Oral Health Knowledge, Attitude and Practices of Bangladeshi Female Sex Workers toward Their School -Going Children: A Cross-Sectional Study

doi:10.21203/rs.3.rs-4717760/v1

Download PDF

Research Article

Oral Health Knowledge, Attitude and Practices of Bangladeshi Female Sex Workers toward Their School -Going Children: A Cross-Sectional Study

https://doi.org/10.21203/rs.3.rs-4717760/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background: Children born into prostitution are at risk of facing barriers in accessing the healthcare sector. This research aimed to assess the knowledge, attitude, and practices of female sex workers regarding their school-going children’s oral health, as well as the oral health status of their children in Dhaka, Bangladesh.

Materials and Methods: A cross-sectional study was conducted with a sample of 180 female sex worker mothers/ institutional caregivers and female sex worker’s school-going children from March 2023 to February 2024 using a structured questionnaire. The caries condition and gingival health were assessed on their children using the DMFT/dmft and gingival index(GI). At the same time, their plaque and calculus levels were evaluated using the calculus index(CI) and plaque index (PI) respectively.

Result: 79% of the mothers or caregivers possessed good knowledge of oral health, 77.2% maintained a positive attitude, and 62.8% were well-informed about the proper oral health practices for their children. Children living with sex worker mothers/institutional caregivers who had higher educational attainment were 3 times more likely to practice good oral health hygiene than those with mothers/caregivers of low educational level (OR=3.27, β:1.11, p-value<0.05, CI=1.36-7.87). Similarly, children living with mothers/caregivers who had good oral health knowledge scores tended to have 3 times higher oral health practice scores compared to those with poor oral health knowledge(OR=3.20, β:1.16, p-value<0.05, CI=1.36-7.87).

Conclusion: Our study suggests that although FSW mothers/ institutional caregivers have better oral health knowledge regarding their children, they are unable to put this into practice for their children. Government-sponsored dental health camps should be made available to address the oral health needs of the targeted community. An educational approach aimed at both the sex worker mother and the children should be designed so that the children can develop improved oral hygiene practices.

Knowledge

attitude

practice

oral health

sex worker.

The word "sex work" serves as a substitute for slanderous terms like "prostitution," which has historically represented immorality and illegality (1). Sex workers provide consenting sexual services or seductive acts in exchange for cash or commodities(2). People exchange sex for a variety of reasons, including choice, situation, or force, the same as they do with every other kind of work under capitalism (3). There are approximately 200,000 female sex workers (FSWs) in Bangladesh (4). These FSWs are dispersed over a spectrum of urban and rural areas, where they work as independent sex workers or in brothels (5). Bangladesh has ‘one of the largest brothels in the world’ in Daulatdia, Rajbari district (6). It accommodates approximately 2000 sex workers(7). Over the past decade, the socioeconomic status of sex workers in Bangladesh has improved due to the combined efforts of NGOs and the legalization of brothels and red-light areas. Nevertheless, despite these advancements, sex workers continue to face marginalization (8). Social exclusion and social stigma play a significant role in economic models of sex work(9, 10). Mondal et al. reported that 96% of sex workers in Bangladesh are mothers with a mean of two children (11). Since prostitution is forbidden and considered taboo in most countries, children born into this profession are neglected, which increases their vulnerability and makes them feel marginalized and deprived, significantly affecting their overall physical and psychological development (12, 13). These children live in a harmful social environment characterized by alcoholism and substance abuse. This environment poses significant challenges, including limited access to healthcare and education, separation from parents, and lack of proper supervision. As a result of these challenges, many of these children end up pursuing the same professions they were exposed to during their childhood (14–16). Oral disorders encompass any anomalies in the morphology or functionality of teeth and supporting tissues. Mostly, these are dental caries caused by gradual decalcification of tooth enamel, diseases of the oral mucosa, and periodontal disease stemming from inflammation of the tissues supporting teeth. Dental caries, one of the leading oral disorders among children, is closely associated with inadequate oral hygiene habits (17–19). However, oral diseases pose a significant burden on socially marginalized communities, largely because they face barriers to accessing preventive measures and treatment (20).In rural regions of Bangladesh, especially those with limited income and education, people do not fully utilize oral health services because of restricted availability or inadequate access to such services (21). Poverty can lead to various issues, including financial instability, lower levels of maternal education, and inadequate knowledge, attitudes, and practices related to children's oral health. These barriers often impede mothers from ensuring proper oral healthcare for their children (22–24). In the context of family dynamics, the importance of the mother's role in a child's oral health behaviors and condition has been highlighted (25, 26). Studies have examined the maternal roles of sex (27–31). yet there is a scarcity of research focusing on the offspring of individuals in the sex work industry (11, 32–34). To our understanding, only a single study has concentrated on the oral health status of female sex workers(35), while the oral health condition of their children remains underexplored. With the intention of bridging the gap in the existing scientific field, our research aimed to evaluate the knowledge, attitude and practices (KAP) of FSWs regarding their children's oral health, as well as the oral health status of their children in Dhaka, Bangladesh.

