|Year : 2016 | Volume
| Issue : 2 | Page : 135-138
Dental care utilization by accredited social health activist and anganwadi workers in Chintamani Taluk, Karnataka
KM Shwetha, HN Pallavi, K Pushpanjali
Department of Public Health Dentistry, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
|Date of Web Publication||10-Jun-2016|
K M Shwetha
Department of Public Health Dentistry, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru - 560 054, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: The Accredited Social Health Activist (ASHA) and anganwadi workers form a strong link between the healthcare delivery system and rural community. The utilization of the dental care facilities by ASHA and anganwadi workers can be an indicator of oral health awareness among them. Aim: To assess the dental care utilization among ASHA and anganwadi workers and their oral diseases status. Materials and Methods: A cross-sectional study was conducted at the community health center, Chintamani, Karnataka. All the ASHA, anganwadi workers present on the day of the study were included in the study. A proforma was used to record demographic details, oral health care utilization during the previous year, reasons for last dental visit, and oral health status. Descriptive statistics and Chi-square test were performed using SPSS version 16 (SPSS IBM, Chicago, IL, USA). Results: The study participants were 321 in number. Among them, 141 (43.9%) were ASHA workers and 180 (56.1%) were anganwadi workers and 28.3% utilized dental services. However, 309 (96.7%) of the participants had oral diseases. There was a significant difference (P = 0.002) in the proportion of the dental care utilization and oral diseases among the participants. Conclusions: The dental care utilization was low and is not proportional to the disease present in the study population.
Keywords: Dental service, health workers, utilization
|How to cite this article:|
Shwetha K M, Pallavi H N, Pushpanjali K. Dental care utilization by accredited social health activist and anganwadi workers in Chintamani Taluk, Karnataka. J Indian Assoc Public Health Dent 2016;14:135-8
|How to cite this URL:|
Shwetha K M, Pallavi H N, Pushpanjali K. Dental care utilization by accredited social health activist and anganwadi workers in Chintamani Taluk, Karnataka. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2017 Mar 30];14:135-8. Available from: http://www.jiaphd.org/text.asp?2016/14/2/135/181820
| Introduction|| |
Regular dental visits help in attaining optimum oral health through early identification of oral diseases, thus reducing the cost of dental services and associated morbidity. Dental care utilization can be defined as the percentage of the population who access dental services over a specified period of time. Further, annual number of dental visits per person, proportion of people visiting a dentist within a year, reported first dental visit in a series of visits, lack of dental visits within a specific period of time, aggregated expenditures for dental visits, and routine verses emergency care are some of the parameters that can be considered for dental service utilization.
Despite increased oral disease burden, less than half the adult population visit the dentist annually. Studies in Jaipur and Bengaluru found that 38.5% of the population had not visited a dentist in past 2 years  and only 28% visited in last 1 year. The reasons for utilization of services was dental pain  and for nonutilization was high cost of oral health care, fear of dentists or dental tools, the distance to travel to seek care, and that the oral diseases are not life-threatening.,
Primary health centers (PHC) forms the first point of contact between the rural community and the healthcare system where 68.84% of the Indian population resides. India has a strong network of over 24,049 PHC and 148,366 subcenters. Yet, the oral healthcare services in rural areas are inadequate. This unequal distribution of the services can be attributed to lack of priority among policy makers, patients, and dental workforce towards oral health.
As a plan of action to improve infrastructure and manpower strengthening, Accredited Social Health Activist (ASHA) were chosen who are involved in preparation and implementation of village health plan along with anganwadi worker. Anganwadi worker is a community-based voluntary frontline worker of the Integrated Child Development Scheme. Thus, these ASHA and anganwadi workers might play a key role in areas where there is deficiency of dental workforce in providing oral health education. Dental care utilization indicates preventive care-seeking behavior of an individual. However, there is no sufficient evidence pertaining to dental care utilization among ASHA and anganwadi workers. Hence, this study was conducted to assess, (1) the dental care utilization among primary healthcare workers (2) the oral diseases among the study group.
| Materials and Methods|| |
Permissions were obtained from the Medical Officer of the community health center (CHC). Ethical clearance was obtained from the Institutional Ethics Committee. This cross-sectional study was conducted at CHC, Chintamani for 3 days in consecutive 2 weeks of September 2013. ASHA and anganwadi workers designated for villages in Chintamani Taluk were informed before to attend the center for their health checkup on specified days. The study sample included all the ASHA and anganwadi workers (n = 321) who attended the center on specified days and their consent for participation was obtained.
Study proforma was prepared to include demographic data, oral health care utilization data assessed as dental visit in last 1 year, reasons for last dental visit, and oral health status. Two investigators were trained to conduct oral examination and record the study proforma in local language. The interexaminer reliability for oral examination ranged from 0.82 to 0.86. The data were collected through face to face interview, and oral health examination was performed using mouth mirror and World Health Organization (WHO) probe under natural light.
The data were entered in the Microsoft Excel. The analysis was carried out using SPSS version 16 (SPSS IBM, Chicago, IL, USA). Data were analyzed for descriptive statistics and Chi-square test to assess factors related to oral health care utilization. A value of P < 0.05 was considered statistically significant.
| Results|| |
A total of 321 primary healthcare workers with mean age of 36.5 ± 8.65 years participated in the study. ASHA workers were 141 (43.9%) and 180 (56.1%) anganwadi workers. Utilization of dental services was seen in 91 (28.3%) participants. Oral diseases were seen in 309 (96.3%) participants. Dental caries alone was seen in 33.3%, only periodontitis in 6.9%, both dental caries and periodontal disease together was seen in 55.5%, and oral premalignant lesions in 0.6% [Table 1].
