Date of Award

11-2024

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Mr. Iqbal Azam

Second Advisor

Dr. Syed Murtaza Raza Kazmi

Third Advisor

Dr. Bushra Moiz

Department

Community Health Sciences

Abstract

Background Adolescents with transfusion-dependent thalassemia (TDT) face a higher prevalence of gingival disease as compared to their healthy peers. To date, their oral health related quality of life has not been explored in Pakistan. This study aimed to compare the oral health related quality of life (OHRQoL) and gingival health between adolescents with and without transfusion-dependent thalassemia (TDT), while assessing socio-demographic factors affecting oral health in TDT patients and exploring oral health behaviors and service access challenges among TDT patients and caregivers, with insights from their healthcare providers.
Methodology: Mixed methods design; with comparative analytical cross-sectional design for the quantitative arm and interpretive descriptive design for the qualitative arm. A primary care hematological facility for the TDT group in both arms along with caregivers and healthcare providers in the qualitative arm, and two schools in Azam Basti, Karachi for the healthy group in the quantitative arm. 104 TDT afflicted adolescents aged 12 to 18 years were recruited for the index group, and 104 healthy adolescents aged 12 to 18 years for the comparison group in the quantitative arm, The qualitative arm included 18 participants ( 8 TDT patients, 7 caregivers and 3 healthcare providers). Tools included an online survey, oral examination, whose outcomes were compared in two arms, and semi-structured interviews with TDT patients, caregivers and healthcare providers, which were coded and thematically analyzed. Triangulation of findings was performed via joint display. Child Oral Impacts on Daily Performance (C-OIDP) index, oral characteristics including gingival health and DMFT index, sociodemographic and clinical factors. Qualitative themes to understand oral health behaviors and service access challenges in TDT patients.
Results Out of 208 participants, 56.25% were male, with a mean age of 15.6±1.66 for the TDT group and 14.66±0.14 for the TDT group. The latter had higher scores on the C-OIDP scale (4.71±7.94) compared to the control group (0.82 ± 3.25). In TDT patients, the most frequently impacted 5 dimensions included brushing (61%) and eating (39%). Gingival disease ranged from 36% in the healthy group to 81% in the TDT group. In the TDT group 64.42% had a DMFT score greater than 0, while in the healthy group (n=104), 34.62% had a DMFT score greater than 0. C-OIDP index was significantly associated with gingival disease and socioeconomic status, DMFT. health status, and canine malocclusion (F statistic=4.99 with p-value< 0.01, R2=29.48%). Identified themes included understanding of oral health, impact of thalassemia on oral health, management of oral health, and barriers in accessibility. Triangulation revealed divergence on understanding of socioeconomic status and traditional healthcare practices of the patients. Convergent data on oral health impact highlights the need for improved education and preventive guidance from healthcare providers.
Conclusion This study highlighted the influence of TDT on OHRQoL of adolescents, necessitating the need for educational interventions, heightened prophylactic care, and enhanced guidance from healthcare providers to improve oral health outcomes in this underserved group.

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1

Last Page

178

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