national oral health survey namibia 2010/11

Transcription

REPUBLIC OF NAMIBIA
MINISTRY OF HEALTH AND SOCIAL SERVICES
NATIONAL ORAL HEALTH SURVEY
NAMIBIA 2010/11
Directorate: Primary Health Care
Division: Family Health
Sub-Division Oral Health and Dental Services
Private Bag 13198
Windhoek
Republic of Namibia
Tel: +264 61 203 2715
Fax: +264 61 234 968
www.healthnet.org.na
March 2013
i
PREFACE
Information on the prevalence and severity of diseases is very important for the Ministry of Health and
Social Services to develop proper strategies and interventions which are scientific sound and evidence based.
Namibia like most of developing countries has witnessed a rapid increase in dental diseases as observed
from the annual oral health reports from the different regions. Although different interventions have been
instituted, most patients who attend the dental clinics present too late and often the only treatment option
is extraction.
Since independence, there has not been a national oral health baseline survey and there have been only a
handful of studies that have attempted to determine the oral health status of the people of Namibia.
A pathfinder study by Schier(1993) was used as a baseline data to develop the National Oral Health
Promotion Programme Policy and Guidelines(1998). Therefore it is important to have information on
the current status of oral health in Namibia.
The report of this National baseline survey will be used to review and update the national Oral health policy
to respond with the emerging oral health needs of Namibians.
I would like to thank all organisers of this survey for a job well done. Special thanks go to sub-division oral
health for their dedication in coordinating this survey, University of the Western Cape in South Africa for
their technical assistance, The Biostatistics Department of the Medical Research Council of south Africa
for the statistical support and Namibian dental personnel who worked hard to make this study a success.
................................................
MR. A NDISHISHI
PERMANENT SECRETARY
ii
Table of Contents
PREFACEii
ABBREVIATIONSiv
2.INTRODUCTION1
2.1 BACKGROUND
1
2.2 AIM OF THE SURVEY
1
2.3 OBJECTIVES OF THE SURVEY
1
3.
STUDY METHODOLOGY2
3.1 BACKGROUND2
3.2 STUDY DESIGN2
3.3 PERSONNEL2
3.6 INSTRUMENTS, EQUIPMENT AND CONSUMABLES
3
3.7 INFECTION CONTROL
3
3.8 CALIBRATION AND TRAINING
3
3.9 DATA COLLECTION PROCEDURE4
3.10 ETHICAL CONSIDERATIONS5
3.11 STATISTICAL ANALYSIS5
4. RESULTS & DISCUSSION6
4.1 AGE GROUP 5-6 YEAR OLDS
6
4.2 AGE GROUP 12 YEAR OLDS
10
4.3 AGE GROUP 15 YEAR OLDS
14
4.4 AGE GROUP 35-44 YEAR OLDS
17
4.5 AGE GROUP 65-74 YEARS OLD
20
4.6 QUESTIONNAIRE DATA ANALYSIS24
5.
CONCLUSIONS AND RECOMMENDATIONS26
5.1 CHALLENGES
26
5.2 DENTAL CARIES
26
5.3 PERIODONTAL DISEASES
26
5.4 RECOMMENDATIONS
27
6.REFERENCES
27
APPENDIXES
28
iii
ABBREVIATIONS
1.
CPITN
Community Periodontal Index Treatment Need
2.
DMFT
Decayed, Missing and Filled Teeth
3.
CPI
Community Periodontal Index
4.
NOHPP
National Oral Health Promotion Programme
5.
OR
Odd Ratio
6. UTN
Unmet Treatment Need
7.
SHPA
Senior Health Program Administrator
8.
SIC
Significant Caries Index
iv
2.INTRODUCTION
2.1BACKGROUND
Namibia is the country with the population of about 2million. The population distribution is skewed with
the northern part more densely populated than the south. This population distribution poses different
challenges in different regions.The country is divided into 13 regions. Currently all the regions are rendering
dental services. The main challenges are shortage of staff, dental equipment and materials. This situation
affects the preventive and health promotion activities.
A pathfinder survey on oral health in Namibia was conducted by Schier in 1993. He found that with
regard to dental caries status: 44% of 12 year olds had dental caries in their permanent teeth. The 12 year
age group had a DMFT of 1.2 and 67% of 13-44 year olds had dental caries. Dental caries was found to
increase rapidly with increasing age and more females were more affected. Urban populations had the
highest prevalence of dental caries and the majority of tooth decay remained untreated. With regard to
periodontal diseases - the 12 year old population had 0.6 healthy sextants on average and in the age group
15-19 years 85% retained all their permanent teeth. The prevalence of edentulism for adults aged 35-44
was 1.5%. A later study by Priwe & Herunga (1997) found significant differences in caries prevalence in
different parts of Namibia with the highest frequency in the southern and lowest in the northern part.
It has been more than ten years since the path finder survey was done and following independence, numerous
interventions have been implemented in order to improve oral health status of Namibians. These include
the Smiling Schools project, outreach services, curative and rehabilitative services. However, little is known
about the effectiveness of these interventions in terms of the prevalence of the most common dental
diseases in the population.
The first national oral health survey in Namibia was initiated by the Oral Health and Dental Services
Sub-Division, Family Health Division of the Primary Health Care Directorate in April 2010, where a
proposal was submitted for a national oral health survey in Namibia. This followed the recommendation
from the National Oral Health Task Force meeting conducted in January 2010. At the same meeting the
Chief Dentist and the Senior Health Programme Administrator (SHPA) at national level were tasked to
spearhead the process. The protocol for a national oral health baseline survey was drafted by the Chief
Dentist with the assistance from colleagues and submitted to the Ministerial Research Ethics committee
for approval in June 2010. Following approval by the Research Committee, the Chief dentist and SHPA were
given the responsibility to execute the project. The Faculty of Dentistry at the University of the Western
Cape was contacted with regard to calibration of the oral health workers who were to collect the data.
2.2 AIM OF THE SURVEY
To generate oral health knowledge in Namibia that will contribute to the revision of the oral health policy,
planning of interventions and act as a baseline for future monitoring and evaluation.
2.3
OBJECTIVES OF THE SURVEY
The objectives of the study were:
2.3.1 To establish reliable base‑line data regarding the oral health status and the treatment needs of
adults and children in Namibia by way of epidemiological examinations.
2.3.2 To monitor trends in the oral health status of the population in Namibia.
2.3.3 To determine knowledge, attitudes and practices influencing oral health in Namibia
2.3.4 To revise and update the National Oral Health Policy and Guidelines document.
2.3 .5 To assist in the planning and evaluation of regional oral health services.
1
3.
STUDY METHODOLOGY
3.1BACKGROUND
A basic oral health survey is defined as the survey conducted to collect basic information about oral
disease status and treatment needs for planning or monitoring oral health care programmes (WHO, 1997).
A national path-finder survey is commonly used in the basic survey of oral diseases as it is convenient and
cheap. The disease pattern of most common dental diseases (dental caries and periodontal diseases) is that
it affects all age groups and hence the path finder sampling method is advantageous as it utilises the index
ages. Namibia has one of the highest dentists to population ratio in Africa although their distribution is
skewed (1:12 000 in central regions and 1:100 000 in the northern regions of the country (NOHPP, 1998).
This iniquitous distribution presents a challenge in the provision of dental services in rural communities.
3.2 STUDY DESIGN
The survey was a cross-sectional descriptive study that followed the World Health Organisation (WHO)
national pathfinder standards. Redesigned WHO data capture forms were used for collection of data of
dental caries and periodontal status. A structured questionnaire was administered to collect information
regarding oral health knowledge, attitude and practices.
The survey was conducted in the thirteen regions of Namibia and consisted of dental caries, periodontal
diseases and treatment need assessments. The survey was conducted among children in the following
age groups: 5-6 years, 12-years and 15-years and adults aged between 34-45 and 65-74 years. The sample
size was determined in accordance with WHO pathfinder formula. The survey was executed between
December 2010 and January 2011.
3.3 PERSONNEL
To supervise the execution of the project, a regional supervisor was appointed in each of the provinces. In
addition to the supervisor the following personnel were also involved with the survey; examiners, record
clerks, dental assistants and drivers.
3.4 SAMPLING
Cluster, random, stratified samples were drawn from all the thirteen regions in Namibia. This ensured that,
in addition to information gathered on the oral health status of the nation, regions will each have their own
baseline data for oral health planning and evaluation. Each region was stratified into urban and rural. Schools
were selected by simple random sampling from templates obtained from the local education authority.Adult
participants were drawn from the areas where the sampled schools will be located. Factories and social
grants issuance points were used to access adult participants.
In each of the rural and urban cluster in each region, 5-6, 12, 15, 35-44, and 65-74 age groups participated
in the survey. Each group had an expected sample of 60 participants, with a total of 300 participants in each
region and 3900 participants in the country. The final realised sample was 3824 which is 98%(Table 1).
2
Table 1: Realised sample for gender & age groups per Region
Males
Females
5-6
12
15
35-44
65-74
5-6
12
15
35-44
65-74
Total
Caprivi
27
25
24
30
25
33
35
36
31
35
301
Erongo
23
31
28
33
27
37
29
32
27
32
299
Hardap
35
33
25
29
21
25
27
35
31
40
301
Karas
32
27
29
26
24
28
33
31
32
32
294
Kavango
29
24
26
31
28
31
37
33
29
32
300
Khomas
27
30
31
25
29
33
30
29
35
31
300
Kunene
27
26
25
34
9
33
34
35
26
11
260
Ohangwena
25
25
29
20
19
35
35
31
38
43
300
Omaheke
30
27
28
32
30
30
33
32
30
28
300
Omusati
27
28
29
20
25
33
31
34
40
35
302
Oshana
31
31
25
