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| ORIGINAL ARTICLE |
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| Year : 2018 | Volume
: 16
| Issue : 2 | Page : 160-164 |
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Oral healthcare-related expenditure among people residing in Durg, Chhattisgarh: A household survey
Swati Verma, Hunny Sharma, Ramakrishna Chevvuri
Department of Public Health Dentistry, Rungta College of Dental Science and Research, Bhilai, Chhattisgarh, India
| Date of Submission | 10-Jan-2018 |
| Date of Acceptance | 23-Mar-2018 |
| Date of Web Publication | 24-May-2018 |
Correspondence Address:
Dr. Swati Verma
W/o Sh. Ravi Baghel, 67 Arcadia Rd Apt B Hackensack, New Jersey - 07601
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaphd.jiaphd_17_18
Background: Oral health is a functional unit of general health. Dental caries and periodontal diseases are considered as the major diseases prevailing in the modern era. Over decades, the perception toward maintaining oral health and interest for preventive oral health measures has decreased, thus increasing the healthcare expenditure. Aim: This study aims to estimate the household expenditure on oral health care among people residing in Durg, Chhattisgarh, India. Materials and Methods: Eight hundred and sixty participants were surveyed who were residents of Durg, Chhattisgarh (C.G.). Participants were selected through multistage cluster random sampling. A self-designed pretested and validated 20 item questionnaire was used to assess the expenditure on oral health care. Data collected were analyzed using IBM SPSS software version 23 for Windows (New York, USA). Frequency, mean and percentage, and Pearson's correlation coefficient tests were used to analyze the data. Results: Out of 860 individuals, 204 (23.7%) were males and 656 (76.3%) were females. Eight hundred and thirty-two (96.7%) individuals reported using a toothbrush as an oral hygiene aid. Majority (58.3%) of the families reported changing toothbrush at 3 months or more duration, while 37.8% of the families in 1 month or less. A statistically significant weak correlation was observed when education, occupation, and income were compared with annual expenditure on dental care (r = 0.219, 0.239, and 0.350, respectively). While a moderately strong correlation was observed between the socioeconomic status of families and annual expenditure on dental care (r = 0.438). Conclusion: People should be aware of preventive oral hygiene aids, and appropriate policies should be formulated which will ultimately result in decreased expenditure on a curative aspect of the dental disease.
Keywords: Dental care, family characteristics, health expenditures, oral health, personal, surveys and questionnaires
How to cite this article:
Verma S, Sharma H, Chevvuri R. Oral healthcare-related expenditure among people residing in Durg, Chhattisgarh: A household survey. J Indian Assoc Public Health Dent 2018;16:160-4 |
| Introduction | |  |
Oral health is an essential part of general health.[1] Regardless of great development in the field of oral health sciences and technologies, global oral health problems continue to be a greatest financial burden on the populations of several countries. Oral health issues such as untreated dental caries, periodontal disease, and tooth loss are major public health problems which significantly affect individuals and communities with reference to pain and suffering, functional impairment, and diminished quality of life. These oral health problems not only cause catastrophic effects on public health budgets, but also bring great financial burden and out-of-pocket (OOP) expenditure for those suffering.[2]
Over decades, health in India has gained less attention, and particularly, oral health is the least.[3] Majority of oral health problems result due to unhealthy environments and behaviors.[4] Prevention of these oral health problems requires a multi-factorial approach which includes proper monitoring of dietary factors and effective maintenance of oral hygiene by means of appropriate chemical and mechanical plaque control methods.[4]
Although products to obtain satisfactory oral hygiene are easily available to buy, cost of such oral hygiene aids can be a significant obstacle for those who wish to achieve the minimum level of plaque control that is considered satisfactory for good oral health.[5] Majority of the expenditure in India on oral and dental care is included in family general budget mainly focusing food, shelter, clothing, and schooling.[5] Diversity also exists in health budget allocation among each family according to their culture, religion, tradition, and beliefs. Health is given less importance, with oral health coming at last.[5],[6],[7]
Lack of attention toward these dental diseases expresses itself in the form of a financial burden on the family, which is mainly dealt with OOP expenditure.[8] Such sudden catastrophic expenditures in India pushes families to sell their monetary assets or borrowing cash from peers even in the middle class families.[9] Hence, it is essential to know general expenditure on oral hygiene maintenance and sudden catastrophic expenditure related to oral disease particularly in Chhattisgarh state where no such studies had been conducted before. Hence, this present household study was undertaken to estimate oral healthcare-related expenditure among people residing in Durg, Chhattisgarh.
| Materials and Methods | | |
This household cross-sectional questionnaire study included a total of 860 households. Among the 860 households, only individuals who managed the household expenditure, i.e., head of family were interviewed. The sample size calculation was assessed using the following formula in which Z α/2 = 1.96, P = 10%, Q = 90% (i.e., 1 − P) d = 3% (minimal detectable difference), and D = 2 (design effect).
