ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE ON ORAL

HEALTH AMONG SCHOOL GOING CHILDREN IN ROYSAMBU SUB-

COUNTY.

TERESA WAMUCII NGATIA (BSC IN HEALTH PROMOTION)

Q34/5537/2019

A RESEARCH PROJECT REPORT SUBMITTED IN PARTIAL

FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE
DEGREE OF HEALTH PROMOTION IN THE DEPARTMENT OF
ENVIRONMENTAL AND OCCUPATIONAL HEALTH, SCHOOL OF
HEALTH SCIENCES OF KENYATTA UNIVERSITY

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
 iii

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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3.6 Sample Size Determination....................................................................................12

3.7 Data Collection Tools And Instruments................................................................13
3.8 Pilot Study and Pretesting......................................................................................13
3.9 Validity...................................................................................................................13
3.10 Reliability.............................................................................................................14
3.11 Data Collection Techniques.................................................................................14
3.12 Data Management and Analysis...........................................................................14
3.13 Logistical And Ethical Considerations.................................................................14
CHAPTER FOUR: DATA ANALYSIS AND INTERPRETATION....................15
4.1 Demographics........................................................................................................15
4.2 Oral Health Knowledge..........................................................................................15
4.3 Oral Health Attitude...............................................................................................17
4.4 Oral Health Practices..............................................................................................19
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND
RECOMMENDATIONS...........................................................................................20
5.1 Introduction............................................................................................................20
5.1.1 Oral Health Knowledge.......................................................................................20
5.1.2 Oral Health Attitude............................................................................................20
5.1.3 Oral Health Practices...........................................................................................21
5.2 Conclusions............................................................................................................21
5.3 Recommendations..................................................................................................22
REFERENCES...........................................................................................................23
APPENDICES............................................................................................................24
Appendix I: Study questionnaire..................................................................................24
Appendix II: Informed consent form...........................................................................28
Appendix III: Map of the Study Area..........................................................................30
Appendix IV: Research Work Plan..............................................................................31
Appendix V: Research Budget.....................................................................................32
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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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Figure 1.1: Conceptual Framework................................................................................6

Figure 4.1: Demographics............................................................................................15

ABBREVIATION AND ACRONYMS

WHO World Health Organization
 ix

GAO Government Accountability Office

KAP Knowledge Attitude and Practice
SPSS Statistical Package Social Sciences

DEFINITION OF OPERATIONAL TERMS

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

Attitude -A settled way of thinking or feeling about something

Practice -The customary, habitual or expected procedure or way or way of doing

something

Oral hygiene -It is the practice of keeping your mouth clean and disease free

Questionnaire -A set of printed or written questions with a choice of answers devised

for the purposes of a survey or statistical study

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
 xi

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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CHAPTER ONE: INTRODUCTION.

1.1 Background of the Study

Oral health is defined as a state of being free of mouth and facial pain, oral infections
and sores and oral and other diseases that limit an individual’s capacity in biting,
chewing, smiling, speaking, and psychosocial well-being according to world health
organization (WHO).Most of oral health conditions are largely preventable and can be
treated in their early stages. The majority of cases are dental caries (tooth decay),
periodontal diseases, oral cancers, cleft lip and palate. The global burden of disease
study (2019) estimated that oral diseases affect close to 3.5 billion people worldwide,
with caries of permanent teeth being the most common condition. Globally, it is
estimated that 2 billion people suffer from caries of permanent teeth and 520 million
children suffer from caries of primary teeth. In Kenya, the prevalence of oral diseases
continues to increase with growing urbanization and changes in living conditions.
This is primarily due to inadequate exposure to fluoride in the water supply and oral
hygiene products such as toothpaste, availability and affordability of food with high
sugar content and poor access to oral health care services in the community.
Marketing of food and beverages high in sugar, as well as tobacco and alcohol, have
led to a growing consumption of products which in turn ends up contributing to oral
health conditions and non-communicable diseases.

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
 2

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.

