Philosophiae Doctor - PhD (Community Oral Health)
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Item Commercial baby food: Consumption, sugar content and labelling practices in Uganda(University of the Western Cape, 2022) Mwesigwa, Catherine Lutalo; Naidoo, SudeshniThere has been a worldwide increase in the consumption of processed foods in low- and middle-income countries. Processed foods are now easily available and accessible with the increased presence of transnational corporations, urbanisation and improving economies—all essential drivers of the nutritional transition. Ultra-processed foods and beverages (UPFB) have been identified as a significant contributor to total dietary energy and, in specific settings, the biggest source of sugar for infants and young children. High consumption of free sugars in early childhood is associated with poor health outcomes, including early childhood caries, overweight/obesity and an increased risk of developing other non-communicable diseases (NCDs).Item A comparative analysis of traditional dental screening versus tele dentistry screening(University of the Western Cape., 2016) Bissessur, Sabeshni; Naidoo, SudeshniBackground: Teledentistry is the use of information and communications technology (ICT) to provide oral health care services and enhance oral health care delivery to communities in geographically challenged areas. The public health services in South Africa needs to be overhauled to address the inadequacies in the current system. As an attempt to minimise or repair the inadequacies in the public health sector, South Africa has identified the use of ICT’s as a potential tool in improving the delivery of health care. However, although SA has recognised telemedicine as a potential solution to improve access to health care, teledentistry does not feature at all in the dental public health sector. Teledentistry and mobile health has the potential to eliminate or minimise the oral health disparities that exist in South Africa with the use of health information systems. Teledentistry can be initiated in an incremental approach by 'piggy-backing' on existing telemedicine sites, thus reducing ICT costs for the public health sector. Stake holders and government officials need to embrace technology to address some of the challenges that exist in the South African public health sector. This study could aid in providing evidence-based information to assist in the introduction of teledentistry in South Africa as an innovative dental screening and management tool. The most recent SA National Oral Health Survey showed that at least 80% of dental caries in children is untreated (Department of Health, 2003) and this poses a significant public health problem. To reduce the double burden of dental caries in children and human resource shortages in the public sector, the use of teledentistry as a school screening tool has been recommended. Teledentistry screening has the potential to improve access and delivery of oral health care to children in underserved and the rural areas. The aim of the study is to compare traditional dental screening versus teledentistry screening for dental caries in children. Methodology: This study consists of two parts: the first part a concordance study and the second part the determination of user satisfaction with regards to the technology used. The concordance study assessed the diagnostic agreement between traditional and teledentistry screening of dental caries in school children aged between 6-8 years old. The methodology included traditional face-to-face dental screening by two trained and calibrated evaluators, and the teledentistry screening method included the same two evaluators together with two trained and calibrated teledentistry assistants (who were of non-dental background). For the traditional face-to-face dental screenings the two evaluators examined 233 children at selected rural primary schools and scored them for DMFT. For the teledentistry screening method the teledentistry assistants captured intraoral images of the same children and web-based stored the images in corresponding eFiles. After a two week wash out period these intraoral images were then examined by the same two evaluators and scored for DMFT. To determine concordance across methods, Kappa Statistics was applied to the data and this revealed intra-examiner reliability. To determine user satisfaction levels, close-ended questionnaires were designed based on the role of the evaluators and TAs in the teledentistry screening process. Results: The intra-rater agreement and reliability across methods for evaluator one was 98.30%, and for evaluator two it revealed a result of 95.09%. Kappa statistics thus revealed that both evaluators were in agreement between a range of 95%-98.30% of the classifications, or 92.79% of the way between random agreement and perfect agreement (p=0.000). The high concordance level indicated that there was no statistical difference between the traditional dental screening method and the teledentistry screening method (intra-rater reliability), thus suggesting that the teledentistry screening method is a reliable alternative to the traditional dental screening method. For the user satisfaction part, both of the evaluators agreed with 8 of the 13 statements (62%). The statements that were agreed upon related mainly to user satisfaction on the technology which included accessing the intraoral images for screening and the ease of scoring decayed and missing teeth off the images; time and technology suggested the screening process of the images saved time; and indicated teledentistry as being an innovative and easy system to use that will save clinical time for dental professionals. The statements they disagreed with related to the clarity of the images, scoring interproximal caries off the images, and the dental screening method of choice. Both of the TAs agreed with 7 of the 11 statements (64%). They agreed upon statements related mainly to perception of children’s