"Ebinyo"-The Practice of Infant Oral Mutilation in Uganda.

Infant oral mutilation (IOM) is a traditional method of extracting un-erupted teeth practiced in several Sub-Saharan African countries including Uganda. This practice is referred to as "ebinyo" by Bantu-speaking Ethnic groups, though it has several terms depending on cultural group and researcher. The un-erupted tooth is gouged out as a cure for medical symptoms in infants that include high fevers and diarrhea. The spreading of IOM practice in African populations is blamed on poor health literacy with regard to the common childhood illnesses. One study in Uganda revealed that adverse cases following IOM seen in the hospital peaked in tandem with the malaria and diarrheal disease cases. This paper is a review of the practice with a particular focus on Uganda as presented in literature compiled from PubMed, Dentaid, Google Scholar, Local Uganda sources, and the authors' observations. The paper explains reason for the persistence of the practice, and to further inform on IOM to health practitioners who were previously unaware of the practice.

Determinants of periodontal health in pregnant women and association with infants' anthropometric status: a prospective cohort study from Eastern Uganda.

BACKGROUND: Preterm-low birth weight delivery is a major cause of infant morbidity and mortality in sub Saharan Africa and has been linked to poor periodontal health during pregnancy. This study investigated predisposing and enabling factors as Determinants of oral health indicators in pregnancy as well as the association between periodontal problems at 7 months gestational age and the infants' anthropometric status. METHOD: A community -based prospective cohort study was conducted in Mbale, Eastern Uganda between 2006 and 2008. Upon recruitment, 713 pregnant women completed interviews and a full mouth oral clinical examination using the CPITN (Community Periodontal Index of Treatment Need) and OHI-S (Simplified Oral Hygiene) indices. A total of 593 women were followed up with anthropometric assessments of their infants 3 weeks after delivery. Multiple logistic regression analyses were used to identify independent determinants of periodontal problems and use of dental services during pregnancy. Analysis of covariance (ANCOVA) was used to investigate the relationship between periodontal problems and the child's anthropometric status in terms of wasting, underweight and stunting. RESULTS: A total of 67.0% women presented with periodontal problems, 12.1% with poor oral hygiene, 29.8% with recent dental visit and 65.0% with periodontal symptoms. Of the infants, 2.0% were wasted, 6.9% were underweight and 10.0% were stunted. The odds ratio of having CPI > 0 increased with increased maternal age and single marital status, and was lower in primiparous women and those who used mosquito bed nets. Mean wasting scores discriminated between mothers with CPI = 0 and CPI > 0 as well as between mothers with good and poor OHI-S scores. CONCLUSIONS: Socio-demographic factors and information about oral health were associated with oral health indicators in pregnant women. Second, the height- for- age status at 3 weeks postpartum was worse in infants of mothers having periodontal problems and poor oral hygiene during pregnancy. Efforts to prevent oral diseases during pregnancy should be part of the local state and national health policy agenda in Uganda.

Periodontal status, tooth loss and self-reported periodontal problems effects on oral impacts on daily performances, OIDP, in pregnant women in Uganda: a cross-sectional study.

BACKGROUND: An important aim of antenatal care is to improve maternal health- and well being of which oral health is an important part. This study aimed to estimate the prevalence of oral impacts on daily performances (OIDP) during pregnancy, using a locally adapted OIDP inventory, and to document how periodontal status, tooth-loss and reported periodontal problems are related to oral impacts. METHODS: Pregnant women at about 7 months gestational age who were members of a community based multi-center cluster randomized community trial: PROMISE EBF: Safety and Efficacy of Exclusive Breast feeding in the Era of HIV in Sub-Saharan Africa, were recruited in the district of Mbale, Eastern Uganda between January 2006 and June 2008. A total of 877 women (participation rate 877/886, 98%, mean age 25.6, sd 6.4) completed an interview and 713 (participation rate 713/886, 80.6%, mean age 25.5 sd 6.6) were examined clinically with respect to tooth-loss and according to the Community Periodontal Index, CPI. RESULTS: Seven of the original 8 OIDP items were translated into the local language. Cronbach's alpha was 0.85 and 0.80 in urban and rural areas, respectively. The prevalence of oral impacts was 25% in the urban and 30% in the rural area. Corresponding estimates for CPI>0 were 63% and 68%. Adjusted ORs for having any oral impact were 1.1 (95% CI 0.7-1.7), 1.9 (95% CI 1.2-3.1), 1.7 (1.1-2.7) and 2.0 (0.9-4.4) if having respectively, CPI>0, at least one tooth lost, tooth loss in molars and tooth loss in molar-and anterior regions. The Adjusted ORs for any oral impact if reporting periodontal problems ranged from 2.7(95% CI 1.8-4.2) (bad breath) through 8.6(95% CI 5.6-12.9) (chewing problem) to 22.3 (95% CI 13.3-35.9) (toothache). CONCLUSION: A substantial proportion of pregnant women experienced oral impacts. The OIDP impacts were most and least substantial regarding functional- and social concerns, respectively. The OIDP varied systematically with tooth loss in the molar region, reported chewing-and periodontal problems. Pregnant women's oral health should be addressed through antenatal care programs in societies with limited access to regular dental care facilities.

Socio-demographic factors related to periodontal status and tooth loss of pregnant women in Mbale district, Uganda.

