Professional Documents
Culture Documents
Tess Project Complete
Tess Project Complete
JANUARY 2024
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DECLARATION
This research project report is my original work and has not been presented for a
degree in any other University.
Signature:.................................................... Date:............................................................
Teresa Wamucii Ngatia
Q34/5537/2019
Supervisors:
This research project report has been submitted for review with our approval as
University Supervisors.
Signature:.................................................... Date:............................................................
Dr. Monicah Wambugu
Department of Environmental and Occupational Health,
Kenyatta University.
DEDICATION
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This research project is dedicated to my parents and siblings for their patience and
support during the entire time of the research project process.
ACKNOWLEDGEMENT
iv
This research has been made possible through support, assistance and guidance from
various individuals and institutions who I acknowledge below. I wish to express my
gratitude to my supervisor Dr Monica Wambugu of Kenyatta University, Department
of Environmental and Occupational health for always creating time to guide me
through out my research and assisting me in the changes that I was required to do also
the head lecturer of this unit, research project, Dr Redempta Mutisya for always
finding the time to assist us in the challenges we experienced as her students and also
for her guidance.
Similarly I thank the head teachers of the schools in Roysambu Sub-County for
allowing me to use their facilities for my data collection. I also thank the parents and
guardians of the children for providing consent for their children to participate in the
study.
I would also like to express my sincere appreciation to the children who participated
in the study and to all the individuals who assisted me either directly or indirectly
through the entire research project process
My sincere gratitudes to my parents for their support especially financially which was
of great assistance in the collection of data.
Finally I would like to thank the almighty God for his guidance throughout the
process and also giving me good health from the beginning upto the end of the
research project process.
TABLE OF CONTENT
DECLARATION.........................................................................................................II
v
DEDICATION...........................................................................................................III
ACKNOWLEDGEMENT........................................................................................IV
TABLE OF CONTENT..............................................................................................V
LIST OF TABLES...................................................................................................VII
LIST OF FIGURES................................................................................................VIII
ABBREVIATION AND ACRONYMS....................................................................IX
DEFINITION OF OPERATIONAL TERMS..........................................................X
ABSTRACT................................................................................................................XI
CHAPTER ONE: INTRODUCTION........................................................................1
1.1 Background of The Study........................................................................................1
1.2 Problem Statement...................................................................................................2
1.3 Justification..............................................................................................................3
1.4 Research Questions..................................................................................................4
1.5 Research Objectives.................................................................................................4
1.5.1 General Objective..................................................................................................4
1.5.2 Specific Objectives................................................................................................4
1.6 Scope/Delimitations And Limitations......................................................................4
1.6.1 Delimitations.........................................................................................................4
1.6.2 Limitations............................................................................................................5
1.7 Conceptual Framework............................................................................................6
CHAPTER TWO - LITERATURE REVIEW..........................................................7
2.1 Introduction..............................................................................................................7
2.2.1 Predisposing Factors.............................................................................................7
2.2.2 Enabling Factors....................................................................................................8
2.3 Available Knowledge on Oral Health......................................................................8
2.4 Actual Practice of Oral Health.................................................................................9
2.5 Attitude Towards Oral Health................................................................................10
CHAPTER THREE - MATERIALS AND METHODS.........................................11
3.1 Research Design.....................................................................................................11
3.2 Location of The Study............................................................................................11
3.3 Variables................................................................................................................11
3.3.1 Dependent Variables...........................................................................................11
3.3.2 Independent Variables.........................................................................................11
3.4 Study Population....................................................................................................11
3.5 Sampling Techniques.............................................................................................11
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LIST OF TABLES
Table 3.1: Schools classified into 3 strata....................................................................12
Table 2Table 4.1 General knowledge on oral health issues.........................................16
Table 3Table 4.2 Knowledge on prevention................................................................17
Table 4Table 4.3 Overall oral health knowledge.........................................................17
Table 5Table 4.4 Oral health attitude...........................................................................18
Table 6Table 4.5 Overall attitude towards oral health.................................................19
Table 7Table 4.6 Composite Oral health practices......................................................19
LIST OF FIGURES
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Knowledge -facts, information and skills acquired through life skills or education.
x
Oral health -Health of the teeth, gums and the entire oral facial system that allows us
to smile, speak and chew
Oral hygiene -It is the practice of keeping your mouth clean and disease free
Oral disease -A range of diseases and conditions such as dental carries that impact
the mouth without proper oral hygiene practice
Access -Overcoming barriers to create an ease with which an individual can get and
use health services
ABSTRACT
Knowledge of oral health is a fundamental preliquisite for healthy behavior, allowing
individuals to take measures to protect their overall health. Poor oral health can have a
profound effect on the quality of life. Pain, tooth abscess endurance, eating and
chewing difficulty, embarrassment over the form of teeth or missing teeth, discolored
or broken teeth can have a negative impact on school going children's everyday life
and wellbeing. This cross-sectional study aimed to examine the knowledge, attitude of
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oral health as well as to assess the oral hygiene habits among school going children.