1.2 Problem statement

Oral health status is ascribed to changing living conditions and lifestyles, effective use
of oral health services, implementation of preventive oral health care programs,
developing regular self-care practices and use of fluoride toothpaste. Oral diseases
quality as a major public health problem afflicting children in Kenya with dental
caries as one of the most common oral diseases public health concern in school going
children (Petersen et al., 2015). An estimated 60- 90% of school going children suffer
from dental caries worldwide (WHO, 2016). Dental caries is the most prevalent
condition included in the 2016 Global Burden of Disease study ranking first for the
decay of permanent teeth (2.3 billion people) and 12th for deciduous teeth (560
million children).

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.

Oral health knowledge is considered to be crucial for developing healthy behaviours,

and it has been shown that there is an association between increased knowledge and
better oral health. Optimum health related practices are more likely to be taken up if
an individual feels a sense of better control over their health with better understanding
of diseases and their etiology. School going children are the ideal target group for an
early intervention because healthy behaviours and lifestyles developed at younger
ages are more sustainable. However, it has been seen in many developing countries
that children have limited knowledge of the causes and prevention of oral disease. In
Roysambu sub-county there is limited health services which can offer oral health
services and also health professionals. This makes it difficult for the population to be
able to access dental services leading to oral diseases like dental carries which later
lead to serious health consequences. Also in schools; there is lack of school programs
which deal particularly with oral hygiene. Because of this, school going children lack
skills and knowledge on oral hygiene like tooth brushing, healthy diet. This study will
 4

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

1.4 Research Questions.

1. What are the oral health practices among the school going children in Roysambu
sub-county?
2. What are the levels of oral health knowledge among school going children in
Roysambu sub-county ?
3. What are the attitudes influencing oral health among school going children in
Roysambu sub-county ?

1.5 Research Objectives.

1.5.1 General Objective.
To determine the knowledge, attitude and practice on oral health among school going
children.

1.5.2 Specific Objectives.

1. To determine oral health practices among school going children in Roysambu sub-
county .
2. To determine the oral health knowledge among school going children in Roysambu
sub-county .
3. To determine the attitudes influencing oral health among school going children in
Roysambu sub-county .

1.6 Scope/Delimitations and Limitations

1.6.1 Delimitations.
Time and financial resources will be limited thus will not allow for a country wide
study on all school going children and therefore this study will be restricted to
Roysambu sub-county , Nairobi County. Furthermore the study will be relying on
information provided by children.
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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.

2. Time allocation for the study is short.

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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1.7 Conceptual framework

Independent variables

Oral health Knowledge

Awareness of oral diseases.

Prevention of oral diseases.

Set of dentition .

Dependent
variable

Attitudes towards Oral

Health
Optimum Oral
Proper attitude to decayed
teeth. Health
Self esteem .

Attitude towards visiting the

dentist.

Oral health practice

Regular brushing of teeth.

Proper brushing and healthy

diet.

Figure 1.1: Conceptual Framework

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CHAPTER TWO - LITERATURE REVIEW

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.

Knowledge and awareness on oral health - Knowledge on dental caries and

periodontal diseases may influence awareness of children on how to take care of their
oral health by brushing their teeth daily with fluoridated toothpaste and intake of
sweets and other carogenic food stuffs.

Oral Hygiene Practice - This may influence oral health status by use of improper
tooth brushing techniques by not using fluoridated toothpaste, time of brushing
 8

including duration of brushing. Improper brushing techniques may result to gingival

recession, plaque retention which may lead to dental caries and gingivitis ( Harris et
al, 2014)

2.2.2 Enabling Factors

Accessibility and availability of dental services is another era that can influence oral
health status of children. The distance from residential area to the dental clinic may
hinder someone who is taking care of primary school going child to seek treatment
when in need or for someone with busy schedule. As well, information on available
dental services may not be available to those in need of such services. The
information which may be from public mass media such as Television, radio or
different persons such as friends and parents may influence knowledge on awareness
and preventive behavior to primary school children towards Oral health.

