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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