|Year : 2022 | Volume
| Issue : 2 | Page : 137-142
Oral health status and oral health related quality of life in Kodhu tribes – A descriptive cross sectional study
Prathyusha Chatti, Vamsi Krishna Reddy, Vineela Parlapalli, Siva Kumar Pydi, Adithya Teja Prasad Pallekonda, Karishma Janapareddy
Department of Public Health Dentistry, Anil Neerukonda Institute of Dental Sciences, Visakhapatnam, Andhra Pradesh, India
|Date of Submission||02-Nov-2021|
|Date of Decision||04-Dec-2022|
|Date of Acceptance||05-Dec-2022|
|Date of Web Publication||31-Dec-2022|
Dr. Prathyusha Chatti
Anil Neerukonda Institute of Dental Sciences, Visakhapatnam - 530 048, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: In this modern era, a significant group of people is living in isolated hilly areas far away from civilization with their custom and beliefs. They are known as “tribes.” “Kodhu” tribe is one of the major Indian tribes present in the remote areas of Visakhapatnam. The objective is to assess the oral health status and oral health-related quality of life and education level in Kodhu Tribe in residing in Araku and Paderu regions of Visakhapatnam.
Material and Methods: A descriptive cross-sectional study was conducted among the Kodhu tribal population situated in the Araku and Paderu areas Visakhapatnam, Andhra Pradesh. The study comprised of 800 participants selected using a simple random sampling technique. Chi-square test was used to assess the oral health status of the tribal population, while, independent t-test was used for multiple comparison of OHIP-14 and oral health status. A p-value ≤ 0.05 was considered statistically significant.
Results: Among 800 participants, 458 were illiterate, and 342 were literate. The prevalence of dental caries was 49% among the illiterates while literates had 50.4% prevalence and the difference was statistically significant (P < 0.03). The periodontal status prevalence was found to be higher in illiterates (56.4%). The domains that are present in OHIP were found to be significantly associated with dental caries, periodontal status, and oral mucosal lesions (P < 0.001).
Conclusion: The oral health status of Kodhu tribe was found to have high prevalence of the periodontal disease and dental caries. Regular oral examination by dental professionals, dental health education, and motivation to maintain oral hygiene should be insisted to improve the oral health status of this tribal community.
Keywords: Education status, oral health, quality of life, tribes
|How to cite this article:|
Chatti P, Reddy VK, Parlapalli V, Pydi SK, Pallekonda AT, Janapareddy K. Oral health status and oral health related quality of life in Kodhu tribes – A descriptive cross sectional study. Indian J Community Fam Med 2022;8:137-42
|How to cite this URL:|
Chatti P, Reddy VK, Parlapalli V, Pydi SK, Pallekonda AT, Janapareddy K. Oral health status and oral health related quality of life in Kodhu tribes – A descriptive cross sectional study. Indian J Community Fam Med [serial online] 2022 [cited 2023 Feb 2];8:137-42. Available from: https://www.ijcfm.org/text.asp?2022/8/2/137/366556
| Introduction|| |
Health is a vital component for both the individual and the social system as the nation may progress rapidly only when its population are healthier and lead a productive life. Oral health is a reflection of the physiological, social, and psychological factors that are essential to an individual's general health and quality of life. Several epidemiological studies have indicated that oral diseases such as dental caries and periodontal diseases are as old as humanity and they continue to be some of the most common diseases. There is a wide variation in the periodontal status of people living in different geographic locations according to their variances in lifestyles and oral hygiene habits, etc.
Although dental diseases are rarely lifethreatening, they do influence the quality of life. Pain, fear, loss of function, and impaired esthetics affect life quality, with chewing and eating problems being substantial concerns. Oral problems may influence the capacity of individuals to live comfortably.
Oral health-related quality of life (OHRQoL) is defined as “a multidimensional construct that reflects people's comfort when eating, sleeping, and engaging in social interaction; their selfesteem and their satisfaction concerning their oral health.” It is essential to understand how people perceive the impact of oral diseases on their quality of life. The concept to OHRQoL is used for various purposes, including the evaluation of people's need and their levels of satisfaction, evaluation of the results of intervention and human services programs, the planning and provision of these services, and the formulation of appropriate policies for the general population and specific subpopulations.
