FACTORS CONTRIBUTING TO LOW UPTAKE OF DENTAL CARE

SERVICES AMONG RESIDENTS OF KATWE- BUTEGO, MASAKA CITY

BY

MUTESI NUULU

NSIN: JUL19/U020/DCN/013

MAY, 2023
FACTORS CONTRIBUTING TO LOW UPTAKE OF DENTAL CARE

SERVICES AMONG RESIDENTS OF KATWE- BUTEGO, MASAKA CITY

BY

MUTESI NUULU

NSIN: JUL19/U020/DCN/013

A RESEARCH REPORT SUBMITTED TO UGANDA NURSES AND

MIDWIVES EXAMINATION BOARD

IN PARTIAL FULFILLMENT OF THE AWARD OF A DIPLOMA IN

COMPREHENSIVE NURSING

MAY, 2023

1
 COPY RIGHT

Copyright ©2023 by Mutesi Nuulu

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 DECLARATION

I MUTESI NUULU, do hereby declare that the information presented in this

research is mine and original, except where references have been made and has never

been presented anywhere for academic award.

Signature…………………………………………date……………………………...

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 AUTHORISATION

The unpublished research report has been supervised and approved by my supervisor

and the principle and submitted to Masaka School of comprehensive nursing and

deposited in the library, its open for inspection but are to be used in regard to the

rights of the Author.

Signature…………………………………… Date…………………………….

MUTESI NUULU

(STUDENT)

Signature……………………………………. Date…………………………….

MS. NATAMBA CHRISTINE

(SUPERVISOR)

Signature……………………………………. Date…………………………….

MS. NAWUSINDO KEKULINA

(PRINCIPAL MSCN)

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 DEDICATION

I dedicate this piece of work to my family especially my loving father Mr. Abdul

Goowa, my mother Namususwa Zamaladi, my big brother Ali Goowa for the

financial and social support through-out my academic life and this course.

Thank you so much for working tirelessly to see that I reach where I am today, may

the Almighty Allah continue blessing you and forgive all your wrongs.

To Wasswa Abdul-Rashid for the endless support toward accomplishing this report

successfully. Thanks for the advises, financial support and guidance, may the

Almighty bless you for me.

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 ACKNOLEDGEMENT

I am sincerely grateful to the Almighty Allah for this academic opportunity,

protection, blessings and provisions he has rendered to me throughout my life

especially the academic life, may you make me obedient to you ever and praise you

throughout my remaining life. Continue blessing me and my family.

Am grateful to my supervisor Ms. Natamba Christine for the tireless supervision and

academic guidance during this study together with my research tutor Ms. Nantume

Susan, may God bless you with more knowledge.

Sincere thanks to the administration of Masaka school of comprehensive nursing,

tutors and non-teaching staff for the love and social support.

Special thanks to the LC1 Chairman Katwe-Butego, Mr. Kivumbi G William for

allowing me to carryout thus study in your area; and the residents of this area for their

time and participating in this study.

Finally, I appreciate my Friend Musonge Joseph for availing me with your laptop

throughout this research period, may the almighty Allah bless you with the light in

Islam.

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 TABLE OF CONTENTS

DECLARATION.....................................................................................................................3
LIST OF ACRONYMS AND ABBREVIATIONS..................................................................9
OPERATION DEFINITIONS................................................................................................10
ABSTRACT...........................................................................................................................11
CHAPTER ONE: INTRODUCTION.....................................................................................12
1.1 Background..................................................................................................................12
1.2 Problem statement........................................................................................................14
1.3 Purpose of the study.....................................................................................................15
1.4 Specific objectives of the study....................................................................................15
1.5 Research questions.......................................................................................................16
1.6 Justification of the study...............................................................................................16
CHAPTER TWO: LITERATURE REVIEW.........................................................................18
2.0 Introduction..................................................................................................................18
2.1 Socio economic factors contributing to low uptake of dental care services..................18
2.2 Individual factors contributing to low uptake of dental care services...........................21
2.3 Health facility related factor contributing to low uptake of dental care services..........24
CHAPTER THREE: METHODOLOGY...............................................................................26
3.0 Introduction..................................................................................................................26
3.1 Study design and rationale............................................................................................26
3.2 Study setting.................................................................................................................26
3.3 Study population..........................................................................................................27
3.7 Data collection tool......................................................................................................28
3.8 Data collection procedure.............................................................................................28
3.9 Data management.........................................................................................................29
CHAPTER FOUR: STUDY RESULTS.................................................................................31
4.0 Introduction..................................................................................................................31
4.1 Demographic characteristics of residents of Katwe Butego..........................................31
4.2 Socio-economic factors contributing to low uptake of dental care services in Katwe
Butego. N=40.................32

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 4.3: Individual factors contributing to low uptake of dental care services..........................34
4.3: Health-facility related factors contributing to low uptake of dental care services in
Katwe-Butego....................................................................................................................38
CHAPTER FIVE: DISCUSSION, CONCLUSION, RECOMMENDATIONS AND
NURSING IMPLICATIONS.................................................................................................40
5.0 Introduction..................................................................................................................40
5.1 Discussion of study findings.........................................................................................40
5.1.1 Demographic characteristics of respondents..............................................................40
5.1.2 Socio-economic factors contributing to low uptake of dental care services among
residents of Katwe-Butego.................................................................................................40
5.1.3 Individual factors contributing to low uptake of dental care services among residents
of Katwe-Butego................................................................................................................43
5.1.4 Health facility related factors contributing to low uptake of dental care services
among residents of Katwe-Butego.....................................................................................45
5.2 Conclusions..................................................................................................................48
5.3 Recommendations........................................................................................................48
5.4 Nursing implications....................................................................................................50
5.5 Areas for further study.................................................................................................50
REFERENCES.......................................................................................................................51
APPENDICES.......................................................................................................................54
APPENDIX 1: CONSENT FORM.........................................................................................54
APPENDIX II: QUESTIONNAIRE......................................................................................55
APPENDIX V: A MAP SHOWING KATWE-BUTEGO IN MASAKA CITY....................62

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 LIST OF ACRONYMS AND ABBREVIATIONS

WHO : World Health Organization

MOH : Ministry of Health

DMFT : Decayed Missing Filled Teeth

OPD : Outpatient department

LMIC : Low-Middle Income country

COHOs : Community Oral Health Officers

OHW : Oral Health Work force

H/C : Health center

DTs : Dental Technologists

PMD : People who have experienced a mental health disorder

CWRU : Case western reserve university

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 OPERATION DEFINITIONS

Dental : Relating to teeth

Utilization : Making use of something

Facility : Is where one accesses services

Children : Anyone below 18 years

Youth : A person between 18 and 35 years

Diseases : Any malfunction in the normal functioning of an organ or tissue

Residents : People living in a specific area

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 ABSTRACT

Background: The WHO global oral health status report (2023) estimated that oral

diseases affect close to 3.5billion people worldwide, with 3 out of 4 people living in

middle income countries, Uganda alone with a dental caries prevalence of 66%

among adult population, (Oral health survey report, 2015).

