Assessing the Level of Oral Health Knowledge and Practice among State University Students in Enugu State, Nigeria.

Okoronkwo SC^1,2*, Ibe SNO², Chukwuocha UM², Nworuh BO², Ugwumba UA³, Azubuine OR¹, Okoronkwo EC⁴, Oyamienlen CS², Ndubuisi, MC¹

¹Dental Technology Department, Federal College of Dental Technology and Therapy, Enugu

²Public Health Department, Federal University of Technology Owerri.

³Dental Prosthetic Unit, Dental Service Department, Federal Medical Centre, Ebute-Meta, Lagos.

⁴Prosthetics and Orthotic Department, Federal College of Technology and Therapy, Enugu.

*Correspondent Author

DOI: https://doi.org/10.51244/IJRSI.2024.1104039

Received: 01 April 2024; Accepted: 08 April 2024; Published: 13 May 2024

ABSTRACT

Background

Oral health is often ignored, especially among young adults, posing risks to overall health and well-being. In Enugu State, Nigeria, like every other place in the globe, inadequate oral health knowledge and practices among university students are of great concern. Hence, this study focuses on state university students, recognizing their unique challenges such as study pressures and limited access to oral healthcare. Understanding their oral health knowledge and practices is essential for targeted interventions. Data generate can inform the state governments to prioritize oral health initiatives and allocate resources effectively within the region, addressing a critical public health concern.

Aim

This study elucidated assessing level of Oral health knowledge and practice among State University students in Enugu State, Nigeria.

Methods

The sample of the study comprised 786 students drawn through a multistage sampling selection method. A pre-tested, well-structured questionnaire was the main instrument of data collection for assessing level of Oral health knowledge and practice among State University students in Enugu State, Nigeria. Statistical Package for Social Sciences (SPSS) Version 23 was used for analysis.

Results

Findings showed 34% of students possess inadequate oral health knowledge while lesser percentage of students 1% showed poor oral health practice compared to students’ total population. Whereas socio-economic status indeed plays a role in shaping students’ oral health knowledge and practices, potentially warranting targeted interventions to address disparities and promote oral health equity among university students. However, Chi-square analysis reveals demographic variables’ associations with knowledge and practice levels among students. Gender lacks significance in both areas (p=0.47 for knowledge; p=0.175 for practice). However, age significantly correlates with knowledge (p<0.001), and class level associates highly with both knowledge and practice (p<0.001). Thus, age and class significantly influence students’ habits.

Conclusion

Relevant oral health educational interventions are required to promote oral health knowledge and practice among State University students in Enugu State, Nigeria.

Keywords: assessing, level, Oral health, knowledge, practice, among, State University, students, State.

INTRODUCTION

Oral health is an essential component of an individual’s overall well-being (World Health Organisation, WHO, 2015), yet it often receives inadequate attention, particularly among young adults (Okoronkwo et al, 2020). In Enugu State, Nigeria, like several other regions worldwide, the level of oral health knowledge and practice among university students remains a matter of concern. Poor oral health knowledge and practices can lead to various dental problems, impacting individuals’ quality of life and overall health outcomes (Tefera, Girma, & Adane, et al., 2023).

Enugu State is home to several state universities, attracting students from diverse backgrounds and regions (Ugwuoke, Eze, & Omeje, 2019). But this study is focused on state university student as students within this study locality often face a lot of challenges, including study pressures, change of lifestyle, and limited access to adequate oral healthcare services (Okoroafor et al., 2023). Hence, understanding the level of oral health knowledge and practices among these students becomes imperative for developing targeted interventions programme to promote better oral health outcomes (Tadin, Poljak, Domazet & Gavic, 2022). Although it is assumed that there is availability of oral health education programs in our higher institutions, yet there is an observed gap in understanding how effective these ideas reach and influence university students in Enugu State. As factors such as socio-economic status, cultural beliefs, and access to oral healthcare facilities may have influenced students’ oral health knowledge and practice (Egbunah, Sofola & Uti, 2023).

Hence, assessing the level of oral health knowledge and practices among state university students in Enugu State will provide valuable insights into their awareness, knowledge and behaviors concerning oral health. This assessment will identify areas of strengths and weaknesses, indicate potential barriers to oral health promotion, and serve as a reference point to the development of interventions programme to improve oral health outcomes among this demographic (Czwikla, et al., 2021). As well as the utilization of this findings by State governments and its health authorities to prioritize oral health initiatives and allocate resources more effectively within the state.

