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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 8  |  Issue : 3  |  Page : 110-115

Evaluation of the effectiveness of oral awareness programs using the knowledge, attitude, and practice study among the Anganwadi workers in Ponnani Block Panchayat: An exploratory study


Department of Pedodontics and Preventive Dentistry, Malabar Dental College and Research Center, Malappuram, Kerala, India

Date of Web Publication18-Sep-2017

Correspondence Address:
Joby Peter
Department of Pedodontics and Preventive Dentistry, Malabar Dental College and Research Center, Manoor Chekanoor Road, Mudur, Edappal, Malappuram - 679 578, Kerala
India
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DOI: 10.4103/srmjrds.srmjrds_36_17

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  Abstract 

Introduction: One of the main reasons for the oral diseases among the children of rural population in a country like India is the inadequate knowledge of the care givers. Attitude towards the oral health and practical approaches about the various oral hygiene measures should be checked and guided by the health providers. Anganwadi workers are the grass root workers who interact with the children and their mothers of their respective work areas with equal importance. So guiding them is indirectly guiding these populations. Aim and Objective: The aim of this paper is to assess the knowledge, attitude and practice of the Anganwadi workers about the child's oral health and also to evaluate effectiveness of the awareness programs in guiding these early care providers. Material and Methods: The study was conducted among the Anganwadi workers of the Ponnani Block Panchayat situated in Edappal ,Malappuram District, Kerala. A total of 15 questions were prepared in regional language (Malayalam) and were given before and after the awareness class session. Awareness class session was conducted using the audio visual aids including PowerPoint presentation and videos. The awareness classes included the topics of child oral health facts and various practical approaches. Statistical Analysis: A paired t-test was conducted and the results were analyzed using the SPSS version 20. Results: The total value before the session was changed from 7.91±2.15 to the after session value of 12.28±1.67 (P value <0.001) indicating a statistically significant shift after the awareness class. Discussion: The comparison of separate sessions of knowledge, attitude and practice is evaluated using the boxplot evaluation and the effectiveness of the awareness class was plotted using the Receiver operating characteristic (ROC) Curve. Conclusion: The study revealed the need of incorporation of more awareness programs among the early care givers regarding a child oral health to improve their knowledge and to incorporate a positive attitude and guide them to practically prevent various oral diseases.

Keywords: Anganwaadi workers, child oral health, early childhood caries, exploratory studies, knowledge, attitude, and practice, receiver operating characteristic curve


How to cite this article:
Peter J, Shivappa V, Kumar K, Augustin M, Agustine TM, Kumar AV. Evaluation of the effectiveness of oral awareness programs using the knowledge, attitude, and practice study among the Anganwadi workers in Ponnani Block Panchayat: An exploratory study. SRM J Res Dent Sci 2017;8:110-5

How to cite this URL:
Peter J, Shivappa V, Kumar K, Augustin M, Agustine TM, Kumar AV. Evaluation of the effectiveness of oral awareness programs using the knowledge, attitude, and practice study among the Anganwadi workers in Ponnani Block Panchayat: An exploratory study. SRM J Res Dent Sci [serial online] 2017 [cited 2017 Dec 11];8:110-5. Available from: http://www.srmjrds.in/text.asp?2017/8/3/110/215019


  Introduction Top


The American Academy of Pediatric Dentistry (AAPD) highlighted the need for prevention, diagnosis, and treatment as the key to maintain the oral health of all children.[1] However, in real scenario, the knowledge gap existing among the caregivers of the child remains the reason as to why many of the preventable oral diseases are left unattended and untreated. Studies have shown that in developing nations, the oral health status of the children is poor and dental caries is the most common chronic childhood disease.[2] hence, a proper guidance and awareness starting from the base level should be advocated to bring about changes in this current scenario.