Purpose: The study was to find out the factors contributing to low uptake of dental

care services among residents of Katwe-Butego, Masaka city.

Methodology: A descriptive and cross sectional study design that employed both

quantitative and qualitative methods was used with self-constructed questionnaires

enrolling 40 respondents and a simple random technique used, and data collected was

manually analyzed and presented in form of figures and table.

Results: Socio economic factors included level of income and unemployment

(77.5%), low levels of education and disruption by Covid 19 (90%). The individual

factors included self-medication (67.5%), poor perception (62.5%), dissatisfaction,

gender and nature of occupation. Health facility factors included length of waiting

lists (19.7%), limited access, far distance to facility (47.3%), few dental specialists.

Conclusion and recommendations: From the study, majority reported low levels of

income, poor perception and long distance to facility respectively to have hindered

dental care uptake. All stakeholder should focus on their respective roles to improve

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oral health among people. Residents be health educated so as to correct their poor

attitude and also prevent self-medication.

CHAPTER ONE: INTRODUCTION

1.1 Background

This chapter consists of the background of the study, the problem statement, the

purpose of the study, outline of the specific objectives, research questions and

justification of the study.

Dental care is the practice of maintaining and restoration of oral health of a person or

population. It involves performance of oral hygiene at home through regular brushing

of teeth and regular diseases. Most of the oral health conditions are largely prevented

and can be treated in their early stages; most cases are dental caries (tooth decay),

periodontal diseases, tooth loss and oral cancers (WHO, 2023).Oral health plays a

crucial role in nutrition, employment, self-esteem and social 1interaction. However,

many people continue to suffer from oral diseases, resulting in preventable pain,

infections, reduced quality of life as well as productivity loss and learning disruptions

among school children (WHO, 2023).

The WHO global oral health status report (2023) estimated that oral diseases affect

close to 3.5billion people worldwide, with 3 out of 4 people living in middle income

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countries. Globally, an estimated 2 billion people suffer from caries of permanent

teeth and 514 million children suffer from caries of primary teeth.

In Sub-Saharan Africa, dental caries incidences have been estimated to be 1,000,000

to 14,000,000 cases per year with mortality rate of 70-90%. In Malawi, out of

1,726,065 OPD visits, 57,234 were due to oral health problems. The research

specifically assessed student, environmental and dietary related factors that attribute

to the prevalence of dental caries (Denis, 2017).

Kenya, a LMIC is one of the 57 counties listed by WHO as having critical shortage of

health workers. Historically, the demand for oral health care in East African country

has always surpassed the supply of its OHW who included dentists, COHOs and

Dental technologists. At the time of this study, the dentist to population ratio was at

1:42000 significantly below the WHO recommended ratio of 1:7000 (Brenda A.

Okumu, 2022).

The government of Uganda in 2007 developed an oral health policy; the policy

recognizes that oral health should be treated like any other serious health issue in the

country. It emphasizes the importance of equity, integration, community

participation, gender, prevention and promotion, and research as a major tool to be

used in addressing oral health burden in Uganda. In Uganda, a national wide oral

health survey report (2015) found a high burden of dental caries experience, with a

prevalence of 66% among adult population. Dental caries have also been found

prevalent especially among people living with HIV, and have been associated with art

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use (Wilfred Arubaku, 2022). Dental caries (DMFT≥1) was recorded in 40% and

62.5% of children and adults, respectively. The overall mean DMFT score was 0.9 for

children and 3.4 for adults. Caries was significantly more severe in females as

compared to males in adults (p<0.05), whereas in adults, there was no significant

gender difference. Kampala had a significantly higher mean DMFT score compared

to other districts in all age group (p>0.05) (Louis M Muwazi, 2021).

Generally, there was a higher mean DMFT score in rural (2.19) compared to urban

areas (1.97) in all districts, except Hoima, there was a high DMFT of children in rural

compared to urban. In adults, similar trend was mainly registered in Masaka, Hoima

and Gulu districts (Kutesa, 2015).

1.2 Problem statement

The vision of the global strategy on oral health is oral health for all individuals and

communities by 2023, enabling them to enjoy the highest attainable state of oral

health and contributing to health and productive lives. About 80%of Ugandan

population has dental problems. But the utilization of dental care is low despite the

numerous dental problems yet if not attended to, they can complicate into

hypertension, endocarditis among other conditions (Shanura, 2018). In Masaka

Regional Referral Hospital (MRRH) dental unit, 168,000 patients that attended from

March to June, only 10% came from Katwe-Butego and from September to

December 2020, 182,000 patients attended but only 9.2% people came from Katwe-

Butego.

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However, still these services are not adequately utilized. Therefore, the government

of Uganda has put up several strategies so as to improve on dental care service

utilization like provision of free dental care services at public health facilities,

integration of dental care services with other health services at various health

facilities including HC1V and other primary health care components for example

good nutrition and health education to improve health seeking behaviors.

Therefore, this study intends to find out the factors contributing to low utilization of

dental care services among residents of Katwe-Butego, Masaka city with the aim of

improving uptake of the services.

1.3 Purpose of the study

This study aims to find out the factors contributing to low utilization of dental

services by residents of Katwe-Butego, Masaka city in order to suggest means of

improving uptake of the services.

1.4 Specific objectives of the study

a) To find out the socio-economic factors contributing to low uptake of dental

care services among residents of Katwe-Butego, Masaka city.

b) To find out the Individual factors contributing to low uptake of dental care

services among residents of Katwe-Butego, Masaka city.

c) To find out the Health-facility related factors contributing to low uptake of

dental care services among residents of Katwe-Butego, Masaka district.

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1.5 Research questions

1. What are the socio-economic factors contributing to low uptake of dental care

services among residents of Katwe-Butego, Masaka city?

2. What are the individual factors contributing to low uptake of dental care

services among residents of Katwe-Butego, Masaka city?

3. What are the facility related factors contributing to low uptake of dental care

services among residents of Katwe-Butego, Masaka city?

1.6 Justification of the study

The study results will help the government through MOH to plan and implement

measures that will help to combat the low utilization of dental care services despite

the wide spread dental problems by training and employing more dental practitioners

to serve even the underserved areas especially the rural areas.

This study therefore aims to report patterns of use of dental care services, factors

associated with use of dental services, and self-reported barriers to using dental care

services by people living in rural areas, and to compare these findings with some

indicators of general population.

