Project – Awareness and Use of Oral Health Services among Pregnant Women Attending Antenatal Clinics: A Study of Selected Primary Healthcare Centres in Ilorin, Kwara State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Oral health is an important component of general health and well-being because diseases and conditions affecting the mouth can influence nutrition, comfort, communication, quality of life and the ability of individuals to participate fully in everyday activities. The World Health Organization (WHO, 2022) identifies oral diseases, including dental caries, periodontal diseases and tooth loss, among the major health conditions affecting populations globally and emphasises the need to integrate oral health into broader health systems. Oral health is particularly important during pregnancy because physiological and hormonal changes may affect the oral environment and can increase women’s susceptibility to conditions such as gingival inflammation and other oral problems. Consequently, maintaining good oral hygiene and obtaining appropriate professional oral healthcare during pregnancy are important components of comprehensive maternal healthcare (WHO, 2022).

Pregnancy represents a period during which women have frequent contact with healthcare providers, especially through antenatal care (ANC), making antenatal clinics important points for promoting preventive health practices. The WHO recommendations on antenatal care emphasise that ANC should provide a broad range of interventions that contribute to the health and well-being of pregnant women and their babies (WHO, 2016). Although antenatal care traditionally focuses on obstetric assessment, nutrition, immunisation, prevention of infections and maternal and fetal monitoring, the integration of other essential health services can improve the comprehensiveness of maternal healthcare. Oral health education, screening, referral and appropriate dental care can therefore complement conventional antenatal services. This is particularly relevant because pregnant women may not independently seek dental services unless they experience symptoms or receive information encouraging preventive dental attendance (WHO, 2016).

Awareness is a major factor that may influence whether pregnant women recognise the importance of oral healthcare and decide to utilise available services. Awareness encompasses knowledge about oral hygiene, the importance of dental check-ups during pregnancy, possible oral changes associated with pregnancy, appropriate responses to oral symptoms and the safety or relevance of seeking dental care during pregnancy. Evidence from Nigeria demonstrates that awareness and use of dental services among pregnant women have historically been limited. For example, a study among antenatal attendees in Calabar found that only 13.5% of respondents reported awareness and use of dental services while pregnant, despite the large majority reporting the use of toothbrush and toothpaste for oral cleaning (Adeniyi et al., 2010). This distinction between practising basic oral hygiene and actually utilising professional oral healthcare suggests that awareness of personal oral hygiene does not necessarily translate into utilisation of professional services.

The utilisation of oral health services during pregnancy is also important because pregnant women may experience oral problems that require professional assessment and management. A study conducted among pregnant women attending antenatal care at the University of Nigeria Teaching Hospital found that only 36 of 413 respondents, representing 8.7%, had consulted a dentist during the index pregnancy. The major reasons for consultation were toothache and dental decay, as well as pain and swelling of the gums. The study also found that many women considered dental consultation unrelated to pregnancy, indicating a possible gap in knowledge about the place of oral health within maternal healthcare (Adeniyi et al., 2021). These findings demonstrate that oral healthcare utilisation may be largely symptom-driven rather than preventive, thereby limiting opportunities for early detection, professional advice and management of oral conditions during pregnancy.

The Nigerian situation is further demonstrated by evidence from Ilorin, the geographical setting of the present study. Olarinoye, Ezeoke and colleagues (2018) investigated the oral health status of pregnant women in Ilorin and reported that oral health conditions were present among pregnant women attending healthcare facilities in the city. Importantly, the authors observed that routine oral healthcare was not incorporated as a standard component of the antenatal care package in Nigeria. The study involved 225 pregnant women and 166 non-pregnant controls from two healthcare facilities in Ilorin, demonstrating the relevance of oral health concerns among pregnant women within the same geographical environment as the proposed study. This local evidence provides an important basis for examining not only the presence of oral health problems but also the awareness and use of oral health services among pregnant women attending primary healthcare facilities in Ilorin (Olarinoye et al., 2018).

More recent evidence indicates that the challenge of oral healthcare utilisation among pregnant women in Nigeria remains significant. A 2024 scoping review of oral health behaviour among pregnant women in Nigeria identified 18 eligible studies and found that the proportion of pregnant women who had utilised dental services ranged from 4% to 62.9% across the reviewed studies. The review identified individual, structural and behavioural factors, including myths and other barriers, as factors associated with dental service utilisation. It further reported that pregnant women often sought dental care for problems such as dental caries, pain and swollen gums rather than for preventive purposes (Adegbite et al., 2024). These findings suggest that the problem extends beyond the physical availability of dental services and includes awareness, beliefs, perceptions, health-seeking behaviour and the integration of oral health promotion into maternal healthcare.