The Objectives of the study were to determine the knowledge, attitude and practice of
oral health among school going children in Roysambu sub-county, to determine their
oral health practices, to determine oral health knowledge among the school going
children and also to determine the attitudes influencing oral health among school
going children in Roysambu sub-county. Qualitative data was collected, entered in
SPSS version 24 for cleaning and analysis to generate descriptive statistics. The
findings were presented in narratives, pie charts, frequency tables and bar
graphs. .The data was collected using interviewer administered questionnaire which
was conducted among a sample size of a total of 16 schools and 384 school going
children were interviewed: 219 (57%) girls and 165 (43%) boys representing the three
school categories: A-low cost, B-public middle class and C-private high cost schools
[165 (43%), 123 (32%) and 96(25%) respectively. Respondent from Type C School
had higher knowledge compared to those from other schools. In contrast, this
knowledge did not translate to better oral health practices. The type of school a
respondent attended had statistically significant association with oral health practices.
There was no statistically significant association between gender and oral health
practices. Nearly half of the school going children in Roysambu Sun-county have low
levels of, f oral health knowledge. Children who had an exposure to school dental
health programs showed better knowledge. Similarly majority of the children had
negative attitudes towards oral health. Attitudes were not influenced by type of
school, age or gender of the respondents. The practices were influenced by the level
of knowledge respondents had and the type of school a respondent attended. Since
oral health knowledge influences practice as shown in this study, there is need to
increase the oral health knowledge to children in Roysambu sub-county through well
planned school based oral health education programmes in primary schools. This
study recommends inculcating routine preventive dental care among the children to
improve oral health seeking behavior.
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Oral hygiene is most important for good health in general. Poor oral hygiene can be a
source of many diseases. By maintaining good oral hygiene, the occurrence of many
diseases can be prevented. Unfortunately, oral hygiene practice is very low in our
society. Dental caries and periodontal problems are due to poor oral hygiene practices.
Oral hygiene, including twice daily tooth brushing, is critical in preventing gum
disease and maintaining good oral health. Dental caries is a multifactorial, irreversible
microbial disease of the calcified tissues of the teeth, characterized by
demineralization of the inorganic portion and destruction of the organic substance of
the tooth, which often leads to cavitation. A large number of school aged students in
developing countries suffer from tooth decay and have limited access to oral health
care services. Dental caries affects 60-90% of school-age children and most of the
adults. Periodontal disease is prevalent in 50-90% of school age children, and is
severe in 10-15% of them, while gingival diseases occur in the majority of children
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and adolescents. Oral disease burden is significantly higher among poor and
disadvantaged populations with an increase in developing countries. Globally, poor
oral hygiene occurring due to increasing plaque and calculus deposits with increasing
age has been reported among children and adolescents recent publication by Folayan
et al. (2012) also showed that the incidence for caries was 9.9% in a population of
primary school children, with a higher incidence in primary teeth than in the
permanent dentition. Understanding caries pattern, its epidemiology and how the
epidemiologic profile changes over time is important because caries is the primary
pathological cause of tooth loss in children in many African countries. A large ratio of
oral diseases can be prevented at individual and community levels by providing oral
health-related education thus improving the oral health attitude and practices among
the general population. For example, proper brushing is essential for cleaning teeth
and gums effectively.
Many developing countries are facing problem of poor oral health particularly for
countries where community oral health care system is not yet established (WHO,
2015). Roysambu sub-county being an urban area , the children studying in the area
are caught up with changing living conditions and lifestyles that are associated with
undesired oral health behaviors such as frequent eating and drinking of foods
containing refined sugars, difficulties to accessibility and affordability of oral health
care services, availability and use of fluoride toothpaste. Teeth affected by dental
caries are often extracted when they cause pain or discomfort. Severe caries can
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impair quality of life including difficulties in eating and sleeping in children and in its
advanced stages it may result in pain and chronic systemic infection. In Kenya, this
problem tends to affect children more so education wise as it leads to truancy, poor
results and reduction of concentration in school (WHO, 2015).
