Assessment of oral health status and associated factors among children with sickle cell disease at Mulago National Referral Hospital, Kampala.

Abstract

Introduction Sickle cell disease (SCD) is an inherited blood disorder, a lifelong condition that is commonly found in regions where malaria is endemic. SCD affects all tissues and organs of the body causing severe systemic complications and lifelong threatening consequences. The pathological effect of SCD also occurs in dental tissues and the oral cavity. Oral disease is a major public health burden worldwide and management of oral complications and treatment needs of children with SCD remains a challenge. If left untreated tooth decay has an impact on the child’s growth and is the leading cause of absence from school and work. Despite the widespread nature of tooth decay and the substantial knowledge about SCD, there is scanty information on the burden of oral diseases and the associated factors among children with SCD in Uganda. Objective The objective of this study was to assess the status of oral health and associated factors among children with SCD at MNRH. Methodology A cross sectional study was conducted among children with Sickle Cell Disease (SCD) from the ages of 3-17years attending the MNRH sickle cell clinic using quantitative data collection method among 385 children with Sickle Cell Disease. Consent was obtained from the caretakers of the study participants between ages 3 -.12 and assent was obtained from children aged 13 -17years. We administered structured questionnaires to the care givers and children (age 13- 17) stratification was done, according to the WHO into three age groups; age group one, children 3-5 years old. Second age group, children 6-12years old and third age group 13-17 years old children.17). Data was analysed using STATAversion. Bi-variate and multi-variate analysis were used to determine associations between oral health status of children with SCD and associated factors. Regression model analysis was used to determine the relationship between oral health status of children with SCD and associated factors at 95% confidence interval. Results The mean age of participants was 8.4 years (standard deviation ±4.4). Most participants 44.42% (171/385) were in the age category of 6 to 12 years, the other age categories were 3 to 5 years 33.24% (120/385) and age group 13 to17 years 22.34% (86/385). Majority of the participants 54.55% (210/385) were male and 42.08% (162/385) were attending Primary level education. The prevalence of good oral health status was 35.58% (137/385). Of the 248 (64.42%), participants who had poor oral health, 11 (4.44%) had periodontal only; 190 (76.61%) had dental caries; and 47 (18.95%) had both periodontal and dental caries. At multivariate level, in the adjusted model, participants who brush their teeth after meals were 1.6 times more likely to have good oral health compared to those who brush before meals (PR: 1.61; 1.03, 2.53).Those who did not often take sugary snacks were twice more likely to have good oral health compared to those who reported consuming sugary snack twice a day (PR: 2.14; 1.05, 4.39). On the other hand, those who were aged between 6 and 12 years were less likely to have good oral health compared to those who were 3 to 5 years old (PR: 0.51; 95% CI: 0.27, 0.95). In addition, those who take painkillers to manage their dental pains were less likely to have good oral health compared to those who visit a dentist when they experience dental pains (PR: 0.50; 95% CI: 0.26, 0.99). Conclusion The findings of this study indicate that majority of the children with SCD had poor oral health status. Majority of the children that participated in the study presented with dental carries. Factors that were associated with good oral health status among children with SCD included brushing teeth after meals, children who did not take sugary snacks, children who had a history of visiting a dentist and those who took painkillers to manage their dental pain.