EXPLORING THE ORAL HEALTH

KNOWLEDGE, ATTITUDES, AND

PRACTICES AMONG PREGNANT WOMEN
AT KASUNGU DISTRICT HOSPITAL

Malawi college of Health sciences

Lilongwe campus

By Bosco Ainani

DDT/20/01/36

Submitting to : Mr D.W. Kajilime

Introduction

Background information

Pregnancy is a critical period in a woman's life that demands attention to various health aspects,
including oral health. Despite its significance for both maternal and fetal well-being, oral health
is often overlooked or given secondary priority compared to other aspects of prenatal care (Cole,
W. W., 2023).

Research has consistently demonstrated the intricate relationship between oral health and
pregnancy outcomes. Studies have revealed that periodontal disease, characterized by
inflammation of the gums and supporting structures of the teeth, is linked to an increased risk of
adverse pregnancy outcomes, including preeclampsia, preterm birth, and low-birth-weight
infants (Berkowitz, R. J., et al., 2010).

Poor oral health, particularly periodontal disease, harbors a milieu of bacteria that can release
inflammatory mediators into the bloodstream. These inflammatory molecules can traverse the
placenta and reach the fetus, potentially triggering systemic inflammation and leading to adverse
pregnancy outcomes (Offenbacher, S., et al., 2008).

Preeclampsia, a pregnancy-specific hypertensive disorder, is associated with an elevated risk of

preterm birth and low birth weight. Periodontal disease has been identified as a significant risk
factor for preeclampsia, independent of other confounding factors (Kim, J., et al., 2016). The
inflammatory burden associated with periodontal disease appears to contribute to the
development of preeclampsia, underscoring the need for meticulous oral hygiene during
pregnancy (Lopez, N. J., et al., 2017).

Preterm birth, defined as delivery before 37 weeks of gestation, is a significant public health
concern due to its association with various short- and long-term health complications for the
infant. Studies have consistently reported an association between periodontal disease and an
increased risk of preterm birth (Macones, G. A., et al., 2005). This association is thought to be
mediated by the inflammatory response triggered by periodontal pathogens and the subsequent
release of pro-inflammatory cytokines, which can stimulate uterine contractions and induce
premature labor (Castillo, E., et al., 2018).

Low birth weight, defined as birth weight below 2500 grams, is associated with an increased risk
of neonatal morbidity and mortality. Periodontal disease has been consistently linked to an
increased risk of low birth weight infants (Khashan, H. S., et al., 2011). The inflammatory
mediators released from periodontal lesions may affect placental function and disrupt nutrient
transfer to the fetus, ultimately contributing to low birth weight (de Oliviera, P. S., et al., 2014).

Given the compelling evidence linking periodontal disease to adverse pregnancy outcomes,
maintaining good oral health during pregnancy is of paramount importance.

Problem statement

Numerous studies and research initiatives worldwide have investigated knowledge, attitudes, and
practices related to oral health among pregnant women. However, there is a lack of documented
evidence regarding such research at Kasungu District Hospital in Malawi. Conducting this
research in all districts of Malawi is crucial because promoting oral health during pregnancy is
paramount. During my practicals at Kasungu District Hospital, I observed two significant issues.
First, the number of pregnant women seeking dental care was alarmingly low, with less than ten
women visiting the dental department during my entire stay. Second, many pregnant women who
did seek dental treatment expressed concerns and fears about potential risks associated with
dental procedures. These observations highlight the need to address knowledge gaps and
misconceptions related to oral health among pregnant women. The encounter with a pregnant
woman misinformed by a nurse about the harmfulness of tooth extraction during pregnancy
further emphasizes the critical need to address knowledge deficiencies and misconceptions
among this population.
The oral health knowledge and practices of pregnant mothers directly influence the oral health
outcomes of their children. High rates of caries in children serve as an indicator of knowledge
gaps among mothers. Therefore, early intervention during pregnancy is essential to improving
the oral health of both the mother and the child. To effectively address this issue, we must first
identify the specific knowledge gaps and misconceptions that exist among pregnant women. This
necessitates an exploration of their knowledge, attitudes, and practices related to oral health.

Study Justification

Understanding the oral health knowledge, attitudes, and practices among pregnant women at
Kasungu District Hospital is essential because the findings can guide the development of
targeted interventions that are tailored to the specific needs and preferences of pregnant women
in Kasungu, This will enhance the effectiveness and relevance of oral health promotion efforts as
the results can inform the design and implementation of oral health promotion programs that
effectively address the knowledge gaps, misconceptions, and barriers to oral health practices
among pregnant women. This will contribute to improved oral health outcomes during
pregnancy and beyond. By understanding the oral health needs of pregnant women, healthcare
providers can take steps to promote and maintain good oral health during this critical period.
This includes providing appropriate oral health education, counseling, and preventive care to
reduce the risk of oral health problems and ensure good oral health for both the mother and the
developing baby.

Broad objective

The broad objective of this research is to assess the current state and level of oral health
knowledge, attitudes, and practices among pregnant women at the Kasungu District Hospital.
Specific objectives

1. Assess the level of oral health knowledge among pregnant women

2. Explore the attitudes of pregnant women towards oral health
3. Investigate the oral health practices of pregnant women
4. Identify factors influencing oral health knowledge, attitudes, and practices among pregnant
women.