INTRODUCTION

Most parents consider the eruption of the primary tooth in a child as a landmark developmental milestone event.^1,2 This physiological process is known as teething, and may sometimes, however, be accompanied by painful and discomforting symptoms.^3,4 Some of the reported signs and symptoms associated with teething include gingiva inflammation of the associated tooth, fever, fussiness, irritability, crying, diarrhea, drooling, increased biting, rhinorrhea, loss of appetite, gingiva irritation, and sleep disturbances.^3,5-9

Several studies^10-13 however, have reported that most of the perceived systemic symptoms associated with teething are due to other causes such as a decrease in maternal antibodies,^8,14 bacterial and viral infections among others.^15-17

Generally, mothers are saddled with early childcare responsibilities.¹⁸ Therefore, their attitude, practice, and care toward events occurring in early childhood including teething are important. These attitudes and practices may have either a positive or negative/deleterious impact on the teething child.

In a study conducted in two North-Western States of Nigeria¹⁹ among nursing mothers, a majority (92.8%, n= 208) admitted visiting the hospital for their children’s teething symptoms, with only a minority (7.2%, n=16) preferring home treatment. Similarly, in a study in Udaipur, India,²⁰ most mothers (86.4%) viewed teething problems as an appropriate reason to visit a healthcare provider. However, in another study among mothers in Lagos, south-western Nigeria,²¹ as high as 47.7% of mothers view teething symptoms as not serious and claim they will not seek medical help.

Treatment practices for teething symptoms by mothers are available in the literature.^19,20,22 They include the use of teething powder, teething syrup, traditional herbs, and no treatment.¹⁹ Others include the nightly use of bottle feeding or breastfeeding as teething symptoms pacifier, tepid sponging, biting on chilled objects, teething toys, use of systemic and/or topical analgesics, and dehydration prevention through high intake of fluids.^20,22 Some of these treatment practices for perceived teething symptoms are not beneficial and may even be harmful to the child.²³

Several studies in Nigeria on teething are available in the literature, and they mainly focused on the beliefs, perceptions, and myths associated with teething.^19,21-23 There is however a dearth of studies in Nigeria that specifically looked at the attitudes and practices of mothers regarding teething. Considering the detrimental impact of negative attitudes and wrong treatment practices on the teething child, this study, therefore, aims to evaluate the attitudes and treatment practices of mothers regarding teething, as this information will serve as a useful tool for the design of targeted healthcare programs for this population.

METHODOLOGY

Study Design and Setting

This study was a descriptive cross-sectional survey conducted in Benin City, Edo State, Nigeria. Benin City mainly comprises Ikpoba-Okha, Egor, and Oredo local government areas (LGA).²⁴ It has a 2016 projected population of 1,433,620.²⁴

Study Population

The study was carried out among mothers in Benin City, Edo State, Nigeria.

Inclusion Criteria

All mothers who were available at the time of the study and were willing, and in addition gave consent to participate in the study were included in the study.

Sample Size Determination

Using Cochran’s formula²⁵ for minimum sample size determination in a cross-sectional study

n=Z²pq/d²

Where n= minimum sample size when the population is >10,000, Z= standard normal deviate set at 1.96 corresponding to 95% confidence Interval, d= Degree of accuracy or error margin = 5%, p= Prevalence in the target population estimated to have a particular characteristic set at 92.8% from a previous Nigeria study,¹⁹ and q= 1.0 – p. The calculated minimum sample size for mothers plus adjustments for 15% non-response, for this study, was 120.

Sampling Method

Systematic random sampling technique was utilized in selecting the streets visited for this study. 10 streets were decided per LGA, giving a total of 30 streets

A list of registered streets in Egor, Ikpoba-Okha, and Oredo LGA constituted the sample frame. The number of streets in the LGA was divided by no of streets to be visited to get the sampling interval for that LGA. For each LGA, a random pick of a street was used as the starting point for that street and every n^th (sampling interval) street from the frame was selected until the required sample size for that LGA was achieved.

To select participants from the individual houses, the total sample size for this study was divided by the three (LGA) for equal representation, i.e., 120/3=40 mothers in each LGA. The number of mothers per street, therefore, was (40 mothers in each LGA/ no of streets) 40/10 = 4 mothers per street. The number of houses in the street was divided by number of mothers to be visited to get the sampling interval for that street. For each street, a random pick of a numbered house was used as the starting point for that street and every n^th (sampling interval) house from the frame was selected until the required sample size for that street was achieved. Where no mother was found the next house was used.

Data Collection Instrument

An anonymous pre-tested interviewer-administered structured questionnaire was utilized. The questionnaire comprised information on Socio-demographic characteristics, attitudes, and treatment practices of mothers towards teething. Questions on the attitudes of mothers towards teething were assessed using 5 item Likert scale of strongly agree, agree, indifferent, disagree, and strongly disagree. The highest score was ‘5’ while the lowest was ‘1’. There were ten questions assessed. The obtained total score was converted to a percentage and graded thus: those having less than 50% were graded as having Negative attitudes and those having 50% or more were graded as having Positive attitudes. Fourteen questions were used to assess practices towards teething. The expected responses were, Always, Sometimes, Rarely, or Never. A score of 3 was given for always, 2 for sometimes, 1 for rarely, and 0 for never. The obtained total score was converted to a percentage and graded thus: poor practice grade = those having between 0-49.9%, fair practice grade = those having between 50 – 69.9% and good practice grade = those having 70% and above

Data Analysis

IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY, USA was used for data analysis. Results were presented using frequency tables and charts. A descriptive analysis (Measure of frequency) of participants with negative and positive attitudes was carried out. Similarly, a descriptive analysis (Measure of frequency) of participants with poor, fair, and good practices was also carried out. The level of significance was set at p= 0.05.

 RESULTS

Socio-demographic characteristics

A total of 120 mothers participated in the study. The participants in the age group of 20-30 years were in the majority, accounting for half of the total participants (50.0%; n=60). Age group >40 accounted for the least number of participants (12.5%; n=15). The mean age of participants was 28.5 ± 2.3 years.  Most of the respondents (89.2%; n=107) were married. Bini was the predominant ethnic group, accounting for 65.0% (n=78) of the total participants. Most of the respondents 113 (94.2%) were Christians. A quarter of the mothers had their last child within the 0-6 months age group; Table 1.

Table 1: Sociodemographic Characteristics of Respondents

 Attitudes of Mothers Towards Teething

Over half, (59.2%; n=71) of the respondents strongly agreed that teething is a physiologic process. A majority (86.7%; n=104) strongly agreed that mothers have a role to play in the management of teething. On the other hand, less than half (41.7%; n=50) strongly agreed that doctors have a role to play in the management of teething. The same percentage of respondents i.e., 58.3% (n=70) were indifferent to the use of an herbal mixture and the use of self-medication for the management of teething symptoms.  Over 45% (48.3%; n=58) disagreed about the dentist being the best health professional to manage teething symptoms; Table 2.

Grading the attitude of the respondents showed that over 70% of them (72.5%; n=87) had negative attitudes towards teething; Figure 1.

Table 2: Attitude of respondents towards teething