|Year : 2018 | Volume
| Issue : 1 | Page : 28-34
Attitude and awareness of expectant and lactating mothers toward infant oral health care in North Indian subpopulation: A cross-sectional study
Ayushi Jindal1, Ritu Namdev1, Gaurav Aggarwal2, Parul Singhal1, Sakshi Asija3, Harleen Thukral4
1 Department of Pedodontics and Preventive Dentistry, Post Graduate Institute of Dental Sciences, Rohtak, India
2 Department of Conservative Dentistry and Endodontics, D.A.V. (c) Dental College, Yamunanagar, Haryana, India
3 Department of Orthodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
4 Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
|Date of Web Publication||12-Mar-2018|
H. No. 536, Sector 17, HUDA, Yamuna Nagar, Haryana
Source of Support: None, Conflict of Interest: None
Introduction: Mothers play a key role in adoption of preventive strategies for an improved oral health in the first few crucial years of life of infants and young children. The purpose of the study is 2 folds: (1) to evaluate and compare the awareness and attitude (Aw-At) levels between expectant and lactating mothers toward infant oral health care and (2) to analyze the influence of maternal sociodemographic variables on their Aw-At levels toward infant oral health care.
Materials and Methods: A total of 500 expectant and lactating mothers visiting the outpatient department of the government hospital in Rohtak, India, were randomly selected and interviewed through a 27-item self-designed, structured questionnaire. Mann–Whitney, Kruskal–Wallis, and Chi-square tests were applied for assessment and comparison.
Results: Lactating mothers scored significantly higher than expectant mothers (P = 0.004) in awareness levels. Awareness score of mothers (26–35 years old) was also significantly higher than the younger ones (P = 0.002). Urban group had a higher attitude score than rural group mothers (P = 0.002). Working mothers scored more in both Aw-At scores (P < 0.001). The awareness scores also increased significantly with increase in educational qualification (P < 0.001) and parity of mothers.
Conclusion: The study had found low awareness levels toward infant oral health care but a positive attitude among mothers. Hence, it is suggested to increase this to ensure optimal dental health for themselves and their children by educating and motivating the mothers, providing prenatal counseling, anticipatory guidance, referral by the medical personnel, and most importantly, establishing the concept of dental home.
Keywords: Attitude, awareness, infant oral health care, mothers
|How to cite this article:|
Jindal A, Namdev R, Aggarwal G, Singhal P, Asija S, Thukral H. Attitude and awareness of expectant and lactating mothers toward infant oral health care in North Indian subpopulation: A cross-sectional study. Saudi J Oral Sci 2018;5:28-34
|How to cite this URL:|
Jindal A, Namdev R, Aggarwal G, Singhal P, Asija S, Thukral H. Attitude and awareness of expectant and lactating mothers toward infant oral health care in North Indian subpopulation: A cross-sectional study. Saudi J Oral Sci [serial online] 2018 [cited 2018 May 26];5:28-34. Available from: http://www.saudijos.org/text.asp?2018/5/1/28/227128
| Introduction|| |
Oral health is intimately related to general health. It has an impact on the quality of life and health outcomes in infants and children. Early childhood caries is a major public health problem, being the most common chronic infectious childhood disease which is generally preventable. According to the Centers for Disease Control and Prevention, caries is the most prevalent infectious disease in the US children. More than 40% of children have caries by the time they reach kindergarten. In India, the prevalence of early childhood caries has also been reported to be high across various parts of the country (68.7% in Gurgaon, Haryana, by Kalra et al. in 2011, 50.6% in Trivandrum, Kerala, by Retnakumari and Cyriac in 2012, and 31.8% in Wardha, Maharashtra, by Gaidhane et al. in 2013).
Improper feeding practices, nutritive or nonnutritive, are not only the major culprits in causing early childhood caries but also affect the occlusal development and the growth of the jaws. Muscular activity plays a paramount role in infant's survival. Dental fluorosis not only poses an esthetic and psychological problem, but also predisposes to dental caries. In India, 19 states have been identified with groundwater fluoride concentration more than the permissible limit (1.5 mg/L). Spread of awareness among parents, caregivers, and children is important to decrease this risk, especially in the fluoride-endemic areas, and at the same time, making its optimum usage.
