health literacy in africa - ghana physicians and surgeons...

HEALTH LITERACY IN AFRICA:

ORAL HEALTH KNOWLEDGE & PRACTICES AMONG NURSES IN GHANA

Prof. ISHMAEL BRUCE, Consultant/Dental Public Health

DEFINITION: HEALTH LITERACY ?

! Health Literacy, by definition, is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions ( Selden et al, 2000; Health People---HHS, 2000 ).

! To have the capacity to obtain health information means the information should be readily available to the individual. The individual should then have the capacity to process the information, and make sense of it enough to now make it his/her own to assume the sick role.

! It must be emphasized, however, that In Ghana, as in most African countries, health illiteracy implies inadequate access AND dentists and government bear considerable responsibility for this inadequacy; and, must take the initiative to solve it.

! Access only brings resources to the neglected, BUT does not solve problem of illiteracy.

! “More than four-fifths of Canadians expect to lose their teeth. Nearly a quarter of the population only see a dentist for specific problems. They see no threat from periodontal (gum ) disease. In short, although they might want to prevent dental disease, they don’t expect to be successful --- and they don’t know how to do it. Canadians are sadly ignorant about periodontal disease. Not only is ignorance widespread, but regular patients are just as confused as the general population. This indicates a serious failure to communicate effectively with Canadians about periodontal disease”.

! Health Literacy therefore implies having the appropriate information to make the right health decisions.

Ghana has:

----- 256 active dentists serving 26 million people. ----- 20% of dentists ( 50/256 ) are employed in private practice ----- the remaining 80% ( 206/256 ) are employed with the Ministry of Health in public service in hospitals and

polyclinics. ----- of the 80% in Public Service in the whole country ----- 61.2% are employed and work in the Accra metropolis alone --- And of the 20% who are in private practice in the whole country --- 74% of them are in private dental practice in Accra alone.

The two large Regions, Accra-Tema Metropolis and Ashanti Regions, alone: ----- have 75% of the country’s Public Dental practitioners and ----- 90% of all the private practitioners.

! There are no dentists ( public or private ) in the Upper East Region ( population 780,000 ) and only two in public practice in the Upper West Region ( population 2million ).

! The dentist to population ratio of 1:104,000 nationally masks the fact that it is less than one dentist for every million people in these three northern Regions (Popn= 5M ; # of DDS=3 ).

Table 1. Age distribution of nursing students 

20-34 yrs..............................50.5% 35-44 yrs..............................38.4% 45-54 yrs............................... 6.9%

Visits to the dentist

----- 45% never been to the dentist and ----- 52.1% had experienced some form of dental problem

Table 2. Why have you not visited the dentist?

No problem / no toothache ------------------ 65% Other reasons : ---- “pain will go by itself” ---- “have not bothered” ---- “apart from bleeding at times, never developed toothache” ---- “no dentist in area”

Table 3. Why Clean Teeth?

Factors % respondents Clean teeth / remove food particles / good oral hygiene 64.2 % Prevent disease / tooth decay / infection 49.0% Fresh mouth / breath 33.6% Prevent bad breath 33.5% Healthy, strong teeth 23.2% Stimulate appetite 6.1% Cosmetic reasons 0.3%

Table 4a. ( % Respondents ) Frequency of intra-day tooth-brushing : Once / day 13.8 % Twice / day 82.0 % Three times / day 3.0%  

Table 5a. Method of tooth-cleaning among the nurses

Tb/Tp………...………………………………………………... 60.3%

Tb/Tp + chewing stick …………….………………….. 28.5%

Tb/Tp + chewing sponge………………………………. 7.5%

Tb/Tp + chewing stick + chewing sponge ….. 3.6%

Table 6. Reasons for the choice of toothpaste

Fluoride, Calcium,“Germichek”(triclosan) ..... 79.3%

Flavour taste........................................... 8.5%

Advertising.............................................. 2.6%

Cost....................................................... 0.7%

Doesn’t matter…………………………………………………….. 0.3%

Table 7. Factors affecting choice of toothbrush

Texture: -- soft ..................................................... 37.9%

-- medium ................................................ 30.8%

-- hard .................................................... 12.0%

Shape, size of head ………................................... ..... 23.8%

Doesn’t matter ..................................………............. 2.3%

Advertising ......................................................... 0.9%

Cost ................................................................... 0.3%

Use of dental floss 69.8% of the nurses did not know what dental floss was and had never used or seen the product ( Table 8 )

Table 8. If you know the floss and don’t use it, why not?

don’t know how to use it 11.0%

not available where I live, never saw one 6.0%

cost 2.3%

does same job as chewing stick 2.6%

Prevalence and causes of bleeding gum

36.1 % of the respondents had bleeding gums.

For causes of gum bleeding the majority ( 49.5 % ) felt gums bled either from hard brushing or from trauma during improper brushing ( Table 9 ).

Table 9. Cause of bleeding gums?

Poor dental health 0.6 %

Trauma from improper brushing / hard brush 49.5 %

Gum infection 22.6 %

Lack of Vitamin C 16.1 %

Other: 10.8 %

-- tooth pick;

-- poor dentition / malocclusion; tooth decay

-- strong flavoured toothpaste;

-- used brush longer than 3 mths./ ‘expired’ toothbrush;

Table 10. What to do for bleeding gums ?

See dentist 14.7 %

Use toothbrush correctly 13.1 %

Take Vitamin C 12.0 %

Brush, clean teeth regularly 8.2 %

Use of mouthwash 2.9 %

Leave it alone 0.6 %

Awareness ➔ reasonably aware ----- 43.0 %

Some Solutions to the Problem

! TOT --- Introduce dental health studies into curriculum of health professionals who are involved in teaching the public about health---eg. teachers in teachers’ training colleges, medical schools and all nursing schools.

! Introduce dental studies in school curricula from Junior High to Senior Secondary Schools. Introduce brush-ins in classrooms each morning at the Primary level.

! Each district ( 430 sub-districts ) should have at least one Dental Health Educator whose duty it will be to go around all schools within the district to disseminate preventive dental information as was done in the former Unilever Dental Health Program and in my program in Ontario, Canada.

! DHEs to visit groups as in Churches, job sites, seniors` residences and High Schools with preventive dental information. Newspaper and TV discussions on dental disease ( eg. Mirror )

! Final year dental students should be sent to the rural communities to stay for about 2 weeks to work under the supervision of the resident dentist using portable and mobile dental equipment in outreach programs.

! Use of providing auxiliaries --- dental therapists, COHOs

in Ghana.

QUESTIONS ???