Community health workers (CHWs) as oral health navigators in a local government area in Lagos State: a pilot intervention

Abstract

Objective: To assess the feasibility of CHWs to be oral health navigators and referral links within a local government area in Lagos state Nigeria. Methods: Prospective mixed methodology assessment of a cohort of 24 consenting CHWs in Mushin local government area in Lagos, Nigeria. Qualitative-FGDs to determine job description, willingness to provide oral health services in the community and set up referral links to the government owned dental clinic in the community. Quantitative- pre and post intervention assessments on knowledge of common oral health conditions and measurement of community oral health referrals, after a three-day training workshop on diagnosis and appropriate management of common oral diseases and proper referral systems. The main outcome measures were dental referral inflow from the community health workers and effect of intervention on knowledge of oral health diseases among the CHWs. Ethical approval was sought Results: All CHWs reported willingness to be oral health navigators, although only 33 patients were referred during the 5-month study period. Less than 30% of referred patients reported to hospital with varying reasons for poor attendance including perception of the hospital to which referral is being made. There was significant increase in the mean knowledge score among the CHWs (11.35±5.8) P=0.02. Conclusion: while CHWs indicated a willingness to act as oral health navigators, there is  need to create functional oral health and referral structures within the Nigerian healthcare system and create an oral health CHW cadre of incentivize the process for existing CHWs to help improve the feasibility of CHWs being oral health navigators.