2.3 Available Knowledge on oral health

Studies by Zhu, Petersen and Wang et al., (2013) showed that a large number of
children in many developing countries have limited knowledge on the causes and
prevention of common oral diseases. Studies in Tanzania indicated low oral health
knowledge among mothers and school teachers and that more than 50% of mothers
had received oral health advice from a dentist (Petersen and Mzee 2015). Other
studies indicated that Indian children had low level of oral health awareness and
practice as compared to their western counterparts (Harikiran et al., 2018). However,
studies by Zhu et al., (2015) illustrated that only a small proportion of children,
parents and school teachers were aware of the harmful effects of hidden sugars and
sugary drinks. It is therefore important to improve the children awareness, attitudes
and behavior towards oral health.

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
 9

inappropriate exposure to fluorides, poor access to safe water or sanitary facilities or

lifestyle behaviors that affect general health such as tobacco use, excessive alcohol
consumption and poor dietary choices, affect oral and general health. According to
Kumar et al. (2015), low socio-economic status is also related to high prevalence of
oral health problems. These studies were conducted on oral health status among 2939
Mexican children aged 6 to 12 years and were able to identify important relationships
between dental caries and lower socio-economic conditions among the study group.
According to an epidemiological study conducted by Kumar et al. (2015) among
school going children aged 5 years and 12 years in Chennai city, India among 1200
randomly selected children, dental caries was the most prevalent disease, affecting
permanent teeth more than primary teeth. The study indicated that the prevalence was
higher in public schools compared to private schools thus implying that socio-
economic status influenced oral hygiene among 12 year olds.

2.4 Actual Practice of Oral health

Studies in Burkina Faso showed that the knowledge and practices on oral health were
low with only 36% of children and adults reported to have brushed their teeth (WHO,
2013). Globally, studies show association between poor oral hygiene and sugar intake
(Petersen, 2016; WHO, 2015). Previous studies in Dodoma and Morogoro, Tanzania,
on adults revealed that 95% of people in Dodoma and 85% in Morogoro sought
treatment because of pain (Petersen et al., 2016).

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
 10

never visited the dentist. For example, in Tanzania, over 75% of 12-year-old children
have never been to the dentist (Mishra, 2013).

2.5 Attitude towards Oral health

Attitude is an acquired characteristic of an individual. People demonstrate a wide
variety of attitudes towards teeth, dental care and dentists. These attitudes naturally
reflect their own experiences, cultural perceptions, familial beliefs and other life
situations.

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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CHAPTER THREE: MATERIALS AND METHODS

3.1 Research Design

This study adopted a community based cross-sectional study design. Cohorts of
school going children were sampled and studied to establish their knowledge, attitude
and practice of oral health (KAP). It provided a description about the characteristics
of study participants, attitude and knowledge in regard to oral health.

3.2 Location of the study

Roysambu sub-county is a commercial and residential suburb of the city of Nairobi. It
is approximately 11 kilometers northeast of Nairobi's central business district off
Thika Road. It has five wards namely Roysambu, Zimmerman, Githurai, Kahawa and
Kahawa West.

3.3 Variables
3.3.1 Dependent Variables
The dependent variable in this study was optimal oral health.

3.3.2 Independent Variables

Independent variables included oral health knowledge variables such as awareness of
oral diseases, prevention of oral diseases and set of dentition; Oral health practice
variables such as regular brushing of teeth, proper brushing and eating healthy diet;
Attitudes to oral health variables which include self-esteem, proper attitude to
decayed teeth and regular visit to the dentist.

3.4 Study Population

This study was targeting school going children attending schools in roysambu sub-
county, Nairobi County.

3.5 Sampling Techniques

Roysambu sub-county was purposively sampled for study because it has a well-
established community health unit. However, it reports poor oral health indicators and
high prevalence of dental carries. It was also selected for having different economic
strata. ie. very high cost primary schools where children of well persons attend,
schools where middle class children attend and very low cost schools in the informal
settlements. Since the sub - county has three school categories the schools were
 12

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.