14
22
29
29
35
46
38
300
Oshikoto
31
28
30
34
32
29
32
30
27
28
301
Otjozonjupa
30
24
15
30
13
25
46
60
18
5
266
National
374
359
344
358
304
401
431
453
410
390
3824
3.5 INDICES AND METHODS FOR ORAL HEALTH STATUS AND NEED ASSESSMENTS
The WHO‑methods with regard to dental caries and periodontal diseases were followed (WHO
1997).
3.5.1 Questionnaire
For each participant taking part in the survey, and the parent or legal guardian of the child completed a health
questionnaire prior to the examination. Explanatory notes on the reasons for the use of the health questionnaire,
during the epidemiological survey is contained in Annexure 1.
3.5.2 Survey forms
A revised version of the WHO form had been devised for the collection of the demographic data and
assessment of oral health status and treatment need (Annexure 2).
3.6
INSTRUMENTS, EQUIPMENT AND CONSUMABLES
The following instruments, equipment and material were used during the survey:
Sterile packs containing periodontal probes: The WHO periodontal probe was used, mouth
mirrors: An ordinary mouth mirror (No 4) was used and gauze packs and tweezers.
Stationery: A clipboard, pencil, sharpener and an eraser were used to capture the data onto the
data capture sheet and questionnaires.
Consumables: Disinfecting agents, paper-towels, rubber gloves and facemasks, plastic disposable
bags.Equipment: Chairs and lights, autoclaves and suitable receptacles for the return of used
instruments.
3.7 INFECTION CONTROL
All mirrors and probes were autoclaves after single use. Disposable gloves, surgical masks and
glasses were used during examinations.
3
3.8 CALIBRATION AND TRAINING
In order to obtain an acceptable level of reliability, all examiners were trained and calibrated prior to the
survey. To limit the confounding factors arising from inter-examiner and intra-examiner variations, dentists
received a one week training and calibration course from members of the Department of Community
Dentistry, Faculty of Dentistry, and University of the Western Cape.
Training consisted of a one day theoretical input and four days of calibration exercises. Each dentist examined
10 children and adults who were selected by a dentist who will be neither receiving calibration training
nor acting as the gold standard. Some of the examinees had dental caries while the others were caries free.
A few examinees were selected for re-examination. As the dentists examined the participants, the findings
were recorded on the WHO data collection form by the recorder, a dental therapist who received training
on capturing the examination findings and administering the questionnaire.
3.9 DATA COLLECTION PROCEDURE
A team consisting of the calibrated examiner and a recorder were allocated to each region. This team
comprised a regional dentist as a team leader, a dental therapist, a dental assistant and two nurses. During
data collection, the team were actively involved with the local authorities as well as school principals and
administrators. Data was collected over a period of 10 working days.
The team began by explaining to the participant the reasons for the survey and the benefits thereof,
checking and re-confirming the consent obtained that the participant was willing to participate in the survey.
Oral examinations were carried out with a plain mirror and periodontal probes under daylight or, where
necessary with a portable light source. No radiographs were taken.
Gauze or a cotton roll held with a pair of tweezers was used to clean and dry the teeth. A laboratory
air blower was also used to dry the tooth where necessary. Examiners adopted a systematic approach
to the examination for dental caries, proceeding in an orderly manner from one tooth or tooth space
to the adjacent tooth or tooth space. A tooth was considered present in the mouth when any part of
it was visible or touchable with the tip of the explorer without unduly displacement of the soft tissue.
Should a permanent and a primary tooth occupy the same tooth space, the status of the permanent
tooth was recorded.
The number of carious defects, fillings and missing teeth were recorded on the data capture sheets in
accordance with the WHO criteria. A numerical coding system was used for recording the status of
permanent teeth, while alphabets were used for primary teeth. Scores were calculated according to
WHO guidelines. Individuals were grouped into tertiles according to their dmft values. The SiC index
was calculated as the mean dmft of one third of the population with the highest caries score (Nishi,
2002; Brathall, 2000).
The examination of periodontal diseases utilised the WHO Community Periodontal Index Treatment Need
(CPITN).
Examiners used a single pair of disposable examination gloves that were discard it into a red waste disposal
bag after each participant was examined. Any gauze used to clean debris and dry the tooth for better
visualization was also discarded. Each team had enough sterilized instruments for examination of each
participant.
At the end of the examination, the team thanked the participant for choosing to participate in the
survey.
4
3.10 ETHICAL CONSIDERATIONS
The proposal for the survey was approved by the ethical committee of the Ministry of Health. The participating
schools and parents of the children were given information through the local education administration on
the intended survey, its benefit, safety and strict confidentiality. Parents were informed that they were
at liberty to withdraw their child at any stage during the survey and that this decision will not affect the
management of the child in any way. Adult participants were given information through the local traditional
authorities and management of any organized entity of interest, such as a factory. During the initial visit the
survey team re-enforced this information again and confirm that the participant was willing to participate.
All participants signed an informed consent form (Appendix 3 & 4) that was translated into the relevant
regional language. For those who were illiterate, a researcher read them the consent form in their mother
tongue language.
All the information collected was treated with utmost confidentiality. Computer entry was anonymous and
excluded any information that might reveal the identity of any participant. All the forms used to collect
information were stored safely in a locked cupboard.
3.11 STATISTICAL ANALYSIS
3.11.1Oral Health Status
The capturing, processing and analyzing of the data were performed by the South African Medical Research
Council Biostatistics Unit, Tygerberg, Cape Town, South Africa. The data was cleaned, collated and analyzed
by means of SAS Version 9.2. The sample was weighted to take in account the structure by age group, region
of the Namibian population. The Chi-square test was used to assess the bivariate associations. The p-value
for statistical significance was set at 0.05. 3.11.2Questionnaire data
The regions of Namibia were divided into two categories on the basis of their caries status. The regions
with caries levels of 55% or higher, were grouped together (viz. Caprivi, Erongo, Kavango and Ohangwena)
and compared with the rest of the country. A logistic regression was done to assess the effect of (i) pain/
discomfort of their teeth; (ii) perceptions of oral health; (iii) visit to the dentist and (iv) use of toothpaste on
region, while controlling for caries status. Results are presented as odds ratios and 95% confidence intervals.
5
4. RESULTS & DISCUSSION
The results of the 2010-2011 survey are described below. The results are descriptive in nature and are
presented for each of the age groups as follows: dental caries and periodontal disease.The percentage caries
in the tables consist of untreated caries (the decayed component of the dmft and the DMFT) and treated
(the missing and filled components of both).
The difference between the percentage caries and the percentage untreated caries represents the treated
caries. In order to obtain an objective view of the quantity of services provided for the treatment of
dental caries, the Unmet Treatment Need Index (UTN) (Jong, 1981) is calculated. The UTN, expressed
as a percentage is calculated by dividing the percentage untreated caries by the percentage caries. The
Community Periodontal Index (CPI) has been adopted worldwide as the appropriate index for large scale
surveys and was used in this survey because of its usefulness in obtaining community profiles on periodontal
diseases and it also provides a guideline to the type of periodontal preventative programme required.
4.1
AGE GROUP 5-6 YEAR OLDS
4.1.1 Dental Caries
Table 2: Prevalence of dental caries and untreated caries in primary teeth of 5-6-year-olds
Age group (years)
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
% Caries
42.95
80.00
48.33
56.67
43.33
70.00
41.67
10.00
40.00
21.67
51.67
21.67
51.67
40.00
% Untreated caries
38.51
41.67
31.67
56.67
41.67
70.00
38.33
8.33
38.33
11.67
51.67
15.00
50.00
32.73
% UTN
89.66
52.09
65.53
100.00
96.17
100.00
91.98
83.30
95.83
53.85
100.00
69.22
96.77
81.83
Nearly two thirds 57% (100-42.95) of the primary dentition of the 5-6-year-olds are caries-free. However,
there is a wide variation in the caries-free-status between the regions, with Kunene having the highest (90%)
and Caprivi the lowest (20%). All the regions, except Caprivi, Kavango, Hardap and Oshikoto have more
than half caries-free 5-6-year-olds. According to the UTN, nationally nearly 90% of all caries in 5-6-year-olds
go untreated.
6
Table 3: Prevalence of dental caries & untreated caries in permanent teeth of
5-6-year-olds
Age group (years)
% Caries
% Untreated caries
% UTN
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
6.36
16.67
5.00
23.33
3.33
3.33
0.00
1.67
3.33
23.33
1.67
13.33
6.67
5.45
4.57
15.00
0.00
21.67
0.00
0.00
0.00
1.67
3.33
15.00
1.67
11.67
0.00
1.82
71.86
89.98
0.00
92.88
0.00
0.00
100.00
100.00
64.29
100.00
87.55
0.00
33.39
93.6% the permanent dentition of this age group is caries-free. However, in Caprivi, Hardap and Omaheke
over 15% already have caries in their permanent dentition. Although this is low for permanent teeth, 71.9%
will be untreated. Oshikoto fared best with regards to the treatment of caries of the permanent teeth of
their 5-6 year olds.