Infant oral health is the foundation upon which preventive education and dental care must be built to enhance the opportunity for lifetime free of preventable oral diseases. There is increasing evidence that, to build a strong preventive dental base, preventive intervention must begin within the 1st year of life., Thus, pediatric oral health care should ideally begin with prenatal oral health counseling for pregnant women. Mothers play the role of primary caregivers, decision-makers in the early formative years of their children, and also the primary source of early education in children with regard to good hygiene and healthy nutritional practices. Considering mother's important role in well-being of infants and young children, it is essential to explore their attitude, awareness, and beliefs as they affect the dental care which the children receive at home and their access to professional dental services. A simple assessment of the parental awareness and attitude (Aw-At) may be the first step in identifying the areas of weakness.
The present study was conducted with a 2-fold purpose: (1) To evaluate and compare the Aw-At levels between expectant and lactating mothers toward infant oral health care and (2) to analyze the influence of maternal sociodemographic variables on their Aw-At levels toward infant oral health care.
| Materials and Methods|| |
The present cross-sectional study included 500 mothers selected by simple random sampling from the outpatient department (OPD) of Pedodontics and Preventive Dentistry, PostGraduate Institute of Dental Sciences, Rohtak, in collaboration with the Department of Obstetrics and Gynecology and Department of Pediatrics, Post Graduate Institute of Medical Sciences, Rohtak. The sample size was selected based on the findings of a pilot study. The study sample was broadly divided into two equal groups – Group A (250 expectant mothers) and Group B (250 lactating mothers). Consent of the heads of respective departments was procured beforehand. Following were the inclusion criteria: (1) Expectant mothers, (2) Lactating mothers whose youngest child is ≤2 years of age, and (3) Expectant mothers and lactating mothers who were willing to participate and signed the written informed consent.
A 27-item pretested, self-designed, structured questionnaire was developed and filled by the investigator after interviewing the study participants in the OPD. All the participants were interviewed by a single investigator to avoid inter-examiner bias. The questionnaire consisted of questions under two sections: (a) Section 1 included six questions pertaining to parent's demographic characteristics including name, age, area of residence, educational level, employment status, and number of children if any. (b) Section II included 21 questions to assess the Aw-At of mothers regarding infant oral health care. Various questions regarding cleaning of child's gum pads and teeth, timing of first tooth eruption, teething, first visit to dentist, breast- and bottle-feeding habits, thumb sucking and its effects, dental fluorosis, etc. were interviewed. A short PowerPoint presentation regarding the importance of infant oral health care was also demonstrated to the mothers after the interview with an aim to increase their knowledge and change their attitude toward the same.
To assess the responses for the questionnaire, a scoring system was developed. Regarding questions on awareness, a score of 1 was assigned to the correct/favorable answer and a score of 0 to the rest of options. Regarding questions on attitude, the option “agree” was assigned a score of 1 while the options “uncertain” and “disagree” were assigned a score of 0. The individual scores were then summed up to yield a total score.
The results were tabulated, analyzed (using IBM SPSS Statistics, version 22.0, New York) and expressed as number, percentage, mean, median, standard deviation, and interquartile range. As our data for Aw-At score were skewed, Mann–Whitney U-test was applied for two groups and Kruskal–Wallis test for more than two groups for assessment and comparison of Aw-At scores according to demographic characteristics of mothers. Chi-square test/Fisher's exact test, whichever appropriate, was applied for categorical data.
| Results|| |
A total of 500 expectant and lactating mothers who participated in the study belonged to various age groups with 64.4% in the age range of <25 years and 60.6% from rural areas. A major proportion of mothers (n = 303, 60.6%) had a senior secondary or below qualification and 90.2% of mothers were nonworking. The detailed description of the demographic characteristics is shown in [Table 1].