Table 3.1: Schools classified into 3 strata

Strata Total schools No. selected Sample size
A- Schools in informal areas 22 7 165
B- public schools not in 15 5 123
informal areas
C- Private high cost schools 11 4 96
Total 48 16 384

3.6 Sample Size Determination

 School going children;
The fishers et al formula (1998) was used to determine the desired sample size where
the study population is >10,000
n=Z2PQ/d2
Where;
n= desired sample size
Z=standard normal deviation set as 1.96
P=proportion in the target population 0.5
Q=1-p
D= degree of accuracy desired set as 0.05
n= (1.962x0.5x0.5)/ (2x0.05)
n=0.9604/0.0025 =384.16
 13

The desired sample size is 384

 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

3.7 Data Collection Tools and Instruments

In this research study, the data was collected by the use of structured self-
administered questionnaires. The researchers designed the questionnaires and
administered them to the students who met the inclusion criteria. The questionnaires
included a series of questions that needed to be answered by the study participants.
Moreover, the participants were required to respond to similar questions that were
arranged in the same order. Using questionnaires is because they were cheap to design
and required little effort compared to other data collection methods.

3.8 Pilot Study and Pretesting

Pilot study was be done in Githurai ward in Roysambu constituency. This ward has
nearly similar features as the study area. This tested research instruments, removed
ambiguity and improved clarity of research tools to ensure that they met the study
objectives. Pretesting involved 38 interviewer administered questionnaires to study
participants who met the inclusion criteria which represented 10% of the sample size

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.
 14

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.

3.11 Data Collection Techniques

Data was collected within a period of one month involving school going children
meeting the inclusion criteria. Upon consenting, the researcher administered
interviewer structured questions.

3.12 Data Management and Analysis

The researchers first ensured that the data collected was accurate, complete, and
uniform before performing the analysis. The data was later numbered and coded using
SPSS version 24 and analysis to generate descriptive statistics. The findings were
presented in narratives, pie-charts, frequency tables and bar-graphs from which the
appropriate conclusions were drawn to answer the research problem.

3.13 Logistical and Ethical Considerations

The researcher sought Ethical approval from Kenyatta University Ethics Committee,
authority to carry out the study and also clearance from relevant local authorities of
Roysambu sub-county. Moreover, the researchers sought informed consent from the
study participants before they participated in the study. The researchers explained the
need and importance of the research study before the study participants signed the
informed consent to indicate that they agreed to participate.
 15

CHAPTER FOUR: DATA ANALYSIS AND INTERPRETATION

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%

Figure 4.1: Demographics

4.2 Oral Health Knowledge

Oral health knowledge was assessed using the WHO 2015 oral health standard which
assesses knowledge in terms of causes and prevention. In this study, oral health
knowledge was assessed based on knowledge on dentition, general knowledge on oral
health, source of information on oral health, common dental conditions and
prevention of dental decay. The results showed that almost half (44%) of the pupils
correctly stated that they had 2 sets of teeth while 18% did not know how many sets
of teeth one had. The other respondents said; 1 set (4.6%), 4 sets (20%) and 3 sets
(13.5%) respectively. This implied that 56% of the children interviewed did not have
the correct knowledge on their dentition. Approximately 6 out of every 10 pupils
interviewed said that there were 20 complete set of milk teeth (58%) which was
 16

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.

Table 4.1: General knowledge on oral health issues

Questions False (%) True (%)
Sweets affect teeth badly 27 (7%) 357 (93%)
Fizzy drinks like soda affect teeth badly 154 (40%) 230 (60%)
It is important to brush your teeth at least 35 (9%) 349 (91%)
twice a day with a toothbrush and toothpaste
Brushing teeth prevents tooth decay 142 (37%) 242 (63%)
Regular visits to the dentist is necessary 65 (17%) 319 (83%)
Using fluoride destroys teeth 269 (70%) 115 (30%)

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

Table 4.2: Knowledge on prevention

Frequency Percentage
Eating a balanced diet 38 10
Regular brushing of teeth with fluoride toothpaste 138 36
Regular visits to the dentist ( at least twice a year) 111 29
All of the above 96 25
TOTAL 100

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.