attitudes & behaviour which suggested the children were comfortable during the imaging process and in addition they were excited to see pictures of their teeth; they found teledentistry to be an innovative and easy system to use; they found teledentistry to be a sterile process and hence they were happy with infection control. Both TAs disagreed with the statement that suggested clear images could be captured irrespective of poor lighting. Discordant statements related mainly to user satisfaction on technology which related to ease of using the intraoral camera, ease of storing the captured images into the eFiles and ease of deleting unwanted images. Conclusion: The key findings of this study highlights the reliability of utilising teledentistry as a dental screening and diagnostic tool which can be valuable in the delivery of oral health care in South Africa. This research study further revealed valuable data on user satisfaction levels of the evaluators and TAs, and has an impact on the utilisation of the teledentistry screening system. To ensure adoption and adaptation of the screening process all users must be satisfied with the ICTs used in the teledentistry system. User friendliness can impact negatively on the adoption of teledentistry.Item The effect of dental treatment on weight gain in children in South Africa(University of the Western Cape, 2017) Yengopal, Veerasamy; Naidoo, SudeshniBackground: There is an increased interest in understanding the effects of severe tooth decay on the physical, anthropometric, psychosocial, functional, and oral health related quality of life (OHRQoL) among children. Children who have severe tooth decay are thought to have lower weight, height, Body Mass Index (BMI), Haemoglobin (Hb) levels and poorer OHRQoL compared to children who are caries free. Comprehensive dental treatment under general anaesthesia (GA) appears to significantly improve these variables to levels equivalent to healthy caries free children. However, there is a paucity of high quality evidence that has demonstrated these gains in the anthropometric (Height, Weight BMI), clinical and oral health related quality of life (OHRQoL) measures following extensive dental treatment under GA. This trial sought to determine the impact of the treatment of severe dental caries on weight, height, body mass index (BMI), Hb levels and oral health related quality of life (OHRQoL) among a group of young children who had access to immediate care compared to a control group of children who waited 6 months before treatment. Methodology: This was a Community based prospective, randomized controlled intervention trial conducted in the peri-urban town of Worcester in the Western Cape Region of South Africa. The study population consisted of crèche going children, aged 2-6 years old who had severe tooth decay with a pufa score ≥ 1and attended public dental facilitates in the town. Simple random sampling using an existing lottery draw system at the clinic was used to divide the children into an immediate treatment group and a delayed treatment group (6 months later). Baseline height, weight, BMI, Hb levels were compared between treatment and no treatment groups at 6 months. OHRQol was measured from both the child and parent/caregiver perspective at baseline, 6 months later (in delayed group) and 6 months post treatment in both groups. Anthropometric variables were reported as unadjusted means and z-scores which were determined by transforming the unadjusted means against a reference group to determine the weight-for-height (WAH), weight-for-age (WAZ) and BMI-for –age (BAZ) in both groups after treatment. OHRQoL scores were dichotomized and/or categorized into high, low and no impacts. Descriptive statistics (means), correlation analyses (by age, gender) and multilevel mixed regression model analysis was undertaken to determine the effect of the treatment on the outcome variables using SPSS version 23. Results: 126 children in the immediate group (mean age 4.4 years, SD 1.2) and 125 children (mean age 3.75 years, SD 1.3) completed this trial. Comparative baseline measures significantly favoured children in the immediate group for age, height, and weight. The average number of teeth extracted under GA was 7.4 (SD 3.53) in the immediate group and 8.55 (SD 3.94) in the delayed group. Unadjusted mean scores for height, weight, BMI and Hb showed significant improvements within the groups at 6 months follow-up. When the group were compared (treatment vs. no treatment) using unadjusted or z-scores, statistically significant gains were noted for height and weight but not for BMI or Hb. Multilevel Regression modelling confirmed these findings implying that the intervention alone was not a factor in the improved Hb or BMI levels. OHRQoL significantly improved from both the child and parent/caregivers' perspective after treatment was received. In the delayed group, there was no improvement in OHRQoL scores during the 6 month waiting period but these significantly improved to comparable levels seen in the immediate group 6 months after treatment. Conclusion: This randomised controlled trial found that children with severe tooth decay who received treatment under general anaesthesia had significantly better height and weight gains than those children who has no treatment. Although gains were also noted in the BMI and Hb levels, these gains were not statically significant and their improvements could not be explained by the intervention alone (dental treatment under general anaesthesia). OHRQoL outcomes showed significant improvement from both the child and parental/caregiver perspective when comparing children who received treatment against those who did not have treatment. Children who had to wait for treatment had similar negative impacts on OHRQoL at 6 months follow-up compared to baseline. However, once they received treatment (delayed group), similar significant improvements for OHRQoL as reported in the immediate group was also found in the delayed group.