[Table 2] and [Table 3] depict the distribution of correct/incorrect responses regarding questions on Aw-At, respectively, by the expectant and lactating mothers along with the P values.
|Table 2: Distribution of responses regarding questions on awareness by expectant and lactating mothers with the P values|
Click here to view
|Table 3: Distribution of responses regarding questions on attitude by expectant and lactating mothers with the P values|
Click here to view
[Table 4] and [Table 5] depict the comparison of Aw-At scores, respectively, according to the sociodemographic variables of children. The awareness score of Group B (lactating) was found to be significantly higher than that of Group A (expectant) children (P = 0.004) while the difference in attitude score between the two groups was not statistically significant (P = 0.569). There was a statistically significant difference in the awareness levels among the three age groups (P = 0.005) while the difference in attitude score was not statistically significant (P = 0.420). The attitude score of urban group was found to be significantly higher than that of rural group individuals (P = 0.002) while the difference in awareness score between the two groups was not statistically significant (P = 0.221). The Aw-At scores of mothers increased with the increase in educational qualification with a statistically significant difference (P< 0.001). The Aw-At scores of working mothers were found to be significantly higher than that of nonworking mothers (P< 0.001). Mothers with 1 child and >1 children had significantly higher awareness scores than mothers with no child with P = 0.001 and <0.001, respectively. The difference in the attitude score between the three groups was not statistically significant (P = 0.979).
|Table 4: Assessment and comparison of awareness scores according to sociodemographic variables of mothers|
Click here to view
|Table 5: Assessment and comparison of attitude scores according to sociodemographic variables of mothers|
Click here to view
| Discussion|| |
The universal prevalence of dental disease is a constant reminder of the need for effective preventive dental health education. In attempts to achieve the best oral health outcomes for children, mothers are considered the key persons in ensuring their well-being. The present study included 500 mothers who were assessed through a questionnaire for their Aw-At levels regarding infant oral health care and also the influence of maternal sociodemographic variables on infant oral health care.
Comparison of awareness-attitude scores according to groups (expectant and lactating mothers)
The present study recorded the overall mean awareness score (n = 500) to be 4.49 ± 2.438 with a minimum score of 0 and a maximum score of 11 and the mean attitude score (n = 500) to be 4.34 ± 1.548 with a minimum score of 0 and a maximum score of 6.
Group B (lactating) mothers showed a comparatively higher median awareness score than mothers of Group A (expectant). On applying Mann–Whitney test, the difference was found to be statistically significant (P = 0.004) [Table 4]. The results showed that Group B mothers had comparatively better awareness levels than Group A mothers, especially when asked questions regarding timing to start cleaning child's teeth, timing of first tooth eruption, effects of frequent and prolonged breast-/bottle-feeding, effects of nighttime breast-/bottle-feeding on child's teeth, and effects of poor maternal periodontal health on child, where the difference has been found to be statistically significant [Table 2]. The results could be explained on the basis that lactating mothers might have gained knowledge due to direct involvement and exposure to the particular event and were better able to recount that event they witnessed or took part in. This is in agreement with the study by Akpabio et al. where pregnant mothers had lower knowledge score levels concerning health behavior, dental care utilization, prevention of oral disease, and consequences of poor oral health. Nagaraj also found similar findings with mothers of child to have comparatively better knowledge than pregnant women regarding age of eruption of first tooth and timing of child's first dental visit.
Comparison of awareness-attitude scores according to age of mothers
The present results showed the median awareness score of mothers in the age range of 26–35 years to be significantly higher than mothers in the age range of <25 years (P = 0.002) [Table 4]. This may be due to the reason that many younger mothers are first-time mothers who are busy pursuing their education or career and more importantly, in our area juggling with the family responsibilities. Therefore, many a times, they rely on their support network to deliver the necessary day-to-day care to their children. This is in agreement with the studies of Akpabio et al., Nagarajappa et al., and Vann et al. In contrast, Rwakatema and Nganga reported younger parents/mothers to have better awareness levels than older mothers. Williams et al. and Myung-Jin reported that age group was not a significant factor for the level of mothers' dental health knowledge. On the other hand, Ashkanani and Al-Sane reported that older participants (>40 years of age) had significantly better knowledge in certain areas such as the effect of untreated caries on growth (P = 0.020), while younger participants had significantly better knowledge with regard to the ideal timing for the child's first dental visit (P = 0.011).