1.3 Justification.
Healthy oral cavity is of great significance for an individual’s overall health and well-
being. Further, it enables an individual to masticate, speak and socialize without any
active discomfort or embarrassment. Oral disease is health problem of considerable
burden which often leads to pain and more significantly tooth loss; a condition that
affects the appearance, quality of life, nutritional intake and consequently the growth
and development. Dental caries and periodontal disease are amongst the most
widespread oral conditions in human population, affecting from about 67.5% to over
80% of school children in some countries which amounts to a great health burden. A
number of factors namely; diet, smoking, alcohol, hygiene, stress and exercise are
linked to a wide range of high morbidity diseases forming the fundamental basis of
common risk factor approach of World Health Organization in order to prevent a
range of conditions including oral diseases. Among these, hygiene is the single most
significant factor when it comes to the prevention of oral diseases.
help determine the knowledge of children and their practices on oral hygiene and
identifying strategies on how to educate them and equip them with skills. With the
information collected, the teachers at school will be able to provide health education
to the pupils
1.6.2 Limitations.
1. Access to information for the literature review has not been so readily available
because relatively few people have assessed students' practice, knowledge, and
attitude towards Oral health.
3. Financial constraints will be experienced. This is because the researcher has to keep
contacting the respondents to follow up on the questionnaires and interviews. They
also have to conduct several objective observations to ascertain the results.
4. Some respondents may not be ready to give correct responses; hence they may be
biased
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Set of dentition .
Dependent
variable
Health
Optimum Oral
Proper attitude to decayed
teeth. Health
Self esteem .
2.1 Introduction
According to WHO, oral diseases while largely preventable, pose a major health
burden especially for preschool and school going children. Majority of cases are
dental caries (tooth decay), periodontal diseases, oro-dental trauma and cleft lip and
palate which mostly affects children under 12 years. Unequal distribution of oral
health care services and use of out of pocket costs to cover for consumption of oral
health care has led to a low consumption of primary oral health care services.
Following this, the WHO has spear headed the promotion of preventative oral health
care services rather that curative (WHO, 2017).
The Government Accountability Office (GAO) report of 2018 revealed that 30% of
low income children have difficulties accessing oral health care services and 49% of
school age children have poor oral health. This has caused significant pain and even
disability. It has also increased the number of absenteeism in schools and has
generally affected education and learning negatively. According to a research done in
Hong Kong in 2017, the prevalence of dental caries among school age children was
75% and this was attributed to poor oral health. This is not uniquely for Hong Kong
but is a burden shared globally including in Nairobi County.
2.2 Factors associated with oral health status among primary school children
2.2.1 Predisposing Factors
Socio-economic factors of their parents or care giver - It refers to the age,
education, occupation and income per month of parents or care givers. These factors
can influence how the parents or care givers take care of their dependents including
prevention of oral diseases and how the parents can manage income for visiting dental
clinics, as well as daily needs of using toothpaste and toothbrush.
Oral Hygiene Practice - This may influence oral health status by use of improper
tooth brushing techniques by not using fluoridated toothpaste, time of brushing
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According to WHO (2016), while there have been improvements in dental health over
the past decade there is not a single country that is free from oral diseases. While
there is a significant decline in tooth decay in some developed countries during the
past few decades, a large number of children worldwide are still suffering from the
disease, much of which is active and untreated, leading to toothache and restricted
activities. The WHO report (2015) attributes high risk of oral disease to socio-cultural
determinants such as poor living conditions, low education, and lack of traditions,
beliefs and culture in support of oral health. Communities and countries with
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A large number of children do not clean their teeth (Zhu et al., 2015). Some may not
have access to a toothbrush (Mishra, 2013). The use of traditional cleaning aids such
as ‘Miswaki’, a traditional chewing stick, is common in some communities (Petersen
and Mzee, 2015). Furthermore, the availability, affordability and quality of fluoride
toothpaste remain a major problem in developing countries (WHO, 2015). Only a
small proportion of children use fluoridated toothpaste (Petersen et al., 2016). In
several countries, many households also do not have access to safe water for drinking,
let alone for cleaning teeth (Petersen and Mzee, 2015). A study conducted by Mishra
(2013) suggests that a large number of children have not visited a dentist by the time
they start school. In some countries, a significant proportion of school children have
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never visited the dentist. For example, in Tanzania, over 75% of 12-year-old children
have never been to the dentist (Mishra, 2013).