Integrated Child Development Services (ICDS), launched in 1975,[3] in accordance to the National Policy for Children in India,[4] is focusing on providing a base for proper mental, physical, and social development of children <6 years in India and to provide health and nutritional information and education to mothers of young children. Over the years, it has grown into one of the largest integrated family and community welfare schemes in the world.[5] Anganwadi workers are communitybased voluntary frontline workers of the ICDS program. As oral health is an integral component of general health, oral health care of the necessity has to be delivered through primary health care infrastructure.[6]

In a country like India, integration of the awareness programs about child's oral health among Anganwadi workers can bring about a ripple effect on the rural community as they are dealing with all the children and their mothers of their respective work areas with equal importance. Children from the rural areas find their first teachers, away from home, in the Anganwadi teachers. These workers not only provide preliminary education but also monitor the general health and nutritional status of the children under them. Hence, upgrading their knowledge about oral health definitely improve their attitude toward the need of good child oral health and also will help them to provide a proper practical guidance for the child and mother to maintain a healthy oral status which will become the mirror of the general health in future.

The aim of this paper is to assess the knowledge, attitude, and practice (KAP) of the Anganwadi workers about the child's oral health and also to evaluate the effectiveness of awareness classes among this group regarding the child's oral health. The study also evaluates whether the multidisciplinary approach of a pedodontist need modification regarding the awareness of these early care givers.


  Materials and Methods Top


The study was conducted among the Anganwadi workers of the Ponnani Block Panchayat situated in Edappal, Malappuram District, Kerala. The total population of 122 Anganwadi workers under the Edappal Block Panchayat was selected and the study was conducted at the ICDS office, Edappal. A prior consent from the Child Development Project Officer and other authorities were obtained. The study was then organized during the project level workers meeting of Anganwadi workers under the Ponnani Block Panchayat.

The program was designed in three sessions, two questionnaire sessions and an awareness class session. The questionnaire session was based on the child's early dental health care and parental guidance. The awareness session was based on the basic oral health care needs and practices of children from the perspective of an early caregiver such as Anganwadi workers.

A total of 15 questions were prepared in regional language (Malayalam) and were given before and after the awareness class session. Reliability and validity of each question were scientifically analyzed. Questions were based on the basic knowledge, attitude, and practical approaches that an early care giver like an Anganwadi worker should know to provide a good oral health for the children and a healthy advice to the mother.

In the first session, the participants were given the questionnaire and asked to complete within 30 min. Questionnaire from all the participants was collected and filed. Second session was the awareness class session taken by the Dental health professionals from the Department of Pedodontics and Preventive Dentistry of Malabar Dental College, Edappal. The session was taken using the audio visual aids including PowerPoint presentation and videos. The awareness classes included the topics of child oral health facts and various practical approaches.

As Anganwadi workers deal with both the child and mother, sessions included various maternal health-related problems that influence the child's oral health. The class also focused on explaining the role of the early caregiver in maintaining a proper oral health care to a child. A separate session for the clarification of the participant's doubts was also included. After the second session, the same questions were distributed and another half an hour was given for answering those questions. The answered questionnaire was collected and filed separately for the analysis.


  Results Top


All the 122 Anganwadi workers who participated in the monthly project level workers meeting showed interest in participating in the study. No demographic classifications were done among the workers as all the 122 Anganwadi workers who participated in this study were female. No one from the sample was reportedly from medical profession, so need of classification based on their educational qualification seemed to be irrelevant as they were not exposed to any of the oral-related health subjects before. A paired t-test using SPSS version 20 (IBM). was used for statistical analysis.

The answers to the questions were scored as “1” if their answer was true and “0” if it was false. The score for each of the contestants are found for the pre- and post-scenario. To assess the effectiveness of the awareness class, a paired t-test was conducted and the results were analyzed using the SPSS version 20.

