MALAWI OLLEGE OF HEALTH SCIENES

RESEARCH PROPOSAL

ASSESSMENT OF THE EFFECTS OF CULTURAL BELIEFS ON ACCESSING

DENTAL TREATMENT IN SALIMA

BY
THANDIZO CHIWANDA (DDT/18/01/005)
Table of Contents
Chapter One: Introduction....................................................................................................................3
1.1 Background Information..........................................................................................................3
1.2 Statement of Problem................................................................................................................4
1.3 Objectives...................................................................................................................................4
1.3.1 Broad Objectives.................................................................................................................4
1.3.2 Specific Objectives..............................................................................................................4
1.4 Research Questions....................................................................................................................4
1.5 Significant of the Study.............................................................................................................4
Chapter Two: Literature Review..........................................................................................................5
2.0.1 Oral Health Practices.............................................................................................................5
2.2.3 Oral Treatment.......................................................................................................................5
2.1.2 Oral Health Knowledge..........................................................................................................5
Chapter 3: Research Methodology........................................................................................................7
3.1 Introduction...............................................................................................................................7
3.2 Study Type.................................................................................................................................7
3.3 Study Design...............................................................................................................................7
3.4 Sample Size................................................................................................................................7
3.5 Sampling.....................................................................................................................................7
3.5 Inclusion and Exclusion Criteria..............................................................................................7
3.6 Data Collection...........................................................................................................................7
3.7 Ethical Consideration................................................................................................................7
3.8 Data Analysis.............................................................................................................................8
3.9 Dissemination of Results...........................................................................................................8
References.............................................................................................................................................9
Appendices..........................................................................................................................................10
Appendices 1: Activity Work plan...............................................................................................10
Appendix 2: Budget and justification...........................................................................................11
Budget justification....................................................................................................................11
Appendix 3: questionnaire............................................................................................................12
Appendix 4: Consent Letter for Salima District Hospital..........................................................13
Appendix 5: Application for Approval........................................................................................14
Appendices 6: Consent Letter for Participants...........................................................................15
 Chapter One: Introduction

1.1 Background Information

Culture is a complex matrix of interacting elements that is ubiquitous, multidimetional and
complex. It is an element that can be learned, shared, and transmitted and represent a way of
life. Culture organizes a group of norms of family life, birth, childrearing, aging and death as
well as their recognition of illness and care-seeking practices around health or medical
conditions. These cultural believes can be a barrier for accessing health care services.
Cultural factors may have important implications for an individual’s own health. Oral health
is important to both physical and social function and is an integral part of overall health
status. Oral diseases are the most prevalence of all health problems. As effort continue to
improve health of all citizens, oral health could not be overlooked. The level of dental health
knowledge, ethnicity, deprivation, education, lifestyle and diet, all together could affect the
oral health (Shameema, Panchmal, Shenoy, Jadolli, & Sonday, 2016)

