|Year : 2015 | Volume
| Issue : 2 | Page : 62-66
Utilization of dental services among civil servants in Port Harcourt, Nigeria
Elfleda Angelina Aikins1, Omoigberai Bashiru Braimoh2
1 Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Choba, Port Harcourt, Rivers State, Nigeria
2 Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Choba, Port Harcourt, Rivers State, Nigeria
|Date of Web Publication||20-Jul-2015|
Elfleda Angelina Aikins
Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Choba, Port Harcourt, Rivers State
Source of Support: None, Conflict of Interest: None
Background: Civil servants are adults that cut across all ages, educational status, and social class. This study describes and compares dental service utilization among federal and state civil servants in Port Harcourt and identifies the determinants and barriers to the utilization of dental services among these groups. Materials and Methods: This study was a comparative cross-sectional study carried out among Federal and State civil servants in Port Harcourt, Rivers State, Nigeria. The study units were selected using multistage sampling technique. Data were collected using pretested self-administered questionnaires and analyzed using the Statistical Package for Social Sciences version 20.0. Results: A total of 638 participants comprising of 313 and 325 civil servants from the federal and state civil service respectively, completed and returned the questionnaires.Only 143 (22.4%) of the participants had visited the dentist in the past 1-year, this is made up of 80 (25.6%) federal and 63 (19.4%) state civil servants. Most of the federal workers 55 (68.8%) and state workers 45 (71.4%) had visited the dentist based on need. Participants with tertiary education were significantly more likely to utilize dental services (P = 0.009). The reasons for nonutilization of dental services reported among the respondents were no need for treatment 59%, cost of treatment 20%, being scared 13.5%, and fear of infection 10.3%. Conclusion: Dental visits were based on the need for treatment. Whereas education was a determinant of dental service utilization, perceived lack of treatment and cost of treatment constituted barriers to utilization of dental services.
Keywords: Civil servants, dental visit, determinants, utilization of dental service
|How to cite this article:|
Aikins EA, Braimoh OB. Utilization of dental services among civil servants in Port Harcourt, Nigeria. J Dent Res Rev 2015;2:62-6
|How to cite this URL:|
Aikins EA, Braimoh OB. Utilization of dental services among civil servants in Port Harcourt, Nigeria. J Dent Res Rev [serial online] 2015 [cited 2020 Jun 6];2:62-6. Available from: http://www.jdrr.org/text.asp?2015/2/2/62/161202
| Introduction|| |
Globally, the incidence and prevalence oral diseases are high. However, the greatest burden of these diseases has been found to be in developing countries, including Nigeria, where dental caries, periodontal diseases and malocclusion are still highly prevalent. Utilization of dental services among Nigerians is poor , and service utilization is often motivated by pain and need for emergency care. , The reported utilization of dental services ranges from values of 7.8% among University students  to 33.0% among pregnant women. 
The actual measures of dental care utilization describe the percentage of the population who have seen a dentist during given periods of time.  Routine dental visits are usually recommended either biannually or annually. Thus a frequently used measure of utilization dental services among several others is whether an individual visited a dentist in the past year.
The reasons for poor utilization of dental services are not very clear period. Several barriers in South-West Nigeria were identified, this included fear related conditions, high cost of dental treatment, and the noise of the dental drill.  It is also reported that accessibility to dental care is a factor in the utilization of dental services  and that adequate access to dental care reduces morbidity, preserves function and enhances the overall quality of life. 
The Nigerian civil service consists of employees in government agencies other than the military. These employees are career civil servants in various ministries and parastatals who progress based on qualifications and seniority until they reach the retirement age of 60 years. Presently, in Port Harcourt Rivers State, there are three government-operated dental hospitals: Two are run by the Federal and one by the State government as well as a number of privately owned ones. One of the government operated dental clinics is situated within the premises of the Federal Government Secretariat, which serves as the hub of federal governmental activities in the State where many civil servants work. The second dental center is located at the University of Port Harcourt Teaching Hospital. The State-owned dental clinic (Oral and Maxillofacial dental center) is situated some distance away from the State Government Secretariat.
Studies on utilization of dental services in Port Harcourt are uncommon. Civil servants are adults that cut across all ages, educational status and social classes, hence their choice in this study. This study describes and compares the utilization of dental services in Port Harcourt between Federal civil servants who have a dental clinic located within their office complex and State civil servants who do not. It further identifies the determinants and barriers to the utilization of dental services among these groups.
| Materials and Methods|| |
This study was a comparative cross-sectional study carried out among Federal and State civil servants in Port Harcourt, Rivers State, Nigeria. Ethical approval for the study was obtained from the Research and Ethics Committee of the University of Port Harcourt. Permission to carry out the study was further obtained from the head (Permanent Secretaries) of the selected ministries and written informed consent obtained from the participants. Selected subjects who did not consent to participate in the study were excluded.