Primary healthcare centres are particularly important for addressing these issues because they constitute an important level of healthcare delivery and provide antenatal services to women within their communities. Effective primary healthcare can facilitate preventive interventions, health education, early identification of health problems and appropriate referral. The WHO’s maternal healthcare recommendations emphasise the importance of providing women with relevant information, support and appropriate health interventions throughout pregnancy and related periods (WHO, 2016; WHO, 2022). In the context of oral health, primary healthcare facilities can potentially provide opportunities for oral health education during ANC, identify women with oral complaints, encourage appropriate dental attendance and establish referral pathways to dental professionals. However, the extent to which pregnant women attending selected primary healthcare centres in Ilorin are aware of available oral health services and actually utilise them requires specific empirical investigation.

The importance of investigating awareness and utilisation is reinforced by the broader challenge of achieving equitable oral healthcare. The WHO Global Oral Health Status Report identifies oral diseases as a major public health challenge and calls for stronger integration of oral health into universal health coverage and primary healthcare systems (WHO, 2022). Evidence from Nigerian pregnant women shows that dental attendance is frequently associated with existing symptoms rather than routine preventive care. For example, Adeniyi et al. (2021) found that toothache, decay, pain and gum swelling were common reasons for dental consultation, while lack of perceived relevance of dental care during pregnancy was a major reason for non-utilisation. Therefore, understanding the level of awareness among pregnant women and the extent to which awareness translates into actual use of oral health services is important for strengthening maternal health promotion in Ilorin.

Against this background, the present study focuses on awareness and use of oral health services among pregnant women attending antenatal clinics in selected primary healthcare centres in Ilorin, Kwara State. The study is designed to examine pregnant women’s awareness of available oral health services, determine the extent to which they utilise such services, identify factors that may influence utilisation and examine the relationship between awareness and utilisation. By focusing on primary healthcare centres in Ilorin, the study will generate context-specific evidence that can contribute to understanding the position of oral healthcare within routine antenatal care and may assist healthcare providers and programme planners in strengthening oral health education, referral and preventive dental service utilisation among pregnant women.

1.2 Statement of the Problem

Oral health is an important component of maternal well-being, yet it has historically received less attention within routine antenatal services than other aspects of pregnancy care. The WHO (2022) identifies oral diseases as a major global public health concern and emphasises the need to strengthen oral healthcare within health systems. Despite this importance, evidence from Nigeria indicates that routine oral healthcare has not traditionally been incorporated fully into antenatal care. In Ilorin specifically, Olarinoye et al. (2018) reported that routine oral health care was not a component of the antenatal care package in Nigeria and identified oral health conditions among pregnant women attending healthcare facilities in the city. This creates a concern because pregnant women may attend antenatal clinics regularly without receiving adequate information, screening or referral concerning their oral health.

A further problem is the apparently low level of professional dental service utilisation among pregnant women in Nigeria. Evidence from the University of Nigeria Teaching Hospital showed that only 8.7% of pregnant women studied had consulted a dentist during their index pregnancy, with many consultations prompted by toothache, dental decay, pain or swollen gums (Adeniyi et al., 2021). Similarly, the Nigerian scoping review by Adegbite et al. (2024) found that dental service utilisation among pregnant women across Nigerian studies ranged from 4% to 62.9% and concluded that utilisation was generally poor and largely driven by curative rather than preventive needs. Such evidence raises concern that pregnant women may delay professional care until oral problems become symptomatic, thereby reducing the opportunity for prevention and early intervention.

Another problem concerns the possible gap between awareness of oral health and actual use of oral health services. Evidence from antenatal attendees in Calabar showed that although 94.4% of respondents reported using toothbrush and toothpaste for oral cleaning, only 13.5% were aware of and used dental services while pregnant (Adeniyi et al., 2010). This suggests that knowledge of basic oral hygiene practices does not necessarily mean that women understand the importance of professional oral healthcare during pregnancy. In addition, evidence from the University of Nigeria Teaching Hospital indicated that a substantial proportion of women did not consider dental visits relevant to pregnancy (Adeniyi et al., 2021). If similar perceptions exist among pregnant women attending primary healthcare centres in Ilorin, they could constitute a barrier to preventive dental attendance and timely management of oral conditions.

The specific problem addressed by this study is therefore the insufficient current evidence on the level of awareness and actual use of oral health services among pregnant women attending selected primary healthcare centres in Ilorin, Kwara State. Although previous research has examined oral health status among pregnant women in Ilorin and other Nigerian locations, there is a need for further investigation focusing specifically on awareness, utilisation and factors associated with the use of oral health services at the primary healthcare level. The 2024 Nigerian scoping review identified individual, behavioural and structural factors influencing utilisation, while the earlier Ilorin study focused primarily on oral health status rather than the present combination of awareness and service use (Adegbite et al., 2024; Olarinoye et al., 2018). Therefore, empirical evidence from selected primary healthcare centres in Ilorin is needed to determine the current situation and provide information that may support improved integration of oral health promotion into antenatal services.

1.3 Purpose of the Study

The main purpose of this study is to examine awareness and use of oral health services among pregnant women attending antenatal clinics in selected primary healthcare centres in Ilorin, Kwara State.

