Status and effective intervention of oral and dental diseases of mong pupils in primary schools in yen bai province

THAI NGUYEN UNIVERSITY NGUYEN NGOC NGHIA STATUS AND EFFECTIVE INTERVENTION OF ORAL DISEASE IN MONG PRIMARY SCHOOL PUPILS IN YEN BAI PROVINCE SPECIALITY: SOCIOLOGY HYGIENE AND HEALTH

THAI NGUYEN UNIVERSITY

NGUYEN NGOC NGHIA

STATUS AND EFFECTIVE INTERVENTION

OF ORAL DISEASE IN MONG PRIMARY SCHOOL PUPILS

IN YEN BAI PROVINCE

SPECIALITY: SOCIOLOGY HYGIENE AND HEALTH ORGANIZATION

Code number: 62.72.01.64

SUMMARY OF MEDICINE DOCTORAL THESIS

THAI NGUYEN, 2014

The dissertation was completed at UNIVERSITY OF MEDICINE AND PHARMACY

THAI NGUYEN UNIVERSITY

SUPERVISOR

Asso Prof Trinh Đinh Hai PhD

Critic 1:

Critic 2:

Critic 3:

The dissertation will be defended nationally to the Evaluation Committee at University of Medicine and Pharmacy, Thai Nguyen University at ……… on ………, 201

The dissertation is available for reference at:

- The library of Thai Nguyen University of Medicine and Pharmacy

- Learing resource centre of Thai Nguyen University

- The National Medical Library

BACKGROUND

Oral and dental disease are common diseases, having about 80 % of the world population, all ages, all walks of life According to the World Health Organization (WHO) currently has approximately 5 billion people worldwide suffer from periodontal disease, focused primarily in Asia and Latin America,

in the developed countries accounted for 60-90 % children of school age have oral disease Caries is a matter of the Governments of the countries concerned launched several measures to solve BRM is the cause of tooth loss, reduction

or loss of strength chewable adult as well as children In Vietnam, according

to oral health survey in 2000, the national rate was 84,9 % milk tooth decay, permanent tooth decay in children 6-8 years old was 25,4 %, this rate increase

by age and up to 69 % at ages 15-17 The rate of gingivitis was 45% and that needs dental treatment are huge and urgent

Yen Bai is a mountainous province faces many difficulties in health care The rate of dental disease primary pupils above 70 % Over the years, Yen Bai has no solutions, no specific pattern to reduce the incidence of dental disease in a sustainable way down The research question here is that interventions to enhance oral health for Mong primary school pupils in Yen Bai province We studied the subject: "Status and effective intervention of oral diseases in Mong primary school pupils in Yen Bai province" with the following objectives:

1 Describe the current status of oral diseases in Mong primary school puples in Yen Bai province 2011

2 Analyze of some factors related to oral and dental disease of Mong primary school pupils

3 Evaluate the effectiveness of preventive intervention for oral and dental disease in Mong primary pupils

THE NEW SCIENTIFIC FINDINGS OF THESIS

1 The study identified that the rate of dental disease in Mong primary school pupils in two mountainous districts in Yen Bai province is 71,4 % of which tooth decay accounts for 69,6 % and gingivitis accounts for 50,1 %

2 Model of community mobilization on taking care of dental health for Mong primary school pupils are interested by community In this model, coordination among commune health centers, village health staff, school teachers, schools and community leaders are very closed and effective Interventions has helped teachers and health workers make a better monitoring and management of pupils’ health at the schools; it has also enhanced awareness of parents and community in prevention of dental diseases at home Supervision activities have helped communal leaders and involved stakeholders in evaluation of the intervention and adjust the intervention plan timely in accordance with the real local situation Intervention model has affected parent’s behaviors and Mong people community This is a basis for them to give up habits which harm the pupils’ dental health

3 Dissertation deeply studied Mong’s customs and habits of dental health care for pupils As the fact that, Mong people do not pay much attention to their health There are a lot of old customs and habits that harm their health

4 After intervention, knowledge, attitude and practice of pupils increased respectively 36,9 %, 42,9 %, 68,3 % Knowledge, attitude and practice of teachers and pupil’s parents changed significantly, the teacher increased respectively 74,9 %, 61,6 %, 76,8 %, the pupil’s parents increased respectively 47,5 %, 31,2 %, 35,1 % Efficiency of intervention for tooth decay: milk tooth; permanent tooth and gingivitis achieved respectively 7,2 %, 10,6 % and 34,4

% Efficiency of intervention for periodontal disease (bleeding gums, tartar) achieved 31,7 %

STRUCTURE OF THE THESIS

The thesis 127 pages long, including the following sections:

The research results are presented in 47 tables, 04 charts, 04 figure, 02 diagrams, 09 qualitative result boxes, Thesis used 115 reference documents including 56 references in Vietnamese and 59 in English

