Dentists in Nepal: A Situation Analysis

Assessing the status of oral health integration in South East Asian Regional Office countries' Universal Health Coverage-A scoping review

BACKGROUND

Oral diseases affect close to 3.5 billion people worldwide and there has been a call by the World Health Organization (WHO) to integrate oral health into the Universal Health Coverage (UHC) agenda.

OBJECTIVES

To collate and synthesise information regarding the status of integration of oral health into the health systems covered by UHC across the 11 countries in the South East Asian Regional Office.

METHODS

Drawing on the framework of the six building blocks of health systems as devised by WHO, we compared the public dental care coverage models, with a focus on outpatient dental care in these countries. We gathered this information from publicly available resources, databases and peer-reviewed publications to populate the template guided by the WHO Health System Building Blocks.

RESULTS

We found a poor access to oral health care, lopsided distribution of manpower, rickety health information systems, and private sector domination and inadequate or absent financing mechanisms for outpatient procedures. The private sector was dominant in all countries except Thailand and Srilanka. Financing was absent in most countries and deficient in Thailand and Indonesia. Dental workforce was deficient in most countries except India, Srilanka, and Thailand. Health information systems were weak with no dental items under price control. Better UHC indicators did not guarantee a lower oral disease burden.

CONCLUSIONS

Our review highlighted the close connection between service quality and human resources, governance, and finance. There is a need to establish standardised dental treatment guidelines that are uniformly adopted across countries, integrate oral health into national health and development programs, push for functional oral health research through collecting robust surveillance, economic, and social impact data and the development of cost-effective strategies tailored to each country's unique needs.

Mapping accessibility to oral health care in coastal India – A geospatial approach using a geographic information system (GIS)

Background: It is imperative to have a thorough assessment of the existing distribution of oral healthcare facilities and understand potential accessibility when planning for expansion of oral health services. In the present study, an attempt to measure geographic accessibility to oral healthcare, by locating the availability of dental practitioners in the coastal districts of Karnataka state, India using a geographical information system (GIS), has been made.

Methods: For the study, data on public and private oral health centres were collected for the three coastal districts of Karnataka state, India. Population and income data were collected, along with geographic attributes (latitudes and longitudes) of the practitioners' addresses. Descriptive statistical analyses and dentist-to-population ratios (D:P) were calculated. Correlation between the number of clinics with population and D:P with per capita income were analyzed using Pearson's correlation coefficient. Chi-square test applied to analyze any association between D:P and urbanization.

Results: Among 340 clinics, 8.5% are public and 91.5% are private clinics catering to a population of 4,704,179. Average D:P for the three coastal districts is 1:13,836. There is an uneven urban-rural distribution of dentists with lower D:P in rural areas. Rural population in four taluks have only one dentist for over a lakh population. Six taluks have only one dentist for every 50000 – 100000 population in rural areas. Six rural areas had only public centers to cater to their oral health.  

Conclusions: From the study, it is concluded that oral health services were concentrated in areas with higher annual income per-capita, increased urbanization and population density.

Dentists' situation and their needs during the COVID-19 pandemic in Nepal: an online questionnaire survey

Background

During the coronavirus disease (COVID-19) pandemic, ordinary dental services were sustained in Nepal. Because a dental practice is considered to involve a high risk of infection, the needs of dentists should be identified, and demand-driven support should be provided. The purpose of this study was to investigate the situation and needs of dentists during the COVID-19 pandemic in order to guide demand-driven support. First, we investigated how the situation of Nepali dentists differed according to their types of practices between private clinics and university/government hospitals. Second, we assessed the characteristics of dentists demanding four types of support: financial, material, technical, and guidelines/guidance support.

Methods

A cross-sectional online questionnaire survey was conducted between July 28th and August 7th 2020. Closed-ended questions were prepared regarding behavior, material availability, economic and psychological impacts, training, and the main support dentists wanted to receive. The situation of dentists between private clinics and university/government hospitals was determined using a chi-squared test for each variable. To examine the association between the characteristics of dentists and four types of support, multivariable logistic regression analyses were used to estimate adjusted odds ratios (ORs) with a 95% confidence interval (CI) for each variable.

