M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Although the nursing sector has not been spared the effects of human resource shortages and Human Immune-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) crisis in Lesotho, it still remains the backbone of the primary health care delivery. There is a well-established linkage between oral health and HIV/AIDS with many of the early symptoms of HIV manifesting in the oro-facial region. However, the lack of oral health personnel at primary health care levels in Lesotho makes Primary Health Care Nurse Practitioners (PHCNPs) often the first health care providers to consult, manage and refer patients with such oral lesions. Aim: To assess the “knowledge, attitude and practice” (KAP) of the PHCNPs regarding oral health and oral HIV lesions in Queen Elizabeth II (QE II) and Roma health service areas (HSA) of Maseru district in Lesotho. Objectives: To assess the demographic profile of PHCNPs in the target health facilities, their knowledge, attitude and practice regarding oral health and oral HIV lesions. Methods and Materials: The research was a descriptive cross-sectional survey. A convenience sample of 57 primary health care nurse practitioners (PHCNPs) from QE II and Roma health service areas were identified. During their monthly PHC meeting, a questionnaire was administered to assess the knowledge, attitude and practice regarding oral health and oral HIV lesions. The information gathered was both quantitative and qualitative. Data was entered and analysed using the SPSS statistical package. Results: The response rate was 87.7%. There was 100% consensus regarding the importance of oral health to the total well being of individuals. The majority of the PHCNPs recognised oral candidiasis (OC) (94.7%), bleeding gums (87.7%), herpes lesions (71.9%) and dental caries (75.4%). Lesions such as acute necrotizing ulcerative gingivitis (ANUG) (40.3%), angular cheilitis (AC) (56.1%) and apthous ulcerations (24.6%) were also recognised but to a lesser extent. The respondents associated OC (84%), herpes (61%), AC (54%), Oral Hairy Leukoplakia (OHL) (49%), Kaposi‟s‟ sarcoma (KS) (49%) with HIV/AIDS. OC was the most common lesion associated with HIV. Some lesions commonly seen in the clinics such as apthous ulceration and ANUG were not significantly associated with HIV (18% and 33%, respectively). The majority of PHCNPs (81%) indicated that they had knowledge about oral HIV lesions. Twenty nine 6 respondents (50.8 %) reported having received this knowledge through training institutions. Mass media (Radio (53%), TV (40%), and newspapers/magazines (49%)) was one of the major sources of information. Forty-four PHCNPs (77.2%) saw only Zero or one (0-1) HIV patients with oral lesions. Similarly, 15.8 % and 7% of the PHCNPs saw 11 to 20 and more than 20 (21+) HIV patients with oral lesions, respectively. The two thirds of the PHCNPs (67%) said they would not advise patients to seek care from Traditional Health Practitioners (THP) due to their lack of trust and confidence in the practices, knowledge and the patient management of the THPs. However, 16% of them reported that they would refer because they thought traditional medicine boosts the immune system. Only seven respondents (12.3%) routinely washed their hands with antiseptics. However, 44 of respondents (77.2 %) cleaned their instruments with bleach and disinfectants. The majority (89.5%) washed their hands with water and soap. Forty three respondents (75.4%) wore gloves during examination. Routine use of facemasks was limited to only 12 respondents (21.1 %). Ninety eight percent of the PHCNPs stated that they would like to learn to manage oral lesions at health centres. The majority (79%) of the respondents said that they would like to receive more training on the management of oral lesions through workshops. Conclusions: There was an observable correlation between PHCNPs self-assessment of oral health knowledge and the objective knowledge as assessed by ability to identify the oral lesions on a chart ( 2 –sided Fischer‟s test-0.000-0.261).This needs to be confirmed by undertaking a study with a larger sample size. OC was the most common lesion associated with HIV as reported by the PHCNPs. The majority of the participants (94.7%) identified OC and associated it (84%) with HIV infection. The finding indicated that with training and/or mentoring, PHCNPs are likely to confidently diagnose oral HIV lesions. PHCNPs showed a positive attitude towards learning more about the oral manifestations of HIV/AIDS. PHCNPs should be utilised more effectively in the diagnosis and management of HIV/AIDS.