Study Design:

A cross-sectional study design was applied to assess the oral health knowledge, attitude and practices of female sex workers/institutional caregivers regarding their children from March 2023 to February 2024. The convenience sampling technique was used as it was very challenging to source the current sample due to the dearth of documentation available.

Study Area:

To gain access to the study area, we partnered with Project Pothchola, a program by the Give Bangladesh (GB) Foundation that focuses on supporting the children of sex workers. Through their cooperation, we were granted access to Daulatdia Brothel and three shelter homes located in Dhaka city. For data collection, two nonprofit organizations (NPO), Shishuder Jonno Amra (SJA) and KK Foundation(KKF) and one day care center, BASHA, in Dhaka City were conveniently selected. In addition, one nongovernmental organization (NGO), Mukti Mohila Shamity (MMS) located near Daulatdia Brothel, was also conveniently selected. BASHA rescued sex workers and their children from different brothels in Bangladesh and provided income-generation opportunities to sex worker mothers. Similarly, the Shishuder Jonno Amra(SJA) and KK Foundation provide residential, educational and medical care to the children of sex workers respectively. Additionally, Mukti Mahila Samity (MMS), a women's and children's rights organization, was established under the ALO (Alternative Livelihood Opportunity) initiative with funding from the Foundation for Humanity and Global Affairs in Canada. MMS focuses on providing child development program for the children of sex workers from Daulatdia brothel.

Study Sample:

The sample size calculation was based on maternal oral health knowledge regarding their children in the Bangladesh context. A standard error of 7%, a 95% confidence interval (CI) and a prevalence of 18.5%(36) of mother’s oral health knowledge of regarding their 5 to 9-year-old children in Dhaka city were used for the calculation. Our initial sample size calculation was 157. After adding 20% for the nonresponse rate, our sample size was set to 188 participants. However, after adjusting for missing values and conducting data screening, the final sample size was determined to be 180 subjects. Due to barriers to accessibility, we kept the sample size small. Data collection included 50 sample from 200 children of sex workers in MMS center, 43 data from 60 children in SJA and 80 children in KKF and 44 sample from 80 children in BASHA respectively. These samples were obtained using simple random sampling method. The study included sex worker mothers or institutional caregivers, along with their children aged 6 to 17 years old, who had no physical or mental health problems. According to the UNICEF, primary education is basically planned for children aged 6 to 11, whereas high school education is intended for students aged 12 to 17 (37).

Data collection:

Data collection included the administration of a questionnaire concerning sociodemographic characteristics and oral health knowledge attitude and practices to each FSW mother/caregiver through face-to-face interviews. We collected data from caregivers for the children staying in shelter homes(SJA, KKF) and from FSW mothers for the children staying in Daulatdia Brothel and one day care center (BASHA) in Dhaka. Oral clinical examinations were performed on children by four dentists, where two dentists calibrated their assessments according to the standard procedure described by the World Health Organization. The children were examined in the organization or daycare, where the children were seated in chairs, with the examiner positioned in front of them. The teeth were dried with cotton pellets, and for adequate sight, torchlight and natural daylight were used. The World Health Organization's recommended methods followed for scoring caries include the use of mouth mirrors and CPI ball-ended probes as examination equipment (38). A consent form was signed by the mothers and caregivers before the survey, and only female sex workers or caregivers and their children with the consent form were recruited for the study.

Research Tool:

Oral health knowledge attitude and practices of female sex workers toward their children

Oral health questions regarding knowledge, attitude and practices were adapted from a previous study conducted by Sharmila et al.(39). The questionnaire was translated into the Bangla language. For reliability testing of the questionnaire, Cronbach’s alpha was selected to measure internal consistency. A Cronbach’s alpha score exceeding 0.7 is regarded as indicative of high internal consistency, whereas scores in the range of 0.40 to 0.69 are considered to indicate moderate consistency. The reliability of the questionnaire items increases with higher Cronbach’s alpha values (40, 41). Cronbach’s alpha values for the knowledge, attitude and practice subscales were 0.81, 0.84 and 0.69 respectively. To categorize knowledge (where 80% is good and < 80% is poor), attitude (where 80% is positive and < 80% is negative), and practice (where 80% is good and < 80% is bad), Bloom's cutoff point approaches were used. This scoring technique (42) was established in compliance with the findings of Bloom et al., Engelhart et al., and Furst et al.

Assessment of oral health status

Following the World Health Organization (WHO) 2013 guidelines, dental caries was evaluated in order to determine decayed, missing, and filled teeth (DMFT) for permanent tooth indices and decayed, missing, and filled teeth (dmft) for deciduous teeth (43). The total values of dmft and DMFT were calculated separately and jointly as the sum of d + m + f + D + M + F to obtain the numerical expression of caries prevalence. The scores were assigned, and the degree of severity of dental caries was defined as dmft + DMFT = 0 (caries-free) or dmft + DMFT > 0 (caries present)(44). The individuals' gingival health status was evaluated using the gingival index (GI) (44), and their calculus and plaque density were assessed using the calculus index (CI) and plaque index (PI) (31)

Statistical analysis:

Statistical analyses were conducted using IBM SPSS version 26. A frequency distribution test was performed to explain the variables. A chi-square test was employed to determine the associations between sociodemographic variables and oral health status variables with knowledge, attitude, and practices scores, with a statistically significant p-value of < 0.05. Logistic regression analysis was applied to investigate the associations between the education level of mothers or caregivers, whether children were living with FSW mothers or institutional caregivers, their knowledge, and their attitude toward the oral health practices of their children. The covariates of this model were selected based on variables having biological and scientific plausibility with the main outcome.