On the other hand, the attitude scores of mothers among the three age groups (<25 years, 26–35 years, and >35 years) were not statistically significantly different [Table 5]. Similar findings were reported by Williams et al. but are in contrast with the studies done by Nagarajappa et al. and Jain et al. Jain et al. reported that mothers in the age group of 30–45 years showed significantly higher mean attitude scores (4.30 ± 1.3) compared with other age groups (P = 0.000).
Comparison of awareness-attitude scores according to area of residence
The median awareness score of mothers in rural and urban groups was found to be 4 and 5, respectively. Though the difference was not statistically significant, the present study found the mothers in urban group to have better awareness levels than mothers residing in rural areas [Table 4]. The present findings are supported by previous studies by Williams et al. and Suresh et al. who reported that urban/nondeprived parents/mothers had higher levels of knowledge than those residing in rural/deprived areas but in contrast to the study conducted by Dogra et al. to determine the knowledge and attitude of lactating mothers regarding infant oral health in Udaipur city, Rajasthan, who reported that urban mothers had a comparatively poorer knowledge than rural mothers.
On the contrary, statistical analysis showed the median attitude scores of mothers in urban group to be significantly higher than those in rural group (P = 0.002) [Table 5]. This might be due to the social environment to which the rural mothers are accustomed to, the culturally based attitude, and the persisting myths and taboos regarding dental treatment. In addition, the rural mothers have limited participation in the decision-making for their child, have poor oral hygiene habits for self, decreased accessibility to health personnel, and might accord low value to primary teeth.
Comparison of awareness-attitude scores according to educational status
The present study found a statistically significant difference in the awareness scores of mothers with different educational qualifications, i.e., illiterate, senior secondary or below, and graduate or above (P< 0.001), indicating that awareness level of mothers increased with the increase in educational qualification [Table 4]. This is in line with the studies conducted worldwide by various authors.,,,,,,,, Similar results were found for the attitude scores (P< 0.001) [Table 5] and were in accordance with studies done by Williams et al., Ashkanani and Al-Sane, and Jain et al. These can probably be explained that parents with a general, improved level of education may be able to assess appropriate source of information and understand that information more completely. Moreover, parents with higher education level believe in preventive services and that increased levels of education bring about increases in social placing.
Comparison of awareness-attitude scores according to professional status
The present study recorded a significant difference in the Aw-At scores of working and nonworking mothers (P< 0.001). This can be attributed to the fact that working mothers might have comparatively higher education levels and can assess the appropriate source of information. Furthermore, they understand the importance of preventive dental treatment and know that it is much more cost-effective than the interventional dental treatment. Vanobberge et al. also reported that occupational status of the parents affected children's oral health.
Comparison of awareness-attitude scores according to number of children
Results of the study showed that mothers with 1 child and >1 children had significantly higher awareness levels than mothers with no child with P = 0.001 and < 0.001, respectively, indicating that the awareness levels increased with the increase in parity of mothers [Table 4]. Similar results were reported by Akpabio et al., Vann et al., and Eigbobo et al. This might be due to increase in the level of understanding and experience with increase in the number of children. In addition, mothers with a child are better able to understand the relationship between child's diet and oral disease.
In a developing country like India where the country's workforce and resources are fully working in a direction to get control over the life-threatening diseases, it is quite obvious that oral health issues get overlooked. The government is still working and investing to the fullest on Global Oral Health Goals 2020 to reduce the morbidity and mortality due to oral and craniofacial diseases. The best and the earliest opportunity lies in the hand of health-care professionals by educating and motivating the parents, especially mothers to help achieve these targets and reduce this burden on the country.
| Conclusion|| |
The present study had found low awareness level about infant oral health care but quite a positive attitude among mothers. Hence, it is suggested to increase this to ensure optimal dental health for themselves and their children by educating and motivating the mothers, providing prenatal counseling, anticipatory guidance, referral by the medical personnel, and most importantly, establishing the concept of dental home.
I sincerely thank Late Dr. Samir Dutta, Senior Professor and Head, Department of Pedodontics and Preventive Dentistry, Rohtak for his guidance and immense help during the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.
