Effect of a consensus statement on initial treatment for traumatic dental injuries.

The aim of this study was to investigate the influence of a consensus statement on dental practitioners' choice of initial treatment for traumatic dental injuries. Dental practitioners working at government dental clinics in eight cluster sample regions of mainland Tanzania were requested to participate in the study; that is, to record the treatment they provided to children aged 1-17 years seeking dental consultation after injury for a period of 12 months. Six months after the beginning of data collection, a consensus statement was introduced. After the dental practitioners received the consensus statement, the correct treatment they provided increased from 51% to 57%. The unnecessary treatments increased from 54% to 59%, while wrong treatments decreased from 55% to 42%. Only a small improvement was observed in the percentage of correct treatments, but there was a slightly significant improvement in the percentage of wrong treatments provided before and after introduction of the consensus statement. We conclude that the consensus statement had a slight influence on the dental practitioners' choice of initial treatment for dental trauma in the desired direction.

Geriatric oral health issues in Africa: Tanzanian perspective.

A review of oral health issues for the elderly in Tanzania is presented and conclusions drawn from the analysis are applied to the broader African situation. It must be remembered that life expectancy (at birth) in Tanzania has been below or equal to 50 years, which places adults aged 35+ years in the elderly group of citizens. Access to professional care is limited, especially in rural areas, resulting in most people seeking care only when in severe pain and often leading to extraction. People aged 40+ years, who live in rural areas, are at higher risk of destructive periodontal disease and it is recommended that oral health education, focusing on behaviour change should be initiated from childhood. Innovative training programmes for primary health workers already working in rural areas can improve both access to professional care and accurate preventive oral health messages. Health professional training programmes should emphasise the importance of good oral health to overall health. Such an emphasis will help galvanise health care workers in the delivery of services. The ultimate goal for the government, health professionals and educators should be to move the Tanzanian people toward a greater understanding of oral health and the prevention of oral diseases, a goal which might also be set elsewhere in Africa.

Factors influencing career choice among high school students in Tanzania.

The aim of this study was to identify factors that influenced career choice among high school students in Tanzania. The information obtained would be used to formulate effective recruitment strategies and counseling students on their career expectations in dentistry. All 352 high school students who were studying in five randomly selected high schools completed a pre-tested questionnaire containing twenty-four items addressing five factors. Image of a profession (good experiences from the work of professionals, professionals who are attractive to respondents, and professionals who command high respect in the community) was perceived as an important factor in career choice by the majority of respondents (over 88 percent). Work/profession characteristics (knowledge about work to be done, treating patients, giving medicines to patients, helping relatives, etc.) was ranked as the second most important factor, and course characteristics (availability of postgraduate studies, size of annual intake, pass rate, geographic location, etc.) was ranked third. Direct gains and advice from important persons were perceived as least important in career choice.

Tanzanian high school students' attitude towards five university professional courses.

OBJECTIVE: To determine the attitude of high school students majoring in Physics, Chemistry and Biology (PCB) towards Medicine, Pharmacy, Dentistry, Veterinary Medicine and Nursing as professions at university. DESIGN: A cross sectional study of a representative sample of high school students using a pretested attitudinal questionnaire. Attitude components tested were degree of liking, degree of admiration and intentions to visit a professional at work. SETTING: High schools in Tanzania mainland majoring in PCB. SUBJECTS AND METHODS: All 352 high school students from a representative sample of five schools: two boy-schools; two girl-schools; and one mixed gender-school participated by filling in a questionnaire. The questionnaire consisted of demographic variables on age, sex, class, education and employment status of father and mother as background variables, and questions on the degree of liking, admiration and preference to visit a particular professional at work. All the attitudinal questions were scored on a 5-point scale. Scores for the three-attitudinal components were summed to group subjects into positive, neutral and negative attitude. MAIN OUTCOME MEASURE: Attitude of students to five professions they could study at a higher level. RESULTS: Eighty seven percent of the high school students had a positive attitude towards medicine, 66% towards pharmacy, 40% dentistry, 12% veterinary and 9% nursing. Dentistry and veterinary had the highest percentage of students (46.5% and 37.3%) who had a neutral attitude towards the professions, and the highest percentage of students (11.7% and 9.9%) who reported to have had no sufficient information to enable them indicate whether they admired dentistry and veterinary medicine or not. Significantly more girls than boys liked, admired and preferred to study nursing (chi2 varied from 11.39 to 12.99; p-value < 0.005). CONCLUSION: Medicine was the most liked profession while nursing was the least liked. Pharmacy, dentistry and veterinary medicine fell in between. There was insufficient knowledge about dentistry and veterinary medicine among the high school students.

