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Introduction
World Health Organization (WHO) estimates that there are more than 370 million indigenous people worldwide.1 Native communities represent a diversity of cultures, religions, traditions, languages and stories, but remain among the most marginalized population groups due to their pluricultural differences.2,3
The health status of indigenous peoples is very different due to the sociodemographic characteristics of this type of vulnerable population. In Peru, child malnutrition has been reduced in recent years, however, it still affects 13.1% of children under 5 in 2016; in rural areas it reaches 26.5% and 7.9% in urban areas.4 Anemia affects 1620 million people worldwide, which corresponds to 24.8% of the population, and its highest prevalence is in preschoolers (47.4%).5)
In addition, in Peru, anemia affects 43.6% of children under three years, several studies show that anemia in infants affects permanent psychomotor development, the weight of anemia correction, observation, long-term, the lowest performance in cognitive, social and emotional areas.6) Oral conditions are one of the most common and endemic problems in Peru, and a preventive and promotional approach is necessary.7
The objective of this study was to determine the relationship between iron deficiency anemia and oral health in schoolchildren from Peruvian native communities.
Methods
Desing and sample
Cross-sectional and relational observational study. The population was made up of the total number of schoolchildren from Coriteni Tarso and Osherato, from the district of Rio Tambo, province of Satipo, Junín, during the month of March 2019 in the framework of the Multidisciplinary University Research and Service Camp (CUMIS) of the Continental Society of Student Medical Sciences (SOCIMEC). The sample consisted of 120 schoolchildren, selected for the convenience of the selected educational institutions.
The level of iron deficiency anemia was determined by capillary puncture in a single contact that met the biosafety criteria, was classified as mild anemia (Hb 11-11.4 g / dL), moderate (Hb of 8-10.9 g / dL ) and severe (Hb <8 g / dL), according to the technical standard on the preventive treatment of anemia in children, adolescents, pregnant women and postpartum women (up to 1,000 masl) of the Ministry of Health of Peru (MINSA) 8) The sample was processed using the Hemocue® Hb 201+ system. To quantify the oral conditions, this was evaluated by the most frequent pathologies of the oral cavity: the prevalence was established by the number of dental caries cases, 9 the dental caries experience was calculated according to the DMFT index, 10) for the degree of severity the significant caries index (SiC) was used,11) the oral hygiene condition was estimated using the simplified oral health index (IHO-S)12) the consequences evaluated the PUFA index of untreated caries clinics.13
The inclusion criteria were: schoolchildren with regular attendance belonging to the selected native communities, signature of the informed consent, the exclusion criteria were: parents who did not sign the informed consent, presence of any systemic disease. WHO indications were used for data collection.14) Natural light and diagnostic equipment were used for the detection of oral disorders. The present study complies with the ethical principles of the Helsinki declaration. The project was approved by the heads and settlers of the selected native communities by signing the informed consent and informed settlement for minors.
Stadistical analysis
The data were analyzed in the Microsoft Excel 2013 program and the statistical quantification was subsequently carried out using the statistical package STATA v 14.0, expressed in percentages and frequency measurements, average scores and standard deviations of the variables. The association between the variables was calculated using the chi-square test p < 0.05 was considered statistically significant.
Results
120 schoolchildren were included, the average age was 8.87 ± 1.95 years. The distribution of the selected sample was 65 women (54.16%) and 55 men (45.84%) (Table 1).
Table 1 Distribution of the sample by communities, according to sex and age.
| Age | Sex | Total | ||||
|---|---|---|---|---|---|---|
| Male | Female | |||||
| n | % | n | % | n | % | |
| 6 | 7 | 5.83 | 13 | 10.83 | 20 | 16.6 |
| 7 | 11 | 9.16 | 4 | 3.33 | 15 | 12.5 |
| 8 | 5 | 4.16 | 12 | 10.0 | 17 | 14.1 |
| 9 | 10 | 8.33 | 10 | 8.33 | 20 | 16.6 |
| 10 | 5 | 4.16 | 12 | 10.0 | 17 | 14.1 |
| 11 | 7 | 5.83 | 12 | 10.0 | 19 | 15.8 |
| 12 | 10 | 8.33 | 2 | 1.66 | 12 | 10.0 |
| Total | 55 | 45.84 | 65 | 50.91 | 120 | 100 |
The average hemoglobin concentration was 11.9 mg/dl (1.49), a prevalence of 44.16% of anemia (53 children) was found, with moderate anemia being the most frequent 42 (34.99%), late due to the level of anemia 10 (8.33%) and severe anemia 1 (0.83%), presenting more cases the sex female sex (Table 2).
Table 2 Classification of anemia, according to sex.
| Sex | Anemia Classification | ||||
|---|---|---|---|---|---|
| Without anemia | Mild anemia | Moderate anemia | Severe anemia | Total | |
| Male | 31 (28,83%) | 4 (3,33%) | 20 (16,66%) | 0 (0,00%) | 24 (19,99%) |
| Female | 36 (15,37%) | 6 (5,00%) | 22 (18,33%) | 1 (0,83%) | 29 (24,16%) |
| Total | 67 (44,20%) | 10 (8,33%) | 42 (34,99%) | 1 (0,83%) | 53 (44,16%) |
A prevalence of dental caries of 93.33% was found, the experience of population dental caries was moderate (5.23), according to the WHO criteria and a population SIC of 7, 51 (Table 3).