The severity of dental caries is shown in Table 4. Dental caries is more severe in the primary than the permanent
dentition. Untreated caries (decayed component) are the highest with low levels of missing teeth and negligible
levels of filled teeth. Nationally the weighted dmft mean is 1.4 with Caprivi having the highest (4.4) and Kunene
the lowest (0.2). The high d component for Karas may be due to the fact that the sample consisted of mainly 5
year olds with very few erupted permanent teeth.The low levels in Kunene may be related to the remoteness of
this region live in consisting mainly of the Himba and Herero people. From a very early age, children are taught
by their parents to use chewing sticks to clean their mouth and teeth. Furthermore, there is a very active schoolbased oral health programme throughout the Opuwo district in the Kunene Region.
The severity of dental caries expressed as the mean DMFT and the components of the DMFT of the
permanent teeth is shown in Table 5. Nationally the DMFT is 0.16, with Khomas the lowest (0.00) and
Omaheke the highest (1.12).
Table 4: Distribution of the mean dmft and components of the dmft in primary teeth
of 5-6-year-olds
Region
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
dmft
1.44
4.40
1.60
2.45
2.08
2.83
1.23
0.22
0.95
0.68
1.73
0.68
1.50
1.13
d
1.17
1.85
0.97
2.38
1.77
2.73
1.12
0.18
0.90
0.32
1.45
0.28
1.48
0.84
m
0.26
2.50
0.55
0.07
0.23
0.10
0.12
0.03
0.05
0.32
0.28
0.37
0.02
0.22
f
0.01
0.05
0.08
0.00
0.08
0.00
0.00
0.00
0.00
0.05
0.00
0.03
0.00
0.07
7
Table 5: Distribution of the mean DMFT and the components of the DMFT in permanent
teeth of 5-6-year-olds
Region
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
DMFT
0.16
0.32
0.07
0.67
0.03
0.05
0.00
0.02
0.03
1.12
0.02
0.35
0.10
0.05
D
0.11
0.28
0.00
0.63
0.00
0.00
0.00
0.02
0.03
0.72
0.02
0.33
0.00
0.02
M
0.04
0.02
0.07
0.03
0.03
0.05
0.00
0.00
0.00
0.40
0.00
0.02
0.10
0.04
F
0.00
0.02
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
The percentage of 5-6-year-old children in Namibia who need treatment for dental caries is 41.9%, with the
regions ranging from 10.0% in Kunene to70.0% in Kavango (Table 6). In seven of the regions less than 50%
are in need for treatment. Nationally, the mean number of teeth needing care per child is 1.3, while in the
regions it ranges between 0.2 and 3.0.
Table 6: Percentage distribution of care needed and the mean number of teeth needing
care in 5-6-year-olds
Region
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
8
% Needing care
41.92
53.33
31.67
60.00
41.67
70.00
38.33
10.00
40.00
26.67
53.33
26.67
50.00
34.55
Mean number of teeth
1.28
2.13
0.97
3.02
1.77
2.73
1.12
0.20
0.93
1.03
1.47
0.62
1.48
0.85
Table 7: Type of care needed for the treatment of dental caries expressed as the
mean number of teeth needing care in 5-6-year-olds
Region
Preventive
Fillings
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
0.13
0.72
0.17
0.00
0.02
0.03
0.00
0.00
0.40
0.00
0.22
0.22
0.03
0.00
0.34
0.22
0.22
0.57
1.20
0.00
0.20
0.03
0.38
0.05
1.07
0.10
1.02
0.78
Crown +
Veneer
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Pulp care
Extractions
Other care
Not recorded
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.58
0.95
0.45
1.22
0.42
2.25
0.63
0.17
0.07
0.22
0.17
0.27
0.38
0.05
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.08
0.00
0.00
0.00
0.00
0.00
0.05
0.25
0.02
0.92
0.05
0.00
0.00
0.00
0.00
0.00
0.02
0.03
0.02
0.00
The type of care needed for the treatment of dental caries expressed as the mean number of teeth needing
care is shown Table 7. Extractions were the most common need in all the regions, followed by fillings and
then preventive treatment. Kavango recorded the highest need for extractions (2.3), Karas for fillings (1.2)
and Caprivi for preventive treatment (0.7).
4.1.2 PERIODONTAL DISEASES
The results of the survey show large variation in the prevalence and severity of periodontal diseases for the
different regions of Namibia (Table 8). Nationally 59.6% of the 5-6-year-old children presented with healthy
periodontal tissues and equal proportions of gingivitis-calculus complex and bleeding tissues (12.9%). Karas,
Khomas and Otjozondjupa (14.7%) did not record CPI as there were no index teeth to take measurements
from. Oshana was the only region where the gingivitis-calculus complex dominates with 73.3% and only
5.0% presented with healthy periodontal tissues.
Table 8: Prevalence & severity of periodontal diseases in 5-6-year-old children in
Namibia
Region
National
Healthy
%
Mean
Bleeding
%
Mean
Calculus
%
Mean
Shallow pockets
%
Mean
weighted
59.64
3.82
12.94 0.35
12.74 0.24
0.00
0.00
Caprivi
93.33
5.80
3.33
0.10
3.33
0.07
0.00
0.00
Hardap
60.00
4.28
40.00 0.78
0.00
0.00
0.00
0.00
Karas
Kavango
33.33
1.93
40.00 0.90
0.00
0.00
0.00
0.00
Khomas
Kunene
85.00
5.07
15.00 0.33
0.00
0.00
0.00
0.00
Ohangwena
75.00
3.68
16.67 0.32
1.67
0.02
0.00
0.00
Omaheke
58.33
2.42
5.00
0.05
3.33
0.05
0.00
0.00
Omusati
46.67
1.68
0.00
0.00
0.00
0.00
0.00
0.00
Oshana
5.00
3.57
21.67 1.13
73.33 1.27
0.00
0.00
Oshikoto
84.17
4.54
5.00
0.05
0.00
0.00
0.00
0.00
Otjozondjupa % = Percentage with highest score over sextants Mean = mean number of sextants affected per person
Deep pockets
%
Mean
Not recorded
%
Mean
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
-
14.68
0.00
0.00
26.67
0.00
6.67
33.33
53.33
0.00
10.83
-
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
-
1.51
0.03
0.00
3.17
0.60
1.98
3.48
4.32
0.03
1.41
-
No CPI recorded for Karas, Khomas and Otjozondjupa.
9
4.2
AGE GROUP 12 YEAR OLDS
4.2.1 Dental Caries
Table 9: Prevalence of dental caries and untreated caries in permanent teeth of
12-year-olds
Age group (years)
% Caries
% Untreated caries
% UTN
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
38.83
90.00
43.33
41.67
13.33
62.30
18.33
18.33
45.00
30.00
42.37
25.00
21.67
15.71
34.43
88.33
21.67
26.67
11.67
49.18
16.67
15.00
43.33
21.67
35.59
15.00
11.67
14.29
88.67
98.14
50.01
64.00
87.55
78.94
90.94
81.83
96.29
72.23
84.00
60.00
53.85
90.96
Figure 1: Prevalence of dental caries and untreated caries in permanent teeth of
12-year-olds
120
100
80
60
40
% Caries
20
Otjozondupa
Oshikoto
Oshana
Omusati
Omaheke
Ohangwena
Kunene
Khomas
Kavango
Karas
Hardap
Erongo
Caprivi
% UTN
National weighted
0
% Untreated Caries
More than two thirds (61%) of 12-year-olds in Namibia are caries-free, but with wide variation between
the different regions. Caprivi has only 10% caries-free, while Karas has the highest proportion of caries-free
12-year-olds (86.7%). All the regions, except Caprivi and Kavango have over 50% caries-free 12-year-olds (Table 9).
Based on the weighted national mean the UTN for the 12-year-olds is 88.7%, which means that over 88% of
all caries go untreated. Large variations also occur in the UTN for the different regions with Erongo (50.0%)
and Oshikoto (53.9%) having the least untreated caries. Caprivi, Khomas, Ohangwena and Otjozonjupa have
over 90% untreated caries.
10
Untreated caries (decayed component) are the highest level, with low levels of missing teeth and negligible
levels of filled teeth (Table 10). The national DMFT of 0.83can be regarded as low in terms of the WHO
classification for dental caries for this age group (Barnes, 1977). Caprivi (3.12) has the highest DMFT of all
the regions.
The percentage of 12-year-old children in Namibia who need treatment for dental caries is 34.4%, with the
regions ranges from 11.7% in Karas and Oshikoto to 88.3% in Caprivi (Table 11). In all the regions except
Caprivi, less than 50% are in need for treatment. Nationally, the mean number of teeth needing care per child
is 0.6, while in the regions it ranges between 0.13 and 2.35.
Table 10: Distribution of the mean DMFT and components of the DMFT in permanent
teeth of 12-year-olds
Region
DMFT
D
M
F
National 12 weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
0.83
3.12
1.35
0.90
0.15
1.43
0.38
0.30
0.82
0.47
0.83
0.58
0.50
0.20
0.64
2.35
0.32
0.48
0.13
1.08
0.30
0.18
0.72
0.30
0.71
0.23
0.25
0.17
0.16
0.72
0.98
0.27
0.02
0.15
0.07
0.12
0.10
0.07
0.12
0.28
0.25
0.03
0.03
0.05
0.05
0.15
0.00
0.20
0.02
0.00
0.00
0.10
0.00
0.07
0.00
0.00
Figure 2: Distribution of the mean DMFT and components of the DMFT in permanent
teeth of 12-year-olds
3.5
3
2.5
2
1.5
1
DMFT
D
0.5
Otjozondupa
Oshikoto
Oshana
Omusati
Omaheke
Ohangwena
Kunene
Khomas
Kavango
Karas
Hardap
Erongo
Caprivi
F
National weighted
0
M
11
Table 11: Percentage distribution of care needed and the mean number of teeth
needing care in 12-year-olds
Region
% Needing care
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
34.43
88.33
21.67
26.67
11.67
49.18
16.67
15.00
43.33
21.67
35.59
15.00
11.67
14.29
0.64
2.35
0.32
0.48
0.13
1.08
0.30
0.18
0.72
0.30
0.71
0.23
0.25
0.17
care is shown in Table 12. Fillings and extractions were the most common need in all the regions, with
Caprivi having the highest need.
mean number of teeth needing care in 12- year-olds
Region
Preventive
Fillings
Crown + Veneer
Pulp care
Extractions
Other care
Not recorded
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
0.01
0.02
0.00
0.02
0.00
0.00
0.00
0.00
0.00
0.00
0.08
0.03
0.00
0.00
0.30
1.42
0.15
0.23
0.10
0.51
0.05
0.05
0.45
0.18
0.46
0.02
0.08
0.10
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.29
0.88
0.07
0.18
0.03
0.48
0.25
0.12
0.23
0.12
0.14
0.17
0.15
0.07
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.01
0.03
0.00
0.03
0.00
0.00
0.00
0.02
0.02
0.00
0.00
0.02
0.00
0.00
12
4.2.2 Periodontal Diseases
Table 13: Prevalence and severity of periodontal diseases in 12-year-old children in
Namibia
Region
Healthy
%
Mean
Bleeding
%
Mean
Weighted
national mean
Calculus
%
Mean
Shallow pockets
%
Mean
35.20
3.80
25.30
1.29
39.42 0.87
0.09
0.00
Caprivi
20.00
4.03
11.67
0.63
66.67 1.28
1.67
0.02
Hardap
56.67
5.17
33.33
0.60
10.00 0.12
0.00
0.00
Karas
21.67
3.63
18.33
0.98
60.00 1.38
0.00
0.00
Kavango
3.33
1.43
58.33
3.90
38.33 0.67
0.00
0.00
Khomas
75.41
5.62
1.64
0.02
22.95 0.36
0.00
0.00
Kunene
45.00
3.60
36.67
2.10
18.33 0.25
0.00
0.00
Ohangwena
8.33
3.30
65.00
2.28
26.67 0.37
0.00
0.00
Omaheke
25.00
4.13
28.33
0.93
46.67 0.85
0.00
0.00
Omusati
28.33
4.08
13.33
0.72
58.33 1.18
0.00
0.00
Oshana
5.08
2.31
8.47
1.15
86.44 2.53
0.00
0.00
Oshikoto
51.67
4.35
30.00
1.30
18.33 0.33
0.00
0.00
Otjozondjupa
100.00 6.00
0.00