This information will generate a powerful advocacy strategy tool for dental health

care resources in this population, and position oral health in broader concept of

personal and social wellbeing.

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The study results are also hoped to be of benefit to future researchers especially those

who might wish to undertake similar or related studies.

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 CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

This chapter presents the existing literature on the matter under study. The existing

literature generally concerns the factors contributing to low uptake of dental care

dental care services as encounter by other researcher elsewhere in the world. This

information will be got from the internet, journals, report and text books.

2.1 Socio economic factors contributing to low uptake of dental care services

In a study carried out in Chile demonstrated that family income has negative

correlation with dental visit, children from low socio economic backgrounds utilized

oral health care services less frequently than those from high socio economic

background and likewise to children growing up with single mothers and step fathers

have poor health outcome due to inappropriate monitoring of oral health. Study

results revealed that the odds of utilizing oral health care services for the study

participants from the middle (AOR: 0.50; Cl: 0.31-0.79; P=0.003) and low (AOR:

0.24; Cl: 0.13-0.45; p=<0.001) social economic strata, and those living with

guardians/ relatives(AOR: 0.o8; Cl: 0.01-0.60; p=0.01) were decreased when

compared to those living with both parents respectively (Nnekakate, Onyejaka,

Oluwatoyin, & Folaranmi, 2016).

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Young age. In a study conducted in United Arab Emirates to access the severity of

early childhood carries in preschool children attending Al-Ain Dental Centre where

176 children were included, results revealed that more than two thirds of children had

never visited a dentist before and 63% had poor oral hygiene. The mean DMFT and

DMFTs scores were 10.9 and 32.1 respectively while the care index was very

low(6.4%) (Kowash, 2015).

Unemployment: In the study carried out in Saudi Arabia, it stated that adults with

higher incomes can afford to pay private dental services, insurance and also access

free government services. Results showed that the social-economic factors associated

with the higher likelihood of dental service utilization in the final fully adjusted

model were high household income (OR=1.43, p=0.043), second and middle

household wealth status (OR=1.51, p=0.003 and OR=1.57, p=0.006) and access to

free governmental health care (OR=2.05, p=0.004) (Deema, et al., 2022).

A study carried out in Saudi Arabia to access need for dental care drives utilization of

dental services among children revealed that one of the perceived barriers to dental

care was financial (22.8%) where 15.7% reported no having enough money as the

most common reason reported (Dania E Al Agili & Farsi, 2020).

Low levels of education of parents and care givers. Care givers’ education levels

influences how often they and their children brush their teeth and visit the dentist for

routine checkups. In a study conducted in African American kindergartens and their

care givers from a CWRU dental school reported that care givers who completed high

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school were 1.76% more likely to visit the dentists, more than those who did not

graduate at high school and also the education level of caregivers was directly

associated with about a third fewer untreated decayed teeth and 28% fewer decayed

teeth or filled teeth among the children they cared for. This is associated with the low

self-esteem associated with low levels of education, communication with dentists and

following instructions (Lee, et al., 2015).

According to the study conducted among immigrants and ethnic minorities, lack of

social support after migration to a new country also affected their oral health. Social

support from their surrounding environment in the form of structural or functional

support plays an important role in attending dental care visits and so their oral health

outcomes. Study results reported social support to be positively associated with dental

care utilization, number of carious teeth, periodontal diseases, oral heath behaviors,

oral health knowledge, oral health related quality of life and self-rated oral health

(Dahlan, et al., 2019).

According to WHO (2023), disruptions by Covid 19 pandemic in the health sector

have exacerbated oral health services in the region, with around 90% of countries to a

WHO survey reporting complete or partial disruption of oral health services between

February and July 2020. Countries have since made efforts to restore the delivery of

essential services.

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2.2 Individual factors contributing to low uptake of dental care services

A study carried out in Nigeria stated that self-medication and use of native medicines

was one of the factors hindering utilization of dental care services, people’s

traditional belief in native doctors. Therefore, most of the diseases went unnoticed by

the physicians as many of these were either tolerated or were self-medicated. Study

results reported 24.4% out of the 119 participants to have used traditional/ herbal

medication and 49.6% self-medicated prior to presentation at dental clinics. This is

because traditional medicines are considered most affordable and accessible

especially in rural areas (Mercy & Enabulele, 2017).

In Uganda, the study carried out in Kanungu district, pointed out dissatisfaction in the

services provided to the people seeking dental services by the dentists as one of the

reasons limiting utilization. This is because the services received in terms of

medication is not as expected for example at times no immediate treatment given

after seeing the dentists, lack of confidentiality and inconveniences at clinics all

contributing to 62.3% failure rate (Arineitwe, 2023).

In a study carried out in Australia, people with mental health disorders and people

who have experienced a mental health disorder (PMD) are reported to have poor

access to dental care services and poor oral health outcomes. Study results revealed

that almost half (45.5%) of the total Austrian population will experience a mental

health disorder at some stage in their life with 20% affected in any given year. PMD

as a group have significantly worse oral health outcomes especially those who are

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hospitalized for their disorder, this is attributed to their low self-esteem, stigma,

phobias, lack of income and poor communication (Slack-smith, et al., 2016).

A study carried out in Japan and kingdom of south Arabia highlighted poor

perception of the importance of oral health, lack of knowledge on the provided dental

services and psychosocial and self-perception factors as another factor to forego

professional dental visits. Study results revealed that 33% out of 395 respondents

think that a dentist should only be visited if they experienced pain and 67% lacked

knowledge. All these leads to low dental care utilization and is seen to affect not only

individuals or communities but the nation as a whole (Faeq, et al., 2017).

According a study carried out in Nigeria among federal and state civil servants of Port

Harcourt, reported that the widely held perception that one needs to visit the dentist

only when there are symptoms such as pain and emergency for example fear of pain

and injection to hinder utilization of dental services. Results showed that out of the

638 participants, 313 and 325 were from federal and state civil service, respectively

with 55(68.8%) federal workers and 45(71.4%) state civil workers who had visited

dentist based on need and 59% reported that the reason for non-utilization is no need

for treatment (Elfleda & Omoigberai, 2015).

According to a study carried out among school adolescents in Uganda, the increase in

the prevalence and severity of dental carries was attributed to inadequate exposure to

fluorides coupled with the growing consumption of sugars. The prevalence of caries

was determined as a percentage of individuals with DMFT score ≥1 and the overall

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prevalence of dental caries was 66.0% and mean DMFT score of 2.18±2.67, and this

was associated with tooth cleaning devices, history of previous dental visit and age,

with a higher prevalence among adolescents (Barbara, et al., 2020).