METHODS

Research Design/Techniques

The study design for this study were descriptive survey design to determine the baseline oral health knowledge and practice among state university students. This design is best fitted for this study as it has been used by similar study by Ibe et al (2020). The sampling Techniques for this study was multistage sampling technique. The first stage sampling techniques, all faculties of the Universities were selected, that is 11 faculties. For second stage, which was the selection of departments from the faculties; 15 departments were selected with population of 3,651 students. This was generated through 30% of departments from each faculty. These was according to the rule of the thumb where 30% of the sample was found to be representative of the population. In the third stage, students were allocated to each sampled department using proportional sampling technique. Here, each of the sampled department were proportionally allocated students base on the departmental and faculty population. In the Fourth stage, proportional sampling technique were used to allocate students to year/level (Year 1 – 4) of study for each department. In the fifth stage, stratified sampling techniques were used to stratify students gender into Male and Female. Then, the Sixth stage was where students were allocated to the strata (Male and Female) using systematic techniques.

Instrument for Data Collection

The instrument required for data collection for this study was a questionnaire. The questionnaire has well-structured questions that were used to collect data for this study which is to determine the level of oral health knowledge and practice among state university students in Enugu state. This instruments were validated, by an expert in the field of oral health, Public health and health education, in relation to language, clarity, adequacy of content and ability to elicit accurate information in relation to the purpose of the study. However, the internal consistency of the instrument was confirmed with kuder-Richardson-21 reliability coefficient of 0.807 and Cronbach’s alpha reliability coefficient of 0.811.

Method of Analysis

The data generated from the questionnaire were collected and collated by the researcher and were entered into computer software called Statistical Package for Social Science (SPSS) version 23 for both descriptive and inferential statistical analysis. Descriptive statistics were used to report frequencies for categorical variables and were illustrated in the form of tables. The outcome was analyzed and presented using score and percentage grading system. This grading system showed that, students with less than 40 % score had Poor knowledge, those with scores within 40% – 55% scores had moderate knowledge while students with scores above 55% had high knowledge. These were also attributed to oral health practice; students with oral health practice score below 40% were regarded as those with poor practice, whereas students with score within 40% to 55% has moderate practice while those with score above 55% were regarded as students with high oral health practice. Inferential statistics were applied using chi-square test tool to test for significance difference between variables (Price, Jhangianiand & Chiang, 2015).

Ethical Considerations/Informed Consent

The department of Public health, School of Health Technology, Federal University of Technology, Owerri approved the study and gave a letter of introduction to the researcher. The ethical committee gave ethical approval after going through the proposal, while a verbal informed consent was sorted and received from the participating students.

RESULT

Socio-demographic characteristics

Result from Table I, showed that students from within Age less than 18years were 140(17.8%) respondents. Students with Age range of 18 – 23 years were 223(28.4%), for students with Age range of 24 – 29years, respondents were 469(34.2%) students. But for Age above 29years, the outcome was 154(19.4%) students. For Gender of the study, Female students the outcome of respondents was 55.3%. But for year of study, year 1, students had 107(13.6%) students. For year 2, students had 213(27.1%) students. For year 3, students had 276(35.1%) students. For year 4, has 190(24.2%) students.

Table 1: Distribution of respondents by Socio – demographic Characteristics, n =786 (100%)

Oral health knowledge

From table 2 below, we have frequency of students with knowledge of oral hygiene at 71% students while for Adequate for cleaning mouth was 493(62.7%) students. For Best time to brush the teeth, the outcome was 82 (10.2%) students indicating poor knowledge on best time to brush the teeth for both school. However, for ways to clean the mouth, the researcher had 448(57%) students for All of the above option, indicating greater respondents with adequate knowledge on ways to clean the mouth. For Food good for the teeth, 19(12.4%) affirmed cake, 156(19.8%) affirmed chewing gum, 21(2.7%) affirmed ice cream, 16(2.0%) affirmed sweet, while 574(73.0%) affirmed vegetables. For Ways to prevent oral disease, the outcome showed 223(28.4%) students for All of the above, 58(7.4%) students for by brushing the teeth, 50(6.4%) students for by Flossing, 375(47.7%) students for by Reducing sugar intake and 80(10.2%) students for by Regular mouth wash. For Oral diseases as a result of poor oral hygiene, the outcome showed 405(51.5%) respondents for Gingivitis, 146(18.6%) for Graves’ disease, 94(12%) for Oral cancer and 141(17.9%) for Oral stomatitis.

