IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rafalimino Holy Nasandratra1* https://ijojournals.com/ Volume 07 || Issue 04 || April, 2024 || FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR Rafalimino HN1,2, Ratsimandresy NN3, 2Randriamalala NC1,5, Rakotonirina FP1,4,Andrianjafinoro TH1,, Ranjarisoa LN6, Ramaroson J1. 1Sub-section of Conservative Odontology Endodontic at the Tropical Odonto-Stomatological Institute of Madagascar (IOSTM), University of Mahajanga ² University Hospital Profesora Zafisaona Gabriel Androva Mahajanga Madagascar, 3 Sub-section of Prosthodontics at the Tropical Odonto-Stomatological Institute of Madagascar (IOSTM), University of Mahajanga, Madagascar 4 Oral Health Center, Ministry of Industrialization, Trade and Consumption Antananarivo, Madagascar, 5 University Hospital Joseph Dieudonné Rakotovao, Befelatanana Antananarivo, 6 Public Health Mention at Tropical Odonto-Stomatological Institute of Madagascar (IOSTM), University of Mahajanga Corresponding author: Rafalimino Holy Nasandratra1, 2 Abstract The aim of this research study was to determine the factors influencing the choice of the type of oral health care center attended by the population of the city of Mahajanga I in Madagascar. Methods based in a cross-sectional observational-analytical study, conducted in the city of Mahajanga I in 2019. Surveys were carried out among the class of population aged over 18 years, residing more than six months in the city of Mahajanga I, visiting an oral health center more than once. The questionnaires were based on a description of the factors motivating patients to choose an oral health center. Uni-variate and bivariate analyses were carried out. The bivariate analysis was conducted to identify the association between the variables studied and the type of oral health center attended. The Pearson Chi² test was used to test the significance of the results and a value of p< 0, 05 was considered significant. Results managing, socio-economic factors and factors for assessing the quality of services influence the choice of the type of oral health care center by the population of Mahajanga I. Gender, age, profession and the type of approach and motivation offered at Oral Health Care Centers were factors associated with the choice of type of oral health care center by the population of Mahajanga. Key words: factors influencing, choice, dental service, cross-sectional analytical study. 1.Introduction In the world, the Global Burden of Disease study showed that 50% of the world's population suffers from oral diseases [1].In Madagascar, in 2016, the prevalence of oral and periodontal IJO JOURNALS Volume 07 | Issue 04 | April 2024 | https://ijojournals.com/index.php/hsn/index 15 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rafalimino Holy Nasandratra1* https://ijojournals.com/ Volume 07 || Issue 04 || April, 2024 || FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR diseases ranged from 80% to 98%. So, the attendance rate at public oral health care centers in Madagascar is only 10.5 [2].The aim of this research study was to determine the factors influencing the choice of the type of oral health care center attended by the population of the city of Mahajanga. 2.Methods A cross-sectional observational-analytical study was conducted in the city of Mahajanga, Madagascar I, in 2019. Our target was to investigate the class of population aged over 18 years, residing more than six months in the city of Mahajanga I. Included in our study was the entire population of the city of Mahajanga, aged over 18, regardless of gender, residing for more than six months in the city of Mahajanga I, attending an oral health center more than once in Mahajanga. Excluded from our study was the entire population of the city of Mahajanga, aged over 18th, regardless of gender, residing for more than six months in the city of Mahajanga I, presenting either a deafness or mental handicap, or those who refused to take part in the survey. Using Andersen's formula, and based on the prevalence of use of oral care in Madagascar (10, 5), the sample size was 145. To ensure that our sample was heterogeneous with regard to the type of oral health center, we adopted a stratified random sampling method based on all twenty-four non-school oral health centers in the city of Mahajanga. Sample selection in each stratum was random. The interviewers were randomly selected.Respecting ethical considerations, previously tested questionnaires were used during the survey. The survey was conducted between January 1 and December 4, 2019. Using SPSS 20.0 software, Uni-variate and bivariate statistical analyses were carried out. The Uni-variate analysis was developed to describe the Socio-demographic profile of the study population. The bi-variate analysis was conducted to identify the association between the variables studied and the type of oral health center attended. The Pearson Chi² test was used to test the significance of the results. A value of p< 0.05 was considered significant. There is strong significance when the p-value <0.001, moderate significance when the p- value = 0.001, and barely significant when p<0.05 - 0.001. 