0.00
0.00
0.00
0.00
0.00
% = Percentage with highest score over sextants; Mean = mean number of sextants affected per person
Deep pockets
%
Mean
Not recorded
%
Mean
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.03
0.03
0.00
0.00
0.00
0.00
0.05
0.05
0.08
0.02
0.02
0.02
0.00
CPI data were not captured for Otjozondjupa. The results of the survey show large variation in the
prevalence and severity of periodontal diseases for the different regions of Namibia. Although 35.2% of the
12-year-old children in Namibia presented with healthy periodontal tissues, the gingivitis-calculus complex
dominates as the most common periodontal condition (39.4%) nationally.
In Kavango, Oshana and Ohangwena less than 10% have healthy periodontium and the gingivitis-calculus
complex dominates as the most common periodontal condition (26.7% - 86.4%). Khomas has the healthiest
periodontal tissues (75.4%) with very little bleeding (1.6%) and 23% calculus. Hardap and Oshikoto have very
similar profiles with healthy dominating (over 50%), followed by bleeding (33.3% and 30% respectively) and
calculus (10% and 18.3% respectively). Caprivi was the only region where shallow pockets were recorded.
4.2.3 Significant Caries Index
In 1981 the World Health Assembly of the WHO declared that the global goal for oral health by the year
2000 should be that the DMFT for the 12-year-olds should not exceed 3. However, a low mean caries level
such as ‘3’ does not exclude a number of individuals with considerably higher DMFT values in the same
population. The Significant Caries Index (Sic) is calculated as the mean of the highest third of the 12-year-old
population. The goal is that the Sic Index should be less than 3 DMFT in the 12-year-olds by the year 2015.
According to these criteria, on a national level, most of the regions are in line with this recommendation.
Caprivi, Erongo and Kavango however, have levels higher than 3. Karas (0.45) has the lowest SiC Index
(Table 14).
13
Table 14: Sic Index in 12-year-old children in Namibia
Region
Name
SIC
Highest DMFT recorded
National
2.32
10
1
Caprivi
5.85
10
2
Erongo
3.75
10
3
Hardap
2.45
7
4
Karas
0.45
2
5
Kavango
3.25
5
6
Khomas
1.15
5
7
Kunene
0.90
3
8
Ohangwena
2.10
5
9
Omaheke
1.40
4
10
Omusati
2.20
6
11
Oshana
1.75
6
12
Oshikoto
1.50
5
13
Otjozonjupa
0.61
2
4.3
AGE GROUP 15 YEAR OLDS
4.3.1 Dental Caries
Table 15: Prevalence of dental caries and untreated caries in permanent teeth of
15-year-olds
Region
%Caries
% Untreated caries
% UTN
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
45.04
100.00
60.00
43.33
16.67
71.19
36.67
18.33
46.67
25.00
38.10
43.33
28.33
38.67
40.35
100.00
48.33
38.33
16.67
57.63
30.00
13.33
45.00
15.00
31.75
38.33
20.00
24.00
89.59
100.00
80.55
88.46
100.00
80.95
81.81
72.72
96.42
60.00
83.33
88.46
70.60
62.06
More than half (55%) of 15-year-olds are caries free, but with wide variation between the different areas of
Namibia. In Caprivi no one is caries free, while Karas has the highest proportion of caries free 15-year-olds
(83.3%). All the regions, except Caprivi, Erongo and Kavango, have over 50% caries free 15-year-olds.Based
on the weighted national mean the UTN for the 15-year-olds is 89.6%, nearly 90% of all caries go untreated.
Large variation also occurs in the UTN for the different regions of Namibia, with Omaheke (60.0%) and
Otjozonjupa (62.1%) having the least untreated caries. Although Karas has the least caries, all of it is
untreated (Table 15).
Untreated caries (decayed component) are the highest level, with low levels of missing teeth and negligible
levels of filled teeth. The national DMFT of 1.11can be regarded as low in terms of the WHO classification
14
for dental caries for this age group (Barnes, 1977). Caprivi (3.03) and Kavango (2.32) have the highest DMFT
of all the regions (Table 16).
Table 16: Distribution of the mean DMFT and the components of the DMFT in
permanent teeth of 15-year-olds
Region
DMFT
D
M
F
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
1.11
3.03
1.08
0.88
0.33
2.32
0.75
0.40
1.13
0.40
0.75
1.02
0.62
0.72
0.80
2.40
0.58
0.73
0.28
1.59
0.53
0.22
0.93
0.20
0.51
0.65
0.33
0.35
0.27
0.57
0.40
0.12
0.05
0.58
0.17
0.18
0.20
0.18
0.24
0.33
0.28
0.31
0.03
0.07
0.10
0.03
0.00
0.15
0.05
0.00
0.00
0.02
0.00
0.03
0.00
0.07
needing care in 15-year-olds
Region
% Needing care
National 15 weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
40.35
100.00
48.33
38.33
16.67
57.63
30.00
13.33
45.00
15.00
31.75
38.33
20.00
24.00
0.80
2.40
0.58
0.73
0.28
1.59
0.53
0.22
0.93
0.20
0.51
0.65
0.33
0.35
The percentage of 15-year-old children who need treatment for dental caries is 40.4%, with the regions
ranges from 13.3% in Kunene to 100% in Caprivi. Except Caprivi and Kavango, less than 50% are in need for
treatment in the other regions. Nationally, the mean number of teeth needing care per child is 0.8, while in
the regions it ranges between 0.2 and 2.4.
15
mean number of teeth needing care in 15- year-olds
Region
Preventive
Fillings
Crown + Veneer
Pulp care
Extractions
Other care
Not recorded
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.03
0.02
0.00
0.00
0.48
1.00
0.18
0.35
0.20
1.03
0.30
0.07
0.65
0.10
0.40
0.18
0.28
0.17
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.02
0.00
0.00
0.29
1.38
0.33
0.37
0.08
0.46
0.18
0.15
0.28
0.07
0.06
0.42
0.03
0.16
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.02
0.00
0.02
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.02
0.00
0.00
care is shown Table 18. Fillings and extractions were the most common need in all the regions.
Table 19: Prevalence and severity of periodontal diseases in 15-year-old children
Region
Weighted
national mean
Caprivi
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozondjupa
Healthy
%
Mean
Bleeding
%
Mean
Calculus
%
Mean
Shallow pockets
%
Mean
Deep pockets
%
Mean
Not recorded
%
Mean
38.66
3.99
17.29
0.92
44.05
1.08
0.00
0.00
0.00
0.00
0.00
0.01
8.33
45.00
60.00
0.00
74.58
43.33
11.67
26.67
21.67
4.76
50.83
44.00
3.15
4.62
4.23
1.30
5.61
3.48
3.50
4.18
4.00
2.02
4.73
4.40
15.00
38.33
21.67
41.67
1.69
35.00
56.67
11.67
10.00
6.35
22.50
0.00
0.90
0.85
1.28
3.40
0.03
2.00
2.05
0.38
0.55
0.86
0.88
0.11
76.67
16.67
18.33
58.33
23.73
21.67
31.67
61.67
68.33
88.89
26.67
56.00
1.87
0.33
0.48
1.30
0.36
0.50
0.45
1.32
1.43
3.13
0.39
1.49
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.08
0.00
0.00
0.00
0.00
0.02
0.00
0.12
0.02
0.00
0.00
0.00
Although 38.7% of the 15-year-old children presented with healthy periodontal tissues, the gingivitis-calculus
complex dominates as the most common periodontal condition (44.1%) nationally (Table 19).
A similar pattern was observed in Caprivi, Kavango and Oshana, but with less than 10% with healthy pockets
and the gingivitis-calculus complex dominates as the most common periodontal condition (58.3% - 88.9%).
In Hardap, Karas and Kunene healthy periodontal tissues dominates (over 40%), followed by bleeding
periodontal tissues (21.7% - 38.3%) and only then Calculus (16.7% - 21.7%).
Khomas has the healthiest periodontal tissue (74.6%) with very little bleeding tissues (1.7%) and 21.7%
calculus. In Oshikoto 50.8% 15-year-olds presented with healthy periodontal tissues with similar proportions
of bleeding and calculus tissues, 22.5% and 26.7% respectively. Otjozondjupa shares a profile similar to that
of the national figures. No shallow or deep pockets were observed.
16
4.4
AGE GROUP 35-44 YEAR OLDS
4.4.1 Dental Caries
Table 20: Prevalence of dental caries & untreated caries in permanent teeth of
35-44-year-olds
Age group (years)
% Caries
% Untreated caries
% UTN
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
66.65
100.00
71.67
76.67
70.69
98.33
68.33
66.67
77.59
59.68
78.33
53.33
68.85
64.58
46.20
100.00
46.67
40.00
44.83
83.33
56.67
28.33
48.28
17.74
53.33
20.00
42.62
20.83
69.32
100.00
65.12
52.17
63.42
84.75
82.94
42.49
62.22
29.73
68.08
37.50
61.90
32.25
Figure 3: Prevalence of dental caries in permanent teeth of 35-44-year-olds
120
100
80
60
40
% Caries
20
% Untreated Caries
% UTN
Otjozondupa
Oshikoto
Oshana
Omusati
Omaheke
Ohangwena
Kunene
Khomas
Kavango
Karas
Hardap
Erongo
Caprivi
National weighted
0
Just over a third (33.4%) of 35-44-year-olds in Namibia are caries-free, but with wide variation between the
different regions. In Caprivi no-one in the sample was caries-free, while Oshana has the highest proportion of
caries-free 35-44-year-olds (44.7%). All the regions have less than 50% caries-free 35-44-year-olds (Table 20).
Based on the weighted national mean the UTN for the 35-44-year-olds is 69.2%, which means that nearly
70% of all caries go untreated. Large variation also occurs in the UTN for the different regions of Namibia,
with Omaheke (29.7%) and Otjozonjupa (32.3%) having the least untreated caries.
17
In most regions the missing teeth component is higher than untreated caries (decayed component), with
lower levels of filled teeth (Table 21). The national DMFT is 3.0, with Karas (5.1) and Kavango (5.2) having
the highest DMFT of all the regions, followed by Caprivi (4.6), Omusati (4.3) and Khomas (4.0). The lowest
DMFT was recorded in Oshana (1.8). The Himba and Herero people live in the remote Opuwo district of
Kunene. Milk and meat form the bulk of their diet.
permanent teeth of 35-44-year-olds
Region
DMFT
D
M
F
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
3.00
4.61
2.28
4.28
5.12
5.22
4.00
2.52
3.31
2.24
4.27
1.80
2.31
2.08
1.21
2.97
0.77
1.38
1.45
2.73
1.53
0.40
1.05
0.40
2.08
0.30
0.98
0.52
1.57
1.61
1.33
2.22
3.40
2.03
2.47
1.98
1.86
1.35
2.12
1.18
1.30
1.29
0.22
0.03
0.18
0.68
0.28
0.45
0.00
0.13
0.40
0.48
0.07
0.32
0.03
0.27
Figure 4: Distribution of the mean DMTF and the components of the DMFT in
6
5
4
3
2
DMFT
D
1
M
F
Otjozondupa
Oshikoto
Oshana
Omusati
Omaheke
Ohangwena
Kunene
Khomas
Kavango
Karas
Hardap
Erongo
Caprivi
National weighted
0
The percentage of 35-44-year-old people in Namibia who need treatment for dental caries is 44.2%, with the
regions ranging from 17.7% in Omaheke to 100% in Caprivi (Table 22). Except for Caprivi, Kavango, Omusati
18
and Khomas, less than 50% are in need for treatment in the other regions. Nationally, the mean number of
teeth needing care in this age group is 1.2, while in the regions it ranges between 0.3 and nearly 3.0.