Table 2: Frequency distribution of oral health knowledge of students, n=785(100%)

Oral health knowledge frequency distribution by score Level

On the assessment of oral health knowledge, table 3 results showed that students with less than 40% score were 34% of the students. While those with moderate score were 13% of the students. However, students with high knowledge were 53.1% students.

Table 3: Distribution of respondents by oral health knowledge score level, n=786 (100%)

Oral health practice

From table 4 below, the outcome showed, 571 (72.6%) students Daily, 2 (0.2%) students for Don’t know, 88(11.2%) for Four times a week, 1(0.1%) students for One a week, 46(5.9%) students for None and 78 (9.9%) students for Others. For question on, do you clean your teeth, the outcome showed 29(3.7%) students affirmed No as their respondents and 757(96.3%) students affirmed Yes. For question on Frequency of cleaning teeth, the outcome showed 44(5.6%) students responded Afternoon only, 470(59.8%) students responded Morning and night, 218(27.7%) students responded Morning only, while none of the students responded Never, but 53 (6.7%) student affirmed Night only and 1(0.1%) student affirmed Sometimes as their responds.

Table 4: Frequency distribution of student’s oral health practice, n=786 (100%)

Oral health practice by score level

Result from table 5, showed that students with poor practice scores was 1% and those with moderate practice score were 10 %. While students with high practice score 88.8%.

Table 5: Distribution of respondents by oral health Practice, n=786 (100%)

Student Parental socio-economic status

Result from table 6, showed that students whose father’s highest level of education was No formal education were 22% of the students while those Father’s highest education was tertiary education were 40.5% students. However, students whose Mother’s highest education was No formal education were 16.2% students while those whose Mother’s highest education was tertiary were 36.5% of the students. Hence, for student father’s occupation, 0.3% of them was in the categories of others. While for mother’s occupation, those with others had 0% students. For Parent’s residence, those with 0.2% in the categories of others while those in urban areas had 41.3% of them resides in semi-urban area. However, those with 15.1% were for those in the categories of N20,000 – N 29,000 monthly upkeep from parents. While 41.6% of the students were at N10,000 – N19,000 monthly upkeeps from parents. But for student’s residence, students respond for others were 0.0% while those in off-camp were 30.5%.

Table 6: Distribution of respondents by student parental Socio – economic status, n=786 (100%)

Table 7: Relationship between Gender and Knowledge of the students

The chi-square value here is 3.5 and the p-value associated with the chi-square value is 0.47, which suggests that there is no significant association between gender and knowledge level at a 95% confidence level. The confidence interval (CI) is also provided, which is 95% in this case, with a range of 0.464 to 0.483. Based on this analysis, there is no strong evidence to suggest a significant relationship between gender and knowledge level among the students in the study.

Table 8: Relationship between Age and Knowledge of the students

The chi-square value here is 24.3 and the p-value associated with the chi-square value is less than 0.001, indicating a highly significant association between age group and knowledge level at a 95% confidence level. The confidence interval (CI) is also provided, which is 95% in this case. The range is from 0 to 0, which suggests perfect agreement between age group and knowledge level. Based on this analysis, there is a significant relationship between age group and knowledge level among the students in the study. Specifically, older age groups tend to have higher levels of knowledge compared to younger age groups.

Table 9: Relationship between class level and knowledge of students

The chi-square value here is 24.9 and the p-value associated with the chi-square value is less than 0.001, indicating a highly significant association between class level and knowledge level at a 95% confidence level. The confidence interval (CI) is also provided, which is 95% in this case. The range is from 0 to 0, indicating perfect agreement between class level and knowledge level. Based on this analysis, there is a significant relationship between class level and knowledge level among the students in the study. This suggests that as students’ progress to higher class levels, their knowledge levels tend to increase.

Table 10: Relationship between Age and Practice of the students

The chi-square value here is 4.9 and the p-value associated with the chi-square value is 0.615, which is greater than the typical significance level of 0.05. This suggests that there is no significant association between age group and practice level at a 95% confidence level. The confidence interval (CI) is also provided, which is 95% in this case, with a range of 0.606 to 0.625. Based on this analysis, there is no significant relationship between age group and practice level among the students in the study. This means that age group does not seem to influence the practice levels of the students.