[Table 2] shows dental care utilization by age, education, and occupation among the study participants. It was seen that oral health care was utilized by 50% of 50–59 years olds compared to lesser age groups and the difference was statistically significant (P = 0.001). Of the 91 participants who utilized dental services, 78 subjects had visited with a history of dental problem and the remaining 13 had visited for general oral examination. Visit to dentist within 1 year was reported by 27 (34.6%) participants.
|Table 2: Dental care utilization by age, education, and occupation of the study participants|
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In our study, dental care utilization was seen in 29.5% among the 309 (96.3%) participants with oral diseases, and this finding was statistically significant (P = 0.002) [Table 3].
|Table 3: Dental care utilization among study participants with oral diseases|
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| Discussion|| |
ASHA and anganwadi workers have access and form a network in the rural areas where more than 70% of the Indian population reside. They form a strong link between the rural community and healthcare delivery system and this study estimated the oral health care utilization among this group.
Dental care utilization is an indirect measure of preventive health care-seeking behavior of an individual. The findings of our study showed that dental care utilization was low (28.3%) among the participants. This finding is similar to the studies conducted on adult population in China with utilization rate of 20%, 28% in Bengaluru, India, and Spain 34.3%. The reason for visiting a dentist reported in most studies is dental pain.,,, This indicates that dental visits are delayed until the occurrence of any symptoms of oral diseases and also a lack of awareness regarding the significance of preventive dental visits.
Dental care utilization was seen only in 29.5% of 96.7% of the participants with oral diseases. This indicates the poor awareness about oral health and also indicates disparity between dental need and utilization. It was observed that oral health care utilization increased with the age from 15.5% in 20–29 years age group to 50% in 50–59 years. This finding may be suggestive of accumulated dental needs with increased age and also supports that dental care is utilized only when symptoms appear. Hence, attempt should be made to increase their awareness and utilization through effective training modules.
Behavioral change pertaining to health care of rural population is the responsibility of the primary healthcare workers along with healthcare professionals. One of the studies conducted by Retnakumari and Cyriac suggested that mother's good oral health behavior could induce better oral condition in their children. Considering this philosophy, as ASHA and anganwadi workers belong to the same community they serve, people trust them. This opportunity may be used to role model prompt dental care utilization to their beneficiaries.
WHO has proposed to include essential oral healthcare services into the existing primary healthcare system to benefit poor and disadvantaged populations. This can be applicable to Indian scenario where unfavorable dentist population exist.,, ASHA and anganwadi workers are in a position to disseminate and role model oral health awareness, improve dental care utilization, and instill healthy behaviors among the rural population.
The study was limited to the participants attended our health camp organized for health workers. However, further research is needed to understand the preparedness of the ASHA and anganwadi workers towards community oral health education and bridge the gap between rural community and healthcare system.
| Conclusions|| |
The utilization of oral healthcare services by ASHA and anganwadi workers is low, and it is not proportional to the disease present in this group. Thus, it is important to create good oral health behavior among the ASHA and anganwadi workers to help improve the oral health of their beneficiaries.
We sincerely acknowledge our Dean Dr. B. V. Sreenivasa Murthy, camp organizers, and all the study participants for their contribution.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Holm-Pedersen P, Vigild M, Nitschke I, Berkey DB. Dental care for aging populations in Denmark, Sweden, Norway, United kingdom, and Germany. J Dent Educ 2005;69:987-97.
National Oral Health Survey and Fluoride Mapping. An epidemiological study of oral health problems and estimation of fluoride levels in drinking water. New Delhi: Dental Council of India; 2004.
Devaraj C, Eswar P. Reasons for use and non-use of dental services among people visiting a dental college hospital in India: A descriptive cross-sectional study. Eur J Dent 2012;6:422-7.
Kadaluru UG, Kempraj VM, Muddaiah P. Utilization of oral health care services among adults attending community outreach programs. Indian J Dent Res 2012;23:841-2.
Maharani DA, Rahardjo A. Is the utilisation of dental care based on need or socioeconomic status? A study of dental care in Indonesia from 1999 to 2009. Int Dent J 2012;62:90-4.
Lo EC, Lin HC, Wang ZJ, Wong MC, Schwarz E. Utilization of dental services in Southern China. J Dent Res 2001;80:1471-4.
Pizarro V, Ferrer M, Domingo-Salvany A, Benach J, Borrell C, Pont A, et al.
The utilization of dental care services according to health insurance coverage in Catalonia (Spain). Community Dent Oral Epidemiol 2009;37:78-84.
Gambhir RS, Brar P, Singh G, Sofat A, Kakar H. Utilization of dental care: An Indian outlook. J Nat Sci Biol Med 2013;4:292-7.
Retnakumari N, Cyriac G. Childhood caries as influenced by maternal and child characteristics in pre-school children of Kerala – An epidemiological study. Contemp Clin Dent 2012;3:2-8.
van Palenstein Helderman W, Mikx F, Begum A, Adyatmaka A, Bajracharya M, Kikwilu E, et al.
Integrating oral health into primary health care – Experiences in Bangladesh, Indonesia, Nepal and Tanzania. Int Dent J 1999;49:240-8.
Vundavalli S. Dental manpower planning in India: Current scenario and future projections for the year 2020. Int Dent J 2014;64:62-7.
Bommireddy VS, Pachava S, Ravoori S, Sanikommu S, Talluri D, Vinnakota NR. Socio-economic status, needs, and utilization of dental services among rural adults in a primary health center area in Southern India. J Int Oral Health 2014;6:56-60.
Vashisth S, Gupta N, Bansal M, Rao NC. Utilization of services rendered in dental outreach programs in rural areas of Haryana. Contemp Clin Dent 2012;3 Suppl 2:S164-6.
[Table 1], [Table 2], [Table 3]