Evidence has shown that people with more positive attitude towards oral health are
influenced by better knowledge in taking care of their teeth (Smyth et Al,2017).
Positive attitude towards importance of tooth brushing for caries prevention was
observed in a study in Burkina Faso by Varenme et Al, (2016) where majority of
Chilton urban areas reported that tooth cleaning and regular dental visits may prevent
oral diseases.
Parents' beliefs and attitudes towards oral health influences how oral health is
promoted to their child (Amin & That's on,2019). A study by Perez and Amin (2014)
found that if parents did not place importance on oral health especially on
preschoolers it was a significant barrier to a child achieving good oral health.
Researchers also noted unfavorable attitude by parents towards dentists as a barrier to
good oral health for their child (Van den Branden et al 2013). Another study found
that many parents viewed dentists as a means of oral treatment rather than as
preventative care (Perez & Amin,2014)
In a study by Wayne et al (2014) Saudi school children had positive attitude towards
their dentists, nevertheless they indicated that they feared dental treatment. Little is
known about oral health attitude and behavior of children in developing countries thus
the need to carry out this study.
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3.3 Variables
3.3.1 Dependent Variables
The dependent variable in this study was optimal oral health.
stratified in three strata ; C- private high cost schools; B-public schools not in the
informal settlement areas; and A- schools in the slum areas some of which are private
but of very low cost. A sample size of 16 schools was used and the number of schools
in each stratum was allocated proportionate to the total number of primary schools in
the strata - Table 3.1. Simple random sampling was employed to select the schools to
participate in the study where the schools from each strata were listed on pieces of
paper which were later folded and mixed thoroughly. The desired number of schools
per strata was randomly picked. The sample size of the pupils to participate in the
study in each school was divided proportionately according to the number of the
pupils in the schools that meet the inclusion criteria. Simple random sampling was
used to achieve the desired sample per school.
Schools
The number of schools that participated in the study was determined with the
formula:
n = N/ 1+ N (e)2 (Israel, 1992)
Where n - is the schools sample size
N - is the total population of the schools under consideration (48)
e – Power of the study, set at 80%
n = 48/1+48(0.2)2
n= 16 schools
3.9 Validity
The study instruments will undergo a pre-test and later expert review by study
supervisors to ensure that accurate and quality data is collected. This will highlight
ambiguous questions requiring reframing the research tools to capture the required
information.
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3.10 Reliability
To bring about consistency and reliability of the data collected, research assistants
underwent a short training and participated in study piloting in order to familiarize
with the study tools. Double-checking of research instruments was done to ensure that
all study objectives were adequately covered and responses entered correctly to
ensure reliable and consistent data.
4.1 Demographics
A total of 384 pupils in 16 schools participated in this study. The schools were
categorized into: Type A which are low cost schools in the informal settlements, Type
B which are government schools in formal settlements and Type C which are the high
cost private schools. Of the 384 pupils, 165 (43%), 123 (32%) and 96 (25%) were
from school type A, B and C respectively. 219 (57%) were girls and 165 (43%) boys
as shown in Figure 4.1 below.
Demographics
Boys
43%
Girls
57%
correct. The other pupils said 10(12%),16 (13%), and 32 (6%) teeth respectively.
Only 48 (11%) did not know how many milk teeth there were. Similarly, 58% of the
pupils correctly stated that there were 32 complete set of permanent teeth. Those who
stated 16, 20, 24 and don’t know were 15%, 5%, 13% and 8% respectively meaning
that 42% did not know how many permanent teeth an individual has. Table 4.1 below
shows pupils general knowledge on general oral health issues.