3.Results 3.1 Uni-variate analyses 3.1.1 Sociodemographic profile The study population was predominantly female (73.1%), with a sex ratio of 0.36. In terms of age, the 50+ age group constituted forty-five point five percent (45.5%) of the sample. Individuals with an occupation in the tertiary sector were predominantly represented (45.5%). Most of the individuals surveyed were married (73.1%). In terms of distance IJO JOURNALS Volume 07 | Issue 04 | April 2024 | https://ijojournals.com/index.php/hsn/index 16 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rafalimino Holy Nasandratra1* https://ijojournals.com/ Volume 07 || Issue 04 || April, 2024 || FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR between home and the oral health care center attended, forty-three point four percent (43.4%) lived between 6km and 10km from the health care center (table I). 3.1.2 Socioeconomic profile Surveyed individuals with a monthly income ≥ 200,000 equivalent to $43.83 or €40.77 made up fifty-six point six percent (56.6%) of the sample. And seventy-five point two percent (75.2%) of the individuals surveyed declared that they had no savings allocated to oral health care (table II). Table I: Distribution of individuals by Sociodemographic profile Socio-demographic profile n N=145) % Gender Male 39 26,9 Sex-ratio = 0,36 Female 106 73,1 Total 145 100,0 Age range 18 to 29 age 35 24,8 30 to 49 age 52 29,7 50 to age 58 45,5 Total 145 100 Profession Primary sector 36 24,8 Secondary sector 43 29,7 Tertiary sector 66 45,5 Total 145 100 Marital status Married 106 73,1 Unmarried 39 26,9 Total 145 100 Distance between home and dental services 0 to 5km 55 38,0 6 to 10km 63 43,4 Over 10km 27 18,6 Total 145 100 IJO JOURNALS Volume 07 | Issue 04 | April 2024 | https://ijojournals.com/index.php/hsn/index 17 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rafalimino Holy Nasandratra1* https://ijojournals.com/ Volume 07 || Issue 04 || April, 2024 || FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR Table II: Distribution of individuals by socioeconomic profiles Socio-economic profiles n (N=145) % Monthly income <200 000 Ariary 63 43,4 ≥ 200 000 Ariary 82 56,6 Total 145 100,0 Possession savings allocated for dental care yes 36 24,8 No 109 75,2 Total 145 100 3.1.3 Type of dental care center visited The majority of individuals surveyed frequented the type of liberal oral health center (62.8%). Twenty point seven percent (20.7%) of the individuals used to attend denominational to attend faith-based oral health centers. Only a proportion sixteen point six percent (16.6%) of the individuals surveyed frequented public oral health centers (table III). Table III: Distribution of individuals by type of oral care center chosen Type of oral health center chosen n (N=145) % Public 24 16,6 Denominational 30 20,7 Liberal 91 62,7 Total 145 100 3.2 Bivariate analysis 3.2.1 Type of oral health care attended and gender Between the type of oral health center attended and gender, a significant difference was found. Male patients (79.5%) were more likely to attend a private liberal dental structure (**p=0.01<0.05) in relation to women patients attended less (17%) public oral health care centers (**p=0.01<0.05) (table IV). IJO JOURNALS Volume 07 | Issue 04 | April 2024 | https://ijojournals.com/index.php/hsn/index 18 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rafalimino Holy Nasandratra1* https://ijojournals.com/ Volume 07 || Issue 04 || April, 2024 || FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR Table IV: Distribution of individuals by type of oral health care centerattended and gender Type of oral health center chosen Gender Khi² Test Male Female n (N=39) % n (N=106) % Public 6 15,4 18 17,0 *p = 0,01<0,05 Denominational 2 5,1 28 26,4 Liberal dental 31 79,5* 60 56,6 39 100 106 100 3.2.2 Type of oral health care attended and age The result showed a highly significant difference in relation to age group and type of dental type of dental facility attended. Subjects aged between 30 and 49 years (78.9%) usually attended public dental facilities (**p=0.006<0.05) (table V). Table V: Distribution of individuals by type of oral health care center attended and age group Type of dental center chosen Age range Khi² test 18 to 29 age 30 to 49 age 50 age + n (N=35) % n (N=52) % n (N=58) % Public 9 25,7 1 1,9 14 24,1 **p = 0,006<0,05 Denominational 6 17,1 10 19,2 14 24,1 Liberal 20 57,2 41 78,9** 30 51,8 35 100 52 100 58 100 3.2.3 Type of oral health care attended and profession According to the type of oral health care center attended and profession, this study has found a significant difference. The majority of the population with an occupation in the tertiary sector (74.2%) opted for private oral health care centers (*p=0.02<0.05) (table VI). IJO JOURNALS Volume 07 | Issue 04 | April 2024 | https://ijojournals.com/index.php/hsn/index 19 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rafalimino Holy Nasandratra1* https://ijojournals.com/ Volume 07 || Issue 04 || April, 2024 || FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR Table VI: Distribution of individuals by type of oral health care center and profession Type of dental center chosen Profession sector Khi² test Primary sector Secondary sector Tertiary sector n (N=36) % n (N=43) % n (N=66) % Public 8 22,2 7 16,3 9 13,7 *p = 0,02<0,05 Denominational 13 36,1 9 20,9 8 12,1 Liberal 15 41,7 27 62,8 49 74,2* 36 100 43 100 66 100 3.2.4 Type of oral health care attended and satisfaction with approach offered by the dentist According to the type of oral health care center attended and satisfaction with the approach offered by the dentist during oral health care, a highly significant difference was found. The majority of patients surveyed (65.5%) attending the type of liberal oral health center mentioned their satisfaction with the therapeutic approach opted for by the practitioner (***p=0.000<0.05) (table VII). Table VII: Distribution of individuals according to type of oral health care center chosen and satisfaction with practitioner's therapeutic approach Type of dental center chosen satisfaction with practitioner's therapeutic approach Khi² test yes No n (N=139) % n (N=6) % Public 23 16,5 1 16,7 ***p = 0,000<0,05 Denominational 25 18,0 5 83,3 Liberal 91 65,5*** 0 0,0 138 100 6 100 4. Discussion 4.1 Discussion of the methodology The urban commune of Mahajanga I was served by six types of school-based oral health care centers and twenty-eight non-school-based oral health care centers [3].The six types of IJO JOURNALS Volume 07 | Issue 04 | April 2024 | https://ijojournals.com/index.php/hsn/index 20 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rafalimino Holy Nasandratra1* https://ijojournals.com/ Volume 07 || Issue 04 || April, 2024 || FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR school-based oral health care centers were excluded from our survey site due to the age of the individuals attending these facilities being under 18. In relation to the type of oral health care center, the sampling method adopted enabled us to obtain a heterogeneous sample. The sample size in each stratum respected the proportion of each stratum (table VIII). 4.2 Type of oral health center and gender: gender-related factors Male individuals (79.5%) were more likely to visit private oral health centers (Table 4). This result differs from the study by Diouf M et al. in 2010. They reported a rate of 62.6% for women attending liberal oral health centers. As an interpretation, they pointed out that women greatly appreciate the high standard of service, where as there is no luxury in public health centers, so they frequent them less frequently [4]. 4.3 Type of oral health center and age: age-related factors Males (79.5%) were more likely to frequent private oral health centers. Compared to age, there was a significant difference between age and the choice of the type of oral health center attended (***p=0.006<0.05) (table 5). Age is a determining factor in the choice of oral health center. This result corroborates with Fernandez R and collaborator’s study on 2020. They evocated a high school level showed high significance (p=.002) towards choosing private clinics for dental treatment. Most patients other the age of 60 have chosen private clinics for dental treatment [5]. 4.4 Type of oral health center and profession: factors related to profession Individuals with occupations in the tertiary sector were the most frequent (74.2%) private oral health care centers (table 6). Individuals with occupations in the tertiary sector were generally considered to be "higher-paid" professions, and able to afford the more expensive care offerings. This finding corroborates with Ndame Dieng S and collaborators’study on 2016. They reported that the majority of civil servants used private dental facilities (54%) [6]. 