Hence, n = 845
Design effect of 2 and 10% nonresponse rate were taken into account as to have a final sample size of 845 that was rounded up to 850; however, a total of 860 individuals were included into the study.
Multistage cluster random sampling procedure was employed to select households from Durg and its suburbs as shown in [Figure 1]. | Figure 1: Multistage cluster random sampling method employed in the survey
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Ethical approval to conduct the survey was obtained from institutional ethics committee (RCDSR/MDS/Syno. Reg./2015-ST3). The survey was carried out from August to October 2015. Inclusion criteria for survey participants were individuals who manage the household expenditure, i.e., family head/wife/mother and those who provided consent to participate. While those who were uncooperative and refused to answer after much persuasion were excluded from the survey. A written informed consent was also obtained before individuals were included in the survey after explaining them about the objectives of the study and assuring them about the confidentiality of the information obtained.
Questionnaire
A self-designed 23-item structured questionnaire was specially designed in both Hindi and English and pretested to suitably adapt to gather relevant information according to the objectives of the study. Questionnaire comprised of four sections apart from a separate section to record sociodemographic details.
- Section I - consisted of three questions regarding education, income, and occupation of the head of the family who manages household expenditure
- Section II - consisted of four questions assessing the nature and frequency of oral hygiene practice and three questions assessing the frequency of oral hygiene measures
- Section III - consisted of four questions to assess the attitude of the person governing expenditure on dental health care by addressing the regular dental checkup, dental problems encountered in the last 1 year, and expenditure on dental health care
- Section IV - consisted of nine questions assessing expenditure on oral health care needs
The questionnaire was subjected to content and face validation among 10 experts in the subject.
Pilot study
The reliability of the questionnaire was assessed by distributing the questionnaire to 86 household members governing the expenditure on oral health care who were not part of the final sample. The data collected was used to assess the reliability of the questionnaire using Cronbach's alpha. Cronbach's alpha was calculated (α =0.82), and test-retest analysis showed a good reliability of 0.82 of the questionnaire.
Single-trained and calibrated examiner carried out the entire interview process in the survey. Only 10 households were interviewed per day to avoid interviewer fatigue.
Statistical analysis
Data collected were categorized and tabulated into Microsoft 2013 excel sheet and were subjected to statistical analysis using IBM SPSS software versions 23 for windows (New York, USA), and frequency and mean and percentage were calculated for expenditure on oral hygiene measures and dental treatment. The correlation was assessed using Pearson's correlation between education, occupation, income, socioeconomic status, and expenditure on dental care
| Results | | |
A total of 860 individuals who gave consent were included in the study, out of which 204 (23.7%) were males and 656 (76.3%) females [Table 1].
On asking about their choice for oral hygiene measures used, out of 860 participants surveyed, the majority (96.7%) reported to be using the toothbrush as an oral hygiene aid and only 3.3% reported of using wooden twig. Majority (58.3%) of the families reported changing of toothbrush at 3 months or more duration; however, 37.8% of the families admitted their toothbrush lasting for 1 month only. About 99.7% reported of using toothpaste/toothpowder and only 0.3% denied of using any kind of dentifrice [Table 1].
Tongue cleaning was practiced by 84.5% individuals while 15.5% reported of not having the habit of tongue cleaning. Use of medicated mouthwash by the family was reported by 34.1%, while 65.9% family heads reported of not using any medicated mouthwash regularly. Use of tooth pick or floss was not a regular practice. Only 9.9% out of 860 individuals reported of use of tooth pick or floss as oral hygiene aids [Table 2]. | Table 2: Frequency of responses for questions regarding other oral hygiene measures used
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The majority of the individuals reported visiting dentist only in need of any treatment, and only 12.1% reported having the habit of regular visits to the dentist. On asking about whether they or their family had encountered any dental problems in the last 1 year, 32.9% reported problem of pain, 64% reported of encountering bleeding gums, while 3.1% reported of suffering from halitosis. Self-medication was the treatment of choice in case of majority for any dental problem, while 35.7% visited dentist and 2% reported of visiting to the physician. Home remedy was treatment of choice for 1.2% while 0.7% preferred to do nothing when they encountered problem.
