MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY NGUYEN NGOC NGHIA STATUS AND EFFECTIVE INTERVENTION OF ORAL DISEASE IN MONG PRIMARY SCHOOL PUPILS IN YEN BAI PROVINCE SPECIALITY: SOCIOLOGY HYGIENE AND HEALTH ORGANIZATION Code number: 62.72.01.64 SUMMARY OF MEDICINE DOCTORAL THESIS THAI NGUYEN, 2014 The dissertation was completed at UNIVERSITY OF MEDICINE AND PHARMACY THAI NGUYEN UNIVERSITY SUPERVISOR Asso. Prof. Trinh Đinh Hai. PhD Critic 1: Critic 2: Critic 3: The dissertation will be defended nationally to the Evaluation Committee at University of Medicine and Pharmacy, Thai Nguyen University at …………… on ……………, 201 The dissertation is available for reference at: - The library of Thai Nguyen University of Medicine and Pharmacy - Learing resource centre of Thai Nguyen University - The National Medical Library 1 BACKGROUND Oral and dental disease are common diseases, having about 80 % of the world population, all ages, all walks of life. According to the World Health Organization (WHO) currently has approximately 5 billion people worldwide suffer from periodontal disease, focused primarily in Asia and Latin America, in the developed countries accounted for 60-90 % children of school age have oral disease. Caries is a matter of the Governments of the countries concerned launched several measures to solve. BRM is the cause of tooth loss, reduction or loss of strength chewable adult as well as children. In Vietnam, according to oral health survey in 2000, the national rate was 84,9 % milk tooth decay, permanent tooth decay in children 6-8 years old was 25,4 %, this rate increase by age and up to 69 % at ages 15-17. The rate of gingivitis was 45% and that needs dental treatment are huge and urgent. Yen Bai is a mountainous province faces many difficulties in health care. The rate of dental disease primary pupils above 70 %. Over the years, Yen Bai has no solutions, no specific pattern to reduce the incidence of dental disease in a sustainable way down. The research question here is that interventions to enhance oral health for Mong primary school pupils in Yen Bai province. We studied the subject: "Status and effective intervention of oral diseases in Mong primary school pupils in Yen Bai province" with the following objectives: 1. Describe the current status of oral diseases in Mong primary school puples in Yen Bai province 2011. 2. Analyze of some factors related to oral and dental disease of Mong primary school pupils. 3. Evaluate the effectiveness of preventive intervention for oral and dental disease in Mong primary pupils. 2 THE NEW SCIENTIFIC FINDINGS OF THESIS 1. The study identified that the rate of dental disease in Mong primary school pupils in two mountainous districts in Yen Bai province is 71,4 % of which tooth decay accounts for 69,6 % and gingivitis accounts for 50,1 %. 2. Model of community mobilization on taking care of dental health for Mong primary school pupils are interested by community. In this model, coordination among commune health centers, village health staff, school teachers, schools and community leaders are very closed and effective. Interventions has helped teachers and health workers make a better monitoring and management of pupils’ health at the schools; it has also enhanced awareness of parents and community in prevention of dental diseases at home. Supervision activities have helped communal leaders and involved stakeholders in evaluation of the intervention and adjust the intervention plan timely in accordance with the real local situation. Intervention model has affected parent’s behaviors and Mong people community. This is a basis for them to give up habits which harm the pupils’ dental health. 3. Dissertation deeply studied Mong’s customs and habits of dental health care for pupils. As the fact that, Mong people do not pay much attention to their health. There are a lot of old customs and habits that harm their health. 4. After intervention, knowledge, attitude and practice of pupils increased respectively 36,9 %, 42,9 %, 68,3 %. Knowledge, attitude and practice of teachers and pupil’s parents changed significantly, the teacher increased respectively 74,9 %, 61,6 %, 76,8 %, the pupil’s parents increased respectively 47,5 %, 31,2 %, 35,1 %. Efficiency of intervention for tooth decay: milk tooth; permanent tooth and gingivitis achieved respectively 7,2 %, 10,6 % and 34,4 %. Efficiency of intervention for periodontal disease (bleeding gums, tartar) achieved 31,7 %. 