Perceived need: Individual’s own judgment about the necessity or benefits of a

particular service. Perceived health need for dental services as experienced by

individuals and which he or she is prepared to acknowledge for example; patients

often present themselves for dental services at later stages of dental diseases when

overt symptoms such as pain and extreme discomfort appear, rather than earlier thus

there may not be perceived need even though there’s a definite clinical need, the

study was carried out in Lesotho (Navoneiwa, Linjewille, & marealle, 2017).

A study carried out in USA reported that women exhibit more positive attitude about

dental visits, greater oral health literacy, and demonstrate better oral health behaviors

than men. Men are more likely to; ignore their oral health, have poor oral hygiene

habits and seek dental care services less often than women. This can as well be

attributed to hormonal differences, immune system and personal life styles like

tobacco use. Results identified that men are about one third less likely than women to

seek preventive care services and almost 60% of men avoid dental care even when

they might have a serious illness (Martin, et al., 2021).

In a study conducted among Japanese workers about Gender-Dependent associations

between occupational status and untreated carries in Japanese adults, results revealed

that individuals’ nature of work greatly affected their oral health. Results reported

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that an odds ratio (OR) for dental carries that was 1.79(95% CI,1.20-2.67) times

higher among males who worked night shifts than those who worked day shifts and

among female the OR for dental carries was 3.51(95% CI, 1.39-20.11) times higher

among those in professional/manager and service/sales occupations than among those

who are home makers/unemployed, respectively (Yuriko, et al., 2018).

2.3 Health facility related factor contributing to low uptake of dental care

services

In the study on the pattern and factors associated with utilization of dental services

among older adults in rural Victoria, it was reported by patients that the length of

waiting lists and availability of oral health care services at the health facilities, where

majority 62.9% did not know of the existence of the dental care services leading to

low utilization of the services (Marino, et al., 2014).

In a study to access the knowledge, attitude and practices of dentists towards

providing care to geriatric patients conducted in Iran showed a better utilization due

to positive attitude by the dentists. There was a significantly a positive correlation

between knowledge and attitude, dentists with a higher knowledge score had a

moderately more positive attitude towards the older people (R=0.33, p_value <

0.006). However, over 60% preferred to provide care to the young patients. (Bahareh

& Skekoufeh, 2021). According to Masika Shanura’s report, it continued to state that

dentists had a negative attitude towards treatment of some clients especially HIV

patients reported discrimination hence feared dentists (Shanura, 2018).

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A study carried out in America stated that limited access to oral health services

especially in rural areas due to inadequate transportation system making it difficult to

access the dentists outside the proximal areas. This was coupled with maldistribution

of dentists and limited numbers of Medicaid providers. Access to dental care is

important to enhance and maintain good oral health so these people less frequently

utilized the services (Catherine, 2017).

According to Magulu Salim’s report 2015 in a study carried out in Mbarara city,

considered the distance to nearest place where one could receive dental services or

information if needed to be associated to uptake of dental services. Therefore, those

who lived far away from the health facility where dental care services are provided

found it a problem to seek and utilize the services.

According to WHO report, its stated that there are few specialists available to provide

dental care services and the high-tech equipment and materials involved in the dental

care service provision are expensive, this is one of the reasons these services are not

integrated with primary health care models thus minimizing utilization (WHO, 2022).

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 CHAPTER THREE: METHODOLOGY

3.0 Introduction

This chapter gives an overview of the research design, study setting, study

population, sample size, sampling procedure, inclusion criteria, study variables, data

collection procedures, data collection tools, data analysis, ethical consideration,

limitations of the study and dissemination of findings.

3.1 Study design and rationale

The study design was descriptive and cross sectional, employed both quantitative and

qualitative data collection methods. The descriptive design was employed since it

accurately and systematically described the facts about the factors contributing to low

uptake of dental care services in Katwe-Butego Masaka district. They were

convenient and affordable given the time and financial constraints the researcher had.

3.2 Study setting

This study was carried out in Katwe-Butego. It is located in in Masaka city 130km

south of Kampala. Katwe-Butego is centrally located in Masaka city with an area of

5.27square miles. It is boarded by Mukungwe and Kingo sub counties in the North,

Nyendo Ssenyange in the East, Kimaanya kyabakuza in the west, and Kiwangala in

the South. It is densely populated with many slum residents constituting of semi-

26
permanent structures and temporary structures. It is inhabited by people of different

economic status and economic activities, for example social centers like bars, and

lodges where people drink and smoke a lot after work. It has people from all sorts of

religions, occupations, education backgrounds, and tribes. Katwe was chosen because

it had respondents of interest and the area is easily accessible by the researcher.

3.3 Study population

This study targeted residents in Katwe-Butego including youth, women and men

whom the researcher came across using the chosen sampling method.

3.4.1 Sample size determination

According to UNMEB guideline a sample size of 30 to 90 is enough to represent a

given study population. Therefore, 40 respondents were a better representation of the

whole study population given the limited time, funds and other resources the

researcher had to conduct the study.

3.5.2 Sampling procedure

The researcher reached out to residents in Katwe-Butego and a convenient sampling

technique was used since it made it easy to access respondents. This was three times

in a week with one day apart for data analysis.

3.5.3 Inclusion criteria

27
  Residents in Katwe who consented to participate in the study were

interviewed.

3.6 Study variables and their definitions

Dependent variable

 Factors contributing to low uptake of dental care services (defined as concerns

that hinder efficient utilization of dental care services by residents of Katwe-

Butego).

Independent variable

 Socio economic factors defined as factors that hinder efficient utilization of

dental care services such level of income, age, employment.

 Individual factors these are factors such as age, gender, marital status,

education level and family nature.

 Health facility related factors defined as factors that hinder utilization of

dental care services such as distance from facility, availability of dental

personnel and their attitude, availability of dental services and equipment.

3.7 Data collection tool

Interview guides, questionnaires containing both structured and non-structured

questions were used to collect data from respondents.

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3.8 Data collection procedure

Upon approval of the research proposal by the research supervisor, an introductory

letter was taken to the chairmen LC 1 of Katwe village for permission to conduct

research in his area. An informed consent was obtained from the respondents and then

provided with a pre-tested questionnaire which was self-administered which enabled

the researcher to cover a larger population quickly and at affordable costs. By the end

of the day, the filled-up questionnaires were collected and kept in a safe place, the

exercise was repeated until the required sample size was reached.

3.9 Data management

It was done by editing and coding as below;

3.9.1 Editing

This was done at the end of each data collection to identify omissions and errors in

the research tool to ascertain consistence, completeness and accuracy of information

obtained.

This was done manually by the researcher reading through the scripts.

3.9.1 Coding

It involved the use of code frames and allocating codes to similar responses for easy

data listing, analysis and tallying of response in the questionnaires and interview

guides, this was done at the end of data collection process from each respondent.