This study mainly focused on economic evaluation of expenditure on oral hygiene measures and dental care. On an average, each family spent about 50.67 to 326.08 INR yearly on the purchase of toothbrushes. While annual expenditure on wooden toothpick ranged from 34.97 INR monthly to 129.08 INR yearly. Toothpaste and toothpowder being the majority type of dentifrices as a preventive oral hygiene measure for dental disease costed on average 1255.65 INR annually. While the habit of tongue cleaning, mouthwash, and toothpick/floss costed around 87.10 INR, 240.46 INR, and 78.36 INR, respectively, for each family [Table 3]. Interviewed people spent around 2254.28 INR for the dental problem encountered last year, but when asked for the budget they kept for sudden dental emergency, only 9 (1%) of them reported of having a budget for the same with an average of 1364.32 INR as an emergency budget [Table 3] and [Table 4]. | Table 4: Monthly and annual mean expenditure on oral hygiene aids and treatment needs
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On assessing the relationship between annual expenditure on dental care with education, occupation, income, and socioeconomic status of the families, a statistically significant weak correlation was observed when education, occupation, and income were compared with annual expenditure on dental care (r = 0.219, 0.239, and 0.350, respectively). While a moderately strong correlation was observed between the socioeconomic status of families and annual expenditure on dental care (r = 0.438) [Table 5]. | Table 5: Relationship between education, income, occupation, socioeconomic status, and expenditure on dental care
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| Discussion | | |
Oral diseases such as periodontal diseases and dental caries are multifactorial; despite great improvements in the global oral health status, gingival and periodontal diseases still remain the major public oral health problems.[1],[11]
Healthcare expenditure in developing and low-income nations relies primarily on OOP expenditure. OOP expenditure on oral care is any direct spending by households, including payment done on preventive measures for oral diseases and treatment of already existing oral health problems.[12]
Analysis of expenditure of households on oral care has shown varying results. The analysis of expenditures, in general, has been a subject of supreme interest and discussion in recent times globally. As per the result of the present study, it was evident that people were less aware about preventive dental measures such as toothpick and floss with very less percentage of people visiting a dentist at regular basis; similar findings were reported by J Nikita et al.[13],[14] The annual expenditure on dental treatment ranged from 2254.28 to 7122.29 INR which was higher as compared to the cost of preventive oral hygiene measure, which created a huge impact on budget of individuals of the family.[6] Very less number of people were found to be prepared for unexpected emergency dental care.
Mainly, the unexpected emergency dental expenses among people was due to lack of regular visit to dentist which resulted in lack of awareness regarding preventive and oral hygiene aids; as a result, there was increase in disease severity and increased dental expenditure.[15],[16]
Due to negligence for oral health, households in Durg city were not able to allocate budget for emergency dental care. People gave less importance to regular checkup which adds to their negligence and restrict their oral healthcare mindset for the purchase on toothbrush and toothpaste and visiting the dentist only for dental pain.
Our study found a positive correlation between income and expenditure, i.e., with the increase in income range, the expenditure on the dental health care increased; similar finding were reported by Barros and Bertoldi.[12] Hence, the cost of dental treatment and oral healthcare needs acted as a significant barrier to achieve good oral health.
Findings of our study reports that most of the people show lack of preparedness toward sudden dental emergencies in terms of budget for sudden dental problems results in undue burden on family budget which is compensated by means of coping strategies such as saving, selling assets, and borrowing which ultimately affects household wellfare in long term. Similar findings were reported by a survey conducted by Quintussi et al.[17],[18]
Our study revealed a weak positive correlation when education, occupation, and income were compared with annual expenditure on dental care and a moderately strong positive correlation when socioeconomic status of families was compared with annual expenditure on dental care, hence increase socioeconomic status with increased educational level increase awareness and concern towards oral health which is seen in the form of increased expenditure on dental health care. The findings of our study are consistent with the finding of a survey conducted by Bhushan et al.[19]
Although this study is the first of its kind conducted in India as far as author's knowledge, the present study has some inherent limitations such as
- During the present survey, individuals are asked to recall their total household expenditures on oral hygiene and dental care, including those for dental care, for the past calendar year of period 12 months, which is practically difficult to remember leading to recall bias or few respondents reporting increased expenditure on preventive measure as a status symbol.
- Families who were below the poverty line and were provided with the smart card (treatment is free/paid by the government) were included in the study, but no steps were taken to include the benefits obtained by the smart card. Hence, the expenditure was not listed by them. The accuracy of the data of the present survey completely depended on the respondent's ability to remember and report truthfully
- No measures were employed to verify that individual expenditures having correctly recalled and reported.
Recommendations
The study highlights the OOP expenditure on oral health care of families residing in Durg (C. G). To reduce OOP expenditure, there should be countrywide dental insurance coverage scheme that would focus on preventive measure. By implementation of such scheme, there will be integration of private and government sector, which will help in listing out probable barrier in utilization of oral healthcare services.
| Conclusion | | |
It can be concluded that people should be made more aware regarding preventive oral hygiene aids which will ultimately result in decreased expenditure on curative aspect of dental disease. Newer governmental policies should be formulated with special attention to tackle the rising burden of oral disease and increasing awareness regarding various preventive measures and oral hygiene aids, which will help in proper utilization and equity of oral hygiene practices among masses.
Acknowledgment
The authors are grateful to all the families who took part in this survey and provided their valuable time and kind support, without whom this study would have not come into the light.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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