Globally, oral health is associated with cultural beliefs. For instance, it is commonly seen in
Africa, Central and South America and Parts of South East Asia that 80% of Hindu Brahmins
and priests clean their teeth using cherry wood, which promotes oral health. Peoples living in
tropical regions remove one or more teeth for ritual or aesthetic reasons, or to denote group
affiliation commonly involves the maxillary incisors (Shameema, Panchmal, Shenoy, Jadolli,
& Sonday, 2016).
According to research done by Basavaarag (2014), almost 60% Orthodox Jains clean their
teeth using fingers and without using the brush, this increases the dental caries experience.
Muslims offer prayer in the form of Namazi, five times in a day. During each Namazi, as part
of the ritual, they use miswak stick, tooth picks and do gum massaging which decreases
dental caries. Use of coconut twigs in the rural areas of Kerala improves oral hygiene.
Tribal and primitive populations have diet patterns which are coarse and fibrous in nature
reducing the risk for dental caries. The western diet on the other hand consists of refined
foods which increase the risk for caries. Scandinavian food habits mainly include variety of
fishes, cheese which offers some anticaries benefit. In Philippines, Indonesia Micronesia,
Melanesia, Polynesia and Australia, today though tooth evulsion is declining in popularity,
still it is practiced among the contemporary peoples, in traditional societies. Back teeth
extraction for aesthetic purpose was observed among Atayal people of Taiwan. Removal of
the permanent mandibular central incisors were reported among the Iraq, Warussha and
Masai people of Tanzania. Over half of the individuals who had submitted to these teeth
provided a route allowing the passage of fluids in the event of a person becoming ill and
being unable to open his or her mouth (Shameema, Panchmal, Shenoy, Jadolli, & Sonday,
2016).
At Salima District Hospital, most dental patients visit dental treatment at a late stage of the
disease such that there is an increase in dental abscess cases (Salima DHO, Dental logbook).
Over 40% of dental abscess cases that come at Salima district hospital are due to delayed
dental treatment. About 70% of them come to the hospital with their local medicine such as
threads around their neck. Over 50% come to the hospital only when their local measures fail.
1.2 Statement of Problem
According to some studies that were done in some countries in Africa, it has shown that
cultural practices have impact on people's access to dental treatment. In Malawi the study
concerning cultural practices and their impacts on accessing dental treatment has not been
conducted before. Therefore, this study seeks to find out the effects of cultural practices on
accessing dental treatment in Salima district hospital. This will help to deal with people's
delays to access dental treatment, which leads to the increase of dental infections at Salima
District Hospital, Dental department.
1.3 Objectives
1.3.1 Broad Objectives
To investigate the effects of cultural beliefs on accessing dental treatment in Salima district
hospital.
1.3.2 Specific Objectives
To assess the knowledge about dental diseases and treatment.
To determine cultural beliefs on dental treatment.
1.4 Research Questions
What knowledge do the respondents have on dental diseases and treatment based on their
culture?
What cultural believes do the respondents have on dental treatment?
1.5 Significant of the Study
The findings of this study will help dental therapists at Salima District Hospital to develop
strategies for reducing an increase of dental infections arising from dental caries through
community outreach, so that people will be aware of causes of dental diseases and their
treatment.
Other stakeholders such as Government will also use the same research findings to fund the
awareness project at Salima District Hospital so that dental infections are reduced.
 Chapter Two: Literature Review

2.0.1 Oral Health Practices

According to research which was done in India, the data shows that most of the participants
(65.3%) think that after cleaning, teeth get loosen. Half of respondents believe that extraction
of upper teeth affects eye sight. Nearly 74% of subjects believe that there is no need to visit a
dentist until all the permanent teeth of children erupt. Less than 50% subjects said that the
spacing between upper anterior teeth is an indication for good fortune. Overall half of the
subjects gave optimistic response regarding proper brushing habits. Most of them were not
having the proper knowledge regarding adverse oral habits. Around 76% of the people said
that it is better to have artificial teeth than to repair one’s original teeth and some consider
that female dentists will not treat the teeth as finely as a male dentist. More than 50% said
that only white teeth are stronger than their counter parts. Approximately 30% of the
participants persist in believing that diseases of oral cavity (like carcinomas) are due to past
sins. A greater portion of rural people have cultural beliefs and taboos related to dentistry as
compared to urban people. Similarly, a significant gender difference was observed, with
females having lower mean scores regarding cultural beliefs and taboos in dentistry compared
to males (Kochha, Singh, Pina, & Anandani, 2014).