BACKGROUND: Information on the socio-behavioral distribution of periodontal status and tooth loss in pregnancy emanating from sub Saharan Africa is sparse. This study examined periodontal status and tooth loss in pregnant Ugandan women and assessed the relationship with socio-demographics factors, parity, dental care and oral hygiene. METHODS: Mothers were participants of a multicentre cluster-randomized behavioral intervention study (PROMISE-EBF Safety and Efficacy of Exclusive Breast feeding Promotion in the Era of HIV in Sub-Saharan Africa). In Uganda, these were pregnant women resident in Mbale district, recruited into the PROMISE EBF study between January 2006 and June 2008. A total of 886 women were eligible to participate of whom information became available for 877 (participation rate 98.9%, mean age 25.6) women who participated in the recruitment interview and 713 (mean age 25.5) women who got a clinical oral examination. Periodontal status was assessed using the Community Periodontal Index of Treatment Needs (CPITN). RESULTS: The prevalence of tooth loss was 35.7%, 0.6% presented with pockets shallow pockets (4-5 mm), whereas 3.3% and 63.4% displayed bleeding and calculus, respectively. A total of 32.7% were without any sign of periodontal disease. Binary logistic regression analyses revealed that older women, women from larger households and those presenting with microbial plaque were respectively, 3.4, 1.4 and 2.5 times more likely to have CPI score >0. Rural (OR = 0.9), nulliparous (OR = 0.4) and women who never visited a dentist (OR = 0.04) were less likely, whereas women from larger households (OR = 1.5) were more likely to have lost at least one tooth. CONCLUSION: The results revealed moderate prevalence of bleeding and tooth loss, high prevalence of calculus, low frequency of pockets 4-5 mm. Disparity in pregnant women's oral health related to parity suggests that education of maternity care providers concerning oral health in pregnancy is warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00397150.

Factors associated with caregivers' perception of children's health and oral health status: a study of 6- to 36-month-olds in Uganda.

BACKGROUND: The impact of oral diseases on quality of life of children and their families has not been thoroughly investigated. AIM: Focusing on Ugandan infants aged 6-36 months and their caregivers, this study examined the degree to which clinical and psychosocial factors were associated with caregivers' overall evaluation of their children's oral health and health status. DESIGN: Eight hundred and sixteen children were examined for dental caries and anthropometric status in 2007. A questionnaire was completed by the caregivers. RESULTS: Poor child oral health was reported by 40.2% and 17.5% of caregivers who reported their children's health as, respectively, poor and good. Having the least family wealth [odds ratio (OR) = 1.9] and reporting distressed family activities (OR = 2.3) were associated with higher odds of reporting poor child oral health, whereas being a rural resident (OR = 0.4) and reporting no symptoms during tooth eruption (OR = 0.3) were associated with lower odds. Perception of poor child oral health (OR = 2.8) and having the least family wealth (OR = 1.7) were associated with higher odds of reporting poor child health status, whereas no stunting was associated with lower odds (OR = 0.5). CONCLUSION: The results support the growing recognition of oral health as a predictor of health and well-being in early childhood.

Pattern of dental caries in Mulago Dental School clinic, Uganda.

UNLABELLED: Information on dental caries among patients attending Mulago Hospital is scarce. Yet knowledge of the pattern of caries can be used to plan preventive and treatment interventions. This study describes the pattern of dental caries (in terms of age group, tooth and tooth surface and gender) among patients attending the Public Health Dental Officers School Clinic, Mulago Hospital. METHODOLOGY: A review of patients' treatment records for the period 1995 to 1999 was done. A total of 1800 cards were reviewed for the diagnosis of dental caries, age, gender and the data was analyzed using EPI INFO 6 program. The patients were from both urban and peri-urban settings and were aged between 10-90 years. RESULTS: The results showed that the most frequently affected tooth surface was the occlusal (68.8%) followed by the interproximal (24%) and the least affected was the lingual/palatal (1.5%). The second molars were found to be the most affected of all teeth, with tooth 37(12%), 47(11%), 17(9.5%) and 27 (9.1%). The distribution of caries was higher in the lower than the upper jaw. There was a slight difference in sex predilection with females having 54.5% and males 45.5% of the lesions and the age group most affected was 20-29 years. CONCLUSION: The results showed a high occurrence of occlusal surface caries in molars especially the second molars in the 20-29 age group in the patients attending the Public Health Dental Officers School Clinic, Mulago Hospital.

Baseline survey of oral health of primary and secondary school pupils in Uganda.

BACKGROUND: Among the issues that determine the performance of a child at school is health. In recognition of this, the Uganda government has embarked on a school health program for the success of universal primary education. Although dental health is an important component of school health there is little information on it. OBJECTIVE: This study aimed at collecting information on dental health of pupils in school for evaluation and planning. DESIGN: A cross-sectional study using a multistage cluster sampling technique was used to select 685 children attending schools in 5 districts. Children were clinically examined for common illnesses/conditions. The oral examinations were done using simplified versions of Decayed, Missing, and Filled teeth (DMFT) index and Community Periodontal Index (CPI). Oral examinations also assessed presence of fluorosis. RESULTS: The pupils attending school were aged from 5 to 22 years. Sixty six percent (456) were found to be caries free with a group DMFT of 0.7. The D-component (decay) accounted for approximately 70% of the cases. Fifty nine percent of the pupils were found to have a healthy periodontium. Sixteen percent of the pupils were found to have some degree of fluorosis of whom the majority were from the highland districts of Kabale and Mbale. Urban school pupils were more likely to have caries (OR 1,69; 95% CI 1.21-2.37) than the rural. CONCLUSION: There is an upward trend in the caries prevalence when compared to studies done earlier. This study revealed a need to develop preventive programs alongside improvement of dental health services.