Results

There were 352 dentists (137 males and 215 females) included in the analysis. Private clinic dentists experienced a bigger economic impact and demanded financial support that 45.5% of them did not receive a salary, compared to 18.9% in university/government hospitals. On the contrary, university/government hospitals experienced lack of PPE and demanded material support that 79.8% had personal protective equipment, compared to 92.5% in private clinics. Financial support was demanded significantly more by male than female dentists (ORs = 5.56; 95% CI = 2.96–10.45). Material support was demanded significantly more by dentists who received training regarding COVID-19 management (ORs = 1.96; 95% CI = 1.01–3.81). Technical support was demanded significantly less by male dentists (ORs = 0.44; 95% CI = 0.23–0.83). Guideline/guidance support was demanded significantly more by dentists who answered that Nepal Dental Association provided appropriate support (ORs = 2.21; 95% CI = 1.25–3.91).

Conclusion

This study articulated the diverse needs of Nepali dentists during the COVID-19 pandemic. Demand-driven support should be provided in the future.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02139-9.

Knowledge of novel coronavirus disease (COVID-19) among dental surgeons of Nepal: a nationwide study

BACKGROUND

COVID-19 is an emerging respiratory disease caused by a novel coronavirus. There is not much evidence assessing the knowledge of dental surgeons regarding COVID-19. This study was conducted to assess the knowledge of COVID-19 among dental surgeons of Nepal.

METHODS

A web-based cross-sectional study was conducted among registered dental surgeons of Nepal. Ethical approval was obtained. Consent was taken, and knowledge on COVID-19 was assessed via a pre-tested structured questionnaire using Google form. The form was emailed to the participants. Descriptive analysis was performed using frequency, percentage, median and inter-quartile range. Man-Whitney test and Kruskal-Wallis tests were carried out to see the difference in knowledge score. P-value < 0.05 was considered statistically significant.

RESULTS

Total 227 dental surgeons responded to the questionnaire (male: 46.4%; female: 53.7%). Almost two-third ( 65.2% ) of the respondents were B.D.S. (Bachelor of Dental Surgery) graduates. Only 29.1% worked in the government hospitals. 17.6% were currently involved in COVID-19 management. Of the participants, 87.7% knew about the condition of the requirement of Personal Protective Equipment (PPE) but only 29.1% could correctly answer the framed question for PPE. The median knowledge score calculated was 14.0 (8.0-18.0). The bivariate analysis showed a statistically significant difference in knowledge score among the age group ≥30 years and < 30 years (p = 0.013); M.D.S. (Master of Dental Surgery) graduate and B.D.S. graduate (0.041); dental surgeons of government healthcare facilities and other healthcare facilities (p <  0.001); dental surgeons of COVID-19 centers and non-COVID-19 centers (0.002).

CONCLUSION

The dental surgeons of Nepal have a good knowledge of COVID-19, and they can be utilized for assisting in the management of COVID-19 cases in Nepal.

Oral health status associated with sociodemographic factors of Nepalese schoolchildren: a population-based study

OBJECTIVES

The aim of this study was to investigate the oral health of Nepalese schoolchildren relative to their sociodemographic characteristics.

METHODS

This school-based, cross-sectional study was conducted among 5-6-, 12- and 15-year-old Nepalese children in 18 randomly selected districts of the 75 in Nepal. Clinical parameters were recorded according to the World Health Organization (WHO) guidelines. Results were presented as mean (SD) and proportions; the chi-square test, t-test and one way-ANOVA were also performed. The risk of dental caries in association with the place of residence was presented according to the outcome of a binary logistic regression analysis.

RESULTS

The mean d-value for the 5-6-year-old children was 5.0 (4.22), which was higher than the mean D-values for the 12- and 15-year-old subjects, of 1.3 (1.77) and 1.9 (2.28), respectively. The youngest children, as well as children from the Kathmandu Valley, were likely to have more untreated caries lesions than children in the other age groups. The mean number of teeth with severe consequences of dental caries (pulpitis/ulceration/fistula/abscess or pufa/PUFA) was 1.3 (1.91) for the 5-6-year-old children, 0.1 (0.35) for the 12-year-old children and 0.3 (0.75) for the 15-year-old children. All age groups had gingival bleeding on probing in more than 15% of teeth. Children from rural locations had significantly more gingival bleeding than urban children. The same was true for 15-year-old girls compared with boys of the same age.

CONCLUSIONS

Among Nepalese children, oral diseases are common, and geographical variation is prevalent. The health policy should address the alarming oral health situation and need for urgent treatment and population-based preventive programmes that is evident in Nepal.