REFINED CARBOHYDRATE INTAKE AND KNOWLEDGE OF ORAL HEALTHAMONG STUDENTS IN PRIVATE AND PUBLIC SECONDARY SCHOOLS IN IBADAN, NIGERIA

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D. Chukwuma¹, M. Adetukasi², O. Opeodu³

1. Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria.
2. Faculty of Dental Surgery, University College Hospital, Ibadan, Nigeria.
3. Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria

Abstract

Background: The knowledge of an individual about oral health and the practice of good oral hygiene will go a long way in determining the oral health status of such an individual. Frequent intake of refined carbohydrates, without optimum oral hygiene procedure, has been implicated in the aetiology of oral diseases such as dental caries and periodontitis. The aim of the study was to assess the oral health knowledge of some secondary school students in two LGAs in Ibadan, Oyo State.

Methodology: This descriptive cross-sectional study was done using multistage sampling techniques and conducted across the classes in the selected senior secondary school. A pretested, self-administered, structured questionnaire with 12 items, adopted from Sternberg et al, was used for the data collection. A total of 248 participants consisting of 97 (39.1%) males and 151 (60.9) females completed and submitted the questionnaires. Data analysis was done using the statistical product and service solutions (SPSS 26.0). Statistical significance was set at p < 0.05.

Results: Knowledge assessment of oral health education; 94.4% of the participants had good knowledge, while 5.6% of the participants had poor knowledge. More females (60.3%) than males (39.7%) had good knowledge of oral health. The age range of participants was from 11 to 19 years, with a mean (SD) –14.68 (±1.45). On the knowledge of oral health, 234(94.4%) of participants perceived excessive consumption of sweet food can cause dental caries; 9(3.6%) did not; and; 5(2.0%) undecided. On teeth brushing at least twice daily 238 (96.0%) participants agreed, and 6(2.4%) did not, and 4(1.6%) were undecided. Participants from public schools had a higher frequency of refined carbohydrate intake, with a low pattern of 9.2%, a moderate pattern of
52.7%, and a high pattern of 38.1%. The socio-demographic characteristics of the participants were not statistically significant against the pattern of intake of refined carbohydrates following bivariate analysis.

Conclusion: The supposedly good knowledge of oral health education of respondents in this study was not matched equally with a good pattern of refined carbohydrate intake. This calls for a concerted effort towards improving oral health campaigns among secondary school students.

Keywords: Knowledge, Oral health, Refined carbohydrate, Secondary school students

Introduction

General health and well-being is fundamentally related to oral health.¹ A healthy mouth enables an individual to talk, eat and socialize without experiencing active disease, discomfort or embarrassment.² . Undoubtedly, oral diseases are caused by a range of modifiable risk factors common to many non-communicable diseases, and this is connected to the rapidly changing lifestyles arising from urbanization and the associated increased intake of diets rich in sugars.^3,4 On account of their high prevalence and incidence in all regions of the world, oral diseases represent a major public health problem.^4,5 Oral health behavior, environmental and life style factors like nutritional status, tobacco smoking, alcohol, poor oral hygiene, stress, and systemic conditions have been found to be associated with oral conditions.^5,6,7 It is not unlikely that a lot of people experience poor oral health without proper knowledge and oral health.^7,8,9 Studies have shown that better oral care practice is strongly related to the knowledge of oral health.^6,8 Globally, the lack of oral health awareness and over consumption of refined carbohydrate have been linked to dental caries in about 90% of children and adolescent of school age.^8,9,10 Thus resulting in the loss of more than 50 million school hours annually following oral health conditions, with attendant negative effect on children’s performance at school and success in future career.⁹

In developed countries, dental care has been systematically organized to improve dental health, knowledge and oral health attitude among children and young adults; with a consequential positive impact on their dental health.^10,11 Consequently this impact on the overall general health of the individuals as they age and lead to more adults maintaining their teeth into the advanced stages of life^12,13 but this is not exactly the case in Nigeria.¹⁵ Ogunrinde et al. indicated that students and adolescents in Nigeria are predisposed to dental caries and periodontal disease coupled with poor oral hygiene following increase daily intake of sugary foods and drinks.14 In another study, Akpata posited that the prevalence of dental caries is as high as 20 to 45% among school children and adolescents in the country, hence constituting a major health challenge.¹⁶