The sample size was determined using the formula for comparison of two proportions  at 95% confidence interval and standard normal deviate (V) at 1.96. The standard normal deviate (U) corresponding to 80% power was set at 0.84. The proportion of federal workers who reported utilization of dental service was 25.3% (0.253).  the proportion of state workers who utilized dental service was assumed to be a difference of 10% (0.1) from federal workers, this was 0.153.  Therefore, the minimum sample size obtained for each group was 300. To accommodate for nonresponse, a total of 350 samples were selected from the federal and state service respectively.
The study units were selected using multistage sampling technique. The participating ministries were randomly selected from both the Federal and State civil service by simple replacement balloting. Subsequently, a list of civil servants was compiled from the nominal rolls of the selected ministries and respondents selected using a table of random numbers until the desired sample size was obtained.
Data were collected using pretested self-administered questionnaires. The study subjects were government workers who must at least know how to read and write before they are employed. The questionnaire contained information on bio-demographics (age, gender, grade level and level of education). Other information obtained included previous dental visits, frequency of visits, place of visit and barriers to utilization of dental services. Pretesting was done using staff from other ministries not selected for the study to ensure simplicity and ease of understanding by the respondents. A total of 70 (10%) of the sample population was used. Necessary modifications were made to the questionnaire before data collection to ensure the validity and reliability of the instrument.
Statistical Package for Social Sciences version 20.0 (IBM Statistics New York, USA) was used for data analysis. Descriptive statistics was used to describe the subjects' utilization of dental services and associated factors. Association between variables was tested using Chi-square tests at 95% confidence interval. P < 0.05 was considered to be statistically significant.
| Results|| |
A total of 700 questionnaires were distributed, 638 comprising of 313 and 325 civil servants from the federal and state civil service respectively, were completed and returned. The completed questionnaires were all found usable. The response rate was 89.4% and 92.8% among the federal and state workers, respectively. The difference was however not significant.
The age of the federal civil servants ranged from 21 to 60 years with a mean of 41.8 ± 9.4 years, while that of the state civil servants ranged from 17 to 65 years with a mean of 43.3 ± 9.5) years. Most (36.9%) of the respondents were in the 44-52 years age group in both the federal (36.4%) and state (37.5%) service. Regarding educational status, 515 (80.7%) had tertiary education, 103 (16.1%) secondary education and 20 (3.1%) primary education. The difference in education status was statistically significant (P = 0.009). The distribution of educational status followed the similar pattern at the federal and state ministries. Overall, there were more males 326 (51.1%) than females 312 (48.9%). However, the state service had more females 165 (50.8%) than males 160 (49.2%). The majority (79.5%) of the workers belong to the senior staff (level 7-16) cadre. The socio-demographic characteristics of the participants are shown in [Table 1].
[Table 2] illustrates the pattern of dental service among the participants. Only 143 (22.4%) of the participants had visited the dentist in the past 1-year, this is made up of 80 (25.6%) federal and 63 (19.4%) state civil servants. Among the federal workers 55 (68.8%) had visited based on need, 20 (25.0%) visited twice and 5 (6.2%) once. Most 45 (71.4%) of the workers in the state had been to the dental clinic only when in need, while 14 (22.2%) and 4 (6.4%) had visited once and twice respectively within a year. There was no significant difference between both groups in terms of previous dental visit and frequency of visit.
There was statistical significant difference in the type of clinic attended by the participants (P < 0.000). Only few 17 (21.3%) of the federal workers attended the dental clinic located within the federal secretariat and 43 (68.3%) of the state workers attended the Oral and maxillofacial center operated by the state government.
|Table 2: Pattern of utilization dental service among the study population |
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[Table 3] shows statistical significant associations between educational status and the utilization of dental services (P = 0.009). Participants with tertiary education are more likely to utilize dental services once and twice annually than those with secondary and primary education. Similarly, senior staff utilized dental service once and twice annually more than junior staff. Regarding age, older participants were more likely to visit the dentist based on need than the younger ones. Though more females 74 (51.7%) than males 69 (48.3%) utilized dental services, equal proportions of men and women utilized dental services once yearly and more males (67%) than females 33% utilized dental services twice annually.
|Table 3: Association between socio-demographic characteristics and utilization of dental services among the participants |
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The reasons for nonutilization of dental services reported among the respondents were no need for treatment 59%, cost of treatment 20%, being scared 13.5% and fear of infection 10.3%. This is shown in [Table 4].