In the present era, still, there are a group of people who are living in isolation far away from civilization with their traditional values, customs, beliefs, and myths intact. They are commonly known as “tribes.” About half of the world's autochthonous people, comprising 635 tribal communities, including 75 primitive tribal communities, live in India. These tribal communities in India are often referred to as Adivasi, Vanyajati, Vanvasi, Pahari, Adimjati, and Anusuchit Jan Jati.
The primitive tribal communities have identified by the Government of India in 15 states/union territories; Andhra Pradesh is the homeland of nearly 33 tribal groups. The Integrated Tribal Development Agency (ITDA), Paderu, Vishakhapatnam District, is a society registered on February 20th, 1975, under the society's Registration Act XXI of 1869 December 4th, 1975. The tribal subplan area comprises 11 Mandal Praja Parishads. These Mandals which are included under ITDA are Paderu, Pedabayalu, Munchingiputtu, Anatagiri, Araku, Hukumpeta, G. Madugula, Chintapalli, G. K. Veedhi, Koyyuru, and Dumbriguda.
The Khond-Savara Region, identified in 1936, is one of the significant tribal habitats having common tribal groups in adjoining Orissa State. This region spreads from forest and hill tracts of Srikakulam and Visakhapatnam districts, and these hill ranges form part of Eastern Ghats. The tribes that are residents in Visakhapatnam areas are known as “Kodhu.” The Kodhu are adept land dwellers, exhibiting greater adaptability to the forest environment. However, due to developmental interventions in education, medical facilities, irrigation, and plantation, they are forced into the modern way of life. Their traditional lifestyle, common traits of economy, political organization, norms, values, and worldview drastically changed over a long period. The development of health facilities for the scheduled tribe got impetus through successive plans. The primary health center's presence in tribal areas are indicators of extension of medical services with supplements from ICDS project. The development of the complete tribal area is under the supervision of ITDC and the Ministry of Tribal Welfare head office at Paderu. The tribal literacy rate is 53.02% and in that male literacy rate is 62.38%, and female literacy rate is 44.01%.
Although the development of tribal areas was implemented and many studies in the literature have regarded the oral health status and OHRQoL of tribal population, there is no literature regarding the oral health status of the Kodhu population. Hence, this present study aimed to assess the oral health status and OHRQoL and education level in Kodhu Tribes residing in Araku and Paderu regions of Visakhapatnam.
| Material and Methods|| |
A descriptive cross-sectional study was conducted between November and December 2019 among the Kodhu tribal population situated in the Araku and Paderu areas of Visakhapatnam, Andhra Pradesh.
The ethical clearance of the study was obtained from the institutional ethical committee review board. The permission regarding the conduct of the study was obtained from the concerned Village Head. Written Informed consent was obtained from each study subject after explaining the procedure performed in the study.
The simple random sampling technique was used to select desired sample of 800 participants. The sample size was calculated based on the prevalence of the previous study done by Vijayakumar et al. on the Sugali tribes. The sample size was calculated by the formula 4pq/l2 (where p = prevalence of the previous study (74%); q = 1-p; l = allowable error (1%). The sample size was derived from 769, which rounded off to 800.
- Stage-1: Out of 2 revenue division, one division and one district are selected by simple random sampling
- Stage-2: Among 11 mandals of the division, two mandals, i.e., Munchingiputtu and Araku valley were selected by simple random sampling
- Stage-3: A list of all the Gram Panchayats of the Munchingiputtu and Araku valley mandals was taken. Keeping sample size into consideration, the number of Kodhu tribes was selected from all the gram Panchayats of Munchingiputtu and Araku valley Mandals till the sample size is reached.
Only the permanent residents (residing for about 10 years) who gave consent to participate in the study were included. Those people, who ere medically comprised (diabetes mellitus, hypertension, etc.), did not give informed consent, not a permanent resident (residing less than 10 years), and who were not present on the day of examination were excluded from the study.