Made available in DSpace on 2014-08-20T14:30:19Z (GMT). No. of bitstreams: 1 Dissertacao Luisa Jardim Correa de Oliveira.pdf: 1594740 bytes, checksum: 0935c9da334b79035287fa249997e9c8 (MD5) Previous issue date: 2014-03-29 / Oral mucosal lesions are conditions that occur in soft tissues of the mouth, and are expressed by several clinical aspects. The literature has reported the need of considering the functional and psychosocial dimensions in regard to the oral health for the evaluation of dental interventions, such as the oral health related quality of life impact. In this context, the oral mucosal lesions can influence people's daily life due to pain and discomfort that they can cause. The aim of this study was to access the prevalence of oral mucosal lesions and their impact on Oral Health Related Quality of Life (OHRQoL) in children aged 5, from a birth cohort of Pelotas, Brazil. In 2009, a sample of 1,303 children born in Pelotas (2004 Cohort) was selected to participate in the study. Data were collected using a questionnaire applied to mothers and with clinical examinations of the children in their household. Oral mucosal lesions (OML) were identified by type, site and size. Early Childhood Oral Health Impact Scale (ECOHIS), consists of 13 questions, was used to assess caregivers perception on children OHRQoL. Descriptive analysis was performed in order to get the absolute and relative frequencies of the variables related to oral mucosal lesions. Bivariate analysis was performed to assess the association between the presence of OML and prevalence, extent and intensity of the ECOHIS items. Poisson regression models were used to investigate the association between lesions of the oral mucosa and ECOHIS score adjusting for confounders. The prevalence of the oral mucosal lesions was 30.1% (95% CI 27.5-32.9). The site more affected was the gum (31.0%) followed by the tongue (23.9%). Ulcers (29.4%) and papule/nodule (21.9%) were the more prevalent types of lesion. The majority of OML (76.8%) had size up to 5mm. A positive association was found between the presence of OML and impact on oral heath related quality of life measured in overall ECOHIS score (p <0.001), extent (p <0.001), prevalence (p = 0.002) and intensity (p = 0.010). Through the Poisson regression was observed that, even after adjustments, children with OML showed greater oral heath related quality of life (RR 95% CI 1:38 1:11; 1.72) than children without OML. Therefore, the main conclusions of this study are: there is a high prevalence of oral mucosal lesions in children 5 years old and these lesions impaired children oral health related quality of life / Lesões de mucosa bucal são condições que ocorrem nos tecidos moles da boca, e que se expressam por aspectos clínicos diversos. Tem sido apontada na literatura a necessidade de considerar as dimensões funcionais e psicossociais da saúde bucal para a avaliação de intervenções odontológicas, como o impacto na qualidade de vida relacionado à saúde bucal. Neste contexto, as lesões de mucosa bucal podem influenciar a vida diária das pessoas devido à dor e ao desconforto que podem causar. Assim, o objetivo deste estudo foi avaliar a prevalência das lesões de mucosa bucal e seu impacto na qualidade de vida relacionada à saúde bucal em crianças de 5 anos de idade pertencentes a uma coorte de nascimentos. Em 2009, uma amostra de 1.303 crianças nascidas em Pelotas e pertencentes à Coorte de 2004 foi selecionada para participar do estudo. Foi realizada a aplicação de um questionário e exames odontológicos no domicílio das crianças. As lesões foram identificadas no exame bucal segundo o tipo de lesão fundamental, localização e tamanho. O impacto na qualidade de vida relacionada à saúde bucal foi investigado através do instrumento Early Childhood Oral Health Impact Scale ECOHIS, respondido pelos responsáveis pela criança, e composto por 13 itens. Os dados obtidos foram analisados utilizando o software STATA 11.0. Análise descritiva foi realizada a fim de obterem-se as frequências relativas e absolutas das variáveis relativas às lesões de mucosa bucal. Análise bivariada foi realizada para verificar associação entre presença de lesões de mucosa bucal e prevalência, extensão e intensidade de respostas do ECOHIS. Modelos de regressão de Poisson foram utilizados pra verificar a associação entre lesões de mucosa bucal e o escore do ECOHIS ajustando por fatores de confusão. A prevalência das lesões de mucosa bucal foi de 30.1% (IC 95% 27.5-32.9). O sítio mais acometido foi a gengiva (31.0%), seguido da língua (23.9%). Os tipos de lesões fundamentais mais prevalentes foram as úlceras (29,4%) e as pápulas/nódulos (21,9%). A maioria das lesões (76.8%) tinha tamanho de até 5mm. Foi encontrada associação entre a presença de lesões de mucosa bucal e impacto na qualidade de vida relacionada à saúde bucal, medido em escore total médio do ECOHIS (p<0,001); extensão (p<0,001); prevalência (p=0,002) e intensidade (p=0,010). Através da regressão de Poisson foi observado que, mesmo após ajustes, crianças com lesão de mucosa bucal apresentaram maior impacto na qualidade de vida relacionada à saúde bucal (RR 1.38 95% CI 1.11; 1.72) do que crianças sem lesão de mucosa bucal. Assim, as principais conclusões dessa dissertação são: a prevalência de lesões de mucosa bucal em crianças de 5 anos de idade é alta e estas lesões causam um impacto negativo na qualidade de vida relacionada à saúde bucal.