The mean score of awareness before the class was 1.34 ± 0.82 which significantly increased to 2.67 ± 0.51 (P ≤ 0.001) [Figure 1]. The mean score of practice changed from 4.27 ± 1.07 to 5.06 ± 1.07 (P< 0.001) [Figure 2]. The knowledge mean score also showed an increase from 2.30 ± 1.24 to 4.55 ± 0.65 (P< 0.001) [Figure 3]. Thus, the total value before the session changed from 7.91 ± 2.15 to 12.28 ± 1.67 (P< 0.001) [Figure 4]. The scores from the test indicate a favorable response from Anganwadi workers toward the training session regarding the child's oral health. The available scores were analyzed and effectiveness of the training was confirmed by the receiver operating characteristic (ROC) curve.
Figure 1: Awareness before and after the awareness program

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Figure 2: Practice before and after the awareness program

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Figure 3: Knowledge before and after the awareness program

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Figure 4: Total change in the knowledge awareness and practice among the Anganwadi workers before and after the awareness program

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Receiver operating characteristic curve analysis of the effectiveness of the study

ROC: Area under the ROC curve indicates the measure of effectiveness and percentage of effectiveness [Figure 5].
Figure 5: Receiver operating characteristic curve: Area under the receiver operating characteristic curve indicates the measure of effectiveness and percentage of effectiveness

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A total score from the pre- and post-test values were also evaluated using the ROC curve which was found to be 0.932, with a highly significant P value, explains the effectiveness of the awareness program in improving the KAP of Anganwadi workers.

The area under the curve is 0.932 and P value is significant

The obtained result explains the need of incorporating such health programs among the early caregivers to find out those areas that need to be addressed more regarding a child's oral health and to guide them in a proper way so that these groups can also put a step toward the early prevention of dental diseases in a child.


  Discussion Top


The knowledge of the participant was assessed using the questionnaire designed on the domains of KAP regarding the child's oral health. Results showed that the participants had some information about the child oral health care, but a knowledge gap existed which was found to be improved by the awareness class session. Such positive responses regarding the efficiency of the awareness classes were also reported by Ocek et al.[7] and Sandhya et al.[8]

Early dental interventions starting during pregnancy were proved to be efficient with respect to the prevention of oral diseases, especially caries.[9],[10] The effect of periodontal diseases of mothers on child's oral health was new information for majority of the participants. Even though 33.1% of the participants responded positively for the question about the periodontal effect of mother on mode of delivery, how much they were aware about the actual scenario was doubtful. However, a positive response of 86.9% obtained from the post test indicates a positive awareness about the perinatal oral health care of child [Table 1].
Table 1: The percentage of correct response given to questionnaire

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The infant dental care was an unsure part among the participants. Most of the participants had doubt about the time to start cleaning the baby's tooth. During the awareness sessions, majority of the participants explained that they were unaware about the importance of cleaning the gum pads after feeding the baby and the improved response was analyzed from the pre test result (55.2%) to post test result (91.6%).

The analysis showed an improvement in the knowledge of the participants about the eruption and total number of primary teeth in a child's mouth. The participants understood the effect of sweets, sticky foods, improper oral hygiene habits, bed-time drinks, and foods in the development of caries which was understood by the improved response from the pre test (56.1) to the post test (95.2). In the pre test, it was found that only 54.2% of participants considered milk tooth as an important factor for the future dental developments which was changed to 94.4% after the awareness class.

Studies have shown that the maternal oral microbes are one of the greatest predictors of infants and children oral flora.[11],[12] AAPD advocated educating the parent on avoiding saliva-sharing behaviors (e.g., sharing spoons and other utensils, sharing cups, cleaning a dropped pacifier or toy with their mouth) to prevent early colonization of MS in infants.[13],[14] However, such information was difficult to accept by majority of the participants during the awareness session. This was shown by the pre test value of 26.8% for the question about the chance of spreading the infection from the mother to the child after birth, but the result was improved to 93.4% on post test evaluation indicated the acceptance of maternal transmission of bacteria to child by the participants.

About 40% of participants responded that the main causative factor for caries is bacteria, but majority believed that other reasons such as calcium deficiency, fungus, and virus might be the main cause for caries. An improved post test response of 92.9% for this question indicated the change of this misconception among the participants. The question regarding the different practical methods to reduce caries was answered differently as oral hygiene practices, brushing twice daily, reduction of sweets, and increased intake of fibers. Although individually these responses made sense, questionnaire contained an option as “all of the above” which was selected by only by 58% in the pre test. This indicated negligence in some common preventive measures by the participants. The post test response of 94.4% indicated an improved knowledge about the different preventive measures in the participants.

