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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 53-58

Knowledge and practices related to oral potentially malignant disorder among the youth living in Urban slum areas in a commercial city in Sri Lanka


1 Research and Surveillance Unit, Institute of Oral Health, Ministry of Health, Sri Lanka
2 Retired, Health Promotion Bureau, Ministry of Health, Sri Lanka

Date of Submission20-Sep-2021
Date of Decision12-Sep-2021
Date of Acceptance20-Dec-2021
Date of Web Publication06-Apr-2022

Correspondence Address:
Halgamuwe Hewawasam Manori Dhanapriyanka
Research and Surveillance Unit, Institute of Oral Health, Maharagama
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_154_21z

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  Abstract 


Background: Oral potentially malignant disorder (OPMD) is an emerging problem among the youth due to the increase in use of different addictive substances. This study aims to assess the level of knowledge and selected practices related to OPMD among the youth between 15 and 24 years residing in urban slum areas in a commercial city in Sri Lanka. Methods: A descriptive cross-sectional study was conducted among a sample of 1435 youths. Cluster sampling technique combined with probability proportionate to size technique was used to select the sample. Data were collected using an interviewer-administered questionnaire. Results: The response rate was 99.7%. The mean age of the study sample was 17.53 years (95% confidence interval: 17.40–17.65). A higher percentage of youths had poor knowledge on OPMD (72%). The majority (around 85%) knew that smoked and smokeless forms of tobacco were risk factors for OPMD. However, the knowledge on areca nut packets, alcohol, and areca nut in betel quid as risk factors for OPMD was found to be relatively poor with proportions 31.9%, 21.6%, and 16.3%, respectively. In addition to that, study participants showed very poor Knowledge regarding the clinical presentations of OPMD. Around 10.9% and 2.3% knew that OPMD can present as a white patch and a red patch, respectively. Very few of the study sample (1.2%) were knowledgeable about the self-mouth examination for identification of OPMD. Conclusion: Poor knowledge on OPMD among the youth living in urban slum areas in a commercial city in Sri Lanka alarmed the need of implementing targeted interventions among these high-risk groups.

Keywords: Knowledge, oral potentially malignant disorder, youth


How to cite this article:
Manori Dhanapriyanka HH, Chandrika Kanthi RD. Knowledge and practices related to oral potentially malignant disorder among the youth living in Urban slum areas in a commercial city in Sri Lanka. J Dent Res Rev 2022;9:53-8

How to cite this URL:
Manori Dhanapriyanka HH, Chandrika Kanthi RD. Knowledge and practices related to oral potentially malignant disorder among the youth living in Urban slum areas in a commercial city in Sri Lanka. J Dent Res Rev [serial online] 2022 [cited 2022 Dec 3];9:53-8. Available from: https://www.jdrr.org/text.asp?2022/9/1/53/342699




  Introduction Top


Oral cancer is one of the common cancers worldwide. According to GLOBOCAN statistics for 2020, it accounted for 377,713 new cases, which is 2% of all cancers. This easily preventable cancer accounted for 177,757 new deaths, which is equivalent to 1.8% of all cancer deaths.[1],[2] Oral cancer is a significant public health problem in Sri Lanka. It is the second most common cancer among Sri Lankans. According to the National Cancer Control Programme, oral cancer accounts for 9.3% deaths of all cancers.[3]

Very often, oral cancers are preceded by clinically identifiable disorders collectively named as oral potential malignant disorders (OPMDs).[3] Most of these OPMDs are related to habits such as smoking, betel chewing, alcohol use, and areca nut chewing.[2] OPMDs are easily identifiable and if detected early and treated survival rates would improve.[3]

People living in urban slums are a neglected and underprivileged group lacking basic facilities and services. They are also prone to have risk behaviors because of poor housing and neighborhood environment, risky lifestyles, lack of health knowledge, and poor physical and psychosocial health.[4]

Associations between socioeconomic status and incidence, morbidity, and mortality of oral cancer have been well researched, and it is evident that patients with low socioeconomic status are at high risk of oral cancer due to lack of knowledge and delayed presentation.[5] Many studies have assessed the association between risk of oral cancer and sociodemographic factors as age, sex, education status, and employment status.[6],[7] Burden of oral cancer is high in low- and middle-income countries due to the different levels of socioeconomic status.[8]

Oral cancer is typically common among the elderly. However, its incidence is increasing among young people.[9] Studies have found that heavy consumption of alcohol and tobacco could cause a 48-fold increase in risk of developing oral cancer among the youth.[10] Due to the increased substance abuse, OPMD is an emerging problem among younger age groups.[11]

In Sri Lanka, only a few studies have been conducted on OPMDs among the youth residing in slum areas. Therefore, the present study was undertaken to assess the level of knowledge related to OPMD among the youth aged between 15 and 24 years of age living in urban slum areas in the district of Colombo, Sri Lanka.


