Feasibility of training community health workers to conduct periodontal examinations: a validation study in rural Nepal

Abstract

Background: In many low-and middle-income countries, insufficient human resources limit access to oral health services. Shifting clinical tasks to less specialized health professionals, such as community health workers, has been used as a strategy to expand the health workforce, especially in remote or underserved locations. The objective of this study was to evaluate the validity of periodontal examinations conducted by auxiliary nurse midwives in a rural home setting in Nepal. Methods: Twenty-one pregnant women < 26 weeks gestation from Sarlahi District, Nepal, underwent full mouth periodontal examinations measuring probing depth (PD) and bleeding on probing (BOP) on 6 sites per tooth by one of five auxiliary nurse midwives, who were trained for this study but had no previous training in dentistry. After a 15-min break, each participant was examined again by an experienced dentist. Measures of validity for PD and BOP were calculated comparing the pooled and individual auxiliary nurse midwives to the dentist. A multivariable GEE model estimated the effect of periodontal characteristics on agreement between the auxiliary nurse midwives and the dentist. Results: Participant mean age was 22 years (SD: ±3 years), mean PD was 1.4 mm (SD: 03 mm), and 86% of women had BOP (according to the dentist). Percent agreement, weighted kappa scores, and intraclass correlation coefficients for PD, with an allowance of ±1 mm, exceeded 99%, 0.7, and 0.9, respectively, indicating an acceptable level of agreement. Auxiliary nurse midwives tended to report higher PD scores relative to the dentist, although this over-estimation was small and unlikely to impact population-based estimates of important indicators of oral health status. GEE regression modeling indicated similar agreement for mandible vs. maxilla, left vs. right side, and PD (≤2 mm, > 2 mm), and lower agreement for posterior teeth and lingual and proximal sites.

Risk of preterm birth associated with maternal gingival inflammation and oral hygiene behaviours in rural Nepal: a community-based, prospective cohort study

“…We estimated the validity of probing depth (PD) measurements of the auxiliary nurse midwives relative to the dentist (NKA), finding per cent agreement, weighted kappa scores and intraclass correlation coefficients, with an allowance of PD ±1 mm, exceeded 99%, 0.7 and 0.9, respectively. 22 …”

Oral health community engagement programs for rural communities: A scoping review

“…The initial category elucidates the community-based dental interventions [ 15 , 22 – 27 ]. The subsequent category delineates the school-based dental interventions implemented in the primary school setting [ 17 , 18 , 28 – 30 ]. The third category emphasizes the importance of integrated dental-based interventions [ 25 , 28 , 32 , 35 ].…”

“…To achieve this, we employed a systematic approach to identify records bearing oral health community engagement programs, which were then categorized into four main intervention groups: community-based, school-based, integrated dental-based, and non-dental volunteer-based strategies. The eligible records that we obtained originated from both developed [ 15 , 25 , 27 , 30 – 34 ] and developing countries [ 16 – 18 , 22 – 24 , 26 , 28 , 29 , 35 , 36 ]. Overall, the results of this scoping review confirmed that oral health community engagement programs were effective in enhancing the knowledge and perception of oral health among children and mothers/caregivers; improving oral health and quality of life of edentulous older adults and children; expanding access to and incorporating oral healthcare services provided by dental personnel; and improving oral health outcomes through the involvement of community health workers and teachers among rural residents.…”

Adherence to and acceptability of three alcohol‐free, antiseptic oral rinses: A community‐based pilot randomized controlled trial among pregnant women in rural Nepal

“…Clinical attachment loss (CAL) was calculated by summing the PD and CEJ‐GM distance; the CEJ‐GM distance was assigned a value of 0 for distal and mesial sites, where this measure was not collected, and these sites were not considered in measures of CAL. We estimated the validity of PD measurements of the auxiliary nurse midwives relative to the dentist and found that per cent agreement, weighted kappa scores, and intraclass correlation coefficients, with an allowance of PD ± 1 mm, exceeded 99%, 0.7, and 0.9, respectively, indicating an acceptable level of agreement 20 …”