diagrams, 09 qualitative result boxes, Thesis used 115 reference documents including 56 references in Vietnamese and 59 in English. SOME PART OF THE THESIS Chapter 2 SUBJECTS AND METHODOLOGY 2.1. Study subjects 2.1.1 In quantitative research: - The Mong pramary school pupils, they are learning from grades 1 to 5 - Parents of pupils, homeroom teacher 2.1.2. In qualitative research: - Health staff of schools, school teachers - Office of district Education and Training leaders - The commune health workers, health staff of district health centre - Head of the village, local government leaders 2.2. Location and time study 2.2.1. The location of study At four pramary schools: Ban Cong school, Xa Ho school of Tram Tau district and Nam Co school, Pung Luong school of Mu Cang Chai district, Yen Bai province. 4 2.2.2. The time of study: - Conducted in three years from 2011 to 2013. 2.3. Research Methodology: - Cross-sectional descriptive study - Intervention study - Combining qualitative and quantitative study 2.3.1. Design of research Intervention Nam Co, Ban Cong school (the data before intervetion) Compare before and after Collecting the data after intervention Compare after Xa Ho, Pung Luong school (The data before intervention) No Intervention The data after (Monitoring after 2 years) Diagram 2.1. Chart comparing previous and after intervention 2.4. Sample of research 2.4.1. The sample size 2.4.1.1. The sample size in the description study Applying the formula for sample size for discribed study: p (1-p) n = Z12 - /2 d2 In which: n: is minimun sample size need to be researched. p: Ratio of pupils with oral and dental disease, according to research before (Dr Dao Thi Ngoc Lan researched 2002), p = 0,7, 1-p = 0,3 5 d: desired accuracy is 0,05. Z(1- /2) is coefficient of confident limit ( = 0,05, Z2(1- /2)) =1,96 0,7 x 0,3 n = (1,96)2 = 330 (0,05)2 Thus, each school study a minimum number is 330 pupils, 4 school is 1320 puples. In fact the survey, the number of pupils at four primary schools is the 1370 pupils to study. We studied 1370 pupils. 2.4.1.2. The sample size of the intervention study Apply the formula research community intervention follows: 2 n Z1 2 P (1 P) Z1 ( P2 P1 (1 P1 ) 2 P1 ) P2 (1 P2 ) In which: P1 = Proportion of pupils with oral and dental disease according to previous study (The survey data previous intervention): 70 % P2 = Proportion of pupils was expected at after intervention. It was estimated 50 % P = (p1 + p2)/2 = 0,6 (60 %) Z1- = is coefficient of confident limit (with = 0,05) = 1,96 Z1- = is coefficient of the sample capacity was expected ( =95 %) = 1,645 n 1,96 2.0,6.0,4 1,65 0,7.0,3 (0,7 0,5) 2 0,5.0,5 2 According to the calculation formula on n is 156 plus 10 % give up was 172 pupils. Thus, the number of pupils enrolled for minimum is 172 pupils in each intervention group and the control group. 2.4.2. Techniques of choosing the sample 2.4.2.1. In discribed study - Choosing the sample in quantitative study + Purposeful sampling: in two districts of Yen Bai province (Tram Tau and Mu Cang Chai district). In this 2 districts have over 95 % Mong people, who are living here. 6 + Sampling schools: We choose 4 primary schools by random draw method. So we had Ban Cong primary school, Xa Ho primary school (in Tram Tau district), Pung Luong primary school and Nam Co primary school (in Mu Cang Chai district). + Sampling pupils: We choosed the entire sample; we made the list of pupil of 4 schools; the pupils in each school choosed from class 1 to class 5. After that, we surveyed under the this list and we had 1370 pupils. They are learning in 4 primary schools and all are Mong people. + Sampling teachers: All the homeroom teachers who are teaching in four primary schools. + Sampling pupil’s parents: We Choosed all parents of pupils in four primary schools, according to the list of class. In fact, there were 1351 parents in four primary school, in which, there were 19 parents had two children are learning at the same school 2.4.2.2. In the intervention study We choosed each district 01 school by random draw methed to implement intervention study. We had the Nam Co primary school in Mu Cang Chai district and Ban Cong primary school in Tram Tau district. The schools will perform intervention model (intervention group), actual intervention group had 691 pupils, and the control group was Pung Luong primary school in Mu Cang Chai district and Xa Ho primary school in Tram Tau districts (control group), the actual control group had 679 students. - Sampling in quantitative study + Group discussion: We conducted 4 group discussions in four school, two group discussions in one school. In the first group discussion is included health staff in commune level, village level, school teachers (8-12 people). In the second group discussion is included commune leaders, head villages, pupil’s parents (8-12 people) + In-depth interview: We conducted interview 01 leader of commune people’s committee, head of commune health station, 05 homeroom teachers. 