Knowledge, attitudes and barriers to maternal oral Health among pregnant women and nurse-midwives at Moi Teaching and referral hospital, Eldoret, Kenya.

Abstract

Introduction: Pregnant women are more prone to oral health problems like periodontitis due to hormonal changes, frequent vomiting, changes in diet coupled with lowered immunity. The mother and child health handbook used in the care of these women at Moi Teaching and Referral Hospital and Kenya includes scanty information on oral care during pregnancy. Failure to mention oral health during pregnancy or other healthcare visits may contribute to poor oral health seeking behaviour. There is little attention given to oral care by routine antenatal care nurses and midwives in a majority of health facilities in Kenya. Objectives: To assess the knowledge, attitude and associated barriers to maternal oral healthcare among pregnant women and nurse-midwives at Moi Teaching and Referral Hospital. Methods: A cross-sectional descriptive study was conducted with 379 participants. A total of 309 pregnant women were selected using systematic sampling technique. A census approach was used to recruit 70 nurse-midwives working at the maternal and child health units. The functionalist theory and health belief model were used to generate the conceptual framework for this study. Interviewer administered structured questionnaire were employed for pregnant women and self-administered questionnaires were used in the case of nurse-midwives. Descriptive results were presented in frequency tables, bar charts and pie charts as appropriate. Ordered logistic regressions were conducted to respectively ascertain the predictors of and differences in pregnant mothers’ and nurse-midwives’ knowledge and perceived barriers to maternal oral health. A p value <.05 at 95% confidence level was considered significant. Results: Majority 266 (86%) had a low level of oral health knowledge by agreeing to the statement that it is normal to have a bleeding gum during pregnancy and that dental extraction is unsafe during pregnancy. The nurse-midwives in the antenatal ward were more knowledgeable on maternal oral health than those in the antenatal clinic (Coef. = 3.082, p<0.005). Women who had basic or secondary education demonstrated poorer knowledge (Coef. =-0.736, p=0.016) and attitude (Coef. =-0.453, p=0.54). Barriers to oral healthcare included and not limited to not being informed about the need to visit the dentist 256(83%) and high cost of dental treatments 232(75%). Barriers cited by nurse-midwives were among others, lack of guidelines on oral healthcare during pregnancy 43(61%) and lack of in-service training on maternal oral healthcare 39(56%). Conclusion: Pregnant women have low knowledge and attitudes on the importance of oral health care during pregnancy. Nurse-midwives knowledge and attitudes on oral health care during pregnancy is sub optimal. Nurse-midwives and pregnant women indicated lack of guidelines and lack of information as major barriers to maternal oral health. Recommendations: There is the need for targeted in-service training programmes for nurse-midwives on maternal oral healthcare and development of customised guidelines for oral health assessment to improve the knowledge and attitude of antenatal care providers. Dental health care should be incorporated into the Kenya free maternity care policy to reduce barriers such as cost of dental treatment.