Table 4.3 Overall oral health knowledge

Level of knowledge Frequency Percent
Low knowledge 188 49
High knowledge 196 51
Total 384 100

4.3 Oral Health Attitude

Almost three quarters (73%) against 23% of the pupils felt that decayed teeth can
affect the appearance of a person with only 4% saying they did not know whether it
affected ones appearance or not. Majority (83%) of the pupils thought regular visits to
the dentist are necessary. Two percent (2%) did not know whether it was necessary or
 18

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 Oral health attitude

Issue Yes (%) No(%) Don't know (%)
I am not satisfied with the 115 (30%) 231 (60. 2%) 38 (9.8)
appearance of my teeth
I often avoid smiling and 77 (20%) 292 (76%) 15 (4%)
laughing because of my teeth
Other children make fun of my 77 (20%) 292 (76%) 15 (4%)
teeth
Toothache or discomfort caused 92 (24%) 280 (73%) 12 (3%)
by my teeth caused me to miss
classes or whole days at school
I have difficulty biting hard 134 (35%) 246 (64%) 4 (1%)
foods
I have difficulty in chewing 58 (15%) 307 (80%) 19 (5%)
I have taking cold or hot foods 142 (37%) 234 (61%) 8 (2%)

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.
 19

Table 4.5 Overall attitude towards oral health

Variable Frequency Percentage
Positive attitude 154 40
Negative attitude 230 60
Total 384 100

4.4 Oral Health Practices

Most of the pupils recorded brushing their teeth once (20%) or twice (59%) a day
with a fluoridated toothpaste and toothbrush. Even though none of the children said
they had never brushed their teeth before the interview, 16% cited that they did not
brush at times because they could not afford tooth paste or tooth brush while 5%
others cited brushing as unimportant and not liking it altogether as the reasons that
made them not brush their teeth. Almost half (44%) of the pupils indicated that they
brushed their teeth in the morning after breakfast and before going to bed. The others
56% reported either not brushing their teeth or brushing before breakfast. Ninety two
(92%) of the pupils who brushed their teeth reported cleaning their tongue whilst
brushing while 8% reported not cleaning their tongue when brushing . Other variable
used to measure oral health practices were how often the respondents took certain
foods or drinks that have a bearing on oral health. More than three quarters of the
children reported to frequently take unhealthy foods as sweets or candy (80.3%),
while 84.4% reported to have frequently taken cakes and sweetened drinks. It is
recommended that one visits a dentist at-least twice a year. In this study, 115 (30%)
had not visited a dentist in previous 12 months, 238 (62%) had visited a dentist once
or more while 31 (8%) could not recall if they had visited a dentist. A composite
measure of oral health practices measured above showed that 215 (56%) respondents
had appropriate oral health practices while 169 (44%) had inappropriate practices as
shown in Table 4.6
Table 4.6 Composite Oral health practices
Practice Frequency Percentage
Appropriate oral health practices 215 56
Inappropriate oral health practices 169 44
Total 100 100
 20

CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND

RECOMMENDATIONS

5.1 Introduction
This study assessed oral health knowledge, attitudes among school going children in
Roysambu sub - county, Nairobi County.