The prevalence of KAP in sex worker mothers/institutional caregivers is displayed in Fig. 1. Greater than three-quarters (79%) of the mothers/caregivers had favorable knowledge regarding their children's oral health. However, only a little over one-third (37.2%) of the surveyed mothers/caregivers acknowledged that their children had embraced bad oral health practices.

Table 1 reveals that out of the 180 participants, 58.9% were female, and 56.7% fell into the age range of 6–11 years. Among the children surveyed, 72.2% resided outside the brothel, with 27.8% living alongside the brothel. In terms of the mothers' information, 41.1% were aged between 18 and 30 years, 66.7% had attained primary school education, and 69.4% had 0–2 children.

Analysis of the demographic details of the respondents' mothers revealed that maternal age was significantly associated with their oral health knowledge (p < 0.05), attitude (p < 0.05), and knowledge concerning oral health practices for children (p < 0.05).

The demographic characteristics of the children, whether they resided inside or outside the brothel were significantly associated with the mother’s oral health knowledge (p < 0.05), attitude (p < 0.001), and oral health practices of children (p < 0.001).

Table 1

Association between mothers’ knowledge, attitude, and practices and socio-demographic characteristics
Variables			Knowledge			Attitude			Practices
Demographic Information	N	%	Good N(%)	Poor N(%)	p-value	Positive N(%)	Negative N(%)	p-value	Good N(%)	Bad N(%)	p-value
Gender of children
Female	106	58.9	84(79.2)	22(28.2)	0.888	85(80.2)	21(19.8)	0.256	72(67.9)	34(32.1)	0.087
Male	74	41.1	58(78.4)	16(21.6)	0.888	54(73.0)	20(27.0)	0.256	41(55.4)	33(44.6)	0.087
Age of children
6–11 years	102	56.7	82(80.4)	20(19.6)	0.572	84(82.4)	18(17.6)	0.061	54(52.9)	48(47.1)	0.002
12–17 years	78	43.3	60(76.9)	18(23.1)	0.572	55(70.5)	23(29.5)	0.061	59(75.6)	19(24.4)	0.002
Age of mothers/caregivers
18–30 years	74		49(66.2)	25(33.8)	0.002	50(67.6)	24(32.4)	0.004	42(56.8)	32(43.2)	0.032
31–40 years	59	32.8	53(89.8)	6(10.2)		54(91.5)	5(8.5)		45(76.3)	14(23.7)
>=41 years	47	26.1	40(85.1)	7(14.9)		35(74.5)	12(25.5)		26(55.3)	21(44.7)
Education of children
Primary School	102	56.7	82(80.4)	20(19.6)	0.572	84(82.4)	18(17.6)	0.061	54(52.9)	48(47.1)	0.002
High School	78	43.3	60(76.9)	18(23.1)	0.572	55(70.5)	23(29.5)	0.061	59(75.6)	19(24.4)	0.002
Education of mothers/caregivers
Primary or less	120	66.7	93(77.5)	27(22.5)	0.518	93(77.5)	27(22.5)	0.9	70(58.3)	50(41.7)	0.081
Secondary or higher	60	33.3	49(81.7)	11(18.3)	0.518	46(76.7)	14(23.3)	0.9	43(71.7)	17(28.3)	0.081
Mother/ institutional caregiver
FSW Mother	97	53.9	63(64.9)	34(35.1)	< 0.001	61(62.9)	36(37.1)	< 0.001	47(48.5)	50(51.5)	< 0.001
Institutional Caregiver	83	46.1	79(95.2)	4(4.8)	< 0.001	78(94.0)	5(6.0)	< 0.001	66(79.5)	17(20.5)	< 0.001
Area of residence
Inside brothel (Daulatdia)	50	27.8	34(68.0)	16(32.0)	0.026	29(58.0)	21(42.0)	< 0.001	24(48.0)	26(52.0)	0.011
Outside brothel (Dhaka)	130	72.2	108(83.1)	22(16.9)	0.026	110(84.6)	20(15.4)	< 0.001	89(68.5)	41(31.5)	0.011
Pearson’s Chi-square test, bold number indicate p < 0.05

The caries status of the children was distinctively associated with their oral health knowledge (p < 0.05) and knowledge about oral health practice (p < 0.05)of the children(Table 2). Additionally, it was established that mothers’ knowledge of oral health practices for children was significantly associated with the education (p < 0.05) and age of the children (p < 0.05).

