Risk factors for caries and periodontal diseases: a comparative4 study among HIV-positive and HIV-negative adults in nyarugenge5 district, Rwanda
| dc.contributor.author | Murererehe, Julienne | |
| dc.date.accessioned | 2024-12-11T08:29:12Z | |
| dc.date.available | 2024-12-11T08:29:12Z | |
| dc.date.issued | 2024 | |
| dc.description | A Thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy to the Faculty of Health Sciences, School of Oral Health Sciences, University of the Witwatersrand,Johannesburg 2024 | |
| dc.description.abstract | Dental caries and periodontal diseases are among HIV-positive persons' most frequent oral conditions. These common oral diseases contribute to the impairment of general health and well- being. Dental and periodontal problems among HIV-positive individuals are more severe and difficult to manage than dental and periodontal problems among HIV-negative people. Thus, risk factors for caries and periodontal diseases must be controlled for comprehensive oral health and the general well-being of HIV-positive patients. The burden of oral diseases is reported to be high in Rwanda. Nearly 65% of the oral health survey participants had experienced dental caries and above 54% had untreated cavities. In addition, dental calculus was found among 60% of participants. More than 34% had oral debris. Surprisingly, more than 70% of this population has never visited dentists or dental facilities. This evidence gives impetus to undertake more focused investigations on oral diseases in Rwanda, particularly among HIV-positive people. Therefore, this study sought to assess the risk factors for caries and periodontal diseases among HIV-positive and negative adults in Nyarugenge District, Rwanda Methods This research used a mixed-method approach (qualitative embedded design). For the quantitative part, a comparative cross-sectional study was conducted among 200 HIV-positive and 200 HIV- negative adults aged ≥18 years. Consecutive and purposive sampling method was used to select participants for quantitative and qualitative parts of the study respectively. Caries was assessed using the Decayed (D), Missing (M), and Filled Teeth (F) index (DMFT). Periodontal disease was assessed using the Plaque Index (PI), Community Periodontal Index of Treatment Need (CPITN), and Clinical Attachment Loss (CAL). Oral health Related Quality of Life (OHRQoL) was assessed using the oral health impact profile short version (OHIP-14). Descriptive statistics, Chi-square test, t-test, Cronbach alpha, and multiple logistic regression were applied to analyse quantitative data using Stata version 15. For the qualitative data collection, in-depth interviews (IDIs) were conducted among 10 HIV-positive and 11 HIV-negative adults with caries and periodontal diseases using a semi-structured interview guide. Thematic content analysis using an inductive approach was applied for data analysis of IDIs. NVivo software version 11 was used to code and organize the data. Results A higher proportion (50.5%) of HIV-positive adults had experienced caries (DMFT>0) compared to HIV-negative counterparts (40.5%) and the difference was statisticaly significant (p=0.045). The prevalence of D was higher (23.5%) among HIV-positive compared to HIV-negative adults (13.6%) (p=0.011). The Mean (SD) DMFT score among HIV-positive and HIV-negative participants were 2.28 (3.68) and 1.29 (2.21) respectively (p=0.001). The predictors of caries in HIV-positive persons were being female (OR= 2.33; 95%CI= 1.14-4.75), frequent dental visits (OR= 4.50; 95% CI=1.46-13.86) and detectable RNA viral load (OR= 4.50; 95% CI=1.46-13.86). Among HIV-negative participants, the middle age range (36-45 years) [OR= 6.61; 95%CI=2.14- 20.37], and frequent dental visits were significantly associated with caries (OR=3.42; 95%CI: 1.337-8.760). For periodontal status, having dental calculus was the most prevalent item of the CPITN found among HIV-positive 168 (84%) and 182 (92%) HIV-negative individuals. The mean (SD) score for CAL was higher in HIV-positive persons 1.23 (0.95) compared to HIV-negative counterparties 0.99 (0.75). The difference was statistically significant (p=0.003). Being a male was a predictor of having dental plaque and a need for periodontal treatment for both HIV-positive (PI OR: 2.90 (95%CI=1.26-6.66)); (CPITN OR: 3.33 (95%CI=1.14-9.70)) and HIV-negative respondents (PI