EVALUATION OF A TRAINING INTERVENTION ON THE PROVISION OF ORAL HEALTH SERVICES AMONG PRIMARY HEALTH CARE WORKERS IN KWARA STATE, NIGERIA

Abstract

Oral diseases are prevalent in Nigeria. There is shortage of dental staff especially at the Primary Health Care (PHC) level. Training of non-dental staff and engaging them in Oral Health services (OHS) will improve OHS coverage. Oral Health (OH) knowledge and the effect of a training intervention among PHC workers, patient's perception of health workers (HWs) practice as well as prevalent Oral Conditions (OC) among community members in Kwara state, Nigeria were assessed. Using a quasi-experimental study design, a four stage sampling technique was used to select 12 health facilities (HFs) from 12 wards in four Local Government Areas (LGAs) which were randomised into intervention (2) and control (2) groups from a total of 16 LGAs. A total of 115 (58 control, 57 intervention) consenting HWs from the selected HFs were interviewed. At baseline information on socio-demographics and knowledge of OH was collected, knowledge of OH was computed on a 22-point scale; scores > 16 were classified as good and ≤16 poor. An interviewer-administered questionnaire to assess patient's perception of HWs' OH practice was administered to 1035 (525 control, 510 intervention) consecutive patients attending the HFs. Patient's perception of HWs' practice was computed on a 13-point scale; scores >5 were classified as good and ≤ 5 poor. Prevalence of OC among 150 randomly selected community members was determined. One day training with two follow-up sessions over two months was conducted for HWs in the intervention group. Training elements included oral anatomy, diagnosis, and prevention of common oral diseases. Evaluation of HWs knowledge and patients assessment of HWs practice was conducted six months later. Data were analysed using descriptive statistics, Pearson and McNemars chi-square tests and logistic regression, p=0.05. Age of HWs was 40.1±8 years. Females were 89.6%. Community Health Extension Workers were 47.0%, nurses 34.8% and 'others' such as technicians 18.3%.The proportion of HWs (control) with good baseline and post-intervention knowledge of OH was 44.8% and 29.3%, respectively. The knowledge score was 15.4±2.9 at pre-intervention and 14.6±3.0 at post-intervention. For intervention group knowledge significantly improved from 43.9% to 64.9%, while the knowledge score was 15.6±3.6 and 16.8±2.3 pre and post-intervention, respectively. The odds of better knowledge of OH was 3.0 among nurses compared to 'others' (95.0% CI: 0.97-8.33). Pre and post-intervention perception of HWs practice of providing OH services as good significantly increased from 9.8% to 52.0% (intervention) and 4.2% to 11.0% (control). Perception score for the intervention group pre-intervention was 0.0 (range = 0-9) and 6.4±2.1 post-intervention. The perception score for the control group was not significant pre and post-intervention. Most prevalent OC were plaque and calculus (66.0%). Oral health training intervention improved the provision of oral health services by nondental staff. Training of health workers should be encouraged to bridge knowledge gap on oral health, towards reducing the prevalence of oral conditions.