2.2.3 Oral Treatment

There are Traditional healers in almost every village in Africa and are respected and utilised.
The estimated healer per population ratio is 1:350. According to research done in South
Africa done by Hellen Apps (2021), 40 (71%) of healers in Zonkizizwe kept written client
records but far fewer 3 (11%) did so in Dube. More than 90% of traditional healers from both
areas correctly identified photographs of gingival inflammation, dental caries and oral
candidiasis. Over 50% of healers from both areas had patients who presented with mouth
problems. Ninety percent of healers in Zonkizizwe referred patients to the formal health care
sector but less than 50% in Dube did so. A vast majority of healers gave oral health advice to
their patients, many of whom gave specific tooth brush instruction. The study provides an
initial understanding of the practices of healers regarding oral health. African traditional
healers are widely distributed, regularly consulted and highly respected health care
practitioners by many people in the community. More recently the health professions are
acknowledging them as an important part of the health team. It is likely that many healers in
South Africa provide treatment for oral diseases and yet there is no published information of
their knowledge of basic oral conditions or the treatment they provide (Apps & Rodoph,
2021).
2.1.2 Oral Health Knowledge
The research conducted in Cameroon by Ashu M.Agbor (2011), there is little collaboration
between the oral health workers and traditional healers and only 6% of all patients seen by
traditional healers are referred to the dentist. Socio-cultural and economic factors affect the
oral health care seeking behaviour of patients in this area and only 6.5% of patients visit
dental clinics. Reasons for not attending dental clinics included high cost, poor accessibility,
superstition and fear. Traditional healers are not experienced in the treatment of pulpitis - the
majority of patients who presented with toothache had temporary or no relief, but despite this
67% reported being satisfied with their treatment. Sixty nine percent of the patients visited
traditional healers because of low cost - the average cost of treatment with traditional healers
is very low, as compared to conventional treatment (Agbor & Naidoo, 2011).

According to research which was done in Somalia by Obeng (1007), most of Somalis feel
that dental care is a personal matter left up to the individual. Poor dental health is generally
thought to be a sign of laziness. In many African cultures, families are responsible for oral
care rather than dentists or other health professionals. Therefore, when a person has to visit
an oral health specialist, it is usually when a decayed tooth has become so painful to be
unbearable. Tooth extraction is the usual result of these visits, so many Somalis associate
dentists with pain and the removal of a tooth. Many Somalis have never even been to the
dentist or even needed one. The refined sugar is not typically found in the traditional Somali
diet; hence dental cavities are rare in most of Somalis. Somali cuisine tends to be high in
calcium, which is generally considered to be integral in promoting robust teeth and gums.
Actually, many Somalis reported their first-ever cavities after they had immigrated to the
United States or another Western country and were introduced to the local diet of more sugar-
processed foods. This state of affairs can lead Western practitioners to the conclusion that
Somalis have generally poor oral health when the situation is the exact opposite.
Oral health is a burden among all populations and is linked with major chronic diseases such
as cardiovascular diseases. Migrants, in particular South Asians, have poor oral health which
requires further understanding to better inform oral health interventions by targeting specific
aspects of this heterogeneous South Asian population. This review is undertaken to
systematically synthesize the evidence of oral health understandings, knowledge, attitudes,
beliefs, practices, and behaviours of South Asian migrants residing in high-income countries
(Batra, Guota, & Erbras, 2019).
 Chapter 3: Research Methodology