The Himba and Herero people live in the remote Opuwo district of Kunene have a tradition of removing
the four incisor teeth when they reach puberty and this may result in the M component being 1.98.
needing care in 35-44-year-olds
Region
% Needing care
National weighted
46.20
100.00
46.67
40.00
44.83
83.33
56.67
28.33
48.28
17.74
53.33
20.00
42.62
20.83
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
Mean number
of teeth
1.21
2.97
0.77
1.38
1.45
2.73
1.53
0.40
1.05
0.40
2.08
0.30
0.98
0.52
Region
Preventive
Fillings
Crown + Veneer
Pulp care
Extractions
Other care
Not recorded
National
weighted
0.00
0.45
0.00
0.00
0.66
0.00
0.02
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.54
0.03
0.30
0.59
0.45
0.33
0.22
0.66
0.02
1.18
0.20
0.57
0.40
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.34
0.25
0.78
0.84
2.18
1.18
0.17
0.40
0.39
0.88
0.08
0.34
0.06
0.00
0.00
0.00
0.00
0.00
0.02
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.08
0.02
0.28
0.00
0.02
0.00
0.02
0.00
0.00
0.00
0.00
0.00
0.00
care is shown in the above table. Fillings and extractions were the most common need in all the regions
(Table 23).
19
Table 24: Prevalence and severity of periodontal diseases in 35-44-year-old people in
Namibia
Healthy
Bleeding
Calculus
Shallow pockets
%
Mean %
Mean %
Mean
%
Mean
National weighted 20.15 2.90
14.67 0.92
53.70 1.83
8.00
0.17
Caprivi
4.92
1.77
3.28
0.69
75.41 3.10
8.20
0.15
Hardap
38.33 3.15
25.00 1.28
33.33 1.18
3.33
0.05
Karas
10.00 2.17
0.00
0.10
65.00 2.85
23.33
0.63
Kavango
5.17
1.29
17.24 1.97
36.21 1.36
31.03
0.72
Khomas
35.00 4.45
0.00
0.18
58.33 1.27
1.67
0.02
Kunene
28.33 2.55
40.00 2.12
31.67 0.93
0.00
0.00
Ohangwena
15.00 3.02
20.00 0.98
46.67 1.45
6.67
0.22
Omaheke
17.24 3.03
1.72
0.67
70.69 2.10
8.62
0.14
Omusati
8.06
2.44
6.45
0.26
79.03 3.08
6.45
0.11
Oshana
1.67
1.53
3.33
0.62
80.00 3.47
15.00
0.18
Oshikoto
8.20
1.51
18.03 1.11
60.66 2.87
6.56
0.26
Otjozondjupa
25.53 3.66
4.26
0.13
59.57 1.94
6.38
0.11
Region
Deep pockets
%
Mean
3.41
0.06
8.20
0.16
0.00
0.00
1.67
0.03
8.62
0.09
5.00
0.07
0.00
0.00
11.67 0.20
1.72
0.02
0.00
0.00
0.00
0.00
6.56
0.23
4.26
0.04
Not recorded
%
Mean
0.08 0.10
0.00 0.11
0.00 0.12
0.00 0.22
1.72 0.57
0.00 0.02
0.00 0.40
0.00 0.13
0.00 0.03
0.00 0.11
0.00 0.20
0.00 0.02
0.00 0.13
Except for Hardap where the gingivitis-calculus complex dominates as the most common periodontal
condition. Nationally 53.7% have calculus, followed by 20.2% healthy and 14.7% bleeding. Hardap have
similar numbers of people with healthy, bleeding and calculus ranging from 25.0% to 38.3% (Table 24).
Oshana (80.0%) has the highest proportion of calculus, followed by Omusati with 79.7%. Kunene has the lowest
proportion of calculus (31.7%). Oshana has the lowest proportion of healthy sextents and at the same time
the highest proportion calculus.The highest proportion of shallow pockets were observed in Kavango (31.0%),
followed by Karas (23.3%). The highest proportion of deep pockets was observed in Ohangwena (11.7%). v and
smoking could be a contributing factor in the regions with high levels of periodontal disease.
4.5
AGE GROUP 65-74 YEARS OLD
4.5.1 Dental Caries
Table 25: The prevalence of dental caries and untreated caries in permanent teeth
of 65-74-year-olds
Age group (years)
National weighted
% Caries
92.20
Caprivi
100.00
Erongo
84.75
Hardap
Karas
98.21
Kavango
100.00
Khomas
96.67
Kunene
95.00
Ohangwena
95.16
Omaheke
93.10
Omusati
95.00
Oshana
88.33
Oshikoto
86.67
Otjozonjupa
100.00
**No caries status data were recorded for Hardap.
20
% Untreated caries
% UTN
52.71
95.00
52.54
42.86
75.00
50.00
35.00
59.68
41.38
56.67
28.33
41.67
11.11
57.17
95.00
61.99
43.64
75.00
51.72
36.84
62.72
44.45
59.65
32.07
48.08
11.11
Figure 5: The prevalence of dental caries and untreated caries in permanent teeth of
65-74-year-old
120
100
80
60
40
% Caries 92.210084.75-
20
% Untreated Caries 52.71
9552.54% UTN 57.179561.99-
Otjozondupa
Oshikoto
Oshana
Omusati
Omaheke
Ohangwena
Kunene
Khomas
Kavango
Karas
0
Nationally only 7.8% of 65-74-year-olds are caries-free, with Erongo having the highest proportion (15.3%),
while in Caprivi, Kavango and Otjozonjupa none in this age group were recorded as caries-free (Table 25).
Based on the weighted national mean the UTN for the 65-74-year-olds is 57.2%, which means that nearly 60%
of all caries in this age group go untreated. Large variation occurs in the UTN for the different regions with
Otjozonjupa (11.1%) having the least untreated caries. The severity of dental caries expressed as the mean
DMFT and the components of the DMFT in Namibia and the different regions, is shown in Table 26. The
results of the survey show that the missing teeth component dominates in this age group.The national DMFT
is 6.9, with Khomas (15.1) having the highest DMFT of all the regions and Kunene (5.9) and Oshana (6.0) the
lowest. Nationally the missing component is 5.2, with Khomas also having the highest missing component
(13.7). The lowest missing component was recorded in Ohangwena and Caprivi, both almost 4.4.
Region
DMFT
D
M
F
National weighted
6.89
8.47
7.22
13.88
6.57
15.13
5.90
6.39
12.03
6.47
5.95
7.40
11.33
1.58
4.02
1.76
0.96
2.37
1.27
0.70
1.76
1.55
1.58
0.63
1.05
0.28
5.23
4.43
5.34
12.79
3.87
13.73
5.20
4.35
9.83
4.88
5.30
6.33
11.06
0.08
0.02
0.12
0.13
0.33
0.13
0.00
0.27
0.66
0.00
0.02
0.02
0.00
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
21
Figure 6: Distribution of the mean DMTF and the components of the DMFT in
16
14
12
10
8
6
4
2
0
DMFT 6.89 8.477.22 D 1.58 4.02 1.76 M 5.23 4.43 5.34 -
Otjozondupa
Oshikoto
Oshana
Omusati
Omaheke
Ohangwena
Kunene
Khomas
Kavango
Karas
F 0.08 0.02 0.12 -
needing care in 65-74-year-olds
Region
% Needing care
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
52.71
95.00
52.54
42.86
75.00
50.00
35.00
59.68
41.38
56.67
28.33
41.67
11.11
1.58
4.02
1.76
0.96
2.37
1.27
0.70
1.76
1.55
1.58
0.63
1.05
0.28
The percentage of 65-74-year-old people in Namibia who need treatment for dental caries is 52.7%, with the
regions ranging from 11.1% in Otjozonjupa to 95% in Caprivi. Nationally, the mean number of teeth needing
care in this age group is 1.6, while in the regions it ranges between 0.3 and 4.0 (Table 27).
22
Region
Preventive
Fillings
National weighted
Caprivi
Erongo
Hardap
Karas
Kavango
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozonjupa
0.03
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.24
0.00
0.02
0.02
0.00
0.00
0.28
0.95
0.17
0.00
0.23
0.25
0.15
0.00
0.24
0.22
0.30
0.08
0.32
0.17
Crown +
Veneer
0.00
0.02
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Pulp
care
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Extractions
1.17
2.90
0.71
0.00
0.68
2.00
1.08
0.65
1.19
1.24
1.18
0.48
0.65
0.11
Other
care
0.00
0.02
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Not
recorded
0.03
0.13
0.07
0.00
0.00
0.00
0.00
0.05
0.00
0.00
0.05
0.05
0.00
0.00
care is shown in the above table. Extractions were the most common need in all the regions (Table 28).
In this age group, calculus and shallow pockets dominates, with 51.5% and 23.7% respectively on a national
level. Deep pockets are also higher than having healthy periodontal tissues. No CPI was captured for Karas
as most of the patients were edentulous in one or both jaws (Table 29).
Table 29: Prevalence and severity of periodontal diseases in 65-74-year-old people in Namibia
Healthy
%
Mean
Bleeding
%
Mean
Calculus
%
Mean
Shallow pockets
%
Mean
Deep pockets
%
Mean
Not recorded
%
Mean
3.25
4.11
51.51
23.65
13.51
0.17
3.98
0.82
Caprivi
1.67
1.10
0.00
0.42
60.00 3.50
11.67
0.35
26.67
Hardap
10.17 0.93
27.12 1.53
42.37 1.34
11.86
0.19
6.78
Karas
Kavango
5.36
0.52
10.71 0.71
19.64 1.09
28.57
0.98
16.07
Khomas
5.00
2.28
1.67
0.30
60.00 2.78
18.33
0.37
15.00
Kunene
11.67 0.65
16.67 0.85
35.00 0.88
5.00
0.05
0.00
Ohangwena
5.00
2.10
5.00
0.25
55.00 2.55
10.00
0.15
20.00
Omaheke
0.00
1.21
0.00
0.50
46.77 3.03
46.77
0.76
6.45
Omusati
1.72
0.40
0.00
0.17
50.00 2.86
25.86
0.40
1.72
Oshana
0.00
0.25
0.00
0.22
70.00 4.48
16.67
0.30
10.00
Oshikoto
5.00
0.73
6.67
0.57
40.00 2.78
35.00
0.75
8.33
Otjozondjupa
5.26
0.42
0.00
0.11
5.26
1.11
21.05
1.58
68.42
0.50
0.07
0.27
0.18
0.00
0.35
0.11
0.02
0.17
0.12
1.16
0.00
1.69
19.64
0.00
31.67
5.00
0.00
20.69
3.33
5.00
0.00
0.12
1.08
2.43
0.08
3.57
0.60
0.39
2.16
0.58
1.05
1.63
Region
Weighted
national mean
0.91
0.52
3.03
0.47
No CPI was captured for Karas.
People in Oshana had the highest levels of calculus (70%), while Otjozondjupa had the lowest (5.3%), but at
the same time Otjozondjupa had the highest deep pockets (68.4%).
23
4.6
QUESTIONNAIRE DATA ANALYSIS
The oral health questionnaire consisted of 13 variables that included presence of pain and discomfort, perception
of their oral health, visits to dentist and cleaning of teeth and gums. The questionnaire data was analysed by
looking at four variables (i) pain/discomfort; (ii) perceptions of oral health; (iii) visit to the dentist and (iv) use of
toothpaste. In view of the oral health status findings described above, In view of the caries status, it was decided
to group together the areas with a caries level of higher than 55% (Caprivi, Erongo, Kavango and Ohangwena)
and the rest of the country. Erongo however, did not complete the oral health questionnaire.A logistic regression
was done to assess the effect of (i) pain/discomfort; (ii) perceptions of oral health; (iii) visit to the dentist and
(iv) use of toothpaste on the region (Cap/Kav/Ohang vs rest of Namibia), while controlling for caries status.
Table 30: Odds Ratio Estimates for Pain/Discomfort
Age group
5-6
12
15
35-44
65-74
Odds
95% Wald
Effect Ratio Confidence Limits
pain
1 vs 2
1.685
1.193
2.380
dmftall
pain
Caries vs Sound
1 vs 2
2.237
1.870
1.598
1.336
3.132
2.618
dmftall
pain
Caries vs Sound
1 vs 2
3.644
1.154
2.601
0.812
5.104
1.639
dmftall
pain
Caries vs Sound
1 vs 2
4.075
1.975
2.882
1.326
5.761
2.944
dmftall
pain
Caries vs Sound
1 vs 2
4.720
1.942
2.791
1.367
7.984
2.759
dmftall
Caries vs Sound
9.397
3.533
24.998
In the 5-6 year age group, a significant association between pain/discomfort and whether they are from
Cap/Kav/Ohang was found OR=1.685 (1.193-2.380). For all other age groups, except 35-44 year olds,
they were significantly more likely to report pain/discomfort if they were from the Cap/Kav/Ohang area