Pierce KM, Rozier RG, Vann WF Jr. Accuracy of pediatric primary care providers' screening and referral for early childhood caries. Pediatrics 2002;109:E82-2.
Kalra G, Bansal K, Sultan A. Prevalence of early childhood caries and assessment of its associated risk factors in preschool children of Urban Gurgaon, Haryana. Indian J Dent Sci 2011;3:12-6.
Retnakumari N, Cyriac G. Childhood caries as influenced by maternal and child characteristics in pre-school children of Kerala-an epidemiological study. Contemp Clin Dent 2012;3:2-8.
] [Full text]
Gaidhane AM, Patil M, Khatib N, Zodpey S, Zahiruddin QS. Prevalence and determinant of early childhood caries among the children attending the Anganwadis of Wardha district, India. Indian J Dent Res 2013;24:199-205.
] [Full text]
Gupta R, Misra AK. Groundwater fluoride in Haryana State: A review on the status and its mitigation. Study Civ Eng Arch 2014;3:24-8.
Lee JY, Bouwens TJ, Savage MF, Vann WF Jr. Examining the cost-effectiveness of early dental visits. Pediatr Dent 2006;28:102-5.
Lee JY, Weber-Gasparoni K. Infant Oral Health: The Handbook of Pediatric Dentistry. 3rd
ed. American Academy of Pediatric Dentistry; 2007. p. 1-7.
Akpabio A, Klausner CP, Inglehart MR. Mothers'/guardians' knowledge about promoting children's oral health. J Dent Hyg 2008;82:12.
Nagaraj A, Pareek S. Infant oral health knowledge and awareness: Disparity among pregnant women and mothers visiting a government health care organization. Int J Clin Pediatr Dent 2012;5:167-72.
Nagarajappa R, Kakatkar G, Sharda AJ, Asawa K, Ramesh G, Sandesh N, et al.
Infant oral health: Knowledge, attitude and practices of parents in Udaipur, India. Dent Res J (Isfahan) 2013;10:659-65.
Vann WF Jr. Lee JY, Baker D, Divaris K. Oral health literacy among female caregivers: Impact on oral health outcomes in early childhood. J Dent Res 2010;89:1395-400.
Rwakatema DS, Nganga PM. Oral health knowledge, attitudes and practices of parents/guardians of pre-school children in Moshi, Tanzania. East Afr Med J 2009;86:520-5.
Williams NJ, Whittle JG, Gatrell AC. The relationship between socio-demographic characteristics and dental health knowledge and attitudes of parents with young children. Br Dent J 2002;193:651-4.
Myung-Jin K. A study of parental knowledge and attitude about infant oral health care. J Korean Acad Pediatr Dent 2000;27:292-9.
Ashkanani F, Al-Sane M. Knowledge, attitudes and practices of caregivers in relation to oral health of preschool children. Med Princ Pract 2013;22:167-72.
Jain R, Oswal KC, Chitguppi R. Knowledge, attitude and practices of mothers toward their children's oral health: A questionnaire survey among subpopulation in Mumbai (India). J Dent Res Sci Dev 2014;1:40-5.
Suresh BS, Ravishankar TL, Chaitra TR, Mohapatra AK, Gupta V. Mother's knowledge about pre-school child's oral health. J Indian Soc Pedod Prev Dent 2010;28:282-7.
] [Full text]
Dogra S, Arora R, Bhayya DP, Thakur D. Knowledge and attitude of lactating mothers towards infant oral health care in Udaipur. IOSR J Dent Med Sci 2014;13:57-60.
Boggess KA, Urlaub DM, Moos MK, Polinkovsky M, El-Khorazaty J, Lorenz C, et al.
Knowledge and beliefs regarding oral health among pregnant women. J Am Dent Assoc 2011;142:1275-82.
Vanobberge JN, Martens LC, Lesaffre E, Declerck D. Parental occupational status related to dental caries experience in 7-year-old children in Flanders (Belgium). Community Dent Health 2001;18:256-62.
Eigbobo JO, Aikins EA, Onyeaso CO. Knowledge of preventive child oral healthcare among expectant mothers in Port Harcourt, Nigeria. Pediatr Dent J 2013;23:1-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]