Nowadays, many oral health companies are introducing different toothbrushes for the need of infants, toddlers, and children with attractive pictures and shapes which reinforce kids to use them. They are also found to be more handy and acceptable for the kids and bring changes in their approach toward brushing. However, in our study, only 35.8% of the participants were aware about the different types of toothbrushes available for children and their awareness became better after the second session (95.4%).

Only 55.9% participants think that the use of toothpaste is necessary for toothbrushing. However, the session in awareness class including the topics related to the cleaning efficiency of tooth pastes and use of fluoridated toothpastes created a positive response which was reflected in the post test result of 92.9%.

From 1986, AAPD is advocating the early dental visit of the child.[15] 86.8% of the participants responded positively about the first dental visit of the child as early as the eruption of the first primary tooth. It was further increased to 100% after the awareness class.

The last three questions were related to the oral care measures that the participants were practicing in their respective Anganwadis. 73.2% of the participants responded that they noticed children taking leave due to the tooth pain. As that question was based on their previous experience, no such statistical change was observed in the post test analysis. In effect, the question made them realize about the severity of the spread and effect of dental related problem on child population. The questionnaire also evaluated the participants' approach in informing the parents about the oral diseases they found in child's mouth especially, with the mother. Even though the response of the participants were obtained as 73.3% in the pre test which was a positive response, the participants reported the fact that they noticed the oral conditions only when the child started to complain about pain or difficulty in eating. This condition would have been due to the lack of knowledge of the participants in the early diagnosis of the caries or due to the negligence. However, this indicated the need of a basic knowledge regarding the different aspects of caries including the preventive measures among the early caregivers and incorporation of more dental checkup programs among the children of rural population.

The last question was about their approach in evaluating the oral hygiene practices of children in their school after meals. This was responded positively as 94.3% in the pre test and 98.2 in the post test response. This indicated the fact that the early caregivers such as Anganwadi workers follow a positive practice regarding a child's health care and it is only the knowledge gap about the different practical and preventive measures of dental diseases that prevents them from noticing dental diseases. This is also the reason why they cannot provide proper instructions to the parents regarding the child's oral condition.

Limitations

The study was a short-term study which could not evaluate the long-term retention of knowledge. The practical approaches these early care givers are following should be analyzed for the expected result of future bright smiles.

Recommendations

Inclusion of the child's oral health programs and training among the early caregivers of rural communities such as Anganwadi workers can make a positive step toward the early prevention of many oral diseases.

A basic knowledge of these early caregivers can make them guide the parents and children to maintain proper oral health practices where the reach of dental forces is inadequate.


  Conclusion Top


The Anganwadis are the grassroots of the community and educating the Anganwadi workers is indirectly educating the community. Even though the technologies are developing at a faster rate, the reach and acceptability of them for the health-care needs are still questionable among the rural populations of India. Hence, a direct interaction through the awareness programs will be more useful considering this population. Through this study, we analyzed that the participants had less knowledge about the different oral health care facts. The reason for that was the lack of knowledge about the importance of oral health, attitude toward the primary dentition and inadequate guidance for the various preventive practical measures regarding the oral health of children.

The awareness classes were welcomed by all the participants and officers of ICDS, Edappal. The participants mentioned about the incorporation of the oral health-related sessions in the future programs to improve the child oral health care in rural areas.

A combined approach of the assessment of the knowledge and incorporation of the awareness programs among the early caregivers regarding a child oral health should be addressed more in the future dental health programs for preserving those bright little smiles.

Acknowlegments

We would like to thank the Department of Pedodontics and Preventive Dentistry and the Department of Public Health Dentistry, Malabar Dental College and Research Center, Edappal; the Integrated Child Development Society, Ponnani Block Panchayat, Edappal; Child Development and Promotion Officer, Ponnani Block Panchayat, Edappal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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