(Table 30) and this could be a reflection of the high unmet treatment needs in these communities together
with the challenges related to lack of infrastructure, and the shortage of staff, dental equipment and
materials. It was interesting to note that there was no significant association between the self-reporting of
excellent-good teeth and the region in which they lived (Table 31).
Table 31: Odds Ratio Estimates for Excellent/Good teeth
Age group
5-6
12
15
35-44
65-74
Odds
95% Wald
teethstat
1 vs 2
1.305
0.909
1.875
dmftall
Caries vs Sound
2.442
1.749
3.410
teethstat
1 vs 2
0.928
0.637
1.352
dmftall
Caries vs Sound
4.250
3.028
5.964
teethstat
1 vs 2
1.193
0.836
1.703
dmftall
Caries vs Sound
4.477
3.227
6.212
teethstat
1 vs 2
0.715
0.490
1.043
dmftall
Caries vs Sound
4.937
2.914
8.367
teethstat
1 vs 2
1.388
0.987
1.952
dmftall
Caries vs Sound
8.961
3.360
23.895
After controlling for caries status, a significant association was found for the 5-6 year olds between a visit to
the dentist in the past 12 months and whether they are from Cap/Kav/Ohang was OR=0.293 (0.144-0.595).
24
The association for never visiting a dentist and residing in Cap/Kav/Ohang was OR=0.745 (0.429-1.291)
(Table 32). For the 12 year olds a similar association for a 12-month visit was found OR=0.670 (0.397-1.130),
but the association for never visiting a dentist and residing in Cap/Kav/Ohang was OR=1.409 (0.893-2.224).
For the 15-year and 35-44 year olds, the association between a visit to the dentist in the past 12 months and
whether they are from Cap/Kav/Ohang was significant OR=1.589 (0.935-2.700) and OR=1.876 (1.196-2.942)
respectively. In addition, a significant association was in 15 year olds between never having a dentist visit
and residing in Cap/Kav/Ohang OR=1.962 (1.238 3.110). A similar, but not significant, association for the
35-44 year olds was found between never having a dentist visit and residing in Cap/Kav/Ohang OR=1.550
(0.950-2.529). For the 65-74 year olds the associations was as follows: having a 12 month dental visit OR=0.665
(0.395-1.120) and never having a dentist visit OR=0.213 (0.132-0.344)
Table 32: Odds Ratio Estimates for Visit to dentist
Age group
5-6
12
15
35-44
65-74
Odds
95% Wald
dentist Last 12 months vs
Previously
0.293
0.144
0.595
dentist Never
vs
Previously
0.745
0.429
1.291
dmftall Caries
vs
Sound
1.576
1.024
2.426
Previously
0.670
0.397
1.130
dentist Never
vs
Previously
1.409
0.893
2.224
dmftall Caries
vs
Sound
5.101
3.592
7.245
Previously
1.589
0.935
2.700
dentist Never
vs
Previously
1.962
1.238
3.110
dmftall Caries
vs
Sound
4.164
2.928
5.920
Previously
1.876
1.196
2.942
dentist Never
vs
Previously
1.550
0.950
2.529
dmftall Caries
vs
Sound
6.193
3.486
11.004
Previously
0.665
0.395
1.120
dentist Never
vs
Previously
0.213
0.132
0.344
dmftall Caries
vs
Sound
9.431
3.518
25.282
After controlling for caries status, the use of toothpaste was significantly associated with whether they are
residing in Cap/Kav/Ohang in all age groups except the 65-74 year olds. In all the age groups people residing
in Cap/Kav/Ohang were less likely to use toothpaste in than in the rest of Namibia (Table 33).
Table 33: Odds Ratio Estimates for using toothpaste
Age group
5-6
12
15
35-44
65-74
Odds
95% Wald
toothpaste
dmftall
toothpaste
dmftall
toothpaste
dmftall
toothpaste
dmftall
toothpaste
dmftall
1Yes vs 2No
0.493
0.341
0.712
Caries vs Sound
2.254
1.606
3.163
1Yes vs 2No
0.187
0.128
0.273
Caries vs Sound
3.995
2.821
5.658
1Yes vs 2No
0.128
0.062
0.263
Caries vs Sound
5.245
3.081
8.930
1Yes vs 2No
0.128
0 .062
0.263
Caries vs Sound
5.245
3 .081
8.930
1Yes vs 2No
0.831
0.589
1.174
Caries vs Sound
9.516
3.578
25.314
25
5.
CONCLUSIONS AND RECOMMENDATIONS
5.1CHALLENGES
Namibia is the country with the population of about 2million. The population distribution is skewed with
the northern part more densely populated than the southern part. This population distribution poses
different challenges in different regions. The country is divided into 13 regions. Currently all the regions
are rendering dental services, however, the main challenges are shortage of staff, dental equipment and
materials. Lack of personnel is of particular concern in the larger districts and in regions with bigger
populations. Populations in the more rural areas are often inaccessible as are the services to them. Lack of
resources such as finances, skilled man power and transport are some of the factors that are barriers to
accessing to care.
Patient factors: It has been surmised that the reason for the mainly extractions services provided is that
most patients present late with often untreatable large carious lesions. Unmet treatment need index is high
due to negligence and lack of oral health care on the part of the public. Furthermore, poor social habits,
such as drinking alcohol and smoking, which are prevalent in the region, could be a contributing factor to
the levels of caries and periodontal disease especially among the 35-44 and 65-74 age groups.
5.2 DENTAL CARIES
According to the WHO standards dental caries severity for 12 year olds in Namibia ranges between very
low and low. Although caries levels could be regarded as low in terms of the WHO classification, the high
levels of untreated caries in many of the regions are a cause for concern. In these regions provided with
water by a particular water provider, it is recommended that the implementation of water fluoridation be
evaluated and that the following should be taken into account:
•
•
•
•
•
The level of caries in an area provided with water by a particular, water provider.
The cost of the implementation of water fluoridation for the particular water provider.
The level of fluorosis in the region or area concerned
The fluoride content of the drinking water.
Trends in dental caries prevalence and severity.
It is clear that other means of achieving oral health need to be explored, including selective community water
fluoridation and/or the use of fluoridated toothpaste in combination with fissure sealants.The treatment of
caries can include the atraumatic restorative treatment, which has been shown to be effective in managing
dental caries, especially among children (Motsei, Kroon, and Holtshousen, 2001). The provision of mobile
dental units could be an alternative means for providing dental services in remote areas of the Namibia
where facilities are not available. This is part of strengthening outreach services by taking services to the
people. The present high unmet oral health needs in the more disadvantaged communities would justify the
implementation of such a measure.
Every effort should be made to encourage and promote the positive dietary habits of the population. It is
important to limit the frequency of cariogenic snacks and drinks through aggressive health education and
positive anti-sugar policies.
5.3 PERIODONTAL DISEASES
The observation of endemic gingivitis and calculus accumulation with a low prevalence of advanced
periodontal diseases has significant implications for oral health services. It implies that a periodontal care
programme will have to be aimed to control slowly progressing chronic inflammatory disease, and this
could entail scaling, polishing and oral hygiene instruction.Without negating the ultimate need and long-term
goal for calculus removal, it may be a practical necessity to direct the focus of care to promoting self-care
26
and that this should take priority over scaling (Pilot, 1987). This approach will not only manage the present
situation efficiently, but will lead to lower calculus figures in future generations.
5.4RECOMMENDATIONS
• Regular screening of primary school children and increased compliance from parents and children.
• Integration of smiling school health into Healthy School Initiatives
• Scaling and polishing as well as good oral hygiene education to improve the periodontal status.
• Oral diseases prevention and Oral health promotion interventions included into a comprehensive
Primary Health Care Services
• Optimal level of resources including funds, standard infrastructure and oral health personnel in all
districts.
6.REFERENCES
Bratthall D. 2000. Introducing the Significant Caries Index together with a proposal for a new global oral
health goal for 12-yearolds. International Dental Journal, 50(6): 378–84.
Jong, A. 1981. Dental Public Health and Community Dentistry. St Louis: CV Mosby Company. p. 79.
Louw, AJ, Carstens, IL. Barrie, RB, & Hayward, MA. 1994. Periodontal profile and treatment needs of the
urban white community of the Namibia. In National Oral Health Survey: South Africa, 1988/89 ed. PJ van
Wyk. P.87-92. Pretoria: Department of Health.
Motsei, SM. Kroon J, Holtshousen, WSJ. 2001. Evaluation of Atraumatic restorative treatment restorations
and sealants under field conditions. South African Dental Journal. 56 (7): 309-315.
National Oral Health Promotion Program Policy and Guidelines. 1998. Ministry of Health and Social
Services. Namibia Nishi Metal. 2002 Caries experience of some countries and areas expressed by the
Significant Caries Index. Community Dentistry and Oral Epidemiology, 30(4): 296–301.
Pilot T. 1987. An update on periodontal conditions in adults measured by CPITN. International Dental
Journal, vol.37, p.169-172.
Priwe C, Herunga, N (1997). Oral Health Among Primary School Children in Namibia IADR First Joint
Congress of the South African division. Cape Town.
Schier GM. 1993. Oral Health in Namibia. A pathfinder survey. A dissertation for the Degree of Masters
of science in dentistry, Faculty of Dentistry, University of Witwatersrand, Johannesburg.
World Health Organisation. 1997. Oral Health Survey: Basic Methods, 4th ed. Geneva: World Health
Organisation.
27
APPENDIXES
APPENDIX 1
Data capture form
Namibian National Oral Health Survey 2010
ORAL HEALTH SURVEY FORM
Name: ________________________________________________________________________
Year
Day
Month
Identification number
Examiner No.
Sex
Date of Birth (YYMMDD)
1=M,2=F
Age in years
Urban 1,
Region
Rural 2
CARIES STATUS AND TREATMENT NEEDS
17
16
47
46
55
15
54
14
53
13
52
12
51
11
61
21
62
22
63
23
64
24
65
25
45
85
44
84
43
83
42
82
41
81
31
71
32
72
33
73
34
74
35
75
26
27
36
37
Status
Treatment
Status
Treatment
Primary
tooth
A
TREATMENT
Sound
Permanent
tooth
0
None
0
Decayed
1
B
Preventive, caries arresting care