  Methods Top


In order to assess the knowledge related to OPMDs, an interviewer-administered questionnaire was designed and pretested. Further, face, content, and consensual validity of the questionnaire were determined. It consisted of five sections, sociodemographic factors, questions related to knowledge of risk factors, clinical features, early identification, practices of risk factors, and self-mouth examination (SME).

Sociodemographic factors considered were age, sex, ethnicity, current status of education or employment status, and marital status. Current status of education and employment was categorized as currently school-going youths, those who were following vocational training, those who were employed, and those who had left school and were unemployed.

The survey was carried out as a community-based descriptive cross-sectional study in selected urban slum areas in the district of Colombo from February 2016 to August 2016. Considering the prevalence of tobacco use as 23%,[12] absolute precision of 5%, design effect of 0.2, and nonresponse rate of 10%, the required sample size was 1435. Cluster size was considered as 20. All youths including males and females between the ages of 15 and 24 years were eligible to participate in the study. One cluster was defined as a slum. Cluster sampling technique combined with probability proportionate to size technique was adopted to select the required number of slums. Every consecutive house was visited starting from the first house physically situated at the right side of the entrance of the slums, and data were collected till the required sample size was achieved.

Knowledge on OPMD was assessed using ten statements. Each statement had three answers, true, false, and do not know. A correct answer was given a score of 1, whereas a score of 0 was given for an incorrect answer and do not know answer. Cutoff points for categorization of level of knowledge were decided based on the literature, and it was kept at three levels as 80%–100%, 50%–79%, and below 49% and was classified as follows: good knowledge: 8–10 scores, fair knowledge: 5–7 scores, and poor knowledge: 0–4 scores.[13],[14]

Ethical clearance was obtained from the Ethics Review Committee, Faculty of Medicine, University of Colombo (the reference number EC 15-199), and written informed consent was obtained from the subjects who were above the age of 18 years and from parents of the study participants who were below that age of 18 years.

Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 15 (International Business machines Corporations, New York, United States of America). Associations were determined using Chi-square test with Yates correction or Fisher's exact test, independent sample t-test, one-way ANOVA, and binary logistic regression as appropriate. P < 0.05 was considered statistically significant for all tests.


  Results Top


Socio demographic characteristics

A total of 1435 interviews were conducted. Of these, data obtained from four interviews were excluded due to incomplete and irrelevance answers, giving a response rate of 99.7%. Fifty-seven percent of the study participants were males, and the mean age of the sample was 17.53 ± 2.33 years. The sociodemographic characteristics of the study participants are given in [Table 1].
Table 1: Sociodemographic characteristics of the study participants

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Pattern of tobacco use

Out of 1431, 30.4% (n = 435) had never used tobacco, 18.9% (n = 270) were not current users, while 50.7% (n = 726) were current tobacco users. The current users comprised smokers (11.5%), smokeless tobacco users (60.5%), and those who used both smoked and smokeless tobaccos (28%).

Knowledge on oral potentially malignant disorders

The mean knowledge score was 3.5 (standard deviation [SD] +2.0). The knowledge score was almost similar for both males (3.5, SD: 2.0) and females (3.52, SD: 1.9). Out of 1431, 1035 (72.3%) had poor knowledge while 27.1% (n = 388) had fair knowledge. Whereas only 0.6% (n = 8) had good knowledge.

[Table 2] shows the knowledge on risk factors, clinical features, and early identification related to OPMD.
Table 2: Knowledge regarding the risk factors, clinical features, and early identification related to oral potentially malignant disorders among the study sample

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Of the total sample, 85.5% (95% CI: 83.6–87.2) knew that smoking is a risk factor for OPMD, but only 21.6% (95% CI: 19.5–23.8) knew that alcohol is a risk factor. Around 84% (95% CI: 81.1–85.7) of the participants knew that betel chewing is a risk factor for OPMD and 83.2% (81.2%–85.1%) knew that tobacco in the betel quid is a risk factor, but only 16.3% (95% CI: 14.2–18.2) knew that areca nut in betel quid is a risk factor for OPMD. Around 32% (95% CI: 29.5–34.3) of the sample knew that tobacco and areca nut packets are a risk factor for OPMD.

The knowledge about clinical features of OPMD was poor. Only 10.9% (95% CI: 9.3–12.6) knew that OPMD can present as a white patch, 2.3% (95% CI: 1.6–3.2) knew that OPMD may present as a red patch, and only one (0.1%, 95% CI: 0.01–0.3) participant knew that OPMD may lead to a difficulty in opening the mouth.

Only 1.2% (95% CI: 0.07–1.8) knew about the importance of SME for detection of OPMDs.