01 leader of district health centre, 01 leader of district Education and Training department. 01 parents in each grade, 01 school health worker. 7 2.5. Content of study 2.5.1. For discribed study - Oral examination to confirm the rate of dental caries, gingivitis and dental manifestations of the disease (periodontal disease), index of dmf, DMF and CPI index before intervention. - Interview the primary school pupils, parents, homeroom teachers to identify factors related to the pupils’ oral disease. - Learning the environmental situation in the oral health care activities (teachers, school health worker), in community (parents of pupil, communication) 2.5.2. For intervention study 2.5.2.1. Develop intervention model After assessing the situation, determine the factors related to dental disease, the researchers will gather communication materials on the basis of the literature used to train the teachers, the core group of villages by the Ministry of Health was regulated. Instructions building workshops and training materials for the core group to organize and implement the activities following the subjects 2.5.2.2. Implement the activities of intervention models Implement the preventive intervention model of oral diseases for primary school students: - Prepare community activities included in the intervention schools. - Develop a plan, work rules, the establishment of a steering intervention, organizing the activities, monitoring and evaluation of interventions and compared with the results of the initial investigation. - Resources for implementation: Subject to mobilize resources is social health officials, village and school teachers in addition to mobilize staff communes and villages directly involved in research model. - The Steering Committee consists of six people: Leadership CPC, Representative school board school, board vice-Chairman of CHCs as deputy director, officer in charge of medical schools, teaching team manager, head of the village are members. 8 Research group Intervention Leaders of commune level Core group Training course, WS Staffs health station, village health worker oral disease examination Comumication on knowledge Pramary pupils Parents of pupils Diagram 2.2. Model mobilize community resources involved in interventions for prevention of dental disease in Mong primary school pupil 2.6. The studied criteria 2.6.1. The studied criteria for objective 1 * The general information of research group: - The characteristics of the pupils: age, gender, class… * The criterria of the pupils with oral and dental disease - The rate of pupils have oral and dental disease. - The rate of pupils have gingivitis. - The rate of decay-missing-filling on milk tooth and permanent tooth. - The expression of periodontal gum disease (tartar, gingivitis and bleeding gums). - Results of depth interviews and workshop with related members of the schools in two commune (qualitative research) 9 2.6.2. The studied criteria for objective 2 - The relationship between pupil’s knownledge, attitude practice in oral health care and oral and dental disease. - The relationship between parent’s knownledge, attitude practice in oral health prevention and oral and dental disease. - The relationship with the social conditions (health care, economic component of household) 2.6.3. The studied criteria for objective 3 2.6.3.1. Group of indicators intervention models - The index describes the results of implementing the intervention model + Human resources: the number of participants models + On the material: The material has been prepared for training, communications, facilities used in the research process. + About the organization model: Decision establishment of direct intervention model, assigning tasks to members of the Steering Committee, operating rules. - The index of the performance of the model - The monitoring indicators of intervention activities 2.6.3.2. The group of indicators describing the performance of health communication and education about oral health care In quantitative research: effective interventions for knowledge, attitude and practice of pupils, parents, school teachers of the two groups before and after intervention. - In qualitative research: evaluating subjects (pupils, parents, teachers) on the results of health education and communication. 