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3.10 Data dissemination

After completion of the study, the approved copies of the research report were

disseminated to the following areas;

 To the Masaka school of comprehensive nursing library for future references

 To the L/C1Chairperson Katwe village for feedback of findings and better

policy making

 To the research supervisor to avoid duplication.

 To the Uganda Nurses and Midwives Examination Board for award of

Diploma in Comprehensive Nursing.

 Masaka regional referral hospital for service delivery to meet patients

demands.

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 CHAPTER FOUR: STUDY RESULTS

4.0 Introduction

This chapter presents the results of the study on factors contributing to low uptake of

dental care services. Data was collected and analyzed manually from 40 respondents

who participated in the study. The findings are presented in form of tables and

figures, in the order of demographic, socio economic, individual and health facility

related factors.

4.1 Demographic characteristics of residents of Katwe Butego.

Variables Particulars Frequency Percentage (%)

Gender Male 15 37.5
Female 25 62.5
Age 10-18 8 20
19-40 25 62.5
41 and above 7 17.5
Religion Moslem 10 25
Catholic 19 47.5
Anglican 6 15
Others 5 12.5
Type of family Nuclear 23 57.5
Extended 17 42.5
Tribe Muganda 29 72.5
Musoga 2 5
Munyankole 5 12.5
Others 4 10
Table 1: Table of Residents’ demographic characteristics. n=40

According the table 1 above, more than a half 25(62.5%) of the residents were

females and a few 15(37.5%) were males.

31
Majority 25(62.5%) of these were youth aged between 19 and 40 years of age and the

minority 7(17.5%) were above 41years.

Most of the residents 23(57.5%) lived in nuclear families with their parents/ children

while a few 17(42.5%) lived in extended families.

An overwhelming number 29(72.5%) of residents are Bagandas and the least 2(5%)

are Busoga.

4.2 Socio-economic factors contributing to low uptake of dental care services in

Katwe Butego. n=40
frequency percentage(%)
70

60

50

40 45

30
30
20

10 12.5 12.5
18
12
5 5
0
primary secondary tertiary did not go to
school
level of education

Figure 1: Presents respondents’ levels of education.

32
According to figure 1 above, the biggest number 18(45%) of residents ended in

secondary school and a few reached tertiary level 12(30) and the rest 5(12.5%) ended

in primary level and the remaining 5(12.5%) never attended school. On average, most

of the residents are below average level of education with no qualified Jobs.

Table 2: Residents’ socio-economic factors contributing to low uptake of dental

care services. n=40

Percentage
Variables Categories Frequency
(%)
Age 10-18 8 20
19-40 25 62.5
41 and above 7 17.5
Total 40 100
Employment Unemployed 12 30
Employed 10 25
Others 18 45
Total 40 100
Time spent at work 6-9hrs 9 22.5
10-12hrs 23 57.5
13hrs and above 8 20
Total 40 100
Services require payment Yes 20 50
No 14 35
Not sure 6 15
Total 40 100
Level of income(family) Below 200,000 19 47.5
200,000-400,000 13 32.5
Above 400000 8 20
Total 40 100
Effect(negative) of Covid Severely affected 29 72.5
19 outbreak Moderately 11 27.5
Not sure 0 0
Total 40 100

33
According to table 2 above; many 25(62.5%) of the respondents were between 19 and

40 years of age and very few 7(17.5%) were 41 and above years old.

Majority 18(45%) had part-time small scale jobs that were temporary and the

minority 10(25%) of residents were employed with permanent/ qualified jobs.

More than a half 23(57.5%) of the residents worked for as long as 10-12hrs a day and

the least 9(22.5%) worked for less than 9hours in a day.

A half 20(50%) of the respondents reported that dental care services required

payment and the least 6(15%) were not sure.

Most of the residents 19(47.5%) earned less than Ugshs. 200,000 monthly and only

8(20%) earned above Ugshs. 400,000 monthly.

An overwhelming number 29(72.5%) of the residents were severely affected by

Covid 19 outbreak and no one was not affected at all or not sure.

34
4.3: Individual factors contributing to low uptake of dental care services

n=40
70

60 62.5

50

40

30

20 25
20
17.5
10
8 7
0
Beneficial Non beneficial Not sure
Attitude towards routine dental check ups

Number of residents Percentages(%)

Figure 2: Presents residents’ attitudes towards routine dental check-ups

According to figure 2 above, more than a half 25(62.5%) of the residents were not

sure if routine dental checkups were beneficial to them and few 7(17.5%) reported

that they were not beneficial at all.

35
Table 3: Table of residents’ individual factors contributing to low uptake of

dental care services. n=40

Frequenc Percentage
Variable Characteristic
y (%)
Last dental visit 6 months ago 7 17.5
1 year ago 13 32.5
Never attended 11 27.5
Do not remember 9 22.5
Total 40 100
Reason for the visit Dental pain 31 77.5
Routine dental check up 2 5
As advised 5 12.5
Do not remember 2 5
Total 40 100
Substances used to Fluoride toothpaste 8 20
clean teeth Charcoal powder/ash 13 32.5
Others/ water 14 35
Did not brush 5 12.5
Total 40 100
Satisfaction about Yes 10 25
dental care services Partly 27 67.5
provided No 3 7.5

Total 40 100
Dental checkup a Yes 11 27.5
smooth procedure Rough/painful 23 57.5
Not sure 6 15
Total 40 100

According table 3 above, majority 13(32.5%) of the residents had had their last dental

visit 1 year ago, only 7(17.5%) had their last dental visit 6 months ago.

36
An overwhelming number 31(77.5%) of residents only attended dental visit in cases

of dental pain and only 2(5%) attended the routine dental checkups.

Many 13(32.5%) of the respondents used charcoal/ash to clean their teeth and the

least 8(20%) used fluoride toothpaste. Few 5(12.5%) did not brush completely.

Majority 27(67.5%) of the residents were partly satisfied and the least 3(7.5%) were

completely not satisfied by the dental care services provided.

More than a half 23(57.5%) of the respondents reported that dental checkup was a

rough and painful procedure and only 6(15%) were not sure.

n=40

13

27

Gender Male Gender Female

Figure 3: Presents the frequencies of male and female residents who attended

dental care services.

37
According to figure 3 above, majority 27(67.5%) of the respondents who attended

dental care services were females and a few 13(32.5%) were males.

n=40

40
35
30
25
20
15
10
5
0
Go to hospital Use herbal Take pain Ignore
medicine killers
How do you manage your dental problems/pain

Frequency Percentage(%)

Figure 4: presents residents’ ways of managing their dental problems/pain

According to figure 4 above, majority 16(40%) took pain killers in cases of dental

pain, many 11(27.5%) used herbal medicine and the minority 6(15%) just ignored.