4.5 Type of oral health center and satisfaction with the practitioner's approach: factors related to the quality of the practitioner's approach The majority of patients surveyed (65.5%) who attended the type of liberal oral health center reported satisfaction with the therapeutic approach chosen by the practitioner (***p=0.006<0.05). According to Fernandez R and collaborators on 2019, a dentist’s reputation and personality played a positive role in influencing a patient’s decision in choosing them for treatment (34,8%) (p < 0.005) [7]. According to the study of Alhabib S and coll, dental professionals play a crucial role in shaping their patients' experience. In the dental field of their study, patients were mainly satisfied with the dentist's attention (77.2%) [8]. IJO JOURNALS Volume 07 | Issue 04 | April 2024 | https://ijojournals.com/index.php/hsn/index 21 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rafalimino Holy Nasandratra1* https://ijojournals.com/ Volume 07 || Issue 04 || April, 2024 || FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR Conclusion In this study, the hypothesis was verified. Socio-economic factors and factors for assessing the quality of services influence the choice of the type of oral health care center by the population of Mahajanga I. Despite the study's limitations, four significant results were found.Gender, age, profession and the type of approach and motivation offered at oral health care centers were factors associated with the choice of type of oral health care center by the population of Mahajanga. Private oral health care centers were attended mainly by men. Public oral health care centers are mainly frequented by the over-50s. The type of approach and therapeutic motivation offered by the dentist within the oral health care center is a factor strongly associated with conditioning the choice of which type of oral health care center to attend. As a perspective, would the design of oral health care rooms influence patients' motivation to seek treatment? Acknowledgement None Conflict of interest No conflict of interest References [1]. World Health Organization. Management of Noncommunicable Diseases, Noncommunicable Diseases, Rehabilitation and Disability. Global oral health status report: Towards universal health coverage for oral health by 2030. America, 2023 : 1-40. [2]. Ranivoharilanto E. Santé bucco-dentaire à Madagascar : état des lieux et perspectives. Aide Odontologique International. Madagascar, 2016 : 1-38. [3]. Ordre National des Odonto-stomatologistes de Madagascar. Annuaire National dentaire. Madagascar, 2019 : 1-55. [4]. Diouf M , Cisse D , Lo CMM , Faye D , Traoré R. Évaluation de la satisfaction des patients admis en service d’odontologie à Dakar. s Pratiques et Organisation des Soins. 2010 (Vol 41) : 225-30 [5]. Ragna Lamprecht, Julia Struppek, Guido Heydecke, Daniel R. Reissmann. Patients’ criteria for choosing a dentist: Comparison between a university-based setting and private dental practices. International Journal of Dental and Health Sciences.Original Article. Volume 03, Issue 06. 2020: 1-7. IJO JOURNALS Volume 07 | Issue 04 | April 2024 | https://ijojournals.com/index.php/hsn/index 22 https://www.who.int/teams/noncommunicable-diseases https://www.who.int/teams/noncommunicable-diseases https://www.who.int/teams/noncommunicable-diseases https://onlinelibrary.wiley.com/authored-by/Lamprecht/Ragna https://onlinelibrary.wiley.com/authored-by/Struppek/Julia https://onlinelibrary.wiley.com/authored-by/Heydecke/Guido https://onlinelibrary.wiley.com/authored-by/Reissmann/Daniel+R. IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rafalimino Holy Nasandratra1* https://ijojournals.com/ Volume 07 || Issue 04 || April, 2024 || FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR [6]. Ndame Dieng S, Cissé d, Lomrail P, Azougui-Levy S. État de santé, offre et recours aux soins bucco-dentaires chez les enfants sénégalais : synthèse des données disponibles. Santé publique .2016 : 257-65 [7]. Fernandez R , Eisa E, Alqattan A , Aldayel A , Alkhalefah O , Alanazi F , Karshe B , Alsulayyim A. Factors influencing patients' decisions while choosing a dental care provider. International Journal of Dental and Health Sciences.Original Article. 2019(Volume 03) : 1-8. [8]. Alhabib S, Albarikan O. Impact of Dental Services on Patients' Perception at Private Dental Clinics in Riyadh, Saudi Arabia. IUGJEPS Islamic University of Gaza 2021 (Vol 29): 262 -75. 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