3.1 Introduction
These are specific procedures that are used to identify, select, process and analyse
information about the topic. This section will explain the research type, design, sample size,
sampling technique, study population, data collection and ethical consideration (Varkevisser,
Pathmanathan, & Brownlee, 1991).
3.2 Study Type
This study will be qualitative
3.3 Study Design
Study design refers to an overall strategy that one chooses to integrate different components
of the study. This study will involve a focus group discussion in order to get their opinions on
the cultural beliefs towards dental treatment.
3.4 Sample Size
Sample size is a representative group of individuals from the population (Varkevisser,
Pathmanathan, & Brownlee, 1991). This study will recruit 40 participants. Out of these 10
will be patients at Salima district hospital specifically Dental department and the remaining
30 participants from villages around Salima district hospital TA Kambwiri. Each village will
have 10 participants.
3.5 Sampling
Probability and non-probability techniques will be used. Three villages around Salima district
hospital will be randomly selected out of 10 villages. Ten folded papers with village names
will be mixed to select 3 papers, the selected villages will qualify for study. The participants
will be randomly selected.
3.5 Inclusion and Exclusion Criteria
Inclusion criteria determine who to be included in the study while exclusion criteria
determine subjects not to be included in the study. Inclusion criteria identify the study
population and objective manner. The exclusion criteria include factors or characteristics that
make the population ineligible for the study(Varkevisser, Pathmanathan, & Brownlee, 1991).
This study will include dental patients and other participants from the randomly selected
villages. Dental therapists will be excluded since they have knowledge about dental diseases
and their treatment.
3.6 Data Collection
Data collection tools are instruments used to gather and analyse information to find solution
to relevant question and evaluate results. The data collection tools should be understandable,
simple and easier in the study (Dawson, 2002). In this study the data collection tool will be
self-administered questionnaires and group discussions.
3.7 Ethical Consideration
The study will first be approved by dental department, then Research Committee of Malawi
College of Health Sciences. Upon approval I will seek consent from Salima District Hospital
Officer (DHO) and the Office in charge of dental department at Salima district hospital and
lastly consent from participants through their village leaders.
3.8 Data Analysis
In this study, the demographic data will be analysed using Statistical Package for Social
Science (SPSS) V22 and thematic analysis will be used.
3.9 Dissemination of Results
The results of this study will be submitted to Malawi College of Health Sciences, dental
department and will be published as well as be put in Malawi College of Health Sciences
library.
References

Agbor, A. M., & Naidoo, S. (2011). knowledge and practice of traditional healers in oral
health in the Bui division Cameroon. journal of ethnobiology and ethnomedicin, 1, 1-
7.
Apps, H., & Rodoph, M. J. (2021). Oral health knowledge and original practices of africal
traditional healers in Zonkiwe and Dube, South Africa. journal of South Africa dental
association, 1-4.
Basavaraj, P., Swati, J., & Ashish, S. (2014). Assessing the influence of culture and oral
health. journal of pearldent, 4.
Batra, M., Guota, S., & Erbras, B. (2019). Oral health beliefs, altitudes and practice of South
Asian Migrants. international journal of invironmental research and public health, 2,
1-16.
Dawson, D. C. (2002). Practical research methods (1st edition ed.). Oxford, UK: How to
book.
Kochha, S., Singh, K., Pina, P., & Anandani, C. (2014). occurrence of oral health beliefs and
mosconceptions among Induan population. journal of dental health, oral disorders
and therapy, 1, 1-4.
Shameema, Panchmal, G. S., Shenoy, R. P., Jadolli, P., & Sonday, L. (2016, 9 4). Culture and
oral health. jornal of applied dental and medical sciences, 2, 1-3.
Varkevisser, C. M., Pathmanathan, I., & Brownlee, I. (1991). Desighning and conducting
health system research project (1st edition ed.). Ontario: Internation Research Centre.
 Appendices

Appendices 1: Activity Work plan

Table 1: showing activity work plan of my research work.

ACTIVITY OCT NOV DEC JAN FEB
Literature
search
Develop and
pilot
questionnaire
Analyze pilot
work and
revise
questionnaire
Send out
questionnaire.
Categorize
returned
questionnaire.
Send out
reminder let-
ter
for non re-
sponses.
Continue to
categorize
retuned
questionnaire.
Data input.
Data
collection.
Report
writing
Finalize re-
port
and
dissemination
Appendix 2: Budget and justification

Table 2: Budget table

CATEGORY ITEM QUANTITY COST OF TOTAL
PRICE PRICE
EACH
Stationary Rim of 1 K4900 K4900
papers
Envelope 3 K200 K600
Printed 10 K20 K200
questionnaire
copies
Pens 2 K150 K300
Transportatio Cash K20 000 K20 000
n
Food Cash K15 000 K15 000
TOTAL K41 000