38
4.3: Health-facility related factors contributing to low uptake of dental care

services in Katwe-Butego.

Table 4: Table of health-facility related factors of residents. n=40

Variable Categories Frequency Percentage (%)

Distance from your home to the Near 16 40
health facility Far 24 60
Total 40 100
Transport amount 2000-3000 11 27.5
3500-5000 14 35
5500 and above 15 37.5
Total 40 100
Number of staffs at the facility Enough 5 12.5
Not enough 26 65
Not sure 9 22.5
Total 40 100
Privacy at the facility Good 5 12.5
Fair 19 47.5
Poor 16 40
Total 40 100
If facilities/equipments in the dental Yes 4 10
clinic were enough No 20 50
Very few 16 40
Total 40 100
Length of waiting lines at the clinic Too long 18 45
moderate/fair 14 35
No lines 8 20
Total 40 100
Staffs’ behavior when attending to Friendly 16 40
you Do not mind 21 52.5
Act as superiors 3 7.5
Total 40 100

39
According to table 4 above, more than a half 24(60%) stayed far away from their

nearest health facility and the minority 16(40%) stayed nearby. Most of them

15(37.5%) used transport of Ug5500/= and above and few 11(27.5%) used

Ugsh.2000-3000.

Majority 26(65%) reported that there were not enough staffs at the health facility and

the least 5(12.5%) said they were enough.

Many of the residents 19(47.5%) reported that the privacy at the health facility was

fair and only few 5(12.5%) reported that was good.

A half 20(50%) of the respondents reported that there were few (not enough)

facilities/equipments at the facility and the least 4(10%) reported that they were

enough.

Most 18(45%) of the residents reported that the waiting lines at the facility were too

long and few 8(20%) reported that there were no lines at all.

More than a half 21(52.5%) of the respondents reported that staffs could not mind at

all when attending to them and the least 3(7.5%) reported staffs acting superior to

them.

40
 CHAPTER FIVE: DISCUSSION, CONCLUSION,

RECOMMENDATIONS AND NURSING IMPLICATIONS

5.0 Introduction

This chapter presents the discussion, conclusion, recommendations and nursing

implications of the major findings of the study.

5.1 Discussion of study findings

5.1.1 Demographic characteristics of respondents

From table 1, the study revealed that majority were female and men were the

minority. This could be due to the fact they are the ones always at home and easily

accepted to participate in the study.

Majority of the respondents were aged between 19-40 years. This could be due to

increased dental problems among this age group and mature enough to consent for

themselves.

Most of the respondents were Bagandas, this is due to the fact that the study was cond

ucted in central region which is most occupied by Bagandas.

5.1.2 Socio-economic factors contributing to low uptake of dental care services

among residents of Katwe-Butego

From table 2, most of the residents did not have permanent/qualified jobs therefore

have no permanent income and few were completely unemployed and idle. This may

41
be attributed to low levels of education with no standard qualifications to get better

jobs so they could not afford to pay for their medical bills or even transport

themselves/their children to dental clinics. This is in agreement with the study carried

out in Saudi Arabia by (Deema, et al., 2022) where results revealed that dental service

utilization in the final fully adjusted model were high household income (OR=1.43,

p=0.043), second and middle household wealth status (OR=1.51, p=0.003 and

OR=1.57, p=0.006) and access to free governmental health care (OR=2.05,

p=0.004).N

From table 2, majority worked for as long as 10-12hrs in a day and the least worked

for less than 9hours. This means that most of these people had little time left for self-

care, could easily ignore their dental issues and so could barely attend these services.

This is in line with a study conducted among Japanese workers by (Yuriko, et al.,

2018) where results reported that an odds ratio (OR) for dental carries that was

1.79(95% CI,1.20-2.67) times higher among males who worked night shifts than

those who worked day shifts.

Half of the respondents paid for the dental care services they received and a few

didn’t. This is so because some received dental care services from private clinics

which are expensive and those who went to government facilities incurred some

money to buy some medicines outside the clinic and this may scare many of them to

go seek the services. This is in line with the study carried out in Israel by (Dania E Al

Agili & Farsi, 2020) which stated that one of the perceived barriers to dental care was

42
financial (22.8%) where 15.7% reported no having enough money as the most

common reason.

From table 2, many earned less than Ugshs. 200,000 monthly and the least earned

above Ugshs. 400,000 monthly. This means that most of them their family income

was too small to take good health care for themselves/ their families. This is similar

with a study conducted in Chile by (Nnekakate, Onyejaka, Oluwatoyin, & Folaranmi,

2016) where the odds of utilizing oral health care services for the study participants

from the middle were (AOR: 0.50; Cl: 0.31-0.79; P=0.003) and low (AOR: 0.24; Cl:

0.13-0.45; p=<0.001) social economic strata.

From table 2, an overwhelming number was severely affected by Covid 19 outbreak

and no one was not affected at all or not sure. This is because movement was

restricted and only limited to critical situations so people could not access some of the

health care services and could not work as well. This is in line with a report by WHO

(2023) where disruptions by Covid 19 pandemic in the health sector have exacerbated

oral health services in the region, with around 90% of countries affected between

February and July 2020.

From figure 2, more than a half were not sure if routine dental checkups were

beneficial to them and only few reported that they were not beneficial at all. This is

because they did not know the importance of routine dental checkups due to the fact

that most of them had never attended dental checkups before. This is almost similar

with the study carried out in Lesotho by (Navoneiwa, Linjewille, & marealle, 2017)

43
which reported that Individual’s own judgment about the necessity or benefits of a

particular service affected utilization of dental care services. Those with poor

perception visited clinic at later stage when overt symptoms such as pain occurred so

there was no perceived need despite definite clinical need.

5.1.3 Individual factors contributing to low uptake of dental care services among

residents of Katwe-Butego.

From table 3, most had had their last dental visit 1 year ago, very few had theirs 6

months ago. This is because majority never knew the importance of the routine dental

visits and the fact that some of them had not attended the visits before, did not know

how often they had to visit the dental clinic. This is in line with a study carried out in

Japan and kingdom of south Arabia by (Faeq, et al., 2017) where results revealed that

33% out of 395 respondents think that a dentist should only be visited if they

experienced pain and 67% lacked knowledge. All these leads to low dental care

utilization and is seen to affect not only individuals or communities but the nation as

a whole.

Study findings also revealed that many attended dental visit only in cases of dental

pain and the least attended the routine dental checkups. These people are reluctant

from attending these services so are only triggered the discomfort accompanied by

tooth aches. This is in comparison with a study in Nigeria by (Elfleda & Omoigberai,

2015) where results showed that out of the 638 participants, 313 and 325 were from

federal and state civil service, respectively with 55(68.8%) federal workers and

44
45(71.4%) state civil workers who had visited dentist based on need and 59%

reported that the reason for non-utilization is no need for treatment.