Table 2

Association between mothers’ knowledge, attitude, and practices and oral health status
Variables			Knowledge			Attitude			Practices
Oral Health Status	N	%	Good N(%)	Poor N(%)	p-value	Positive N(%)	Negative N(%)	p-value	Good N(%)	Bad N(%)	p-value
Caries
Caries Free	85	47.2	73(85.9)	12(14.1)	0.03	68(80.0)	17(20.0)	0.401	63(74.1)	22(25.9)	0.003
Caries Present	95	52.8	69(72.6)	26(27.4)	0.03	71(74.7)	24(25.3)	0.401	50(52.6)	45(47.4)	0.003
Plaque
Absent	52	28.9	39(75.0)	13(25.0)	0.415	36(69.2)	16(30.8)	0.103	28(53.8)	24(46.2)	0.114
Present	128	71.1	103(80.5)	25(19.5)	0.415	103(80.5)	25(19.5)	0.103	85(66.4)	43(33.6)	0.114
Calculus
Absent	67	37.2	51(76.1)	16(23.9)	0.483	47(70.1)	20(29.9)	0.081	34(50.7)	33(49.3)	0.01
Present	113	62.8	91(80.5)	22(19.5)	0.483	92(81.4)	21(18.6)	0.081	79(69.9)	34(30.1)	0.01
Gingivitis
Absent	117	65	96(82.1)	21(17.9)	0.153	93(79.5)	24(20.5)	0.323	72(61.5)	45(38.5)	0.639
Present	63	35	46(73.0)	17(27.0)	0.153	46(73.0)	17(27.0)	0.323	41(65.1)	22(34.9)	0.639
Pearson’s Chi-square test, bold number indicate p < 0.05

Regarding the demographic characteristics of the children, residing inside or outside the brothel (Table 3) was significantly associated with age of children (p < 0.001), education level of children (p < 0.001), and whether the child lived with the mother or caregiver (p < 0.001)(Table 2). A significant association was found between the living area of the respondents (whether inside or outside the brothel) and the age of the mother/caregiver (p < 0.0001), as well as the number of children the mother had (p < 0.05).

Table 3

Association between children’s place of residence and socio-demographic factors
Variables	Children's Place of Residence
Demographic Information	N	%	Inside brothel(Daulatdia) N(%)	Outside brothel (Dhaka) N(%)	p-value
Gender of children
Female	106	58.9	28(26.4)	78(73.6)	0.625
Male	74	41.1	22(29.7)	52(70.3)	0.625
Age of children
6–11 years	102	56.7	45(44.1)	57(55.9)	< 0.001
12–17 years	78	43.3	5(6.4)	73(93.6)	< 0.001
Age of mothers/caregivers
18–30 years			32(43.2)	42(56.8)	< 0.001
31–40 years	59	32.8	16(27.1)	43(72.9)
>=41 years	47	26.1	2(4.3)	45(95.7)
Education of children
Primary School	102	56.7	45(44.1)	57(55.9)	< 0.001
High School	78	43.3	5(6.4)	73(93.6)	< 0.001
Education of mothers/caregivers
Primary or less	120	66.7	35(29.2)	85(70.8)	0.556
Secondary or higher	60	33.3	15(25.0)	45(75.0)	0.556
Mother/ institutional caregiver
FSW Mother	97	53.9	49(50.5)	48(49.5)	< 0.001
Institutional Caregiver	83	46.1	1(1.2)	82(98.8)	< 0.001
Pearson’s Chi-square test, bold number indicate p < 0.05

Analyzing the oral health-related details of the children (Table 4), associations were reported between living inside and outside the brothel and caries (p < 0.05), plaque (p < 0.001), and calculus(p < 0.001) in the children.

Table 4

Association between children’s place of residence and oral health status
Variables	Children's Place of Residence
Oral Health Status	N	%	Inside brothel(Daulatdia) N(%)	Outside brothel (Dhaka) N(%)	p-value
Caries
Caries Free	85	47.2	16(18.8)	69(81.2)	0.011
Caries Present	95	52.8	34(35.8)	61(64.2)	0.011
Plaque
Absent	52	28.9	28(53.8)	24(46.2)	< 0.001
Present	128	71.1	22(17.2)	106(82.8)	< 0.001
Calculus
Absent	67	37.2	33(49.3)	34(50.7)	< 0.001
Present	113	62.8	17(15.0)	96(85.0)	< 0.001
Gingivitis
Absent	117	65	37(31.6)	80(68.4)	0.116
Present	63	35	13(20.6)	50(79.4)	0.116
Pearson’s Chi-square test, bold number indicate p < 0.05

Table 5 shows predictors of having good oral health practices of children according to mothers or caregivers. Children living with sex worker mothers/institutional caregivers who had higher educational attainment were 3 times more likely to practice good oral health hygiene than those with mothers/caregivers of low educational level (OR = 3.27, β:1.11, p-value < 0.05, CI = 1.36–7.87). Children who were living with mothers exhibited 87.4% less good oral health practices than the children who were living with institutional caregivers (OR = 0.126, β: -2.075, p-value < 0.05, 95% CI: 0.021–0.767). Similarly, Children living with mothers/caregivers who had good oral health knowledge scores tend to have 3 times higher oral health practice scores compared to those with poor oral health knowledge(OR = 3.20, β:1.16, p-value < 0.05, CI = 1.36–7.87). However, No association was found between oral health attitude and practice level among them.