3 STRUCTURE OF THE THESIS The thesis 127 pages long, including the following sections: - Background: 02 Page - Chapter 1: Overview 35 Page - Chapter 2: Subjects and Methodology 21 pages - Chapter 3: Results of the study 39 pages - Chapter 4: Discussion 28 pages - Conclusion: 2 pages The research results are presented in 47 tables, 04 charts, 04 figure, 02 diagrams, 09 qualitative result boxes, Thesis used 115 reference documents including 56 references in Vietnamese and 59 in English. SOME PART OF THE THESIS Chapter 2 SUBJECTS AND METHODOLOGY 2.1. Study subjects 2.1.1 In quantitative research: - The Mong pramary school pupils, they are learning from grades 1 to 5 - Parents of pupils, homeroom teacher 2.1.2. In qualitative research: - Health staff of schools, school teachers - Office of district Education and Training leaders - The commune health workers, health staff of district health centre - Head of the village, local government leaders 2.2. Location and time study 2.2.1. The location of study At four pramary schools: Ban Cong school, Xa Ho school of Tram Tau district and Nam Co school, Pung Luong school of Mu Cang Chai district, Yen Bai province. 4 2.2.2. The time of study: - Conducted in three years from 2011 to 2013. 2.3. Research Methodology: - Cross-sectional descriptive study - Intervention study - Combining qualitative and quantitative study 2.3.1. Design of research Intervention Compare Compare before and after after No Intervention Diagram 2.1. Chart comparing previous and after intervention 2.4. Sample of research 2.4.1. The sample size 2.4.1.1. The sample size in the description study Applying the formula for sample size for discribed study: p (1-p) n = Z 1 2 - /2 d 2 In which: n: is minimun sample size need to be researched. p: Ratio of pupils with oral and dental disease, according to research before (Dr Dao Thi Ngoc Lan researched 2002), p = 0,7, 1-p = 0,3 Nam Co, Ban Cong school (the data before intervetion) Collecting the data after intervention Xa Ho, Pung Luong school (The data before intervention) The data after (Monitoring after 2 years) 5 d: desired accuracy is 0,05. Z(1- /2) is coefficient of confident limit ( = 0,05, Z 2 (1- /2)) =1,96 0,7 x 0,3 n = (1,96) 2 = 330 (0,05) 2 Thus, each school study a minimum number is 330 pupils, 4 school is 1320 puples. In fact the survey, the number of pupils at four primary schools is the 1370 pupils to study. We studied 1370 pupils. 2.4.1.2. The sample size of the intervention study Apply the formula research community intervention follows: 2 12 2 221111 )( )1()1()1(2 PP PPPPZPPZ n In which: P 1 = Proportion of pupils with oral and dental disease according to previous study (The survey data previous intervention): 70 % P2 = Proportion of pupils was expected at after intervention. It was estimated 50 % P = (p 1 + p 2 )/2 = 0,6 (60 %) Z 1- = is coefficient of confident limit (with = 0,05) = 1,96 Z 1- = is coefficient of the sample capacity was expected ( =95 %) = 1,645 2 2 )5,07,0( 5,0.5,03,0.7,065,14,0.6,0.296,1 n According to the calculation formula on n is 156 plus 10 % give up was 172 pupils. Thus, the number of pupils enrolled for minimum is 172 pupils in each intervention group and the control group. 2.4.2. Techniques of choosing the sample 2.4.2.1. In discribed study - Choosing the sample in quantitative study + Purposeful sampling: in two districts of Yen Bai province (Tram Tau and Mu Cang Chai district). In this 2 districts have over 95 % Mong people, who are living here. 6 + Sampling schools: We choose 4 primary schools by random draw method. So we had Ban Cong primary school, Xa Ho primary school (in Tram Tau district), Pung Luong primary school and Nam Co primary school (in Mu Cang Chai district). + Sampling pupils: We choosed the entire sample; we made the list of pupil of 4 schools; the pupils in each school choosed from class 1 to class 5. After that, we surveyed under the this list and we had 1370 pupils. They are learning in 4 primary schools and all are Mong people. + Sampling teachers: All the homeroom teachers who are teaching in four primary schools. + Sampling pupil’s parents: We Choosed all parents of pupils in four primary schools, according to the list of class. In fact, there were 1351 parents in four primary