The oral health status and OHRQoL of the study participants were assessed using the self-administered, pre-tested pro forma, Oral Health Impact Profile (OHIP-14), and WHO Oral Health Assessment form 2013.
A pre-tested pro forma and OHIP-14 were administered to the study participants, Visakhapatnam, in the English and the local language (Telugu). The pro -forma collected the socio-demographic information, personal habits, information, and information regarding their oral health practice, while, OHIP-14 was for assessing their OHRQoL using an interview. The OHIP-14 consisted of 14 multiple-choice questions assessing oral health-related problems in seven academic areas, including functional limitation, pain, physiological discomfort, physical disability, psychological disability, social disability, and physically challenged. Based on the presence or absence of the problem and its severity, each question had three options: always, sometimes, and never. The study pro -forma and OHIP-14 were administered to the participants after providing necessary instructions followed by a clinical examination.
A pilot study was conducted among 60 subjects who were not included in the main study and comprised 10% of the study sample to check for reliability and validity. Reliability was measured through test–retest, and it showed that the measured kappa (κ) is 0.88, and the weighted kappa (κ) is 0.92. Internal consistency measured through Cronbach's alpha (α) found to be 0.76. Construct validity was assured using Spearman's correlation coefficient.
The clinical examination was carried out to assess the oral health status based on the WHO oral health assessment form 2013. Type III examination using a plain mouth mirror and WHO probe assessed the dental caries experience, periodontal status, oral mucosal lesions, dental trauma, dental erosion, dental, and prosthetic status. All the standard procedures and protocols were followed to ensure infection control during the study.
All the examinations and interviews were carried out by three qualified examiners. The examiners were standardized and calibrated before the commencement of study in the department of public health dentistry, by the head of the department, to ensure uniform interpretation, understanding, and the application of codes and criteria for the diseases to be observed and recorded and to ensure a consistent examination for assessing the oral health status. The inter-examiner reliability was found to be 92%.
The obtained data were coded and entered into an Excel sheet. Later, it was transferred to the SPSS (Statistical Package for Social Sciences) software version 21 IBM Corporation, United States and used for statistical analysis. Chi-square test was used to assess the oral health status of literate and illiterates of the tribal population, while independent t-test was used for multiple comparison of OHIP-14 and oral health status of illiterates and literates in the tribal population. Any P ≤ 0.05 was considered statistically significant.
| Results|| |
The present study was conducted among 800 tribal population in which 458 were illiterate, and 342 were literate. The age groups were categorized as 25–34 years, 35–44 years, 45–54 years, and 55–65 years. A relatively high percentage illiterates were present among 35–44 years of age (27.95%) while maximum literates were in the age group of 45–54 years (28.65%). 21.18% of illiterates and 27.78% literates were there in the youngest age group of 25–34 years. According to gender, 68.78% illiterates and 74.56% literates were male, while the rest 31.22% illiterates and 25.44% of literates were female [Table 1].
The oral health status of the tribal population show a 56.6% prevalence of dental caries among illiterates and 43.4% among literates, which showed a significant difference (P ≤ 0.05). On the other hand, the periodontal status was high in illiterate (56.7%) compared to the literate (43.6%). The prevalence of dental erosion, dental fluorosis, dental trauma, and oral mucosal lesions was found to be higher among illiterates (53.4%, 60.3%, 58.9%, and 64.3%, respectively) when compared with the literates (46.6%, 39.4%, 41.1%, and 35.7% respectively) [Table 2].
|Table 2: Oral health status of literate and illiterates of the tribal population|
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The mean OHIP-14 scores were found to be 1.32 ± 0.45 in illiterates and 1.16 ± 0.37 in literates. Based on the results obtained from the OHIP-14 questionnaires, it shows education levels have negatively impacted the OHRQoL in illiterates in the tribal population than that of the literates [Table 3].