Testing a consensus conference method by discussing the management of traumatic dental injuries in Tanzania.

OBJECTIVES: To test the recommended consensus conference methods in Tanzania by discussing the management of traumatic dental injuries, and to reach consensus on the feasibility of the treatment modalities of traumatic dental injuries recommended in western countries in the Tanzanian situation. STUDY PARTICIPANTS: Fifteen dentists as representatives of the profession and two lay people as representative of potential consumers. INTERVENTIONS: Presentation of treatment modalities for traumatic dental injuries recommended in western countries. MAIN OUTCOME MEASURE: Consensus on the feasibility of the recommended treatment modalities of traumatic dental injuries in the Tanzanian situation. RESULTS: For most types of injuries, consensus on the feasibility of the recommended treatment methods for Tanzania was reached immediately. More time was spent to discuss management of some injuries where the members felt that the recommended management regimes for these injuries are not feasible in the current Tanzanian situation. Panel members made three recommendations. First, parents and teachers should be provided with guidelines or instructions about self-care following trauma. Second, teaching on the management of traumatic dental injuries at training institutions should be emphasised and third, dental practitioners at dental clinics in the country should get continuing education about the management of traumatic dental injuries. CONCLUSION: The methods for achieving consensus were useful in the Tanzanian dental situation, therefore it is recommended that the methods be adopted to reach consensus on other oral health issues.

Oro-dental injuries and their management among children and adolescents in Tanzania.

OBJECTIVE: To investigate, by utilising patient records, the occurrence of the various types of dental trauma and the treatment provided among children aged one to seventeen years. DESIGN: A retrospective survey of dental clinic records. SETTING: Paedodontic clinic of the Faculty of Dentistry, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. SUBJECTS: Records of 130 dental patients aged one to seventeen years who were treated in 1995 and 1996. MAIN OUTCOME MEASURE: Types of injuries (periodontal, soft tissue, dental tissues). Types of treatment given in relation to type of injury. Evaluation of treatment provided by using European treatment standards. RESULTS: Soft tissue injuries were recorded in 49% of the patients. Periodontal and dental tissue injuries were recorded in 34% and 8% of the patients respectively. While injured teeth were extracted in 30% of the cases, soft tissues were stitched in 70% and antibiotics were prescribed in 34% of the patients respectively. Evaluation of treatment provided showed that 31%, 52% and 17% of the teeth received the correct, wrong and unnecessary treatment respectively. CONCLUSION: Our observations correlate well with other reports. However, efforts on standardisation of treatment for oro-dental injuries should be undertaken.

Job satisfaction amongst rural medical aides providing emergency oral health care in rural Tanzania.

OBJECTIVE: To investigate to what extent the rural medical aides (RMAs) in Tanzania were satisfied with their new (added) role of providing emergency oral health care services, and to analyse factors influencing job satisfaction amongst them. DESIGN: Cross-sectional survey using a self-administered job satisfaction questionnaire. SETTING AND SUBJECTS: All 40 RMAs providing emergency oral health care in rural health centres and dispensaries in Mbeya and Tanga regions, Tanzania. MAIN OUTCOME MEASURE: RMAs ratings of their overall satisfaction with the job of providing emergency oral health care. RESULTS: Overall, 95% of the RMAs were satisfied with providing emergency oral health care. Patient relations, personal time and stress were significantly correlated with overall job satisfaction in providing emergency oral health care. CONCLUSIONS: The RMAs' newly added role of providing emergency oral health care does not seem to generate problems with job satisfaction.

Distribution of dental therapists and assistant dental officers trained under the Tanzania-Danida Dental Health Programme 1981-1993.

The purpose of the present study was to describe the production of Dental Therapists and Assistant Dental Officers trained in Ministry of Health institutions in Tanzania during more that ten years of support from the Danish International Development Agency (Danida) through the Tanzania-Danida Dental Health Programme and to investigate their distribution and location. A total of 169 Dental Therapists and 38 Assistant Dental Officers have been trained from 1981 to 1993, representing more than 70% of the training capacity of the schools for training of oral health personnel under Ministry of Health. The distribution of both Dental Therapists and Assistant Dental Officers according to working station was, however very similar to that found before the Danida support began. Two out of every three Dental Therapists in government service were stationed in district clinics or non-government clinics at the district level. The same was true for one out of every three Assistant Dental Officers. It is concluded, that the intentions laid down in Tanzania's National Plan for Oral Health 1988-2002 of first staffing the district hospitals and, later on, the health centres with Dental Therapists have not yet been fulfilled.