2.6.3.3. Group counseling indicators of treatment consultancy - The pupils were consulted treatment. - Number of pupils were moved to higher level - The pupils were consulted to prevent the complications. 2.6.3.4. Results capacity for core group in the implementation of activities in the village, at the school. - The training courses were implemented - The number people participant training courses and workshop 10 - The results of training courses 2.6.3.5. Results of coordinated methods for the prevention of pupils oral diseases. - Effective application of the intervention methods in quantitative research. - Maintain and expand the model intervention. 2.7. The assessment of knowledge, attitude and practice of oral health care of pupils In this study, based on interviews with questionnaires and checklists to assess the knowledge, attitude and practice of students, teachers and parents. Each correct answer is counted as 1 point, wrong answer no points. The total point of knowledge, attitude and practice is divided into 3 main level: weak, average, good, under the classification of Bloom as follows: - The number of point is 8-10 (≥ 80 %): Good. - The number of point from 6-7 (60-79 %): Average - The number of point under 6 (≤ 60 %): Weak 2.8. Standard classification of poor and non-poor household: According to Decision No. 09/2011 / QD-TTg dated 30/01/2011 of the Prime Minister on the issuance poverty line, poor households applied for 2011-2015 states: poor households in rural / mountains are households with an average income of 400,000 VND / person / month (from 4.8 million VND / person / year) or less. Thus, poor households are households with an average income of 401,000 VND / person / month or more. The other evaluation criteria: - Check your oral health routine: Organizations oral examinations for pupils at schools in 6 months a time. In order to detect oral diseases and counseling, guiding, families of pupils take examinations and treatment. - Guide oral hygiene routine: The pupils are instructors oral hygiene (brushing, gargling, prevention of disease risk factors Dental) weekly classroom teacher dean or school health personnel perform. - Eat regularly shoots peppers: the students ate pickled chilli bamboo shoots in the daily meal. Not regular eat as monthly, weekly and eat once or not eat. 2.9. Review effectiveness of the intervention - Test 2 was used to compare 2 proportion (%) - The difference with statistical significance was assessed at p <0,05 11 - Evaluation of intervention based on effective indicators and effective intervention. - The effective indicator as formula: p1 – p2 Effective indicator (%) = ------------------- x 100 p1 Trong đó: p1 is proportion of study before intervention P2 is proportion of study after intervention - Effective intervention as formula (%) Effe indicator (Intervention grour) – Effe. indicator (control grour) 2:10. Evaluating of community acceptance for intervention - Based on qualitative research, information was recorded, classified by contents and assessmented the results. Chapter 3 RESULTS OF STUDY 3.1. Status of oral diseases in Mong primary school pupils Table 3.4. The rate of oral disease follow school (n=1370) Oral disease Disease Have disease Schools No disease Number % Number % Ban Cong 226 65,3 120 34,7 Nam Co 254 73,6 91 26,4 Xa Ho 220 67,5 106 32,5 Pung Luong 278 78,8 75 21,3 Total 978 71,4 392 28,6 Comment: Incidence oral disease of the pupils are 71,4 %. In Ban Cong school is 65,3%, Nam Co school is 73,6 %, Xa Ho school is 67,5 %, Pung Luong 78,7 %. The number of pupils do not have oral disease is 28,6 %, incidence between the schools are similar. 