P
Filled & decayed
2
C
Fissure sealant
F
Filled, no decay
3
D
1 Surface filling
1
Missing due to caries
4
E
2 or more surface filling
2
Missing any other reason
5
Crown for any reason
3
Fissure sealant
6
F
Veneer or laminate
4
Bridge abutment/special crown or
veneer/implant
7
G
Pulp care and restoration
5
Unerupted tooth
8
Extraction
6
Trauma (fracture)
T
Need for other care (specify)
8
Not recorded
9
Not recorded
9
STATUS
28
T
PERIODONTAL STATUS (CPI) DENTURE STATUS
16
11
26
46
31
36
Upper
0 = Healthy
1 = Bleeding
2 = Calculus
3 = Shallow Pocket
4 = Deep Pocket
6 = Excluded Sextant
Lower
0 = No Denture
1 = Partial Denture
2 = Complete denture
Dental Trauma:
Please ask how the trauma was caused (falls, while playing, in a fight etc)
………………………………………………………………………….………………………………….......
12
11
21
22
42
41
31
32
Trauma:
Code
Fracture of enamel only
1
Fracture of enamel and dentine, without pulp involvement
2
Fracture of enamel and dentine with pulp involvement
3
Discolorations of the tooth, with or without a sinus
4
Displacement, extrusion, intrusion, and lateral displacement
5
Tooth loss as a result of trauma
6
Tooth restored by composite or crown following fracture
7
Treatment provided:
12
11
21
22
42
41
31
32
Type of treatment provided, if any
Code
Untreated trauma
1
Acid etch restoration
2
Permanent crown
3
Denture due to trauma
4
Other restoration (specify) .…………………………………………..………………………………......... 9
29
Treatment need:
12
11
21
22
42
41
31
32
Type of treatment needed, if any
Code
No treatment needs
1
Acid etch restoration
2
Permanent crown
3
Denture
4
Acid etch restoration & endodontic treatment
5
Acid etch restoration, endodontic treatment & bleaching
6
Permanent crown & endodontic treatment
7
Other restoration (specify) …………………………………….....…………..........................................…..… 9
30
APPENDIX 2: Report on Calibration Exercise for DMFT
Following the calibration exercise held from 8 – 11 November 2010 in Windhoek, the following agreement
levels were obtained by the dentists being calibrated:
Names
Region
Kappa DMFT
Agreement
Dr Esteban Santana
OTJOZONDJUPA
1.00
Good
Dr Rosalia Ndilenga
OSHANA
0.95
Good
Dr Vaino Shipombo
OHANGWENA
1.00
Good
Dr Revival Geises
OSHIKOTO
0.95
Good
Dr Lucill Appolus
ERONGO
0.92
Good
Dr Alex Thopil
HARDAP
0.95
Good
Dr Arthur Chigova
KARAS
0.87
Good
Dr Iven Mpofu
OMAHEKE
0.91
Good
Dr Francis Mburu
OMUSATI
0.87
Good
Mr Mulenga Chisala
KAVANGO
0.93
Good
Ms Tina Marodza
KUNENE
0.87
Good
Mr Bernard Musonda
CAPRIVI
0.94
Good
Dr Christine Tenga
KHOMAS
0.92
Good
We consider the examiners to have been calibrated to an acceptable level.
Prof. S Naidoo
Dr RB Barrie
31
PPENDIX 3: Record of informed consent to conduct interview
Date:
Interviewer’s name: ........................................................
Tel: (264) 0812065253
Facility: ...............................................................................
Interviewee’s number:....................................................
E-mail: .........................................................................
Place at which the interview was conducted:
Thank you for allowing me to interview you. What follows is an explanation of the purpose and process of
this interview. You are asked to give your consent for me to conduct an interview with you and to use this
data for improving quality of oral health services in Namibia.
1.
Purpose and contents of interview
To generate oral health knowledge in Namibia that will contribute to the revision of the oral health
policy, planning of interventions and act as a baseline for future monitoring and evaluation.
2.
The interview process
This will consist of an individual interview using a questionnaire. I will read out each question to you
and ask for your answer. Answering the questionnaire will take approximately thirty minutes and will
be conducted in an isolated room. Only the researcher will hear your answers.
3.
Anonymity of participants
At all times, I will keep all your information confidential and anonymous. I will only refer to you or
your words by a randomly assigned number. I shall keep records of your participation locked away at
all times, and destroy them after the data is collected. Only I will have access to your data.
4.
Things that may affect your willingness to participate
The interview may touch on issues which are sensitive.. If there is anything that you prefer not to discuss
please feel free to say so. I will not be offended and there will be no negative consequences if you would
prefer not to answer a question. I would appreciate your guidance should I ask anything which you see
as intrusive. You can withdraw from the interview at any time during the process and there will be no
consequences. Should you request it, a copy of this consent form will be provided to you.
5.Agreement
5.1
Interviewee’s agreement
If you are willing to participate in the research then please sign and put the date below.
Signed (interviewee): .................................................
Date: ..............................................................................
Place: ...........................................................................
5.2 Interviewer’s agreement
I shall keep the contents of the above research interview confidential. A randomly assigned
number will be used instead of real names in all documents that refer to the interview. The
contents will be used for the purposes referred to above, but may be used for published or
unpublished research at a later stage without further consent. Any change from this agreement
will be renegotiated with you.
Signed (interviewer): ...................................................
Date: ................................................................................
32
Place: ...........................................................................
Appendix 4
ORAL HEALTH QUESTIONNAIRE
FOR CHILDREN
2010
World Health Organization, Oral Health Programme Appia, CH-1211 Geneva 27, Switzerland Tel.: +41 22 791 3475 20 Avenue
Fax: +41 22 791 4866
33
ORAL HEALTH QUESTIONNAIRE FOR CHILDREN
Page 1
First we would like you to answer some questions concerning yourself and
your teeth
Identification number 1.
2. 1
Sex Boy Girl Location
Urban Periurban 4 1 2 1
2 3
How old are you today?
(Years)
3. How would you describe the health of your teeth and gums?
Teeth Excellent......................................................................  1 Very good....................................................................  2
Good............................................................................  3
Average ......................................................................  4
Poor ............................................................................  5
Very poor ..................................................................  6
Don’t know ...............................................................  9
4.
Gums
1
2
3
4
5
6
9
How often during the past 12 months did you have toothache or feel discomfort
on account of your teeth?
34
Rural
Often......................................................................................................  1
Occasionally..........................................................................................  2
Rarely ....................................................................................................  3
Never ....................................................................................................  4
Don’t know ..........................................................................................  9
Page 2
Now some questions on dental care
5.
How often did you go to the dentist during the last 12 months?
(One answer only)
Once ....................................................................................................... 1
Twice........................................................................................................ 2
Three times............................................................................................ 3
Four times.............................................................................................. 4
More than four times ......................................................................... 5
I had no visit to dentist during the last 12 months ..................... 6
I have never received dental care/visited a dentist....................... 7
I don’t know/don’t remember............................................................ 9
If you did not visit the dentist during the last 12 months, go on to question 7
6.
What was the reason of your last visit to the dentist?
(One answer only)
7.
Pain or trouble with teeth, gums or mouth................................... 1
Treatment/follow-up treatment ....................................................... 2
Routine check-up of teeth/treatment ............................................ 3
I don’t know/don’t remember............................................................ 9
How often do you clean your teeth?
(One answer only)
Never ...................................................................................................... 1
Several times a month (2-3 times) ................................................... 2
Once a week ......................................................................................... 3
Several times a week (2-6 times) ..................................................... 4
Once a day.............................................................................................. 5
2 or more times a day ........................................................................ 6
35
Page 3
8. Do you use any of the following to clean your teeth or gums?
(State each item)
Yes 1
Toothbrush ....................................................................  Wooden toothpicks.....................................................  Plastic toothpicks..........................................................  Thread (dental floss)....................................................  Charcoal .........................................................................  Chewstick/miswak .......................................................  Other................................................................................  No
2