SOME PART OF THE THESIS

Chapter 2 SUBJECTS AND METHODOLOGY 2.1 Study subjects

2.1.1 In quantitative research:

- The Mong pramary school pupils, they are learning from grades 1 to 5

- Parents of pupils, homeroom teacher

2.1.2 In qualitative research:

- Health staff of schools, school teachers

- Office of district Education and Training leaders

- The commune health workers, health staff of district health centre

- Head of the village, local government leaders

2.2 Location and time study

2.2.1 The location of study

At four pramary schools: Ban Cong school, Xa Ho school of Tram Tau district and Nam Co school, Pung Luong school of Mu Cang Chai district, Yen Bai province

2.2.2 The time of study:

- Conducted in three years from 2011 to 2013

Diagram 2.1 Chart comparing previous and after intervention 2.4 Sample of research

2.4.1 The sample size

2.4.1.1 The sample size in the description study

Applying the formula for sample size for discribed study:

p (1-p)

n = Z12 - /2

d2

In which:

n: is minimun sample size need to be researched

p: Ratio of pupils with oral and dental disease, according to research before (Dr Dao Thi Ngoc Lan researched 2002), p = 0,7, 1-p = 0,3

Nam Co, Ban Cong school

(the data before intervetion)

Collecting the data after

intervention

Xa Ho, Pung Luong school

(The data before intervention)

The data after (Monitoring after

2 years)

1320 puples In fact the survey, the number of pupils at four primary schools

is the 1370 pupils to study We studied 1370 pupils

2.4.1.2 The sample size of the intervention study

Apply the formula research community intervention follows:

2 1 2

2 2 2

1 1

1 1

) (

) 1 ( ) 1 ( )

1 ( 2

P P

P P

P P

Z P P

Z n

In which:

study (The survey data previous intervention): 70 %

P2 = Proportion of pupils was expected at after intervention It was estimated

50 %

P = (p1 + p2)/2 = 0,6 (60 %)

Z1- = is coefficient of confident limit (with = 0,05) = 1,96

2

2

) 5 , 0 7 , 0 (

5 , 0 5 , 0 3 , 0 7 , 0 65 , 1 4 , 0 6 , 0 2 96 , 1

n

According to the calculation formula on n is 156 plus 10 % give up was

172 pupils Thus, the number of pupils enrolled for minimum is 172 pupils in each intervention group and the control group

2.4.2 Techniques of choosing the sample

2.4.2.1 In discribed study

- Choosing the sample in quantitative study

+ Purposeful sampling: in two districts of Yen Bai province (Tram Tau

and Mu Cang Chai district) In this 2 districts have over 95 % Mong people, who are living here

+ Sampling schools:

We choose 4 primary schools by random draw method So we had Ban Cong primary school, Xa Ho primary school (in Tram Tau district), Pung Luong primary school and Nam Co primary school (in Mu Cang Chai district)

+ Sampling pupils:

We choosed the entire sample; we made the list of pupil of 4 schools; the pupils in each school choosed from class 1 to class 5 After that, we surveyed under the this list and we had 1370 pupils They are learning in 4 primary schools and all are Mong people

2.4.2.2 In the intervention study

We choosed each district 01 school by random draw methed to implement intervention study We had the Nam Co primary school in Mu Cang Chai district and Ban Cong primary school in Tram Tau district The schools will perform intervention model (intervention group), actual intervention group had 691 pupils, and the control group was Pung Luong primary school in Mu Cang Chai district and Xa Ho primary school in Tram Tau districts (control group), the actual control group had 679 students

- Sampling in quantitative study

+ Group discussion: We conducted 4 group discussions in four school, two group discussions in one school In the first group discussion is included health staff in commune level, village level, school teachers (8-12 people) In the second group discussion is included commune leaders, head villages, pupil’s parents (8-12 people)

+ In-depth interview: We conducted interview 01 leader of commune people’s committee, head of commune health station, 05 homeroom teachers

01 leader of district health centre, 01 leader of district Education and Training department 01 parents in each grade, 01 school health worker

2.5 Content of study

2.5.1 For discribed study

- Oral examination to confirm the rate of dental caries, gingivitis and dental manifestations of the disease (periodontal disease), index of dmf, DMF and CPI index before intervention

- Interview the primary school pupils, parents, homeroom teachers to identify factors related to the pupils’ oral disease

- Learning the environmental situation in the oral health care activities (teachers, school health worker), in community (parents of pupil, communication)

2.5.2 For intervention study

2.5.2.1 Develop intervention model

After assessing the situation, determine the factors related to dental disease, the researchers will gather communication materials on the basis of the literature used to train the teachers, the core group of villages by the Ministry of Health was regulated Instructions building workshops and training materials for the core group to organize and implement the activities following the subjects

2.5.2.2 Implement the activities of intervention models

Implement the preventive intervention model of oral diseases for primary school students:

- Prepare community activities included in the intervention schools

- Develop a plan, work rules, the establishment of a steering intervention, organizing the activities, monitoring and evaluation of interventions and compared with the results of the initial investigation

- Resources for implementation: Subject to mobilize resources is social health officials, village and school teachers in addition to mobilize staff communes and villages directly involved in research model

- The Steering Committee consists of six people: Leadership CPC, Representative school board school, board vice-Chairman of CHCs as deputy director, officer in charge of medical schools, teaching team manager, head of the village are members

Training course, WS

oral disease examination

Comumication on knowledge

Diagram 2.2 Model mobilize community resources involved in

interventions for prevention of dental disease in Mong primary school pupil

2.6 The studied criteria

2.6.1 The studied criteria for objective 1

* The general information of research group:

- The characteristics of the pupils: age, gender, class…

* The criterria of the pupils with oral and dental disease

- The rate of pupils have oral and dental disease

- The rate of pupils have gingivitis

- The rate of decay-missing-filling on milk tooth and permanent tooth

- The expression of periodontal gum disease (tartar, gingivitis and bleeding gums)

- Results of depth interviews and workshop with related members of the schools in two commune (qualitative research)

Intervention Leaders

Core group

Staffs health station, village health worker

Pramary

pupils

Parents of pupils Research

group

2.6.2 The studied criteria for objective 2

- The relationship between pupil’s knownledge, attitude practice in oral health care and oral and dental disease

- The relationship between parent’s knownledge, attitude practice in oral health prevention and oral and dental disease

- The relationship with the social conditions (health care, economic component of household)

2.6.3 The studied criteria for objective 3

2.6.3.1 Group of indicators intervention models

- The index describes the results of implementing the intervention model

+ Human resources: the number of participants models

+ On the material: The material has been prepared for training, communications, facilities used in the research process

+ About the organization model: Decision establishment of direct intervention model, assigning tasks to members of the Steering Committee, operating rules

- The index of the performance of the model

- The monitoring indicators of intervention activities

2.6.3.2 The group of indicators describing the performance of health communication and education about oral health care

In quantitative research: effective interventions for knowledge, attitude and practice of pupils, parents, school teachers of the two groups before and after intervention

- In qualitative research: evaluating subjects (pupils, parents, teachers)

on the results of health education and communication

2.6.3.3 Group counseling indicators of treatment consultancy

- The pupils were consulted treatment

- Number of pupils were moved to higher level

- The pupils were consulted to prevent the complications

2.6.3.4 Results capacity for core group in the implementation of activities in the village, at the school

- The training courses were implemented

- The number people participant training courses and workshop

- The results of training courses

2.6.3.5 Results of coordinated methods for the prevention of pupils oral diseases

- Effective application of the intervention methods in quantitative research

- Maintain and expand the model intervention

2.7 The assessment of knowledge, attitude and practice of oral health care of pupils

In this study, based on interviews with questionnaires and checklists to assess the knowledge, attitude and practice of students, teachers and parents Each correct answer is counted as 1 point, wrong answer no points The total point of knowledge, attitude and practice is divided into 3 main level: weak, average, good, under the classification of Bloom as follows:

- The number of point is 8-10 (≥ 80 %): Good

- The number of point from 6-7 (60-79 %): Average

- The number of point under 6 (≤ 60 %): Weak

2.8 Standard classification of poor and non-poor household:

According to Decision No 09/2011 / QD-TTg dated 30/01/2011 of the Prime Minister on the issuance poverty line, poor households applied for 2011-2015 states: poor households in rural / mountains are households with an average income of 400,000 VND / person / month (from 4.8 million VND / person / year) or less Thus, poor households are households with an average income of 401,000 VND / person / month or more

The other evaluation criteria:

- Check your oral health routine: Organizations oral examinations for pupils at schools in 6 months a time In order to detect oral diseases and counseling, guiding, families of pupils take examinations and treatment

- Guide oral hygiene routine: The pupils are instructors oral hygiene (brushing, gargling, prevention of disease risk factors Dental) weekly classroom teacher dean or school health personnel perform

- Eat regularly shoots peppers: the students ate pickled chilli bamboo shoots in the daily meal Not regular eat as monthly, weekly and eat once or not eat

2.9 Review effectiveness of the intervention

- The difference with statistical significance was assessed at p <0,05

- Evaluation of intervention based on effective indicators and effective intervention

- The effective indicator as formula:

p1 – p2

Effective indicator (%) = - x 100

p1

Trong đó: p1 is proportion of study before intervention

- Effective intervention as formula (%)

Effe indicator (Intervention grour) – Effe indicator (control grour)

2:10 Evaluating of community acceptance for intervention

- Based on qualitative research, information was recorded, classified by contents and assessmented the results

Chapter 3 RESULTS OF STUDY

3.1 Status of oral diseases in Mong primary school pupils

Table 3.4 The rate of oral disease follow school (n=1370)