5.1.1 Oral health knowledge

Basic oral health knowledge amongst the pupils interviewed varied with less than half
of the pupils (44%) knowing the correct set of teeth an individual can have. However,
the pupil’s knowledge of the actual number of milk or permanent sets of teeth was
approximately 6 of every 10 pupils interviewed. General knowledge of causes and
practices that would lead to tooth decay was high with 93% of the pupils correctly
attributing decay to Sugary foods. Similarly 91% and 83% acknowledging that
brushing teeth twice a day and regular dental visit were necessary in prevention of
oral health related problems. The findings differ with those by Barber, 2013 who
reported that half of the population in Kenya was unaware of preventive measures for
dental diseases. These figures are much higher compared to 75% and 49% of
participants who thought that brushing teeth prevented teeth and gum diseases and
sweets caused teeth decay respectively (Harikiran et al., 2018). This study established
that 22% of the children drew their knowledge on oral health from the television, a
much lower figure compared to 58.4% who received information regarding oral health
mainly via the same media in the study conducted by Harikiran et al (2018). Overall,
about half of the children (51%) exhibited high level of oral health knowledge.
However, there was a statistical association between the type of school the pupils
attended and their overall oral health knowledge.

5.1.2 Oral health attitude

A majority (73%) of the pupils felt that decayed teeth affected the appearance of a
person. Similarly, when asked for self-evaluation, most respondents (66%) felt that
their teeth and gums were either in excellent or very good condition while less than
5% perceived their teeth and gums condition as poor. Similar results were also
recorded by Prasad et al (2013) and Harikiran et al (2018) where 2.1% and 7% of the
study participants considered their oral health status as poor. With 36%, 35% and
37% of the study participants not satisfied with the appearance of their teeth, having
 21

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.

5.1.3 Oral health practices

The study results show 59% participants brushing their teeth twice a day and 14%
only once a day. Similar studies established comparable results: Okemwa et al (2013)-
48%, Gathecha et al (2014) between 41%-60% in two study sites, Harikiran et
al2018)-39%, and Omiri et al (2016)-69%. Ninety six (96%) of the pupils used a
toothbrush in this study. This figure differs from other similar studies: Al Omiri et al
(2006)-83%, Gathecha et al (2015)-77%. Almost half (44%) of the pupils indicated
that they brushed their teeth in the morning after breakfast and before going to bed.
Ninety two (92%) of the pupils reported cleaning their tongue whilst brushing.
Overall, 56% of the respondents had appropriate oral health practices while 44% had
inappropriate practices. These results differ with those by Zhu who reported poor oral
health practices (Zhu et al., 2013). This study showed age was a factor influencing
oral health practices. Children from high cost schools had poorer oral health practices
though they had better knowledge. This could be due to the fact that they have access
to most unhealthy foods.

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.

Majority of the children in schools in Roysambu sub-county had negative attitudes

towards oral health. Attitudes were not influenced by type of school, age or gender of
respondents.

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.
 23

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

Van den Branden,S.,Van den Broucke,S,Leroy,R.,Declerck,D.,&

Hoppenbrowers,.K,(2017). Oral health and oral health-related behaviour in
preschool children: evidence of social gradient. European Journal of Pediatrics
172(3),231-237.

Vargas, C.M.,& Ronzio,C.F.(2019). Disparities in early childhood caries.BMC Oral

Health,6(Suppl1).S3.

World Health Organization.(2016). Guideline: Sugar Intake for Adults and Children.
Geneva.

World Health Organization. (2015). Local Action: Creating Health-Promoting

Schools. The WHO Information Series on School Health. Geneva: WHO.

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

Appendix I: Study Questionnaire

INSTRUCTIONS:
I. Do not write any personal details such as name, phone number, identity card
number etc anywhere in this questionnaire.
II. Please respond to all the questions as much as possible and be free with the
interviewer.
III. Confidentiality of all response and information collected will be maintained.