Budget justification
This research will require money for transportation to and from Salima district and for trans-
port within the district during data collection, money for stationeries for example; papers, en-
velope, questionnaire and consent letters printing and pens. Money for food during data col-
lection.
Appendix 3: questionnaire

Malawi College of Health Sciences

Date :
Village name :
Number of participants:
1. What dental diseases do you know?
2. What do you think are the causes of the dental diseases?
3. What are the traditional ways of treating the mentioned dental diseases?
4. How best are the traditional ways of treating dental diseases?
5. At what stage does the tooth disease be treated?
6. Is there any complication with the local treatment of dental disease?
a) Yes
b) No
7. If yes, what are the complications and how do you manage that?
Appendix 4: Consent Letter for Salima District Hospital

Malawi College of Health

Sciences
Post Office Box 3o368
Lilongwe

Salima Dental Department

C/O Salima District Hospital
Post Office Box 101
Salima.

Dear sir/madam,
REQUEST TO CONDUCT A STUDY AT SALIMA DISTRICT DENTAL
DEPARTMENT
I am a year three generic student studying for a diploma in dental therapy, conducting a
health-related research as part of an important objective in my studies.
I write to seek permission to conduct research at Salima district hospital dental department
and some areas around the hospital, under the topic “assessment of the effects of cultural
beliefs on accessing dental treatment in Salima.
I will be grateful if you consider my request at your earliest convenience time.
Yours faithfully,
Thandizo Chiwanda.
Appendix 5: Application for Approval

Malawi College of Health

Sciences
Post Office Box 30368
Lilongwe.

The Chairperson,
Research and Publication Committee,
Malawi College of Health Sciences,
Post Office Box 30368,
Lilongwe

Dear Sir/Madam
APPLICATION FOR APPROVAL TO CONDUCT A RESEARCH STUDY
I am a year three generic student, studying diploma in dental therapy at Malawi College
Health Sciences Lilongwe campus. I am conducting a health-related research as part of an
important objective in my studies.
I write to seek permission to conduct a research study in Salima district, under the topic
“assessment of the effects of cultural beliefs on accessing dental treatment in Salima”.
I will be grateful if you consider my request at your earliest convenience time.
Yours faithfully,
Thandizo Chiwanda.
Appendices 6: Consent Letter for Participants

Malawi College of Health Sciences

Post Office Box 3036

Lilongwe 3.

09 February 2022

Dear Participant(s),

I am a third year students from Malawi College of Health Sciences, pursuing a Diploma in
Dental therapy, am conducting a study on assessing effects of cultural beliefs on accessing
dental treatment in Salima.

You will not be penalized for not participating in this study and you will be allowed to quit at
any time of your choice. If you will agree to take part in this study in-depth interviews will be
used where you will be required to answer questions related to the usage of spectacles.

All information discussed will be kept private and confidential and there will be no any fee
for participating in this study.

Participant’s name

Signature

Witness’s name

Signature
Malawi College of Health Sciences

Post Office Box 3036

Lilongwe 3.

29 August 2021

Wokondedwa atengambali,

Ndife ophunzira za mavuto a mkamwa (mano) pa sukulu ya Health sciences ku Lilingwe

tikuchita kafukufuku amene tikufuna kudziwa za momwe zikhulupiliro zachikhalidwe
zimakhuzira kapezedwe ka thandizo lamano loyenerera kuno ku Salima.

Simupasidwa chilango chilichose Ngati mungasankhe kusatenga nawo mbali

mukafukufukuyu nthawi inailiyonse yomwe mungazafune. Ngati mukuvomereza kutenga
nawo mbali pakafukufukuyu muzapephedwa kuyankha mafunso mofotokoza zomwe
mukudziwa. Zonse zomwe mudzanena dzizakhala za chinsisi komanso mukudziwitsidwa kuti
palibe cholowa chilichonse monga ndalama yomwe idzapelekedwa pakafukufukuyu.

Dzina la mtengambali

Dzina la mboni