Date of Award

12-31-2020

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Sameen Siddiqi

Second Advisor

Dr. Nousheen Pradhan

Third Advisor

Dr. Saida Rasul

Department

Community Health Sciences

Abstract

Background: Healthy and well functional teeth are an important part of every individual. It helps in speaking, smiling, chewing, eating, and socialization. Dental health is part of general, physical, and mental wellbeing. Poor oral health has significant psychological, societal, and economic outcomes. Dental diseases are contributors of non-communicable diseases (NCDs) which is the leading cause of disability and mortality globally. There is a connection between overall health and dental health as most NCDs share common risk factors with dental diseases. Diseases like diabetes, cardiovascular disease, HIV, gastric ulcers, and cancers have oral manifestation. So, the early detection of dental diseases is important to prevent these diseases. Mouth cancer is the seventh occurring cancer worldwide, but it is the 2nd most common cancer in females and 3rd most common cancer among males in Pakistan. Dental caries in Pakistan is said to be prevalent among 60-65% of the population. The high burden of oral disease represents an underestimated challenge for low middle-income countries including Pakistan. Quality in dental healthcare is a complex and multidimensional concept and every individual who utilizes health services wants to receive quality care dental services. Quality is an important attribute for the success of the health care sector. Dental health affects the quality of life, the lower the socio-economic status of a person higher the health risks of the individual, the determinants of health are important to understand the relationship between health systems, community, and their disease problems.
Objective of study: The objective of this study is to explore the range, quality, and level of utilization of dental services at different public sector healthcare facilities and also to determine the barriers that deter the population from the utilization of the available dental services at different levels of public sector dental healthcare facilities in the district, Thatta Sindh, Pakistan.
Method/Design: This study is descriptive research design used to survey different levels of public sector dental facilities in district Thatta for availability & functionality of dental services, equipment & supplies, and for the availability of healthcare providers using facility assessment tool (Facilities n = 7). The utilization of dental service was evaluated through patient satisfaction assessment conducting patient exit interviews (n= 197). In-depth interviews with a key informant (patients, xi attendants, and community members n=8, health managers n=6) were done using a semi-structured interview guide to assess gaps in dental services and to identify barriers to dental services utilization. Data for the quantitative study was analyzed using micro-soft excel, frequency, and percentages presented in tables & charts. IDI was analyzed using thematic content analysis approach, transcribing verbatim in English from the interview audios then identifying main themes, sub-themes from data by deductive approach.
Results: Findings from Quantitative study reported 48% of dental services were available in public sectors dental facilities,52% of basic amenities were present,61% of equipment and supplies related to dental procedures were present and 60% of available were functional, 53% of equipment and supplies for infection prevention and control were present and utilize at public sector dental facilities. Services utilization at Civil hospital Maklli (DHQ) was 65% which is the highest level of dental service utilization in the whole district. One dental surgeon was present at all public sector dental facilities. The patient satisfaction evaluation reported 93% of patients are satisfied with service fees and 90% of patients were satisfied with the attitude of the healthcare provider. Qualitative finding reported that there were multiple barriers exists for utilization of dental services in this district which includes individual-level Factors; low dental health literacy, poor dental health habits and dental hygiene practices which were religiously and culturally bounded. Community and environmental level factors include extended family system, low socioeconomic status, low family and social support, health system related factors including the absence of national dental health program & policy, absence of separate oral health budget & resources and non-availability of community needed dental services. Conclusion: Finding from this study indicated that the district dental healthcare delivery system needs to improve dental services availability and readiness. SOP's and guidelines need to be built and made available and implemented aimed at quality improvement. The range of dental services needs to be developed according to patient's needs and segregated according to the level of the healthcare system. Determinants of oral health need to be addressed to improve population dental health literacy and ultimately for dental health utilization.

First Page

1

Last Page

100

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