Table 5

Logistic regression model exploring predictors of Self-reported Oral health practices among the children according to mothers/caregivers
Variables	β	St.Error	Wald	df	p-value	OR	95%CI
Education of Mothers	1.11	0.44	7.03	1	0.008	3.27	1.36–7.87
FSW Mother/Institutional caregiver	-2.075	0.923	5.048	1	0.025	0.126	0.021–0.767
Knowledge	1.16	0.59	3.85	1	0.049	3.20	1.00-10.25
Attitude	-0.70	0.71	0.97	1	0.32	0.49	0.12-2.00

Logistic regression analysis, bold number indicate p < 0.05, OR: Odds ratio, CI: Confidence interval.Hosmer-Lemeshow test showed that p-value = 0.170 indicates that the model is a good fit for the data.

Children from brothels are viewed by society as the most “tainted” or “rotten.” Whether because of their actual engagement in the prostitute industry or just by affiliation, they bear a sense of shame about their origins (45). Even though children of sex workers are a socially excluded group, no attention has been paid to the oral health issues except education, health, and social well-being of the children (11, 32). The present study findings focused on sex worker mothers’ knowledge, attitude, and practices toward the oral health of their school-going children, which have not been previously reported.

The prevalence of mothers’ knowledge, attitude, and practices regarding their children was significantly associated with the mother's age. Similar associations were suggested by Jain et al.(46). FSW mothers/caregivers demonstrated a good level of knowledge (78.9%) concerning the oral health of their children. This finding is consistent with previous studies in which populations share similar cultural norms (47). However, reports from other populations have displayed contradictory findings (48). The difference in the knowledge level of mothers may be related to different contexts in different countries. Despite the relatively good dental health knowledge of female sex workers/caregivers, the knowledge has not been fully reflected in the practices of their children. Nonetheless, the existing literature indicates that parental knowledge, attitude, and beliefs affect a child's dental health (49).

Of those mothers who were well aware of their children's oral health practices, 52.6% had caries and 69.9% had dental calculus. Female sex workers suffer in an exceedingly challenging context of the stigma associated with the sex work profession, HIV status, and human rights breaches(50). The children’s oral health was found to be greatly impacted by their mothers’ employment activities (51). It has been shown that the lower the material standard of living conditions as defined by money, social class, and social network- and support is, the more the level of oral health deteriorates, regardless of the metrics used, whether clinical or self-reported oral health indicators (52).

Children of FSWs living outside of the brothel significantly exhibit good oral health practices compared to children of FSWs living inside the brothel. Sex worker mothers rarely have enough time for these frequently “unwanted” offspring due to their line of work (45). Basha, a nonprofit initiative, provides a sustainable livelihood for women who were trapped in the sex trade, experiencing deep shame and a desperate need for freedom. It provides literacy courses, vocational skill training, counseling, health, and parenting classes to the women. The organization's daycare facility provides educational lessons and other extracurricular activities for the women's children while they are enrolled in the training program (53, 54). This holistic approach may elucidate why children living in brothels exhibit poorer dental health compared to those residing in institutional care settings.

According to our findings, children of FSW mothers or institutional caregivers with high educational experience exhibit good oral health practices compared to mothers/caregivers with less formal education. This finding suggests that maternal education plays a critical role in promoting the oral health behavior of their children. However, parallel findings have also been discussed by Jain et al. and Vann et al.(46) (55).

Children living with FSW mothers had poorer oral health practices compared to children living with institutional caregivers. In Bangladesh, when providers learn that the mother is a sex worker, stigma and prejudice appear to influence access to health treatments for children. Compared with mothers and children, female sex worker mothers have reported that they and their children are frequently humiliated and receive less attention (56). Stigma, criminality, and other marginalizing factors, however, limited the ability of female sex workers to become mothers and jeopardize the health, safety, and well-being of both them and their children (57).

To date, this was the first-ever study to investigate the oral health knowledge, attitude, and practices of sex worker mothers regarding their children. Furthermore, in-person interviews and dental examinations gave us additional insight into the children's oral health status.

Areas of limitations were also identified in the study. The study sample was not entirely representative of all sex workers and their school-going children in Bangladesh since the data were collected from Dhaka city and Daulatdia, Bangladesh. However, obtaining access to their source was difficult exclusively for other parts of the country. Inquiries concerning the start of the initial dental appointment and the onset of brushing and flossing teeth could introduce recall bias into the research.

Our study suggests that although FSW mothers/ institutional caregivers have better oral health knowledge regarding their children, they are unable to put this into practice for their children. Government-based dental health camps should be facilitated to acknowledge the oral health needs of the targeted group of the population. An educational approach targeting both the sex worker mother and children should be tailored so that the children can practice better oral hygiene habits. Effective oral health promotion programs should be carried out to improve oral health status for this population.