OR:3.28 (95%CI=1.48-7.28)); (CPITN: OR: 7.78 (95%CI=1.04-58.07)). A higher percentage of HIV-positive individuals had poorer OHRQL than HIV-negative counterparties in all items of OHIP-14 except for OHIP3 (found it uncomfortable to eat any foods because of problems with teeth or mouth) and OHIP-14 items (being totally unable to function because of problems with teeth or mouth). The findings revealed significant results regarding OHIP1 “trouble pronouncing any word” with a prevalence of 11(2.5%) and 9(2.25%) in HIV-positive and HIV-negative participants, respectively. Also, HIV-positive persons had higher percentage 11(2.75%) for the OHIP 13 item “life not satisfying due to teeth and mouth problems” than HIV-negative counterparties 8(2%) and the difference was statistically significant p≤0.05. Moreover, dental caries was significantly associated with poor OHRQoL among HIV-positive and HIV-negative participants for all 14 items of OHIP-14 tool. There was no association between periodontal disease and OHRQoL in both HIV-positive and HIV-negative adults. Two broad domains and five themes emerged from the interviews. The first broad domain was “perceptions on causes of oral diseases” with 2 themes (individuals and external themes). The second broad domain was “perceptions on oral diseases effect” with 3 themes (physical or functional effect, psychological effect and social effect themes). Conclusion and recommendations This research showed a higher prevalence of caries and CAL among HIV-positive adults than HIV- negative counterparts. Also, the mean (SD) PI value was significantly higher in HIV-positive adults compared to the mean PI value in HIV-negative individuals. The reported higher prevalence of caries in HIV-positive persons was associated with being female, detectable viral load, and frequent dental visits. Periodontal disease was associated with older age, being male in HIV-positive and HIV-negative participants. Moreover, HIV-positive adults reported poorer OHRQoL than HIV-negative counterparties. Furthermore, qualitative results revealed individual and external levels factors of oral disease and emphasized the physical/ functional, psychological and social effects of oral diseases on quality of life. Therefore, there is a need for effective oral health interventions specific to HIV-positive persons in Rwanda. The interventions should also raise awareness of the risk of common oral diseases (such as dental caries, and periodontal disease) and provide preventive oral health services among the Rwandan population, especially HIV-positive individuals. There is a need for a collaborative effort to establish programmes for regular and timely screening and management of periodontal disease and dental caries among the general population and specifically, HIV-positive individuals in Rwanda. To ensure timely oral health care among HIV- positive Rwandans, this study provides baseline data to aid policymakers and stakeholders to integrate oral health care services within HIV treatment programmes in R | |
| dc.description.submitter | MM2024 | |
| dc.faculty | Faculty of Health Sciences | |
| dc.identifier | https://orcid.org/0000-0001-7980-1107 | |
| dc.identifier.citation | Murererehe, Julienne . (2024). Risk factors for caries and periodontal diseases: a comparative4 study among HIV-positive and HIV-negative adults in nyarugenge5 district, Rwanda [PhD thesis, University of the Witwatersrand, Johannesburg]. WireDSpace.https://hdl.handle.net/10539/43265 | |
| dc.identifier.uri | https://hdl.handle.net/10539/43265 | |
| dc.language.iso | en | |
| dc.publisher | University of the Witwatersrand, Johannesburg | |
| dc.rights | © 2024 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg. | |
| dc.rights.holder | University of the Witwatersrand, Johannesburg | |
| dc.school | School of Oral Health Sciences | |
| dc.subject | Dental caries | |
| dc.subject | Periodontal diseases | |
| dc.subject | Risk factors | |
| dc.subject | Perceptions | |
| dc.subject | Oral Health-Related183 Quality of Life | |
| dc.subject | HIV | |
| dc.subject | Adults | |
| dc.subject | Rwanda | |
| dc.subject | UCTD | |
| dc.subject.other | SDG-3: Good health and well-being | |
| dc.title | Risk factors for caries and periodontal diseases: a comparative4 study among HIV-positive and HIV-negative adults in nyarugenge5 district, Rwanda | |
| dc.type | Thesis |