12 Table 3.7. The rate of milk tooth decay follow school Cavities Disease No cavities n Schools Number % Number % Ban Cong 346 218 63,0 128 37,0 Nam Co 345 227 65,8 118 34,2 Xa Ho 326 198 60,7 128 39,3 Pung Luong 353 219 62,0 134 38,0 Total 1370 862 62,9 508 37,1 Comment: The rate of pupils of milk tooth decay are 62,9 %, Ban Cong school is 63,0 %, Nam Co school is 65,8 %, Xa Ho school is 60,7%, Pung Luong school is 62,0 %. The rate of infant milk tooth decay of pupils are similar. Table 3.8. The rate of permanent tooth decay follow school Cavities Disease Schools No cavities n Number % Number % Ban Cong 346 156 45,1 190 54,9 Nam Co 345 131 38 214 62,0 Xa Ho 326 123 37,7 203 62,3 Pung Luong 353 160 45,3 193 54,7 Tổng 1370 570 41,6 800 58,4 Comment: The rate of permanent tooth decay is 41,6 %, Ban Cong school is 45,1 %, Nam Co school is 38 %, Xa Ho is 37,7 %, Pung Luong is 45, 3 %. 13 Table 3.9. Indicator of decay, lost, fill and structure decay, missing, filling on milk tooth and permanent tooth Milk tooth Features Tooth Tooth Permanent tooth Tooth Num. Tooth decay missing filling Quantity 1370 Indicator Tooth Tooth dmf 4541 985 53 3,3 0,7 0,03 DMF decay missing filling 5579 1630 4,1 1,2 457 50 2137 0,3 0,03 1,6 Comment: The indicator decay-missing-filling (dmf) on milk teeth was 4,1, index cavities was 3,3, tooth missing was 0,7. The indicator decaymissing-filling on permanent tooth (DMF) was 1,6. 3.2. The factors related to oral disease in primary school pupils 3.2.1. The factors related to oral disease in quantitative study The research team conducted a study and analysis of some factors related to oral and dental disease of primary school pupils who have eating habits is not good, the oral health care regularly, knowledge, practice oral hygiene of pupils, the results are as follows: Table 3.17. The relationship between knowledge and oral disease in the primary school pupils Oral disease Disease Have Knowledge OR, p No have 2 Number % Number % Not good 635 80,4 155 19,6 Good 343 59,1 237 40,9 978 71,4 392 28,6 Total p<0,001 2 =72,8 OR=2,8 Comment: There is an association between oral disease and oral care knowledge of the pupils, the pupils have poor knowledge will have oral disease incidence higher than pupils who have a good knowledge. 14 Bảng 3.19. The relationship between tooth brushing everyday in pupils and oral disease Oral disease Disease OR, p Have No have 2 Practical Number % Number % Not good 589 74,8 198 25,2 p<0,05 Good 389 66,7 194 33,3 2 978 71,4 392 28,6 Total = 10,4 OR=1,4 Comment: There is an association between dental practice daily brush with dental disease, the pupils practice poor oral hygiene, the incidence of oral higher than the pupils to practice brushing good daily. Bảng 3.20. The relationship between oral health care regularly and oral disease (n=1370) Oral disease Disease Have Oral health care OR, p No have 2 Number % Number % Not regular 759 79,6 194 20,4 Regular 219 52,5 198 47,5 978 71,4 392 28,6 Total p<0,001 2 =7,6 OR=3,5 Comment: There is an association between oral disease to diagnose and treat oral diseases regularly, the pupils do not get regular medical examination, the prevalence of oral disease was higher than students who were examined regularly. 3.3. Effective prevention interventions in Mong primary school pupils 3.3.1. Results implement intervention model: 3.3.1.1. The results of training the core group The team building activities planned for the process and monitor, supervise and evaluate the results achieved: The research team has organized two workshops, each social class. Participants in the training is done Steering Committee model, the core group 15 consists of (school teachers, commune health workers, villages chief). The results are as follows: Table 3:26. Evaluation results for staff training of core group Location Nam Co commune Ban Cong commune Before training After training Before training After training Num. % Num. % Num. % Num. % Good 4 16,0 9 36,0 3 13,6 7 31,8 Rather 5 20,0 11 44,0 7 31,8 12 54,6 Medium 11 44,0 5 20,0 9 40,9 3 13,6 Weak 5 20,0 0 0,0 3 13,6 0 0,0 Total 25 100,0 25 100,0 22 100,0 22 100,0 evaluation Comments: Before the training, the students understanding of periodontal disease is low, with good level (Nam Co 16 %, Ban Cong 13,6 %), after training rate has increased quite with good level (Nam Co 36 %, Ban Cong 31,8 %) and did not have any person classified as weak. 3.3.1.2. The results of specific activities of the participants in the intervention model. Before the operation of the team members have advised the CPC decision established the Steering Committee for implementation of interventions by the Deputy Chairman of the commune chief, general administration, the member of the Board representing school administrators, teacher union team, representing the commune health workers, representatives of village heads and representatives of village health workers, total is 6 people. The mission of the member is assigned and mainly focuses on the direction, management, monitoring and evaluation activities to be implemented in the commune 3.3.2. The effectiveness of interventions in health communication and education in the prevention of oral disease for pupil in quantitative research. 