FSW

Female sex workers

NPO

Nonprofit organization

NGO

Nongovernmental organization

Human ethics and consent to participate:

The study was conducted in acocordance with the declaration of Helsinki. The Institutional Review Board/Ethics Review Committee (IRB/ERC) of North South University reviewed and approved this study(2023/OR-NSU/IRB/0204). Before interviewing each participant, all participants were thoroughly informed about the study's objectives and methods. The mothers and caregivers who were literate provided signed informed written consent. Given that a few participants lacked literacy skills, their verbal consent was obtained (47).

Consent for publication:

Not applicable

Availability of data and material:

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Registry and registration no. of the study/trial:

The Institutional Review Board /Ethics Review Committee (IRB/ERC) of North South University reviewed and approved this study(2023/OR-NSU/IRB/0204).

Source of funding:

This study has not received any specific funding.

Competing Interest:

The authors declare that they have no competing interests.

Acknowledgment:

The authors would like to thank the Institutional Review Board (IRB) of North South University for their kind approval in conducting this study. We would also like to express our heartfelt gratitude to the Give Bangladesh (GB) Foundation for providing access to each of the organizations and shelter homes in Dhaka City and Daulatdia. Furthermore, the authors acknowledge the valuable time and information participants contributed to this study.

Author contributions:

Conceptualization: Afia Mahmuda Khan, Sumaiya Zabin Eusufzai, Taseef Hasan Farook

Methodology: Afia Mahmuda Khan, Sumaiya Zabin Eusufzai, Sheikh Jamal Hossain

Software: Afia Mahmuda Khan, Sumaiya Zabin Eusufzai

Validation: Afia Mahmuda Khan

Formal Analysis: Afia Mahmuda Khan, Sumaiya Zabin Eusufzai

Investigation: Afia Mahmuda Khan, Mehnaj Sharmin, Sabrin Shohid, Tabassum Zerin, Diptendu Kumar Chanda

Resources: Taseef Hasan Farook, Mehnaj Sharmin, Sumaiya Zabin Eusufzai, Diptendu Kumar Chanda

Data Curation: Afia Mahmuda Khan, Sabrin Shohid, Tabassum Zerin, Lameea Shahed, Diptendu Kumar Chanda

Writing- Original Draft: Afia Mahmuda Khan, Sabrin Shohid, Lameea Shahed,

Writing- Review & Editing: Mohammad Delwer Hossain Hawlader, Sheikh Jamal Hossain, Taseef Hasan Farook, Sumaiya Zabin Eusufzai

Visualization: Afia Mahmuda Khan, Lameea Shahed

Supervision: Mohammad Delwer Hossain Hawlader, Sheikh Jamal Hossain, Sumaiya Zabin Eusufzai, Taseef Hasan Farook

Project Administration: Afia Mahmuda Khan, Taseef Hasan Farook , Sumaiya Zabin Eusufzai

Funding Acquisition: Taseef Hasan Farook, Mehnaj Sharmin, Afia Mahmuda Khan Sumaiya Zabin Eusufzai, Sabrin Shahid, Tabassum Zerin

