Abstract
Background: Covid-19 global pandemic ravaged health and wealth
of people in developed and developing countries crippling
health care systems and economies across the globe. Despite countries
resuming normalcy powered by mass scale immunization
drives after battling sinister waves of Covid-19 epidemics, its
pervasive impact is yet to be fully explored. Early childhood caries
(ECC) ranks top among the leading chronic childhood diseases especially
among high risk toddlers and children in developing
countries and disadvantaged minority groups in developed countries.
Covid-19 induced interruptions into preventive oral health
care services compounded by lock-down related life-style changes
fostering unhealthy dietary patterns were common scenarios
in those troubled times. Against this backdrop, present study attempts
to explore and expound the impact of Covid-19 milieu on
antibiotic use among high caries risk toddlers and children attended a
public preventive oral health care unit.
Method: The study design was retrospective, hospital based,
and the study setting was the Preventive Oral Health Unit of the
National Dental Hospital (Teaching) a premier, multispecialty, tertiary
care public dental hospital in Sri Lanka. The patient statistics
data base for the year 2019 was used as the pre-Covid-19 baseline,
compared with the years of 2020 and 2021 affected by Covid-19
global pandemic. The proportionate episodes of child-patient visits
needed antibiotics for dento-alveolar infections to the total
number of child-patient visits from 1st January to 31st December each
year and during peak Covid-19 periods in 2020 and
2021 were compared. Data were entered and analysed using SPSS-21
Statistical Software Package. Frequency distributions and
descriptive statistics were used for data presentation. The means were
compared by independent sample T-Test, Mann-Whitney U
test and one-way ANOVA test of statistical significance after assessing
the distribution of data by Kolmogorov-Smirnov and Shapiro-
Wilk tests of normality.
Results: In overall, there was a proportionate increase in
presentation of symptomatic dento-alveolar infections to total visits
during the peak periods of Covid-19 waves in 2020 & 2021 compared to
respective months of pre-Covid 19 era (year 2019). The
mean percentage proportion of prescribing antibiotics to total number of
visits was 18.07 for the year 2019 whilst it was 31.25
and 32.73 for the years 2020 and 2021 respectively. Those indicated
increased use of antibiotics in Covid-19 mileu compared to
the baseline year. However, those differences did not reach statistical
significance (p=0.078) in 3-year comparison. Nevertheless,
there was a statistically significant increase (p=0.006) in percentage
proportion of prescribing antibiotics to overall visits in 2021
compared to 2019 however, the increase of prescribing antibiotics in
2020 compared to 2019 did not reach statistical significance
(p=0.319). Furthermore, comparisons of antibiotic use in months of peak
Covid-19 epidemic periods in 2020 and 2021, with
corresponding periods of pre-Covid 19 era showed statistically
significant increases (p=0.007 and p=0.0001).
Conclusions: As evident from the findings, Covid-19 milieu in
its peak periods, significantly impacted the use of antibiotics for
dento-alveolar infections of high risk toddlers and children favouring
an over- use, which could be attributed to interruptions to
proactive preventive oral health care service utilization. As overuse of
antibiotics could aggravate the existing global public health
threat of antimicrobial resistance (AMR), this becomes a cause of
concern. However, further studies are warranted to confirm the
evidence generated from this study
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