16 Table 3.28. Knowledge in preventive oral disease of pupils before and after intervention Time Control group (n=691) (n=679) Knowledge Before intervention After intervention p( Interven. group 2 Num. % Num. % Good 225 32,6 224 33,0 Medium 274 39,7 298 43,9 Weak 192 27,8 157 23,1 Good 314 45,4 230 33,9 Medium 290 42,0 299 44,0 Weak 87 12,6 150 22,1 test) p<0,001 p>0,05 39,6 2,7 Effect. index % (good) Intervention effect. (%) p ( 2 test) p>0,05 p<0,001 36,9 Comment: There has been a change in the student's knowledge level of "good" at times before and after the intervention, effective interventions to knowledge was increased 36,9 %. Table 3.29. Attitude of pupil’s prevention before and after intervention Time Control group (n=679) Num. % Num. % Good 261 37,8 257 37,9 Medium 286 41,4 293 43,2 Weak 144 20,8 129 19,0 Good 379 54,9 263 38,7 Medium 254 36,8 298 43,9 Weak 58 8,4 118 17,4 Attitude Before intervention After intervention p( Interven. group (n=691) 2 test) Effect. index % (good) Intervention effect. (%) p<0,01 p>0,05 45,2 2,3 42,9 p ( 2 test) p>0,05 p<0,05 17 Comments: There has been a change in the pupils’ attitudes at the "good" in the period before and after the intervention, the effective intervention on attitudes increased 42,9 %. Table 3.30. Practice of pupil’s prevention before and after intervention Time Practice Before intervention After intervention p( 2 Interven. group (n=691) Control group (n=679) SL % SL % Good 188 27,2 190 28,0 Medium 259 37,5 262 38,6 Weak 244 35,3 227 33,4 Good 347 50,2 221 32,6 Medium 210 30,4 269 39,6 Weak 134 19,4 189 27,8 test) Effect. index % (good) p<0,001 p>0,05 84,6 16,3 Intervention effect. (%) ( 2 p test) p>0,05 p<0,001 68,3 Comment: Through the intervention had a change in the practice of pupils in the "good" at the time before and after the intervention, effective intervention to increase 68,3 % attitude. Table 3.32. Effective intervention of teacher’s KAP Effective index (%) Interven. group Control group Effective intervention (%) Knowledge 103,5 28,6 74,9 Attitude 63,4 1,9 61,6 Practice 96,8 20,0 76,8 KAP p( 2 test) p<0,001 Comment: The effective intervention for oral disease prevention’s KAP of teachers had changed, knowledge 74,9 %, attitude 61,6 %, practice 76,8 %. 18 Table 3.34. Effective intervention of parent’s KAP Effective index (%) KAP Interven. group Control group 48,9 31,2 36,8 1,4 0,0 1,7 Knowledge Attitude Practice p ( 2 test) Effective intervention (%) 47,5 31,2 35,1 p<0,001 Comment: The effectiveness of interventions for oral disease prevention knowledge of parents was 47,5 %, attitudes 31,2 %, practice 35,1 %. 3.3.3. The effectiveness of interventions in health communication and education for pupils in qualitative research. Through group discussions and in-depth interviews of 16 officers are school teachers, commune health workers, commune, village’s leader of the two intervention commune, results were as follows: - Communication and education was to raise awareness for pupils, teachers, parents contribute to enhancing the prevention of oral diseases is essential - Intervention model with communication coordination among sectors participated (health and education), the government and the people that fit. - Communication model oral disease prevention has more impact on the perception of local leader health care to children. 3.3.4. Effective coordination of interventions for oral disease in primary pupils in quantitative research. 3.3.4.1. For tooth decay Table 3.36. The effective index and intervention effectiveness for milk tooth and permanent tooth Milk tooth Permanent tooth Group Interven. Control Interven. Control Before intervention 64,4 61,41 41,5 41,7 After intervention 64,7 66,1 42,1 46,7 Effect. index % 0,5 % 7,7 % 1,4 % 12,0 % Intervention effect. (%) 7,2 10,6 2 p<0,05 p<0,05 p( test)