When asked about where they got most of their oral health information, the pupils
responded thus: Radio 15 (4%), TV 84 (22%), Oral Health educators 242 (63%),
Shopkeepers 1 (0.2%), Newspapers/Magazines 11 (3%), My parents/guardians 27
(7%) and Friends 2 (0.5%). Two pupils (0.4%) mentioned teachers as their greatest
source of oral health information. Two thirds (66.7%) of the pupils who participated
in the study correctly indicated that one should change tooth brushes every 1 to 3
months. A further 58 (15%) said every 4 to 6 months with the remaining 23 (6%) and
15 (4%) reported every 7 to 12 months and over 12 months respectively. Eight
percent (8 %) did not know how often they should change their tooth brushes. This
indicates that most of the pupils 90%) knew that changing toothbrushes regularly was
vital with only 10% unaware of the importance of changing toothbrushes. When
asked what plaque was, the pupils responded thus: soft deposit on teeth 61 (16%)
which was correct; hard deposit on teeth 108 (28%); discoloration of teeth 65 (17%),
gum inflammation 84 (22%) and 69 (18%) did not know what it was. These results
show that 84% of the interviewed pupils did not know what plaque is. A vast majority
of the respondents (86%) related gum bleeding to gum disease or inflammation with
27 (7%), 11 (3%), and 19 (5%) associating it with calcium deficiency in the body,
17
healthy gums and not knowing what it was respectively. Regular brushing of teeth
with fluoridated tooth paste 138 (36%) and at least two regular visits to the dentist in a
year 111 (29%) were cited as the main methods of preventing dental decay. Eating a
balanced diet was cited by only 38 (10%) while 96 (25%) felt that all the three
responses would prevent dental decay. The results clearly indicate that 75% of the
children did not know how dental decay could be prevented as shown in Table 4.2
On table 4.2 above, 10%, 36%, 29% and 25% reported eating balanced diet, regular
brushing of teeth with fluoride tooth paste, regular visits to the dentist and a
combination of all of the above as ways that they knew of preventing oral health
diseases.
The overall level of oral health knowledge based on all variables above showed that
nearly half of the pupils (51%) exhibited high oral health knowledge while 49% had
low knowledge as shown in Table 4.3.
not to have regular dental check-up while 15% did not find such visits necessary
altogether. Equally, 83% of the interviewees did not think it was important to replace
missing natural teeth with artificial teeth whilst 15% thought otherwise and a paltry
2% did not know whether it was necessary or not. A large proportion of respondents
269 (70%) and 115 (30%) of the pupils thought that it was important and not
important respectively to seek treatment for toothaches just as other parts of the body.
It is correct therefore to deduce that all the pupils who participated in the study had
the right attitude to oral health.
Table 4.4 above shows that 30%, 20% and 20% of the study participants were not
satisfied with the appearance of their teeth, avoided smiling because of their teeth and
had been made fun of by other children respectively. Similarly, 35% of the
respondents had difficulty in biting hard foods, 15% had difficulty in chewing and
37% had difficulty in taking cold or hot foods.
Overall, majority of the respondents (60%) had negative attitudes on oral health while
40% exhibited positive attitudes as shown in table 4.5. This was a composite measure
of the entire attitude variable measured.
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5.1 Introduction
This study assessed oral health knowledge, attitudes among school going children in
Roysambu sub - county, Nairobi County.
difficulty biting hard and cold/hot foods respectively and a further 76% and 78%
avoiding smiling because they had been made fun of by other children and had
difficulty chewing respectively. It is very clear that oral health has a direct impact on
the quality of life especially in growing and school going children. In their study,
Harikiran et al (2018) 21.9% of study participants avoided smiling and laughing
because of their teeth. Overall, majority of the children (61.9%) had negative attitude
towards oral health while 38.1% had positive attitudes.
5.2 Conclusions
The oral health knowledge among school going children in Roysambu sub-county is
low with nearly half of the pupils having low levels of knowledge. Children who had
an exposure to school dental health programs showed better knowledge.
Respondents in this study had unsatisfactory oral health practices. The practices were
influenced by the level of knowledge respondents had, and the type of school a
22
respondent attended. Practices were not significantly associated with oral health
attitudes and the gender of the respondent.
Majority of the school going children had not visited a dentist yet they reported
experiencing some form of ill oral health-related symptoms indicating they had
inadequate oral health-seeking behavior both for treatment and for routine preventive
services.
5.3 Recommendations
Since oral health knowledge influences practice as shown in this study, there is need
to increase the oral health knowledge to school going children in Roysambu sub -
county through well planned school based oral health education programmes in
primary schools.
There is urgent need to address the problem of poor oral health practices by including
oral health into the primary school curriculum with the overall aim of improving oral
health practices and attitudes.
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REFERENCES
AG, Pallavi SK, Hariprakash S, Ashutosh, Nagesh KS. Oral health related KAP
among 11- to 12-year-old school children in a government aided missionary
school of Bangalore city. Indian J Dent Res [serial online] 2008 [cited 2011
Dec 26]; 19:236-42. Available from:
http://www.ijdr.in/text.asp?2018/19/3/236/42957
Kumar, P.M., Joseph, T., Varma, R. B. and Jayanthi, M. (2015). Oral health status of
5 years and 12 years school going children in Chennai city - An
epidemiological study. J Indian Soc Pedod Prev Dent, 23:17-22.
