Oral health-related quality of life and oral hygiene status among special need school students in amhara region, Ethiopia

Study area

This institution-based cross-sectional study was conducted from November 2020 to April 2021 in special needs schools in the Amhara region, Ethiopia. Amhara region is found in the northern part of Ethiopia and Bahir-dar is the capital city of the region. Eight special needs schools were included in the study. In Ethiopia, only 4% of children with disabilities are currently attending school [28]. Children with only physical disabilities enrolled in ordinary schools, while special needs schools provide education for children with other types of disability as well as those who have both physical and other types of disability.

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(source: Source for shape file-OpenAfrica)

Study population

The study population were students in special needs schools living with hearing, visual, physical, and mental disabilities in the Amhara region. Students living with disability and attending special needs education in the region were included in the study. Students with uncooperative behavior, absent during the data collection period, and unable to provide data were excluded from the study. However, we did not excluded any student from the study.

Sample size and sampling procedure

A single population proportion formula was used to determine the sample size, that was done for another study [29] considering a prevalence of 50% (no-previous study in the country), a 5% margin of error (d), 95% confidence level, and 15% non-response rate. Accordingly, the final sample size was 443 students living with a disability. To recruit study participants, a simple random sampling technique using a computer random number generator was used.

Study variables

Oral hygiene status and oral health-related quality of life (OHRQoL) were the dependent variables. The independent variables were; sociodemographic characteristics (age, sex, religion, grade level, family educational status, and monthly income), tooth brushing, carbohydrates intake, self-reported dental health problems, treatment-seeking behavior, disability (types and duration).

Operational definitionOral hygiene status

The oral hygiene status was recorded based on a simplified oral hygiene index, OHI-S, and recorded as follows: 0–1.2, Good; 1.3–3.0, Fair; and 3.1-6.0, Poor [30].

OHRQoL

The OHRQoL of the study participants was assessed using the oral health impact profile (OHIP-14), which measures the frequency of oral impacts on everyday life within the past year [27]. It contains 14 questions and 7 domains (functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap). Responses were provided using 5-point ordinal scales (never = 0, hardly ever = 1, occasionally = 2, fairly often = 3 and very often = 4). Domain scores were calculated by adding the responses to the two corresponding items (range: 0 to 8) and the total score by adding the responses to all 14 items (range: 0 to 56). Higher scores indicated worse OHRQoL [31]. Summary OHIP-14 scores were calculated by summing ordinal values for 14 items. Higher OHIP-14 scores indicate worse and lower scores indicate a better oral health-related quality of life.

Hearing impairment

The term hearing impairment refers to students who had either complete or partial hearing problems.

Visual impairment

Visual impairment refers to an impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness.

Data collection procedure

Data were collected using a pretested structured interview-administered questionnaire that was adapted from the WHO oral health survey, OHIP-14, and other literature [27], [32]. In the very beginning, the tool was prepared in English and then translated into the local Amharic language. To check the consistency of the questionnaire, the Amharic version was translated back to English. A pretest was done on 23 students (5%) at Injibara, which is not selected for the main study. Based on the input from the pretest, unclear questions were modified, wording in the questionnaire was improved and the order of the questions was rearranged. Dentists and special needs teachers were involved in the data collection process.

The intra-oral examination was done by four dentists at the schools using normal light, a tongue depressor, mouth mirror, periodontal probe, and dental explorers. The DMFT index (decayed, missed, and filled teeth) and oral hygiene status (based on simplified oral hygiene index, OHI-S) data were recorded.

A five days training was given to the data collectors and were calibrated on the data collection procedure, content of the instrument, and ethical considerations during data collection. Throughout the data collection procedures, COVID-19-related safety precautions were undertaken. Each returned questionnaire was reviewed for completeness and consistency on daily basis.

Data analysis

The collected data were entered into Epi-Data (version 4.6) and exported into STATA (version 14) for analysis. Descriptive analyses such as median, mean, proportion, standard deviation, and frequency were computed. The reliability test of OHIP-14 items for Cronbach’s alpha was 0.81. The normality of OHRQoL was assessed with its kurtosis and skewness values. Since the score of all domains didn’t follow the normal distribution, we employed Spearman’s correlation analysis to assess the relationship among OHRQoL dimensions. In addition, the statistical significance of differences in mean OHIP-14 scores was assessed using the Kruskal-Wallis equality-of-populations rank test and Wilcoxon rank-sum (Mann-Whitney) tests. The association between oral hygiene status and socio-demographic independent variables was assessed using Chi-square tests. Bivariable and a multivariable ordinal logistic regression model was fitted to identify the factors associated with oral hygiene status. Those variables with a p-value of less than 0.25 in the bivariable ordinal logistic regression model were fitted in the multivariable model. Variables with a p-value of < 0.05 at a 95% confidence interval were considered statistically significant.

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