|Table 4: Reasons for nonutilization of dental services among respondents |
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| Discussion|| |
This study carried out among civil servants in Port Harcourt, Rivers State, Nigeria provides valuable information about whether the location of dental clinics play a role in the utilization of dental services or not. Early diagnosis, provision of preventive care and treatment of oral diseases can be achieved through regular dental visits.  Preventive dental visits are recommended biannually in order to reduce the burden of oral diseases. In the present study, many of the participants had not visited the dentist and very few visited the dentist for preventive care. The poor utilization of dental services reported in this study may be attributed to ignorance or perceived lack of need for treatment.
Accessibility to dental care is a factor in the utilization of dental services.  The finding of this study was at variance to this report. It would have been expected that the location of a dental center within the federal secretariat would encourage dental service utilization, this was not so because there was no significant difference in the pattern of utilization observed between the federal and state civil servants. Furthermore, among the federal workers with a history of previous dental visits, only 21.3% utilized the dental center within the office complex. The other 78.7% utilized dental services outside the secretariat. The reason given for this was a lack of awareness of its existence. This is indicative of the fact that though the location of the dental clinic is a factor in service utilization as reported, utilization may be influenced by awareness, educational level, poverty, anxiety and fear among others. Therefore, effort should be made to raise the level of awareness and educate the public on the need to utilize dental services and promote community participation and ownership.
Whereas 25.6% of federal and 19.4% of state civil servants had visited the dentist in the last 1-year, the overall utilization among the workers was 22.4%. The results obtained from this study are comparable to 26% obtained among adult populations in Nigeria  and 28% in Indian population.  This may be due to similarities in the study population. However, the level of utilization obtained in this study was lower than 42.7% reported in a similar study carried out among government employees in Thailand.  The difference may be explained by the fact that the Thai employees, unlike Nigerians, operate a Social Security Scheme where dental treatment could be accessed.
This study showed that more than two-thirds (70%) of the respondents who utilized dental services did so based on the need for dental treatment rather than for preventive care. This observation is similar to the results of other studies, which reported that dental visits are often motivated by pain and need for emergency care. ,,
The knowledge of dental care promotes utilization of dental services  and the higher the level of education, the more frequent the utilization of dental services. In the present study, participants with tertiary education visited the dentist more frequently than those with secondary education and participants with secondary education than those with primary education. This was consistent with findings of other studies, , however contrary to a study carried out among pregnant women where the level of education was not seen to have any effect on dental service attendance. 
The civil servants who participated in this study consisted of both junior and senior civil servants. The senior civil servants earn higher salaries than junior civil servants. The present study shows that more senior civil servants had visited the dentist than junior civil servants, but the difference was not significant. This finding was in agreement with other studies, which reported that high socio-economic status was associated with increased utilization of dental services. 
Females utilized dental services more than males in this study, this was however not significant. This is similar to other studies that reported higher utilization among females. ,,, Females may access dental care more than males because they are generally more concerned about their health than men and will take time off work to access care. Women are also more concerned about dental esthetics.  Males on the other hand are seen as manly, strong and invulnerable thus the search for health care may be associated with weakness, fear and insecurity. 
The cost of providing preventive and curative oral care at the early stages is relatively inexpensive. However, a number of factors limit the utilization of dental services. The major barrier to utilization of dental services in this study was the perceived lack of need for treatment. This is followed by the cost of dental treatment. Dental care is obtained on pay for service basis in government dental centers with no insurance or subsidy. This could be the reason why it constitutes a major barrier to dental service utilization. Ajayi and Arigbede  reported the cost of treatment as the second most common reason for not seeking dental care, similar to Maharani and Rahardjo.  The study of Varenne et al.,  reported the cost of treatment as the most common discouraging factor to dental service utilization. Other barriers are anxiety, fear of pain and injection, time wasting, and previous bad experience. These are in agreement with the results of other studies. ,,,,,
| Conclusion|| |
The utilization of dental service among the participants was poor. About two-thirds of the study population had never visited the dentist. Dental visits were based on the need for treatment and accessibility to dental care in terms of proximity did not promote utilization of dental services. Whereas education and social status were a determinant of dental service utilization, perceived lack of need for treatment and cost of treatment constituted barriers to utilization of dental services. There is need to inform and direct the public on where to seek dental care, educate people on routine dental visits and reduce the burden of treatment cost through subsidy and social insurance scheme.
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[Table 1], [Table 2], [Table 3], [Table 4]