school, in which, there were 19 parents had two children are learning at the same school 2.4.2.2. In the intervention study We choosed each district 01 school by random draw methed to implement intervention study. We had the Nam Co primary school in Mu Cang Chai district and Ban Cong primary school in Tram Tau district. The schools will perform intervention model (intervention group), actual intervention group had 691 pupils, and the control group was Pung Luong primary school in Mu Cang Chai district and Xa Ho primary school in Tram Tau districts (control group), the actual control group had 679 students. - Sampling in quantitative study + Group discussion: We conducted 4 group discussions in four school, two group discussions in one school. In the first group discussion is included health staff in commune level, village level, school teachers (8-12 people). In the second group discussion is included commune leaders, head villages, pupil’s parents (8-12 people) + In-depth interview: We conducted interview 01 leader of commune people’s committee, head of commune health station, 05 homeroom teachers. 01 leader of district health centre, 01 leader of district Education and Training department. 01 parents in each grade, 01 school health worker. 7 2.5. Content of study 2.5.1. For discribed study - Oral examination to confirm the rate of dental caries, gingivitis and dental manifestations of the disease (periodontal disease), index of dmf, DMF and CPI index before intervention. - Interview the primary school pupils, parents, homeroom teachers to identify factors related to the pupils’ oral disease. - Learning the environmental situation in the oral health care activities (teachers, school health worker), in community (parents of pupil, communication) 2.5.2. For intervention study 2.5.2.1. Develop intervention model After assessing the situation, determine the factors related to dental disease, the researchers will gather communication materials on the basis of the literature used to train the teachers, the core group of villages by the Ministry of Health was regulated. Instructions building workshops and training materials for the core group to organize and implement the activities following the subjects 2.5.2.2. Implement the activities of intervention models Implement the preventive intervention model of oral diseases for primary school students: - Prepare community activities included in the intervention schools. - Develop a plan, work rules, the establishment of a steering intervention, organizing the activities, monitoring and evaluation of interventions and compared with the results of the initial investigation. - Resources for implementation: Subject to mobilize resources is social health officials, village and school teachers in addition to mobilize staff communes and villages directly involved in research model. - The Steering Committee consists of six people: Leadership CPC, Representative school board school, board vice-Chairman of CHCs as deputy director, officer in charge of medical schools, teaching team manager, head of the village are members. 8 Training course, WS oral disease examination Comumication on knowledge Diagram 2.2. Model mobilize community resources involved in interventions for prevention of dental disease in Mong primary school pupil 2.6. The studied criteria 2.6.1. The studied criteria for objective 1 * The general information of research group: - The characteristics of the pupils: age, gender, class… * The criterria of the pupils with oral and dental disease - The rate of pupils have oral and dental disease. - The rate of pupils have gingivitis. - The rate of decay-missing-filling on milk tooth and permanent tooth. - The expression of periodontal gum disease (tartar, gingivitis and bleeding gums). - Results of depth interviews and workshop with related members of the schools in two commune (qualitative research) Intervention Leaders of commune level Core group Staffs health station, village health worker Pramary pupils Parents of pupils Research group [...]