Magister Chirurgiae Dentium - MChD / Purpose: To assess the oral health status of 4-15-year-old schoolchildren in the Western Region of the Eastern Cape Province, by determining the prevalence of dental caries, periodontal disease, dental fluorosis, malocclusion and oral mucosal lesions and to create baseline data for planning oral health services in this region. Materials and Methods: The prevalent analytic survey was undertaken on 822 schoolchildren between the ages of 4-15 years in 27 different schools. The sample size selected for this region by the Department of Statistics, University of Pretoria, for the National Oral Health Survey of 1999/2000 was used. The data on 209, 210, 209 and 194 scholars in the 4-5, 6, 12 and 15-year-old age groups respectively were collected. The World Health Organization's (1997) criteria were used to determine the prevalence of caries, periodontal treatment needs, the dental fluorosis, malocclusion and prevalence of oral mucosal lesions. Six calibrated and trained examiners recorded the data on a survey form. The WHO survey forms were used for data collection. The data were analysed and processed by the author on Microsoft Excel 2000. Results: The sample size consisted of 1.35 % Asian, 51.89 % Black, 26.07 % Coloured and 20.06 % White scholars. Nearly equal amounts of males (48.3 %) and females (51.7%) were examined. The dental caries prevalence in the primary dentition of 4-5-year-olds with an average age of 4.43 years was 40.67%, with a mean dmft of 3,56. The dental caries prevalence in the permanent dentition of6-, 12- and 15-year-oldage groups was 67.62%, 46.05% and 67.92% respectively. The mean DMFT for 6-, 12- and 15 year olds were 0.05, 1.19 and 2.02 respectively. Gender differences and differences in prevalence of dental caries between the populations groups were recorded. The Coloured children experienced the highest dental caries prevalence. In the 4-5- and 15-year-old groups the males were affected more than the females by dental caries. Prevalent differences were recorded between rural and urban areas in the same population group. The prevalence of periodontal disease in 373, 12-15-year-olds was 79.09%. Only 4.02 % were in need of dental hygiene instructions and polishing. Dental education, dental hygiene instructions, dental scaling and polishing were needed by 75.07% of the children. Dental fluorosis prevalence in 450, 6-15-year-olds was 13.03%. Dental fluorosis did not affect 86.97% of the scholars; 10.63% had mild fluorosis and 2.05% was severely affected. The mean fluoride concentration in the drinking water in this region were 1.07 mgIL, ranging between 0.3-3 mgIL. Definite malocclusion was recorded in only 0.48% of the 12-year-old group, whom needed elective treatment. In the 12-year-olds, 99.52% needed no or slight treatment for no or minor malocclusions. The majority of children had no oral mucosal lesions (91.55%). The prevalence of oral mucosal lesions was 8.5% in this survey. The most frequent conditions were traumatic lesions (1.96%), dento-alveolar abscess (1.22%) and herpes labialis (1.22%). The intra-examiner reliability for caries, dental fluorosis, periodontal treatment needs and prevalence of malocclusions was 97.66%, 100%, 88.89% and 86.67% respectively. The inter-examiner reliability was 98.75%, 98.34%, 100%, 100% and 100% respectively for the five examiners. Conclusion: This survey indicated a higher prevalence of dental caries in the primary dentition (63.48%), than the permanent dentition (41.3%). The mean dmft was 3.65 and the DMFT 1.2, which indicated a low mean caries experience for these children. The WHO goal for the year 2000 for the 6-year-olds of 50% being caries free has not reached for only 32.56% were caries free. The mean DMFT of 1.2 for 12-year-olds in this survey is below the WHO goal of a mean DMFT of 1.5 or less. The lack of available preventative service provision, were ) indicated by the low percentage of fissure sealants (2.8%). The need for dental treatment was highlighted by the need mostly for one-surface restorations. Preventative treatment, two-surface fillings and extractions were also needed. Periodontal disease was a major public oral health concern for this region for a prevalence of 79.09% was recorded for the 12-15-year-olds. The majority of the children affected by periodontal disease (75.07%) were in need of professional cleaning and calculus removal. The prevalence of dental fluorosis was 8.2%, 19.87% and 13.05% for 6-, 12- and IS-year age groups respectively. The prevalence of malocclusion was 0.48% for the 12-year-old group. The prevalence of oral mucosa lesions was 8.5% for 4-15-year-old schoolchildren. Therefore, the conclusion can be made that dental fluorosis; malocclusions and oral mucosal lesions were no public concern in this region. The major public oral health concerns were dental caries in the primary dentition and periodontal disease in all age groups. Recommendations: Dental services in this region should be directed towards prevention of dental caries in the primary dentition and periodontal disease in all age groups. The focus of dental services should be primarily on preventative programs and treatments. The public dental treatments needs indicated in this survey, namely scaling and polishing, restorations and extractions, consists of the primary health care package delivery. Currently, no evaluation tool exists to monitor the efficiency of oral health programs, no baseline data for the Province exists. Therefore, the urgent need for dental research and oral health service planning and delivery are recommended.