Part 1: BACKGROUND INFORMATION

 What is your gender? A) Male B) Female
 Consent granted A) Yes B) No
 Type of school A) B) C)
 How old are you today? (Years)
Dental knowledge
1. How many sets of dentition/teeth do we have
One [ ] Two[ ] Three[ ] Four[ ] Don’t know[ ]

2. How many milk teeth do we have?

10[ ] 16[ ] 20[ ] 32[ ] Don’t know[ ]

3. How many permanent teeth do we have?

16[ ] 20[ ] 24[ ] 32[ ] Don’t know[ ]

4. Please tell me whether the following statements are true or false.

a) Sweets affect the teeth badly

b) Fizzy drinks like soda affect the teeth badly

c) It is important to brush teeth at least twice a day with a toothpaste and toothbrush

d) Brushing teeth prevents tooth decay

e) Using fluoride destroys teeth

f) Regular visits to the dentist is necessary

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

d) More than 1 year

e) Don’t know

7. What does plaque mean? (tick one)

a) Soft deposit on teeth

B) Hard deposit on teeth

c) Discoloration of teeth

d)White patches on teeth

e) Don’t know

8. What does gum bleeding mean? (tick one)

a. Healthy gum

b. Calcium deficiency in body

 26

c. Gum disease(inflammation)

d. Don’t know

9. What are the methods to prevent dental decay? (tick one)

a. Eating balanced diet

b. Regular brushing with fluoridated tooth paste

c. Regular visit to the dentist at least twice in a year

d. All the above

Attitude

10. Do you think decayed teeth can affect the appearance of a person? (tick one)

Yes ( ) No ( ) Don’t know ( )

11. Do you think regular visit to a dentist is necessary? (tick one)

Yes[ ] No[ ] Don’t know[ ]

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 [ ]

b) I often avoid smiling and laughing because of my teeth

Yes [ ] No [ ]

c) Other children make fun of my teeth

Yes [ ] No [ ]

d) Toothache or discomfort caused by my teeth forced me to miss classes at school or

for whole days

Yes [ ] No [ ]
 27

e) I have difficulty biting hard foods

Yes [ ] No [ ]

f) I have difficulty in chewing

Yes [ ] No [ ]

g) I have difficulty taking cold or hot foods

Yes [ ] No [ ]

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

16. When do you brush your teeth?

a) In the morning before breakfast
b) In morning after breakfast
c) After every meal
d) In the evening before going to bed
e) After taking sweet meals

17. Do you clean your tongue?

Yes No

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............. [ ] [ ] [ ] [ ] [ ] [ ]
 28

Appendix II: Informed Consent Form

My name is Teresa Ngatia ,a degree student in Health Promotion at Kenyatta
University.I am conducting a study on"ASSESSMENT OF KNOWLEDGE,
ATTITUDE AND PRACTICE OF ORAL HEALTH AMONG SCHOOLS
GOING CHILDREN IN ROYSAMBU SUB-COUNTY ". I will be asking
questions about awareness of oral health and how knowledge,attitude and other
factors determine your practice on oral health.The goal of this study your knowledge,
attitude and practice on oral health.The findings of this study will help in identifying
gaps in oral health services, developing guidelines and delivery strategies.The
duration of the interview is approximately 10 minutes.

Significance of the study

The study will equip pupils with knowledge and skills on oral hygiene.
The study sill help prevent bad breath,tooth decay and gum disease.
The pupils will be able to establish good oral hygiene and healthy eating habits.

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
 29

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…………………………..........
 30

Appendix III: Map of the Study Area

 31

Appendix IV: Research Work Plan

Activity Time frame

Identification of research topic January

Developing a concept paper and January -February

presentation

Proposal writing and presentation February -May

Data piloting and testing of instruments June -July

Data Collection August - October

Analysis of data and report writing November

Report writing December

Appendix V: Research Budget

 32

No. Main Activities Activity Breakdown Amount (kshs)

1. Transport To and from field @ 200 per day for 4000

20 days

2. Typing and binding Direct cost from printing and binding 3000

3. Piloting Traveling to piloting site, research 3000

instruments and analysis @ 300 per
day for 10 days

4. Data collection Transport @ 200 and lunch @ 200 8000

per day for 20 days

5. Communication Before and during data collection @ 8000

200 per day for 40 days

6. Binding and Typing and printing 2000

presentation

7. Presentation and Final report presentation and 1500

publishing publishing

TOTAL Kshs.29,500