Good oral health knowledge and behaviour is an indication of the efficacy of applied dental health education programs.¹⁷ Increased awareness has to be associated with improved oral hygiene and a more positive attitude towards oral health.¹⁸ Therefore, in line with the thought of enhancing positive oral health practices, the World Health Organization prioritized promotion of oral health education among adolescents.¹⁹ In order to embark on a timely and appropriate health education program, it is important to know the target populations, oral health behaviour, mindset and practice towards oral health.^20,17

On account of the dearth of studies on oral health knowledge and poor oral health practice in relation to the frequency and pattern of refined carbohydrate intake among children and adolescents from low and middle-income countries, such as Nigeria, compared to those from developed countries, this study is therefore aimed at knowing the oral health behaviour and knowledge of oral health among public and private secondary schools and its socio-demographic relationship. In addition, it seeks to provide data for future research and allows comparisons with adolescents’ knowledge of oral health in relation to refined carbohydrate intake among public and private secondary schools in Ibadan North West and North Local Government Areas of Oyo State.

METHODOLOGY
This descriptive cross-sectional study was conducted among secondary school students in Ibadan North West and Ibadan North LGA of Oyo State, Nigeria. It was done from May to October, 2023. Multistage sampling technique was applied. Two local governments were randomly chosen from 33 local government of Oyo State. A total of seven senior secondary schools were purposively selected from the two local governments comprising both males and females across the classes in the public and private senior secondary schools. At the final stage a total of 248 comprising of 97 male and 151 female were conveniently selected.

The Sample size was calculated to be students numbering 229 using the formula n = Z 2pq/d2 while allowing for attrition rate of 8% resulting in total sample size at 248.

A pretested, self-administered, structured questionnaire with 12 items, adopted from Petersen et al. and Stenberg et al., with four parts that was modified to include only two parts and socio demographic component. The parts adopted were to assess the respondents’ oral health knowledge (part 1) and to assess the respondents’ dietary habits (frequency of intake) on sweet foods, sweet snacks and soft drinks (Part 4). Pretesting was done on 25 students who met the inclusion criteria prior to the study without any further modification. The questionnaire consisted of 3 parts. The first part had 5 questions on sociodemographics, and the second part had 9 questions to assess the respondents’ oral health knowledge based on the effects of brushing, use of fluoride on dentition, gum bleeding, dental plaque, and sweet food and drinks on dentition. Each correct answer is given 1 mark and wrong answer 0 mark. This gave rise to a minimum score of 0 and a maximum score of 9. A simple average of the maximum score (9) was obtained (50% of 9 =4.5) and used to categorize the participants into good and poor knowledge classes. Those that scored >5 were categorized as having good knowledge (since the questions had whole number scores, 4.5 was not used). Those that scored <5 were categorized as having poor knowledge. The third part consisted of questions to assess the respondents’ frequency and pattern of refined carbohydrate intake in relation to sweet foods, sweet snacks and soft drinks. Concerning the frequency of intake of refined carbohydrates among the participants, a 3-point, 4-point and a 6-point scale respectively was used to grade the various levels of ingestion of refined carbohydrates among the participants. Students were gathered in one classroom with the help of the teacher and the questionnaires were self-administered.

Data analysis was done using the statistical product and service solutions (SPSS 26.0). Statistical tests done included frequencies for the univariate analysis, Chisquare test and Fisher‘s Exact Test for the bivariate analysis. Categorical variables such as gender, LGA, school, school type and so on were cross tabulated against the participants’ oral health knowledge, frequency and pattern of intake of refined carbohydrates. For cross tabulations that had a smaller sample frame, a Fisher’s exact test was carried out to obtain a representative outcome. Ethical approval to carry out this study was granted from the University of Ibadan and University College Hospital (UI/UCH) Health Research Ethics Committee.

Approval ID:NHREC/05/01/2008a.