... level and village level 5 Continue to apply, maintain and expand the model to mobilize the community to care for the oral health of pupils in the highland districts in Yen Bai province THE ARTICLES WERE PUBLISHED RELATED TO THE THESIS 1 Nguyen Ngọc Nghia, Nguyen Van Tu, Trinh Đinh Hai (2013), Status and some factors related to dental disease of Mong primary school pupils in Yen Bai Province in 2011",... participant training courses and workshop 10 - The results of training courses 2.6.3.5 Results of coordinated methods for the prevention of pupils oral diseases - Effective application of the intervention methods in quantitative research - Maintain and expand the model intervention 2.7 The assessment of knowledge, attitude and practice of oral health care of pupils In this study, based on interviews with... Journal of Science and Technology, Thai Nguyen University, 107 (7), p 163-168 2 Nguyen Ngọc Nghia, Trinh Đinh Hai (2014), Status of knowledge, attitude and practice of preventive oral dental disease in Mong primary pupils in Yen Bai province" , Journal of Science and Technology, Thai Nguyên University, 115 (01), p 163-168 3 Nguyen Ngọc Nghia, Trịnh Đinh Hai (2014), Status and effective prevention interventions... risk 23 3 The effectiveness of some preventive interventions dental disease 3.1 Effectiveness of the intervention model Model mobilize community participation in health education and prevention of oral diseases for Mong primary school pupils in Yen Bai province has implemented efficiently by implementing the activities and focus on improving the knowledge, attitude and practice of dental hygiene students,... Evaluation of intervention based on effective indicators and effective intervention - The effective indicator as formula: p1 – p2 Effective indicator (%) = - x 100 p1 Trong đó: p1 is proportion of study before intervention P2 is proportion of study after intervention - Effective intervention as formula (%) Effe indicator (Intervention grour) – Effe indicator (control grour) 2:10 Evaluating of community... efficiency Index of intervention schools was higher than the control group, the effectiveness of interventions 20 for intervention schools with bleeding gums and tartar increased 31.5%, with the obvious changes and have different between the two groups 3.3.4.3 For gingivitis Table 3.47 Effective index intervention effectiveness for gingivitis Group Gingivitis Intervention group(3) Control group(4) Before intervention. .. average income of 401,000 VND / person / month or more The other evaluation criteria: - Check your oral health routine: Organizations oral examinations for pupils at schools in 6 months a time In order to detect oral diseases and counseling, guiding, families of pupils take examinations and treatment - Guide oral hygiene routine: The pupils are instructors oral hygiene (brushing, gargling, prevention of. .. implementation of preventive intervention model for periodontal disease of Mong primary school pupils showed the effectiveness of the intervention group higher than the control group in both types of teeth Remarkably effective intervention for milk teeth is 7,2 %, for the permanent tooth is 10,6 % Table 3.39 The effective index and intervention effectiveness for index of decay-missing- filling on milk tooth and. .. supervision and monitoring of officers involved have been strengthened, contribute to the implementation of the intervention activities In the process of implementing the intervention, officials core group has been involved in many workshops and seminars on oral health care, to exchange and learning experience in other elementary schools in the district and beyond So, The people, who direct communication and. .. Percentage of bleeding gums and tartar after the intervention significantly reduced The effectiveness of interventions for bleeding and tartar were 31,7 %, with the changes and differences between the two groups before and after the intervention - Effectiveness of the gingivitis was 34,4 % 24 RECOMMENDATIONS 1 The Yen Bai Health sector strengthening coordination with the Education and Training to implement . MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY NGUYEN NGOC NGHIA STATUS AND EFFECTIVE INTERVENTION OF ORAL DISEASE IN MONG PRIMARY SCHOOL PUPILS IN YEN BAI PROVINCE. " ;Status and effective intervention of oral diseases in Mong primary school pupils in Yen Bai province& quot; with the following objectives: 1. Describe the current status of oral diseases in. diseases in Mong primary school puples in Yen Bai province 2011. 2. Analyze of some factors related to oral and dental disease of Mong primary school pupils. 3. Evaluate the effectiveness of preventive