Ministry of Health (2018). Early Childhood Oral Health: A toolkit for District Health
Boards, primary health care and public health providers and for oral health
services relating to infant and preschool oral health. Wellington: Ministry of
HealthHarikiran
Mishra P. (2013). Nepal Country Report: School oral health promotion programme. In
The 2nd Asian Conference of Oral Health Promotion for School Children.
Prospectus for Our Future Generation. Ayutthaya, Thailand, February 2013.
Pp.25-38. Bangkok: Thammasat University, 2013.
Petersen PE, MzeeMO. (2018). Oral health profile of school children, mothers and
schoolteachers in Zanzibar. Community Dent Health 2018; 15: 256-62
World Health Organization.(2016). Guideline: Sugar Intake for Adults and Children.
Geneva.
World Health Organization. (2013). Global Oral Health Data Bank. Geneva: W.H.O.
World Health Organization (Kwan S and Petersen PE). 2013. WHO
Information Series on School Health. Oral Health Promotion through Schools.
Document 11. Geneva: WHO, 2013.
24
APPENDICES
c) It is important to brush teeth at least twice a day with a toothpaste and toothbrush
5.Where do you mostly get information regarding oral health? (tick one)
25
a) Radio
b) TV
c) Dentist
d) Newspapers/Magazines
e) Shopkeepers
f) My parents/guardians
g) Friends
h) Others……………………..
6. How often should you change your tooth brush? (tick one)
a)1 – 3 months
b) 4 – 6 months
c) 7- 12 months
e) Don’t know
c) Discoloration of teeth
e) Don’t know
a. Healthy gum
c. Gum disease(inflammation)
d. Don’t know
Attitude
10. Do you think decayed teeth can affect the appearance of a person? (tick one)
12. Do you think that treatment of toothache is important as any other organ in the
body? Yes[ ] No[ ] Don’t know[ ]
13.Because of the state of your teeth, have you experienced any of the following
problems during the past year?
a) I am not satisfied with the appearance of my teeth
Yes [ ] No [ ]
Yes [ ] No [ ]
27
Practices
14. How many times in a day do you brush your teeth?
(Tick one) Never Once Twice Thrice or more
15. If your answer above is NEVER, what makes you never to brush your teeth?
a) I cannot afford a Tooth paste
b) I cannot find a tooth brush
c) Brushing is not important
d) I don’t like brushing my teeth
18. How often do you eat or drink any of the following foods, even in small
quantities? (Read each item)
Several Several Several times
Every times Once times a day
day a week a week a month Never
1 2 3 4 5 6
Fresh fruit................[ ] [ ] [ ] [ ] [ ] [ ]
Biscuits, cakes, cream
cakes, sweet pies,
buns etc.....................[ ] [ ] [ ] [ ] [ ] [ ]
Lemonade, Coca Cola
or other soft drinks.... [ ] [ ] [ ] [ ] [ ] [ ]
Sweets/candy............. [ ] [ ] [ ] [ ] [ ] [ ]
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Confidentiality
The information gathered in this interview will be kept strictly confidential. No
physical identifiers, like your name, phone number, identity card number will be
recorded on the questionnaire. Completed questionnaires will be kept safely in a
locked cabinet and no third party will have access to it.
Voluntary participation
Your participation in this study is voluntary. It is up to you to decide whether or not to
take part in this study. If you decide to take part in this study, you will be asked to
sign a consent form. After you sign the consent form, you are still free to withdraw at
any time and without giving a reason. Withdrawing from this study will not affect the
relationship you have, if any, with the researcher. If you withdraw from the study
before data collection is completed, your data will be returned to you or destroyed.
Contact Information
In case you have questions at any time, you may contact;
Teresa Ngatia
School of Health Sciences
0791233592
teresangatia76@gmail.com
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Participant’s statement
I have been given opportunity to be interrogated in the study and all my concerns
have been satisfactorily addressed and this information with regard to my
participation in the study is clear to me. My participation in this study is entirely
voluntary. I understand that my records will be kept private and that I can opt out of
the study at any time.
Participant’s
Signature………………………………………… Date…………………………..........
Interviewer’s statement
I, the undersigned, have explained to the volunteer in a language she understands the
procedures to be followed in the study and the risks and benefits involved.
Interviewer’s
Signature………………………………………… Date…………………………..........
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2. Typing and binding Direct cost from printing and binding 3000
TOTAL Kshs.29,500