|Table 3: Oral health impact profile-14 Items among the illiterates and literates|
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The functional limitation due to dental caries, periodontal status, and dental trauma and oral mucosal lesions was seen more among illiterates than literates, and the difference was highly significant (P ≤ 0.05). Due to poor periodontal status, dental trauma and dental fluorosis illiterate group felt more physical pain than the literates, and this difference was significant (P ≤ 0.05). Psychological discomfort due to the poor periodontal status, dental fluorosis, dental trauma, and oral mucosal lesion, was found to be higher among illiterates than literates with a significant difference. Physical disability was found to be more among literate than illiterates with a statistically significant difference (P ≤ 0.05). The psychological disability due to dental caries, periodontal status, dental trauma, and the oral mucosal lesion was present higher among illiterates compared to literates. The mean difference of illiterates and literates in the social handicap and handicap group were found to be statistically significant (P ≤ 0.05) [Table 4].
|Table 4: Multiple comparison of oral health impact profile.14 and oral health status of illiterates and literates in the tribal population|
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| Discussion|| |
The assessment of oral health status is necessary for preparing timely and satisfactory oral health services and oral health education programs to upgrade the dental health of the Kodhu population. Therefore, the present study aimed to assess the oral health status and OHRQoL of Kodhu tribes. As the literature is scarce on oral health status among this particular tribal population in India, an effort has been made to compare the present study's findings with studies done on other groups.
The sociodemographic details recorded showed that among the Kodhu tribal population, the majority were illiterate. Tribes gave very little importance to education. Most of them are not yet conscious of the benefits of education and consequent economic gains. This low literacy can be considered as the root cause of their socioeconomic backwardness. The results from the present study showed that the majority of them belong to lower socioeconomic status and the same was found with other studies on the tribal population.,, The literacy rate found in this study is 57.6% which is low compared to the study done by Sirisha et al., on Yendai's Tribes where the illiterate were 85.9%.
The prevalence of the dental caries was found to be 49% among the illiterates of the tribal population and this showed agreement with the study by Kumar et al. in which the dental caries prevalence among Santhal tribes was 52%. Sirisha et al. on Yendai's tribes found out dental caries prevalence to be 54.2%, and Valsan et al. on Paniya tribes found 40%, prevalence of dental caries and these findings were in contrast with the study done by Das et al. on Juang tribes where it shows a high prevalence of dental caries of 83.4%.
The prevalence of the periodontal status in the present study was 56.4% which is similar to the study done by Naheeda et al. on the Konda Reddy tribes, where the prevalence was 58.9%. The prevalence was 60% in a study by Vijayakumar et al. on the Sugali tribes, whereas it was 56% in a study by Dey et al. on the Koraga tribes. These results were in stark contrast to those of Das et al. research. According to studies on the Juang and Paniya tribes, where prevalence rates were respectively 83.4% and 76.9%, respectively.
In the present study, the prevalence of the dental fluorosis was 60.3% and this result was higher compared to the study done on the Sugali tribes by Vijayakumar et al., which shows 49% prevalence. The prevalence of oral mucosal lesions among the present study participants was higher (64.3%) when compared with the study done by Asrif SM et al. and Valsan et al. on which shows 3.23% and 4.53% prevalence.
| Conclusion|| |
According to the present study results, it may be concluded that the Kodhu tribe had poor oral health quality of life with a high prevalence of periodontal diseases and dental caries. The study also revealed that there is a lack of awareness among tribes about oral health due to deep-rooted dental beliefs and limited access to oral health services. Oral health, which is an integral part of everyone's well-being, was found to be a neglected part in the case of Kodhu tribes. The findings of this study, however, limited, may bring to the light the magnitude of the oral health problem that exists among the tribal people. The tribes are in definite need of oral health care and proper awareness.
Periodic oral examination by dental professionals may help to control oral disease among these Kodhu tribes. Various dental programs should be conducted to improve oral health status and health education, ultimately improving the OHRQoL of the Kodhu population. Further studies among tribes may throw more light on this field to gain a more detailed understanding of oral health needs of tribal population.
The study had limitation of a smaller sample size and these samples have a specific nature. Hence, the findings of the study cannot be generalized.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]