The Involvement of Routine Dental Care in Prenatal Care as a Tool for Quality Counseling in the context of Zika in El Salvador
Dr. Lorena Arevalo, dentist UCSFI San Isidro, Cabanas sharing Zika prevention methods with patients during dental treatments
UCSFI San Isidro is one of the Health Centers in the north of El Salvador that USAID's Project Applying Science to Strengthen and Improve Health Services (ASSIST) is providing support to prevent the transmission of Zika virus. In San Isidro, pregnant women receiving care were interviewed about their knowledge of Zika , 0% knew anything about Zika. The lack of knowledge of the 5 key ways to prevent the disease and the lack of condom use during pregnancy generates a possibility that 13% of babies are born with microcephaly and 40% with a problem of future development.
Getting pregnant women to know about the risks of Zika before or during pregnancy and preventing the transmission of sexually transmitted Zika is a health goal for all people, including children. Using preventative measures, families would avoid future disabilities and decrease the economic and social cost to families and the State.
JE, an 18-year-old girl, ignored the risks of Zika and sought care at UCSFI to start her prenatal check-up. Once a month she walks 2 hours to get to the health center for her visits. While there, a health advisor to verifies the weight gain and searches for any pregnancy warning signs. JE has the added risk of being a pregnant teenager. When enrolled in Prenatal Control (CPN) you will have at least 5 prenatal appointments with mandatory dental care in your first visit, access to two laboratory profiles, an obstetric USG, access to multivitamins and information on nutrition, HIV, sexually tramitted infections, lactation, family planning, newborn care, violence prevention and cytology. Despite this package of services and constant visits to the establishment, there was no sure counseling on Zika. She and her partner began to be concerned about the health status of their future baby after listening to media reports.The anxiety and uncertainty of these future parents is due to the lack of quality counseling in the context of Zika in the health package, and the lack of time available for this task by health providers.
USAID began to provide technical assistance to UCSFI San Isidro in October 2017 with the objective of helping to reduce the impact of the disease. Through the participation of health workers and liaison facilitators in the health centers, the following points were emphasized to achieve quality counseling in Zika context:
- Ensure that quality counseling is provided in Zika context during dental care
- Transmit the 5 key messages emphasizing sexual transmission and correct and consistent condom use.
- Guarantee the direct delivery of condoms during dental care.
- Provide intensive and conscious counseling in an appropriate place in the corresponding health facilities on the date of your scheduled appointment.
- Ensure community adherence through visits by the promoters, one week before their appointment.
- Counsel the pregnant woman and her partner about signs and symptoms of Zika at each CPN visit to the facility.
- Reinforce counseling in Zika context in each NPC.
Dr. Galán, director of the establishment, aware of the difficult task, sent the dentist in the only place he had for the first workshop to strengthen the skills of his resources. He bravely mentioned: "if we can do it, our people need it." After her first visit to UCSFI San Isidro during the initial dental care, JE received all the pertinent information under the care of Dr. Arevalo, who kindly and in an environment of trust did the following:
- Cared for and built trust with patients
- Asked about symptoms of risk of Zika of the mother, her partner or the housing area, asked about the presence of mosquitoes. She explained the main clinical triad (rash, fever and non-purulent conjunctivitis) of the Zika virus
- Explained forms of transmission (mosquito bites, sexual and blood transfusion), and risks of contracting the disease for both babies (congenital malformations, microcephaly and CSaZ) and the carrier (SGB, and in pregnant women: miscarriages or intrauterine fetal death).
- Emphasized personal protection measures (including the delivery of condoms and emphasizing their correct and consistent use) and environmental measures.
- Asked about doubts about the disease, emphasizing that 8 out of 10 people are asymptomatic and that men can be carriers for 2 months after contracting the disease.
After 3 months of follow-up, the confidence and mood of JE as well as her partner were completely different. Through the involvement of her partner, who achieved a high understanding of condom use, they presented a positive attitude with healthy habits to avoid a possible transmission of Zika.
Today, JE helps health personnel to share the knowledge in the waiting room to every patient waiting to be attended. In July 2018 she arrived with her baby with great enthusiasm mentioning "how good that my son was born healthy, thanks to the clinic that advised me well to avoid the Zika". Dr. Galán mentions that the successful experience is "thanks to the idea of changing dental care to ensure the counseling of Zika to every pregnant woman in San Isidro.”