Oral Health in Nyarugenge District of Rwanda: The Role of Mobile Application in Oral Health Education

Abstract

Introduction Oral diseases (OD), including dental caries and periodontitis, are a major public health problem. Poor oral hygiene is associated with OD, leading to tooth loss, disability, and compromised oral health. In Rwanda, OD is among the leading causes of morbidity at the health center level. Oral healthcare professionals are faced with considerable challenges in addressing the oral disease burden. Mobile health applications (mobile Apps) can help the individuals to manage their health and wellness, encourage healthy lifestyles, and provide valuable information as needed. Therefore, the purpose of this study was to evaluate oral health in Nyarugenge District of Rwanda and assess the role of using a mobile App for oral health education in this community. The study objectives were to assess the knowledge, attitudes, and oral health practices (KAP) among adult participants in Rwanda, to explore the challenges faced by oral health practitioners in Nyarugenge, Rwanda; to evaluate the availability and adequacy of oral hygiene equipment, instruments, and materials. and to assess the feasibility and acceptability of a mobile App for oral health education among adults in Rwanda. Methods A cross-sectional quantitative study design was used to assess the knowledge, attitude, and oral hygiene practices among adults in Nyarugenge District, Rwanda. Furthermore, an audit of oral health services in Nyarugenge District was conducted. Additionally, a cross-sectional quantitative survey was used to assess the feasibility and acceptability of the mobile App for oral health education. All seven public health facilities and 14 dental professionals working in Nyarugenge were included in the study. Descriptive statistics were used to analyze the quantitative data. The interviews were analyzed using thematic content analysis. Bivariate analysis using the Chi-square test was performed to detect significant associations amongst the variables. STATA version 16 was used for quantitative data analysis, and statistical tests were conducted at 5% significance level. Results Among 426 participants who participated in the KAP study, 39.44% (n=168) were 18-27 years old, and the majority were female 61.5% (n=262). Poor oral health knowledge was found in 42% (n=179) of the participants, whilst 12.44% (n=53) showed poor oral health attitudes, and 67.37% (n=287) were found to have poor oral health practice. Participants with high school level of education were more likely to vi have better oral health knowledge and the results were statistically significant (aOR: 1.79, 95% CI 1.14; 2.82; p = 0.011). There were five health centers and two hospitals that were audited for equipment, instruments, and materials. The audit of the facilities revealed that most facilities have dental equipment and instruments, but none have adequate preventive dental instruments and materials. Most of the oral health professionals (OHPs) who were interviewed were dental therapists (n=11), women (n=9), aged 31–40 years (n=7), and with 11–20 years experience as oral health practitioners (n=6). The most significant challenges that oral health practitioners were faced with included high patient ratios to OHPs, lack of adequate and appropriate equipment and materials, patients’ lack of oral health awareness, and a lack of administrative support. The response rate for the feasibility and acceptability of a mobile App was 81% (n=90) of 111 participants who took part in the study. The majority of participants 44.44% (n=40) aged between 18 and 27 years old. Just over half of the participants were male 51.11% (n=46). The mobile App was found to be highly acceptable (87.78%; n=79) and considered highly feasible (84.44%; n=76) by most of the participants. The differences in acceptability and feasibility across education levels were statistically significant (p=0.000 for acceptability and p=0.038 for feasibility). Conclusions The findings of our study showed that 42% of the participants had poor oral health knowledge. Oral health attitude and oral hygiene practices were also lacking. There is a need to enhance oral health education of this community to improve their oral health knowledge, attitudes and practices. Challenges faced by oral health professionals (OHPs) included staffing shortages, supply chain issues, and low patient awareness, all of which could be mitigated through better health facility management. Optimizing management could lead to more personnel, enabling OHPs to focus on education and preventive care. Additionally, ensuring access to dental resources and advocating for broader health insurance coverage for dental services would enhance service delivery. Well-established community preventive interventions, such as a mobile oral health App, could reduce the patient/provider ratio by increasing population awareness of oral health and encouraging healthy behaviours. The study revealed that the mobile App for oral health education (BrushDJ) was highly acceptable and feasible among the participants. The mobile App had a user-friendly interface and comprehensive guidance on oral hygiene procedures facilitated by its diverse and well-integrated function