Out of the current smokers, 75% knew that smoking is a risk factor for OPMD. Out of the current smokeless tobacco users, 86.7% knew that betel chewing is a risk factor for OPMD and 85.8% knew that tobacco in betel quid is a risk factor for OPMD. However, only 31.8% knew that areca nut in betel quid could cause OPMD and 50.3% knew that commercially prepared areca nut and tobacco could cause OPMD.

Factors associated with the knowledge

[Table 3] shows the factors associated with the knowledge on OPMDs. Age, current status of education, and employment status were significantly associated with the mean knowledge score, whereas sex, marital status, and ethnicity were not significantly associated with knowledge.
Table 3: Factors associated with the knowledge

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The mean knowledge score among ever tobacco users (3.59) and never tobacco users (3.33) was not significant. In binary logistic regression analysis, only 0.3% of the tobacco using behavior (ever user or never user) is explained by the knowledge of OPMD (R2: 0.003).

Self-mouth examination for oral potentially malignant disorder

[Table 4] shows the factors associated with the practice of SME. Practicing SME was significantly associated with the level of knowledge related to OPMD but not with the age group, sex, ethnicity, current status of education or employment status, marital status, and pattern of tobacco usage.
Table 4: Factors associated with the practice of self-mouth examination

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  Discussion Top


One of the important strategies to reduce the burden of oral cancer is early detection. Early detection of OPMDs would reduce mortality, morbidity as well as the economic burden to the individual and the society. OPMDs can be easily detected by health professionals and even by individuals because OPMDs are often visible. The stage of diagnosis is one of the vital factors that determine the outcome of any disease or condition. Delays in diagnosis could be a reason for failures in treatment and further it would incur additional costs to the individual and to the health system.[5],[15]

Health professionals could identify OPMDs, only when patients present to hospitals and demand treatment or by opportunistic screening. Therefore, early identification at an individual level plays a vital role in diagnosing the disease at correct stage. Knowledge of oral cancer has been identified as a significant factor for early detection.[16] Therefore, a high level of public awareness on oral cancer and OPMDs is of utmost importance for the individuals to present early to health-care facilities.[17],[18]

This study highlights that the knowledge related to OPMDs among the youth residing in urban slum areas in Colombo district is poor. Only 27.3% and 0.6% had fair and good levels of knowledge related to OPMDs. A study conducted among indigenous medical practitioners working in the Western province of Sri Lanka has found that 63.7% had a satisfactory level of awareness related to OPMD.[19]

The differences of the knowledge levels among different groups of people are due to various factors. One of the important factors for poor knowledge levels regarding OPMDs among high risk groups is not receiving the updated information to them. Further, less frequency of using health sector and lower level of health literacy among these high-risk groups aggravate the problem. Lower level of socioeconomic status is also the main reason for the differences in the knowledge about the OPMD.[6]

Similar features have been reported in another study conducted among high-risk individuals where only 23% were aware about the OPMDs.[20] A study conducted among the general public in the UK reported that in comparison to lung cancer where the awareness was 97%, only 56% of the participants of the survey were aware of oral cancer.[16] Many studies reported that the high level of education is associated with the higher awareness of oral cancer and OPMD.[21],[22],[23]

The present study found that the mean knowledge score is significantly high among school-leavers (those who were unemployed) and the 20–24 years old. The participants of the present study differ from other youth categories in Sri Lanka due to cultural factors and social determinants of health-related them. A Indian study conducted among youth residing in uraban slum areas has reported that one of the major outcome of using social media is acquire general knowledge.[24] To improve the knowledge levels of children, lectures would not be appropriate, because those does not captive the attention of children.[18] Knowledge of OPMD was also higher among the older youth compared to the younger youth where most of the unemployed school-leavers fall.[23],[25],[26]

Interestingly, the present study found that the knowledge of OPMD was not a factor that determines the tobacco using behavior. As this is a descriptive cross-sectional study, causal relationships cannot be established. But above finding is compatible with many studies done worldwide.[27],[28],[29]

Furthermore, the present study found that the practice of SME for early detection of OPMDs was significantly associated with the level of knowledge with an odds ratio of 14.75 but not with the other sociodemographic factors such as age, sex, level of education, marital status, ethnicity, and tobacco using behavior pattern.

The present study was conducted as a descriptive cross-sectional study and was limited to one district in the country. Therefore, further studies need to be conducted among the high-risk youth living in different other parts of the country.


  Conclusion Top


The present study assessed the knowledge of OPMD among the youth living in urban slum areas in a commercial area in Sri Lanka and revealed that the knowledge about OPMD was not satisfactory. To facilitate early detection of OPMDs, targeted interventions directed at improving the knowledge with relevant skills need to be implemented.

Ethical clearance

Ethical clearance was obtained from the Ethics Review Committee, Faculty of Medicine, University of Colombo (the reference number EC 15 199).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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