Majority were partly satisfied and the least were not satisfied at all by the dental care

services provided. This is related to individual expectations about services provided at

the dental clinic by the health care providers. So if one failed to get what is expected

in terms of medications and other services could not go back again. This is similar

with the study with a study carried out in Kanungu district, Uganda by (Arineitwe,

2023) where services received in terms of medication is not as expected for example

at times no immediate treatment given after seeing the dentists, lack of confidentiality

and inconveniences at clinics all contributing to 62.3% failure rate therefore,

dissatisfaction in the services provided to the people limit utilization.

From table 3, more than a half of the respondents reported that dental checkup was a

rough and painful procedure and few were not sure. This was because they lacked

knowledge about the use of anesthesia whenever the procedure to be undertaken was

painful and even the fact that some did not know what exactly took place during

dental visit because they had not gone there before. This is related to a study carried

out in Japan and kingdom of south Arabia (Faeq, et al., 2017) where results revealed

that 33% out of 395 respondents think that a dentist should only be visited if they

experienced pain and 67% lacked knowledge on the provided dental services.

From figure 3, majority who attended dental care services were females and a few

were males. Women are more concerned about their health and physical appearance

45
(cosmetic purpose) and the fact that oral health affects their physical beauty than men.

And in addition, women are often not very busy whole day like most men so they

attended these services more often. This is in line with a study conducted in USA by

(Martin, et al., 2021) where women exhibit more positive attitude about dental visits,

greater oral health literacy, and demonstrate better oral health behaviors than men and

results identified that men are about one third less likely than women to seek

preventive care services and almost 60% of men avoid dental care even when they

might have a serious illness.

Majority took pain killers in cases of dental pain, many used herbal medicine and the

minority just ignored. This is because of the costs involved in terms of transport and

buying some medicines yet other substitutes seemed free and locally available. This

also contributed to why most people did not attend the services. This is similar to a

study carried out in Nigeria where results reported 24.4% out of the 119 participants

to have used traditional/ herbal medication and 49.6% self-medicated prior to

presentation at dental clinics. Therefore, most of the diseases went unnoticed by the

physicians as many of these were either tolerated or were self-medicated (Mercy &

Enabulele, 2017).

5.1.4 Health facility related factors contributing to low uptake of dental care

services among residents of Katwe-Butego.

According to table 4 above, more than a half stayed far away from their nearest health

facility and the minority stayed nearby. Staying far away means incurring more

transport costs and the fact that it’s a rural area roads are poorly built. This made

46
health facilities inaccessible and this hindered uptake of dental care services. This is

similar to a study carried out in America by (Catherine, 2017) where limited access

to oral health services especially in rural areas due to inadequate transportation

system make it difficult to access the dentists outside the proximal areas. This was

coupled with maldistribution of dentists and limited numbers of Medicaid providers.

Another study conducted in Mbarara city, Uganda by Magulu Salim (2015) also

reported that the distance to nearest place where one could receive dental services or

information if needed to be associated to uptake of dental services. Therefore, those

who lived far away from the health facility where dental care services are provided

found it a problem to seek and utilize the services.

Majority reported that there were not enough staffs/equipments at the health facility

and the least reported they were enough. This is because it’s expensive to train high

numbers of specialists in every medical aspect dental health inclusive and also dental

care equipments and machines are too expensive to purchase and make them

available in every health care facility. This makes the few available services very

expensive thus minimizes service delivery. This is comparable with a (WHO, 2022)

report where it found out that there are few specialists available to provide dental care

services and the high-tech equipments and materials involved in the dental care

service provision are expensive, this is one of the reasons these services are not

integrated with primary health care models thus minimizing utilization.

Many reported that the waiting lines at the facility were too long and few reported no

lines at all. The long waiting lines meant that a person could spend a lot of time at the

47
facility without being attended to despite the responsibilities they had. This scared

many of them and they resorted to other means which are probably inappropriate for

their health for example self-medication. This is however contrary to a study by

(Marino, et al., 2014) on the pattern and factors associated with utilization of dental

services among older adults in rural areas where majority(62.9%) did not know of the

existence of the dental care services leading to low utilization of the services. This is

attributed to the differences in the study area, level of development and the time these

studies were carried out due to increased awareness.

Majority reported that staffs could not mind at all when attending to them and the

least reported that staffs acted superior to them. This was most reported by vulnerable

groups of people and those with HIV because they needed more specialized care and

more frequent visits. This could probably turn into a burden to some staffs attending

to them. This is in line with a study to access the knowledge, attitude and practices of

dentists towards providing care to geriatric patients conducted in Iran by (Bahareh &

Skekoufeh, 2021) where results revealed that there was a significantly a positive

correlation between knowledge and attitude, dentists with a higher knowledge score

had a moderately more positive attitude towards the older people (R=0.33, p_value <

0.006). However, over 60% preferred to provide care to the young patients. Another

study conducted in Kizungu Mbarara city by (Shanura, 2018) continued to state that

dentists had a negative attitude towards treatment of some clients especially HIV

patients reported discrimination hence feared dentists.

48
5.2 Conclusions

The study concluded that socio-economic factors like level of income, extreme age,

unemployment, low levels of income, lack of social support, time spent at work and

disruption by Covid 19 hinder effective uptake of dental care services.

The individual factors like self-medication, dissatisfaction in services provide at the

health centre, poor perception of the importance of oral health, belief that one has to

first have dental pain before seeking the services, people with mental health disorders

and other illnesses like HIV, individual judgment of the necessity of dental services

(perceived need), male gender and nature of occupation or environment are too risky

and cause poor oral health and low uptake of dental services as well.

Also health facility related factors like limited access to health facility due to poor

roads, far distances to nearest health facility, long waiting lists, the few dental

specialists available and poor treatment by health workers discourage people from

seeking these services. This means that there are several factors hindering the health

seeking behavior of people despite the large numbers of government facilities

offering these services at cheap prices some even freely.

5.3 Recommendations

With the above findings, discussions and conclusions, the following

recommendations are for purposes of improving uptake of dental care services.

To the government of Uganda

49
  Ministry of health should provide more facilities and Improve budget

allocations on matters of dental care service production so as to enable

purchase of more equipments.

 Policy makers should enhance effort to expand access to information on

routine dental checkups.

 The government should provide an enabling environment and materials for

health education to people to improve awareness and uptake.

To health facility

 Conduct regular continuous health education on importance of dental

checkups.

 Motive health workers so as to improve their attitude towards dental care

service production.

 Improve privacy, confidentiality and hospitality at the hospital so as to make

clients comfortable and express their issues freely.