Specifically, the study seeks to:

1. determine the level of awareness of oral health services among pregnant women attending selected primary healthcare centres in Ilorin, Kwara State;
2. assess the extent of utilisation of oral health services among pregnant women attending selected primary healthcare centres in Ilorin, Kwara State;
3. identify the factors influencing the utilisation of oral health services among pregnant women attending selected primary healthcare centres in Ilorin, Kwara State; and
4. examine the relationship between awareness of oral health services and their utilisation among pregnant women attending selected primary healthcare centres in Ilorin, Kwara State.

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of awareness of oral health services among pregnant women attending selected primary healthcare centres in Ilorin, Kwara State?
2. To what extent do pregnant women attending selected primary healthcare centres in Ilorin utilise oral health services?
3. What factors influence the utilisation of oral health services among pregnant women attending selected primary healthcare centres in Ilorin?
4. What relationship exists between awareness of oral health services and their utilisation among pregnant women attending selected primary healthcare centres in Ilorin?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between awareness of oral health services and utilisation of oral health services among pregnant women attending selected primary healthcare centres in Ilorin, Kwara State.

1.6 Significance of the Study

The study will be significant to pregnant women because it will provide information about the importance of oral healthcare during pregnancy and the availability and utilisation of appropriate oral health services. Improved awareness may encourage women to seek professional oral healthcare before dental problems become severe.

The study will also be useful to antenatal healthcare providers, including nurses, midwives, community health officers and other primary healthcare workers. The findings may help healthcare providers understand the level of oral-health awareness among pregnant women and identify misconceptions or barriers that may prevent appropriate use of dental services. This could support the inclusion of oral-health education and appropriate referral during antenatal consultations.

The study will be useful to dental healthcare professionals because the findings may provide information about the reasons pregnant women do or do not utilise oral health services. Such information may assist dental professionals in developing pregnancy-specific health education and preventive strategies. The evidence from Nigerian studies indicates that many pregnant women seek dental services because of pain or other symptoms rather than for preventive purposes (Adeniyi et al., 2021; Adegbite et al., 2024).

The findings will also be relevant to primary healthcare administrators and policymakers in Kwara State. Evidence from the study may assist health authorities in considering ways of strengthening oral-health promotion, screening, education and referral within antenatal services. This is consistent with the WHO’s broader emphasis on strengthening oral healthcare as part of universal health coverage and primary healthcare (WHO, 2022).

The study will further be useful to researchers and students in public health, nursing, community health, dentistry, maternal health and related disciplines. It will provide locally relevant evidence concerning oral health service awareness and utilisation among pregnant women in Ilorin and may serve as a reference point for subsequent studies.

1.7 Scope of the Study

The study focuses on awareness and use of oral health services among pregnant women attending antenatal clinics in selected primary healthcare centres in Ilorin, Kwara State.

The geographical scope is limited to selected primary healthcare centres within Ilorin, Kwara State.

The population scope comprises pregnant women attending antenatal clinics in the selected primary healthcare centres during the period of the study.

The content scope covers awareness of oral health services, utilisation of oral health services, factors influencing utilisation and the relationship between awareness and utilisation.

The study does not cover all pregnant women in Kwara State and does not seek to assess the clinical oral-health status of every pregnant woman in Ilorin. Rather, it concentrates on awareness and utilisation of oral health services among pregnant women receiving antenatal care in the selected primary healthcare centres.

1.8 Operational Definition of Terms

Antenatal Care: Healthcare and related services provided to a woman during pregnancy for the purpose of promoting maternal and fetal health, detecting complications and providing appropriate preventive and therapeutic interventions.

Antenatal Clinic: A healthcare unit or facility where pregnant women receive routine pregnancy-related healthcare, education, monitoring and related services.

Awareness: The extent to which pregnant women possess knowledge or understanding of oral health, available oral health services and the importance of seeking professional oral healthcare during pregnancy.

Oral Health: The condition of the mouth, teeth, gums and related oral structures that enables an individual to eat, speak and function without disease, discomfort or significant impairment.

Oral Health Services: Preventive, diagnostic, educational and treatment services provided by oral-health professionals or healthcare facilities for the maintenance and improvement of oral health.

Oral Health Service Utilisation: The actual use of available oral health services by pregnant women, including dental consultation, oral examination, preventive care, treatment and professional oral-health advice.

Pregnant Women: Adult females who are carrying a developing fetus and are attending antenatal care during the period covered by the study.

Primary Healthcare Centre: A healthcare facility providing first-level healthcare services, including preventive, promotive, basic curative and maternal healthcare services to individuals and communities.

Dental Consultation: A professional interaction between a pregnant woman and a dentist or other appropriately qualified oral-health professional for assessment, advice, prevention or treatment of an oral-health problem.

Oral Health Education: Information and instruction provided to individuals to improve knowledge, attitudes and practices concerning oral hygiene, prevention of oral diseases and appropriate use of oral healthcare services.

Project – Awareness and Use of Oral Health Services among Pregnant Women Attending Antenatal Clinics: A Study of Selected Primary Healthcare Centres in Ilorin, Kwara State