Please specify _____________________________________________
_____________________________________________
9. Yes a) Do you use toothpaste to clean your teeth?.....................................................  1 Yes No
b) Do you use toothpaste containing fluoride?................................  1  2
No
2
Don’t
know
9
10. Because of the state of your teeth and mouth, have you experienced any of the
following problems during the past year?
Yes
No
1
2
a) 

b) 

c) d) 



e) f) 



Yes
No
1
2
I am not satisfied with the appearance of my teeth .......................... 

I often avoid smiling and laughing because of my teeth .................... 

Other children make fun of my teeth.................................................... 

Toothache or discomfort caused by my teeth forced me to
miss classes at school or for whole days 

I have difficulty biting hard foods............................................................. 

I have difficulty in chewing .......................................................................  
36
Don’t
know
0






Page 4
11. How often do you eat or drink any of the following foods,
even in small quantities?
(Read each item)
Several times a day 6
Fresh fruit ..............................  Biscuits, cakes, cream
cakes, sweet pies,
buns etc...................................  Lemonade, Coca Cola
or other soft drinks ............. Jam/honey................................  Chewing gum
containing sugar .................... Sweets/candy..........................  Milk with sugar .....................  Tea with sugar .......................  Several Every day 5

Several
times a week 4

Once a week 3

times
a month Never
2
1





































(Insert country-specific items)
12. How often do you use any of the following types of tobacco?
(Read each item)
I smoke cigarettes,
pipe or cigars .......................
I use chewing
tobacco or snuff ..................
Several Every day 6
Several
times a week 5
Once a week 4
times
a month
3
Seldom 2
Never
1












37
Page 5
13. What level of education has your father completed (stepfather,
guardian or other male adult living with you)?
No formal schooling.............................................................................................................................. 1
Less than primary school .................................................................................................................... 2
2 Primary school completed...............................................................................................................  3
Secondary school completed.............................................................................................................. 4
High school completed ........................................................................................................................ 5
College/University completed............................................................................................................. 6
No male adult in household ............................................................................................................... 7
Don’t know ............................................................................................................................................. 9
(Insert country-specific categories)
That completes our questionnaire
Thank you very much for your cooperation!
Year Month Day Interviewer: ..................................................................................................................................................................
District: .........................................................................................................................................................................
Country: .......................................................................................................................................................................
38
Appendix 5
ORAL HEALTH QUESTIONNAIRE
FOR ADULTS
2010
World Health Organization, Oral Health Programme Appia, CH-1211 Geneva 27, Switzerland Tel.: +41 22 791 3475 20 Avenue
Fax: +41 22 791 4866
39
ORAL HEALTH QUESTIONNAIRE FOR ADULTS
Identification number 1.
1
4
Page 1
SexLocation
Male Female Urban Periurban Rural
1
2
1
2
3
2. How old are you today? ___________________________
(Years)
3.
How many natural teeth do you have?
4.
During the past 12 months did your teeth or mouth cause any pain or discomfort?
5.
No natural teeth .................................................................................  0
1-9 teeth ...............................................................................................  1
10-19 teeth ...........................................................................................  2
20 teeth or more ................................................................................  3
Yes ...........................................................................................................  1
No............................................................................................................  2
Don’t know ..........................................................................................  9
No answer ............................................................................................  0
Do you have any removable dentures?
(Read each item)
Yes No
1
2
A partial denture? .................................................................... 

A full upper denture?............................................................... 

A full lower denture?............................................................... 

6.
How would you describe the state of your teeth and gums? Is it “excellent”,
“very good”, “good”, “average”, “poor”, or “very poor”?
Teeth
Gums
Excellent..................................................................................  1
1
Very good................................................................................ 2
2
Good .......................................................................................  3
3
Average ................................................................................... 4
4
Poor ........................................................................................  5
5
Very poor................................................................................  6
6
Don’t know ...........................................................................  9
9
40
ORAL HEALTH QUESTIONNAIRE FOR ADULTS
7.
Page 2
How often do you clean your teeth?
Never ....................................................................................................  1
Once a month ....................................................................................  2
2-3 times a month..............................................................................  3
Once a week ......................................................................................  4
2-6 times a week ...............................................................................  5
Once a day............................................................................................  6
Twice or more a day...........................................................................  7
8. Do you use any of the following to clean your teeth?
(State each item)
Yes
1
Toothbrush ........................................................................... 
Wooden toothpicks............................................................ 
Plastic toothpicks?............................................................... 
Thread (dental floss)........................................................... 
Charcoal ............................................................................... 
Chewstick/miswak............................................................... 
Other...................................................................................... 
Please specify ....................................................................... 
No
2








9. Yes No
a) Do you use toothpaste to clean your teeth............................................  1  2
Yes No Don’t
know
b) Do you use toothpaste containing fluoride?............................................  1  2  9
41
ORAL HEALTH QUESTIONNAIRE FOR ADULTS Page 3
10. How long is it since you last have seen a dentist?
Less than 6 months............................................................................................................................... 1
6-12 months...........................................................................................................................................  2
More than 1 year but less than 2 years...........................................................................................  3
2 years or more but less than 5 years ............................................................................................ 4
5 years or more ...................................................................................................................................  5
Never received dental care ...............................................................................................................  6
11. What was the reason of your last visit to the dentist?
Consultation/advise..............................................................................................................................  1
Pain or trouble with teeth, gums or mouth...................................................................................  2
Treatment/ follow-up treatment ......................................................................................................  3
Routine check-up/treatment ............................................................................................................  4
Don’t know/don’t remember ...........................................................................................................  5
12. Because of the state of your teeth or mouth, how often have you experienced any of the following problems during the past 12 months?
Very Fairly Some
Don’t often
timesNo often
know
4 3 2 1 0
a) Difficulty in chewing/biting foods ..................................................  



b) Difficulty with speech/trouble pronouncing words ..................  



c) Embarrassed about appearance of teeth .....................................  



d) Felt tense because of problems with teeth or mouth .............  



e) Avoid smiling because of teeth ......................................................  



f) Sleep is often interrupted ...............................................................  



g) Days taken off work ..........................................................................  



h) Difficulty doing usual activities .......................................................  



i) Less tolerant of spouse or people who are close to you .......  



j) Reduced participation in social activities ...................................... 



42
13. How often do you eat or drink any of the following foods,
even in small quantities?
(Read each item)
Several Several Several
times Every times a day day a week a week a month /never
6
5
4
3
2
1
Fresh fruit ..............................................................................  




Biscuits, cakes, cream cakes ............................................... 




Sweet pies, buns ...................................................................  




Lemonade, Coca Cola or other soft drinks ................  




Jam or honey ........................................................................  




Chewing gum containing sugar ........................................  




Sweets/candy..........................................................................  




Once times Seldom
(Insert country-specific items)
14. How often do you use any of the following types of tobacco?
(Read each item)
Several Several
Every times Once times
day a week a week a month Seldom Never
6
5
4
3
2
1
I smoke cigarettes.............................................................  




I smoke cigars.....................................................................  




I smoke pipe ......................................................................  




I use chewing tobacco ....................................................  




I use snuff ...........................................................................  




Other....................................................................................  




Please specify ________________________________________________________________
________________________________________________________________
43
15. During the past 30 days, on the days you drank alcohol, how many drinks did you
usually drink per day?
Less than 1 drink .................................................................................................................................. 0
1 drink ..................................................................................................................................................... 1
2 drinks.................................................................................................................................................... 2
3 drinks.................................................................................................................................................... 3
4 drinks.................................................................................................................................................... 4
5 or more drinks .................................................................................................................................. 5
I did not drink alcohol during the past 30 days.............................................................................  9
16. What level of education have you completed?
No formal schooling............................................................................................................................. 1
Less than primary school ................................................................................................................... 2
Primary school completed.................................................................................................................. 3
Secondary school completed............................................................................................................. 4
High school completed........................................................................................................................ 5
College/University completed............................................................................................................ 6
Postgraduate degree ............................................................................................................................ 7
(Insert country-specific categories)
That completes our questionnaire
Thank you very much for your cooperation!
Year Month Day Interviewer: ..................................................................................................................................................................
District: ..........................................................................................................................................................................
Country: ........................................................................................................................................................................
45

national oral health survey namibia 2010/11

Transcription

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