Initial treatment of traumatic dental injuries by dental practitioners.

The aim of this study was to investigate the nature of initial treatment provided by dental practitioners to children aged 1-17 years with various types of traumatic dental injuries at public dental clinics in Tanzania. Questionnaires on initial treatment were mailed to 188 practitioners and returned by 138 (73%). The reported treatments were analyzed in relation to the dental practitioners' qualifications and area of practice. Extraction of injured teeth was frequently reported for 64% of the injuries and prescription of antibiotics was reported by 67%, 48% and 46% of the practitioners for soft tissue injuries, concussion, and alveolar fracture respectively. Practitioners working at the Faculty of Dentistry were less involved in treating dental trauma than those at urban and rural clinics (P = 0.001), while no significant association was found with the level of education of the practitioners. Equal proportions of practitioners, about one-third each, reported correct, unnecessary and wrong treatment options. The quality of the treatments provided could not be explained by background variables. It can be concluded that dental practitioners in Tanzania provide a lot of over-treatment for traumatic dental injuries. Therefore, it is suggested that efforts should be made to improve and standardize treatment methods in Tanzania.

Patient satisfaction with emergency oral health care in rural Tanzania.

Emergency oral health care, as conceived in Tanzania, is an on-demand service provided at a rural health center or dispensary by a Rural Medical Aide. The service includes: simple tooth extraction under local anesthesia, draining of abscesses, control of acute oral infection with appropriate drug therapy, first aid for maxillo-facial trauma, and recognition of oral conditions requiring patient referral for further care at the district or regional hospital dental clinic. The objective of the present study was to describe patient satisfaction with emergency oral health care services in rural Tanzania and determine the relative importance of factors influencing patient satisfaction. The study was carried out as a cross-sectional interview survey between April 1993 and May 1994 using a patient satisfaction questionnaire in rural villages in the Rungwe district of Tanzania. It included 206 patients aged 18 years or more who had received emergency oral health care between April 1993 and March 1994. Overall, 92.7% of the respondents reported that they were satisfied with the service. Patients who were married, had no formal education and lived more than 3 km from the dispensary were more likely to be satisfied with treatment. In a logistic regression model, a good working atmosphere at the dispensary, a good relationship between care provider and patients (art of care) and absence of post-treatment complications significantly influenced patient satisfaction with odds ratios of 10.3, 17.4 and 6.2, respectively.

Household survey of access to and utilisation of emergency oral health care services in rural Tanzania.

BACKGROUND: Emergency oral health care, as conceived in Tanzania, is an on demand free-of-charge service provided by primary health workers called Rural Medical Aides(RMAs). OBJECTIVE: To evaluate accessibility and utilisation of emergency oral health care services. DESIGN: Cross-sectional household questionnaire survey. SETTING: Rural villages forming a catchment area for rural health centres and dispensaries providing emergency oral health care in Rungwe district, Mbeya region, Tanzania. SUBJECTS: Two hundred households containing about 1,106 persons. Half the households were randomly selected from a village where the dispensary or health centre was located. The other households were from a village distant from the health centre or dispensary. MAIN OUTCOME MEASURES: Self-reported use of emergency oral health care in a household and perceived barriers to the utilisation of this service. RESULTS: More than 90% of the respondents knew that emergency oral health care was available at the health centre or dispensary. In 40% of the households surveyed, there was a person who had used emergency oral health care. Half the respondents perceived that there were some barrier in using emergency oral health care. Lack of money to pay for treatment or transportation and fear of dental treatment were mentioned as the perceived barriers for using emergency oral health care by thirty and seven per cent respectively. In a logistic regression model, use of emergency oral health care was explained by a positive history of dental problems in the household (OR = 4.3) and the age of the household informant being more than 40 years (OR = 4.5). CONCLUSIONS: The majority in the rural Tanzanian villages surveyed knew about the availability of emergency oral health care services. The proportion of households which had used these services were relatively high compared to the time span. Inability to pay for the services was one of the perceived barriers to their utilisation.