Table 11: Relationship between Gender and Practice of students

The chi-square value here is 4.9 and the p-value associated with the chi-square value is 0.175, which is greater than the typical significance level of 0.05. This suggests that there is no significant association between gender and practice level at a 95% confidence level. The confidence interval (CI) is also provided, which is 95% in this case, with a range of 0.168 to 0.183. Based on this analysis, there is no significant relationship between gender and practice level among the students in the study. This means that gender does not seem to influence the practice levels of the students.

Table 12: Relationship between Class level and Practice of students

The chi-square value here is 14.9 and the p-value associated with the chi-square value is less than 0.05, which suggests that there is a significant association between class level and practice level at a 95% confidence level. The confidence interval (CI) is also provided, which is 95% in this case, with a range of 0.025 to 0.032. Based on this analysis, there is a significant relationship between class level and practice level among the students in the study. This indicates that students in different class levels tend to have varying levels of practice habits.

DISCUSSION

The findings of this study of oral health knowledge among students from a state university in Enugu state revealed that 34% of students possess inadequate oral health knowledge. Contrary to expectations, given their level of education, it was surprising to discover that the outcome suggests otherwise, indicating a deficit in oral health awareness among university students. However, a study by Tadin, et al., (2022), on Oral Hygiene Practices and Oral Health Knowledge among Students in Split, Croatia, is not in agreement with this study by saying that there is a good oral health knowledge among tested university students.

However, on oral health practice among state university students in Enugu state, the outcome of this study showed lesser percentage of students 1% with poor oral health practice compared to students’ total population. These outcomes showed that there was higher percentage of students in that practiced oral health. Fortunately, this outcome is not surprising, as it was expected that university students based on their level of education should have good oral health practice. Besides, this outcome of another study done by Alakija (1981) on oral hygiene practice in primary schools in Benin City, Nigeria showed that Girls had higher oral hygiene scores than boys, and there was little difference between the scores of girls in the two schools and that oral health practice can be achieved through good oral hygiene.

Furthermore, the socio-economic status in this study presents a complex picture that could potentially impact students’ oral health knowledge and practices (Aslan et al., 2022). While a significant portion of parents have attained tertiary education, suggesting a higher level of education within households, disparities in parental education levels and occupations between genders could influence the transmission and reinforcement of oral health knowledge within families. Additionally, the amount received for upkeep may reflect financial constraints that could limit access to oral health services or products. Moreover, the diverse living arrangements, with a substantial portion of students living off-campus, could affect their access to and engagement with oral health resources and practices (Nayee, et al., 2018). These factors collectively suggest that socio-economic status may indeed play a role in shaping students’ oral health knowledge and practices, potentially warranting targeted interventions to address disparities and promote oral health equity among university students.

The chi-square analysis reveals varying associations between demographic variables and knowledge or practice levels among the students. Gender shows no significant association with knowledge or practice levels, with p-values of 0.47 and 0.175, respectively. Likewise, age group exhibits no significant association with practice level (p = 0.615). However, age group displays a highly significant association with knowledge level (p < 0.001), indicating that older students tend to have higher knowledge levels. Additionally, class level demonstrates a highly significant association with both knowledge and practice levels (p < 0.001 for both), suggesting that as students’ progress to higher classes, their knowledge and practice levels increase. Therefore, while gender does not seem to influence knowledge or practice levels, age group and class level significantly impact students’ knowledge and practice habits.

CONCLUSION

The findings of this study on oral health knowledge among students in Enugu state university reveal a concerning inadequacy, with 34% exhibiting insufficient awareness. Despite expectations of higher knowledge levels among university students, this deficit suggests a need for improved oral health education. Conversely, oral health practices show a more positive trend, with only 1% exhibiting poor habits, aligning with the anticipated higher standards among educated individuals. However, disparities in socio-economic status highlight potential influences on knowledge and practices, indicating a need for targeted interventions. While demographic factors like gender and age show varied associations with knowledge and practice levels, class level emerges as a significant predictor, underscoring the importance of educational progression in fostering oral health literacy and behaviors among students.

Competing Interests

Authors have declared that they have no competing interests

FUNDING

 No funds were received for this study

ACKNOWLEDGEMENTS

Not Applicable

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