Table 3 Prevalence, experience and importance of dental caries, according to school sex.
| Sex | Prevalence | Tooth Decay |
Tooth lost due to tooth decay |
Filled teeth |
DMFT |
SiC |
|---|---|---|---|---|---|---|
| Male | 53 (96,36) | 5,27 (2,10) | 0,15 (0,36) | 0,33 (1,51) | 5,75 (1,85) | 7,94 |
| Female | 59 (90,77) | 4,54 ( 2,30) | 0,12 (0,33) | 0,20 (0,73) | 4,00 (2,13) | 7,09 |
| Total | 112 (93,33) | 4,88 (2,23) | 0,23 (1,14) | 0,23 (1,14) | 5,23 (2,06) | 7,51 |
As for the PUFA index, a prevalence of 31.66% was found, pulp involvement was the most prevalent clinical consequence 17 (14.16%) (Table 4).
Table 4 PUFA index, according to sex in schoolchildren of Coriteni Tarso and Osherato, of the district of Río Tambo, province of Satipo
| Clinical consequences of untreated tooth decay | |||||
|---|---|---|---|---|---|
| Sex | Pulp Commitment n ( |
Ulceration n ( |
Fistulan ( |
Abscess n ( |
PUFA n ( |
| Male | 6 (0,15) | 3 (0,05) | 2 (0,02) | 4 (0,07) | 15 (0,29) |
| Female | 11 (0,18) | 4 ( 0,06) | 1 (0,03) | 7 (0,11) | 23 (0,38) |
| Total | 17 (93,33) | 7 (2,23) | 3 (1,14) | 11 (1,14) | 38 (2,06) |
Regarding the nutritional status of schoolchildren, it was found that the majority presented malnutrition 109 (90.83%), this condition is higher in the female sex (Table 5).
Table 5 Nutritional status in schoolchildren of Coriteni Tarso and Osherato, from the district of Río Tambo, province of Satipo
| Nutritional states | ||||
|---|---|---|---|---|
| Sex | Underweight n (%) | Normal weight n (%) | Overweight n (%) | Obesity n (%) |
| Male | 48 (40,0) | 7 (5,83) | 0 | 0 |
| Female | 61 (50,83) | 4 (3,33) | 0 | 0 |
| Total | 109 (90,83) | 11 (9,16) | 0 | 0 |
Regarding the oral hygiene condition, the overall average of the IHO-S was 5.02 (SD = 0.51), the majority present in a good oral hygiene condition 72 (60%), followed by the poor oral condition 25 (21%) and the regular condition 23 (19%) (Fig. 1).
Fig. 1 Condition of oral hygiene in school children of Coriteni Tarso and Osherato, from the district of Río Tambo, province of Satipo.
In relation to the association between the history of dental caries and the condition of iron deficiency anemia, a statistically significant association was found (p = 0.011) (Table 6).
Table 6 Relationship between the level of anemia and oral conditions in school children in Coriteni Tarso and Osherato, in the district of Río Tambo, province of Satipo.
| Anemiaa | No caries history n | With a history of tooth decay n | Total n | Chi-square test |
|---|---|---|---|---|
| Yes | 4 | 49 | 53 | 0,011* |
| No | 7 | 60 | 67 |
*p < 0.05 had a statistically significant difference.
aBased on the standards established by Ministry of health of Peru (MINSA)
Discussion
In relation to the prevalence of anemia, it was high, which is consistent with what was reported by Ferreira et al. (45%),15Udovicich et al. (52%),16 which exemplifies health inequality, so it is necessary to promote nutritional health programs in native populations.17 Anemia generates a high cost in the Peruvian state, which mainly affects the education sector,4) to solve this problem it is necessary to involve the different social actors.
As for the most affected gender, it was higher “the female sex”, which differs from that reported by Ferreira et al.,15) and Morais et al.,18 where male sex was the most affected, it should be noted that anemia is more frequent in rural areas than in urban areas.19) With respect to the assessment of nutritional status, it is consistent with that reported by Moshena et al.20
Malnutrition in native communities arises from a set of factors, among which are the ethnography of their diet, the lack of economic resources, the lack of health workers that promote healthy eating,21) it is necessary to promote actions in favor of nutritional status. of vulnerable populations.
In relation to oral health, a prevalence and experience of dental caries was found similar to that reported by Pérez et al.,22) also, in relation to the prevalence of the clinical consequences of untreated tooth decay was lower than reported by Aquino et al.23) what evidences that the inhabitants of the native communities are more prone to present affections in the oral cavity, reason why it is necessary to reorient the capacities of the oral health professionals with respect to the recognition of the cultural differences that promote social inclusion.
The study found an association between history of dental caries and anemia due to iron deficiency in schoolchildren studied, which coincides with reported by Tang et al. (p < 0.05),24Bansal K et al. (p = 0.01),25) however the evidence is controversial, this may be due to the multifactorial etiology of dental caries.
The native communities of Peru, are in a disadvantage in relation to other populations, oral health is a human right, therefore, working the issue of intercultural health is not only a necessity of these communities, but also a duty of the Peruvian state, communities should be considered as part of the solution and development and not as part of the problem.26,27
However, this study has limitations. The study design was cross-sectional, which does not allow for the determination of true cause and effect. It was extremely challenging to find caries free age matched controls to participate in the study, also the sample was not randomly selected.