 Health workers should be encouraged to change their attitudes on some

patients and provide appropriate care without discrimination.

To residents

 Parents should provide for their children all their needs in order to improve

oral health and encourage their children/take them to hospital in case of any

dental concerns.

50
  Residents should attend the routine dental care services together with their

families and also seek medical care at the health facilities in cases of any

dental concerns for appropriate management and avoid self-medication.

 They should correct their poor perceptions about uptake of the dental care

services and health service providers.

5.4 Nursing implications

The above findings implore the need of health workers especially nurses to improve

their attitudes to provide quality services and also use every available opportunity to

sensitize people about the merits associated with routine dental check-ups and

utilization of the available dental care services to improve their health wellbeing.

Nurses also plays an important role in improving health seeking behaviors through

their hospitality, courtesy and counselling.

5.5 Areas for further study

 Factors contributing to high prevalence of dental caries among children and

adults.

 Knowledge, attitudes and practices to oral care among men above 18 years.

51
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Bahareh, T., & Skekoufeh, S. m. (2021). Knoweldge, attitudes and practice of dentists
towards providiving care to geriatric patients.

Barbara, Ndagire, A., Kutesa, R., Ssenyonga, H., Mayanja, Kizza, D., . . . Rwenyonyi.
(2020). Prevalence, severity and factors associated with dental carries among school
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Brenda A. Okumu, M. T. (2022). Geospatial analysis of dental access and work force
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Catherine, H. (2017). Access to oral healthcare: A national crisis and call for reform. journal
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Dahlan, Rana, E., Ghazal, H., Saltaji, B., Salam, M., & Amir. (2019). PLOS ONE. Impacts of
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Dania E Al Agili, N., & Farsi. (2020). need for dental care drives utilization of dental services
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Deema, A, Sahab, M., S, Bamashmous, A., Ranauta, V., & Muirhead. (2022). Socioeconomic
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Denis, O. (2017). Factors contributing to prevalenceof dental caries among students of

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Elfleda, A., & Omoigberai, B. (2015). Utilization of dental services among civil servants in
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Fatme, Al, Anouti, M., Abboud, D., Papandreou, S., Haidar, N., . . . rizk. (2021). Oral health
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Kutesa, A. (2015). prevalence and factors associated with dental caries among children and
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Lee, Wonik, s., Nelson, P., Milgrom, C., Karla, J., S, & Diekhoff. (2015). the daily.
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Marino, r, k., a, t., a, k., c, s., & c. (2014). pattern and factors associated with utilisation of
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Shanura, M. (2018). Factors leading to low utilasation of dental services in kizungu,

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54
 APPENDICES

APPENDIX 1: CONSENT FORM

Introduction

Dear respondents, am MUTESI NUULU a student at Masaka school of

Comprehensive Nursing. I am carrying out this study with the aim of finding out the

factors that contributing to low up take of dental care services among residents of

Katwe-Butego.

The study is genuinely and solely for academic purposes, there is no material

rewarded for participating in the study and therefore one is allowed to withdraw from

participation according to his or her wish, privacy during the interviewing process

and confidentiality of the information is guaranteed.

Statement of consent

I……...........…………………………. (Right thumb print) have been requested to

participate in the above study. I have been explained the purpose of the study and
understood it. I therefore accept to be part of the study.

Signature……………………………….... Date…………………………

Witness’ name…………………………… Date…………………………

Researcher/researcher assistant’s signature……………………………….

55
Contact: 0700790654/0783236774 (MUTESI NUULU)

APPENDIX II: QUESTIONNAIRE

Interviewer guide questionnaire on the factors that contributing to low uptake of

dental care services in among residents of Katwe-Butego.

Date…………………………………………….

Questionnaire number………………………….

SECTION A: Demographic data of respondents

Circle your opinion

1. How old are you?

a) 10-18

b) 19-40

c) 41 and above

2. What is your sex

a) Female

b) Male

3. What is your religion?

a. Catholic

b. Anglican

c. Moslem

56
 d. Other

Specify……………………………………………….

4. What kind of family do you come from?

a) Extended

b) Nuclear

c) Other

5. Which tribe are you?

a) Muganda

b) Musoga

c) Munyankole

d) Others

SECTION B: Socio-economic factors contributing to low utilization of dental

care services

5. What is your sex

c) Female

d) Male

6. How old are you?

a) 10-18

b) 19-40

c) 41 and above

57
7. Do these services require payment?

a) Yes

b) No

c) Not sure

8. What is your employment status?

a) Employed

b) Un employed

If employed, specify type of

job……………………………………………….

9. How many hours do you work out of 24hrs?

a) 6 to 8hrs

b) 9 to 12rs

c) 14hrs and above

10. What is your family income per month?

a) Above 400,000

b) 200,000-400,000

c) Below 200,000

11. What is the level of education of the child/ parents?

a) Tertiary

b) Secondary

c) Primary

d) Did not go to school

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SECTION C: Individual factors contributing to low utilization of dental care

services

11. When was your last dental visit?

a) Never attended

b) 6months back

c) 1year back

d) Do not remember

12. For what reason do you go for the dental checkup?

a) Dental pain

b) Routine dental checkups

c) Advised/treatment follow up

d) Do not remember

13. Are you satisfied with dental cares services provided at the health facility?

a) Yes

b) No

c) Partly

14. What do you use for brushing our teeth?

a) Fluoride tooth paste

b) Charcoal powder/ash

c) Herbal medicine

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 d) Others/just water

15. In case of any dental problems for example cavities and pain, how do you

manage?

a) Go to hospital

b) Use herbal medicine

c) Take pain killers

d) Ignore

16. What is your attitude towards routine dental checkup?

a) Beneficial

b) Non beneficial

c) Not sure

17. What do you really think happen during dental checkups?

a) Smooth procedure

b) Very rough procedure involving a lot pain

c) Not sure

SECTION D: Health facility related factors contributing to low utilization of

dental care services

18. What is the distance from your home to the health facility?

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 a) Near

b) Far

If far, how much do you use for transporting yourself?

………………………………………………………..

19. Looking at the staff at the facility, in your view how are they?

a) Enough

b) Not enough

c) Not sure

20. How is the behavior of the staffs at the health facility when attending to you?

a) Friendly

b) Do not mind

c) Act as superior

21. In your view how do you look at the privacy at the health facility?

a) Good

b) Fair

c) Poor

22. In your view looking at the facilities/equipments in this clinic, how are they?

a) Enough

b) Not enough

c) Very few

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23. What is the length of waiting lists when you go for dental care services at the

facility?

a) Too long

b) Moderate/ fair

c) No lines

THANK YOUR PARTICIPATION IN THE STUDY

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APPENDIX V: A MAP SHOWING KATWE-BUTEGO IN MASAKA CITY

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