Berg H. Working for Love, Loving for Work: Discourses of Labor in Feminist Sex-Work Activism. Feminist Studies [Internet]. 2022;40:693–721. Available from: https://api.semanticscholar.org/CorpusID:152198638
Open Society Foundations. Understanding Sex Work in an Open Society. Open Society Foundations [Internet]. 2019 [cited 2024 Mar 30]; Available from: https://www.opensocietyfoundations.org/explainers/understanding-sex-work-open-society
Nina Luo. Decriminalizing Survival. DATA FOR PROGRESS [Internet]. 2020 [cited 2024 Feb 21]; Available from: https://www.dataforprogress.org/memos/decriminalizing-sex-work
Tania Rashid, Soraya Auer. “I Am Not Like Before”: Sex Workers in Bangladesh’s Mega-Brothel Are Stuck in a Life of Drugs and Slavery. Vice News [Internet]. 2015 [cited 2024 Feb 25]; Available from: https://www.vice.com/en/article/bjaqam/i-am-not-like-before-sex-workers-in-bangladeshs-mega-brothel-are-stuck-in-a-life-of-drugs-and-slavery
Clark J. Bangladesh’s ignored female sex workers [Internet]. Vol. 350, BMJ (Online). BMJ Publishing Group; 2015 [cited 2024 Mar 26]. Available from: https://www.researchgate.net/publication/279629206_Bangladesh’s_ignored_female_sex_workers
Claudia Hammond. “I’m just here for survival.” The Guardian [Internet]. 2008 [cited 2024 Feb 29]; Available from: https://www.theguardian.com/world/2008/jan/09/gender.humantrafficking
Nazra Amin. Daulatdia: A Look Into One of the World’s Largest Brothels. New Security Beat [Internet]. 2019 Sep 9 [cited 2024 Mar 25]; Available from: https://www.newsecuritybeat.org/2019/09/daulatdia-worlds-largest-brothels/
ECPAT. End Child Prostitution, Child Pornography and the Trafficking of Children for Sexual Purposes (ECPAT). Global Monitoring Report on the Status of Action Against Commercial Sexual Exploitation of Children: Bangladesh. Bangkok. ECPAT. 2006;
Edlund Lena, Evelyn Korn. “A Theory of Prostitution.” Journal of Political Economy. 2002;110(1):181–214.
Cameron S. The Economics of Sin: Rational Choice or No Choice at all? Cheltenham: Edward Elgar [Internet]. 2002 [cited 2024 Mar 26]. Available from: https://bradscholars.brad.ac.uk/handle/10454/3672
Willis B, Hodgson I, Lovich R. The health and social well-being of female sex workers’ children in Bangladesh: A qualitative study from Dhaka, Chittagong, and Sylhet. Vulnerable Child Youth Stud. 2014;9(2):123–31.
Beard J, Biemba G, Brooks MI, Costello J, Ommerborn M, Bresnahan M, et al. Children of female sex workers and drug users: A review of vulnerability, resilience and family-centred models of care. Vol. 13, Journal of the International AIDS Society. 2010.
Das D. Giving the children of prostitutes their due. ICCW news bulletin. 1991;
Bletzer K V. Sex workers in agricultural areas: Their drugs, their children. Cult Health Sex. 2005;7(6):543–55.
Pokharel BR, Aryal S, Bhattarai A, Pyakuryal A, Suvedi BK, Nagar A. Situation analysis of HIV/AIDS in Nepal. Teku, Kathmandu: National Center for AIDS and STD Control. 2000;
Pandey SP, Singh AK, Pandey SK. Rehabilitation of Disadvanced Children and Women Sex Workers. 2008.
Heba A. Alkarimi, Richard G. Watt, Hynek Pikhart, Aubrey Sheiham, Georgios Tsakos. Dental Caries and Growth in School-Age Children . American Academy of Pediatrics. 2014;133(3).
Sheiham A. Dental caries affects body weight, growth and quality of life in pre-school children. Vol. 201, British Dental Journal. 2006. p. 625–6.
Mishu MP, Tsakos G, Heilmann A, Watt RG. Dental caries and anthropometric measures in a sample of 5- to 9-year-old children in Dhaka, Bangladesh. Community Dent Oral Epidemiol. 2018 Oct 1;46(5):449–56.
Paul Erik Peterson. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003;31:3–24.
Jürgensen N, Petersen PE. Promoting oral health of children through schools - Results from a WHO global survey 2012. Community Dent Health [Internet]. 2013 Dec [cited 2024 May 8];30(4):204–18. Available from: https://cir.nii.ac.jp/crid/1573387451037298944
Feldens CA, Kramer PF, Sequeira MC, Rodrigues PH, Vítolo MR. Maternal education is an independent determinant of cariogenic feeding practices in the first year of life [Internet]. 2012 [cited 2024 Apr 11]. Available from: https://link.springer.com/article/10.1007/BF03262847
Khan MAI, Rahman MM, Hossain MM, Shahin ASM. Dental Caries and associated factors among 2-5 years children attending OPD of a selected Dental Hospital in Bangladesh. Update Dental College Journal. 2013;1:2–5.
Luz PB, Pereira JT, Knorst JK, Bonfadini I, Piva F, Scapinello M, et al. The role of mother’s knowledge, attitudes, practices in dental caries on vulnerably preschool children. Pesqui Bras Odontopediatria Clin Integr. 2020;20.
Astrom AN. Parental influences on adolescents’ oral health behavior: two-year follow-up of the Norwegian Longitudinal Health Behavior Study participants. Eur J Oral Sci. 1998;106(5).
Okada M, Kawamura M, Kaihara Y, Matsuzaki Y, Kuwahara S, Ishidori H, et al. Influence of parents’ oral health behaviour on oral health status of their school children: an exploratory study employing a causal modelling technique. Int J Paediatr Dent. 2002;12(2):101–8.
Ciabattari T. Cohabitation and Housework: The Effects of Marital Intentions. Journal of Marriage and Family. 2004 Feb;66(1):118–25.
Geeta Pardeshi GP, Bhattacharya S. Child rearing practices amongst brothel based commercial sex workers. 2006;
Sloss CM, Harper GW. When Street Sex Workers Are Mothers. Vol. 33, Archives of Sexual Behavior. 2004.
Das D. Giving the children of prostitutes their due. ICCW News Bull. 1991;39(3–4):31–7.
Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22(1):121–35.
Jannat T, Letchamanan H. The Role of Safe Home in Accessing Education for the Children of Sex Workers in Bangladesh 78 Tasnim Jannat and Hema Letchamanan. Vol. 1, APJFES. 2022.
Blanchet T. Lost innocence, stolen childhoods. Dhaka: University Press [Internet]. 1996 [cited 2024 Feb 20]; Available from: https://www.scirp.org/reference/referencespapers?referenceid=2006998
Arefeen H and HS. Situation of children of homeless sex workers in Dhaka City. Dhaka: Save the Children Demark. 2006;
Nouaman MN, Meless DG, Coffie PA, Arrivé E, Tchounga BK, Ekouévi DK, et al. Oral health and HIV infection among female sex workers in Abidjan, Côte d’Ivoire. BMC Oral Health. 2015;15(1).
Tamannur T, Das SK, Nesa A, Nahar F, Nowshin N, Haque Binty T, et al. Mothers’ knowledge and practices towards oral hygiene of their children aged 5-9 years old: a cross-sectional study in Dhaka [Internet]. 2024 Apr [cited 2024 May 25]. Available from: https://www.medrxiv.org/content/10.1101/2024.04.05.24305403v1
UNICEF. UNICEF Data: Monitoring the situation of children and women [Internet]. 2022 Jun [cited 2024 May 24]. Available from: https://data.unicef.org/topic/education/primary-education/
World Health Organization. Oral health surveys: basic methods. World Health Organization; 1997.
M. K. JS, R. U, V. M. AE. Knowledge, attitude and practice on oral hygiene among primary school children in an urban area of Kancheepuram district, Tamil Nadu. Int J Community Med Public Health. 2019 Dec 25;7(1):311.
Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.
Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53.
Bloom BS, Engelhart MD, Furst EJ, Hill WH, Krathwohl DR. Taxonomy of educational objectives: The classification of educational goals. Handbook 1: Cognitive domain. Longman New York; 1956.
WHO. Oral health surveys: basic methods. World Health Organization; 2013.
Ayan G, Dayı B. Evaluation of Plaque Index, Gingival Index and Oral Health-Related Quality of Life in Obese Patients. Odovtos - International Journal of Dental Sciences. 2023;25(1):166–78.
Uddin F and MS and SM. Growing Up in the Brothel: Children in Daulatdia and Kandapara Brothel Communities of Bangladesh. Dhaka: Save the Children Australia. 2001;
Jain R, Oswal K, Chitguppi R. Knowledge, attitude and practices of mothers toward their children′s oral health: A questionnaire survey among subpopulation in Mumbai (India). Journal of Dental Research and Scientific Development. 2014;1(2):40.
Suresh BS, Ravishankar TL, Chaitra TR, Mohapatra AK, Gupta V. Mother’s knowledge about pre-school child’s oral health. Vol. 28, Journal of Indian Society of Pedodontics and Preventive Dentistry. 2010. p. 282–7.
Alzaidi SS, Alanazi IA, Abo Nawas OM. Childhood Oral Health : Maternal Knowledge and Practice in Tabuk, Saudi Arabia. Egypt J Hosp Med. 2018 Jan;70(9):1544–51.
Petersen PE, Lennon MA. Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach. Community Dent Oral Epidemiol. 2004;319–21.
Mk G, Hm D. Level of stigma among female sex workers: comparison of two surveys of HIV behavioral data, Ethiopia. Vol. 11, African Health Sciences. 2011.
Mbawalla HS, Masalu JR, Åstrøm AN. Socio-demographic and behavioural correlates of oral hygiene status and oral health related quality of life, the Limpopo - Arusha school health project (LASH): A cross-sectional study. BMC Pediatr. 2010 Nov 30;10.
Locker D. Commissioned review. Community Dent Oral Epidemiol. 2000;28:161–70.
Basha. Basha Boutique [Internet]. 2011 [cited 2024 Feb 27]. Available from: https://www.bashaboutique.com/
Walsh SF. The EMDR Integrative Group Treatment Protocol for Ongoing Traumatic Stress with Female Survivors of Child Marriage, Trafficking, and Exploitation in Dhaka, Bangladesh [Internet]. 2020 [cited 2024 Apr 29]. Available from: https://digitalcommons.liberty.edu/doctoral/2518/
Vann Jr WF, Lee JY, Baker D, Divaris K. Oral health literacy among female caregivers: impact on oral health outcomes in early childhood. J Dent Res. 2010;89(12):1395–400.
Willis B, Hodgson I, Lovich R. The health and social well-being of female sex workers’ children in Bangladesh: A qualitative study from Dhaka, Chittagong, and Sylhet. Vulnerable Child Youth Stud. 2014;9(2):123–31.
Decker MR, Crago AL, Chu SKH, Sherman SG, Seshu MS, Buthelezi K, et al. Human rights violations against sex workers: Burden and effect on HIV. Vol. 385, The Lancet. Lancet Publishing Group; 2015. p. 186–99.
HRPP. Enrolling Subjects Who Are Legally Blind, Illiterate, or Cannot Talk or Write [Internet]. Human Research Protection Program. 2023 Aug [cited 2024 May 14]. Available from: https://irb.ucsf.edu/enrolling-subjects-who-are-legally-blind-illiterate-or-cannot-talk-or-write

No competing interests reported.

Download PDF

Editorial decision: Revision requested
30 Jul, 2024
Editor assigned by journal
30 Jul, 2024
Submission checks completed at journal
30 Jul, 2024
First submitted to journal
10 Jul, 2024

You are reading this latest preprint version

Oral Health Knowledge, Attitude and Practices of Bangladeshi Female Sex Workers toward Their School -Going Children: A Cross-Sectional Study

Status:

Version 1

Abstract

Figures

Background

Materials and Methods

Study Design:

Study Area:

Study Sample:

Data collection:

Research Tool:

Oral health knowledge attitude and practices of female sex workers toward their children

Assessment of oral health status

Statistical analysis:

Results

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1