Diagnosis of Newly Delivered Mothers for Periodontitis with a Novel Oral-Rinse aMMP-8 Point-of-Care Test in a Rural Malawian Population
Abstract
:1. Introduction
2. Results
2.1. Patient Characteristics of Included and Excluded Participants
2.2. Covariates/Cofactors of aMMP-8 Test Results
2.3. The Association between aMMP-8 Test Results and ABL and PAL
2.4. Screening Utility of the aMMP-8 Test for Alveolar Bone Loss Cases
3. Discussion
4. Materials and Methods
4.1. Design, Study Site, Participants, and Enrolment
4.2. Data Collection
4.3. Ethics
4.4. Statistical Methods
4.4.1. Descriptive Analysis of Study Population and Variable Definitions in Statistical Analysis
4.4.2. Association between the aMMP-8 Test and Extent of ABL or PAL
4.4.3. Relative Size of Association between the aMMP-8 test and ABL in Comparison to PAL
4.4.4. Screening Utility of the aMMP-8 Test to Correctly Identify Periodontitis Referring to ABL Cases
5. Patents
Author Contributions
Acknowledgments
Conflicts of Interest
References
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Patient Characteristics | |||
---|---|---|---|
Included (n = 461) | Excluded (n = 25) | ||
Mean (95% CI)/Count (%) | Mean (95% CI)/Count (%) | ||
General Health Characteristics | |||
Mother Age (years, self-reported) | 24.8 (24.2–25.3) | - | |
BMI (kg/m2) | 23.2 (22.9–23.5) | 22.3 (21.1–23.4) | |
CRP (mg/L) | 33.5 (31.0–36.0) | 41.9 (25.2–58.6) | |
CRP above 40 mg/L | 138 (30%) | 8 (32%) | |
Haemoglobin Levels (g/L) | 105 (103–106) | 106 (98–114) | |
HIV test | Negative | 411 (89%) | 18 (72%) |
Positive | 48 (10%) | 7 (28%) | |
Not Tested | 2 (1%) | 0 | |
Malaria test | Negative | 452 (98%) | 25 (100%) |
Positive | 8 (1.7%) | 0 | |
Not Tested | 1 (0.3%) | 0 | |
Oral Health Characteristics | |||
Tooth Cleaning (self-reported) | No daily basis cleaning | 0 | 0 |
Once a day | 28 (6%) | 2 (8%) | |
Twice a day | 433 (94%) | 23 (92%) | |
Tooth Cleaning Method (self-reported) | Finger | 16 (3%) | 2 (8%) |
Toothbrush | 445 (97%) | 23 (92%) | |
aMMP-8 Test Results | Negative | 189 (41%) | 5 (20%) |
Weak positive | 192 (42%) | 15 (60%) | |
Strong positive | 80 (17%) | 5 (20%) | |
Proportion of mothers with ABL (case) * | 116 (25%) | 8 (32%) | |
Proportion of mothers with caries | 255 (55%) | 19 (76%) | |
Proportion of mothers with PAL | 127 (28%) | 11 (44%) | |
Proportion of mothers with missing teeth | 112 (24%) | 11 (44%) |
Potential Covariates/ Cofactors of aMMP-8 Test | aMMP-8 Test Results | |||
---|---|---|---|---|
Negative (n = 189) | Weak Positive (n = 192) | Strong Positive (n = 80) | ||
Mean (95% CI)/Count (%) | Mean (95% CI)/ Count (%) | Mean (95% CI)/ Count (%) | ||
General health-related variables | ||||
Age (years, self-reported) | 24 (23–25) | 25 (24–26) | 27 (25–28) | |
Haemoglobin (g/L) | 105 (102–108) | 103 (101–106) | 106 (101–110) | |
BMI (kg/m2) | 23.5 (23–24) | 22.9 (22.5–23.3) | 23.1 (22.3–23.8) | |
CRP (mg/L) | 34.3 (30–38.5) | 34.6 (30.8–38.3) | 29 (24.3–33.7) | |
HIV | Positive | 15 (8%) | 24 (13%) | 9 (11%) |
Negative | 173 (92%) | 168 (87%) | 70 (88%) | |
Not tested | 1 (0.5%) | 0 | 1 (1%) | |
Malaria | Positive | 3 (1.5%) | 5 (3%) | 0 |
Negative | 185 (98%) | 187 (97%) | 80 (100%) | |
Not tested | 1 (0·5%) | 0 | 0 | |
Oral-health-related variables | ||||
Tooth cleaning twice a day (self-reported) | 178 (94%) | 186 (97%) | 69 (86%) | |
Tooth Cleaning Method (self-reported) | Finger | 5 (3%) | 4 (2%) | 7 (9%) |
Toothbrush | 184 (97%) | 188 (98%) | 73 (91%) | |
Number of teeth with ABL | 1.4 (1.0–1.8) | 3.0 (2.4–3.6) | 4.9 (3.7–6.2) | |
Proportion of mothers with ABL (case) | 23 (12%) | 58 (30%) | 35 (44%) | |
Number of teeth with caries | 1.6 (1.3–1.9) | 2.2 (1.8–2–7) | 1.9 (1–3–2–4) | |
Proportion of mothers with caries | 96 (51%) | 114 (59%) | 45 (56%) | |
Number of teeth with PAL | 0.4 (0.2–0.5) | 0.6 (0.5–0.8) | 0.7 (0.4–0.9) | |
Proportion of mothers with PAL | 43 (23%) | 55 (29%) | 29 (36%) | |
Number of missing teeth | 0.4 (0.3–0.5) | 0.6 (0.4–0.8) | 0.7 (0.3–1.0) | |
Proportion of mothers with missing teeth | 45 (24%) | 43 (22%) | 24 (30%) |
Outcome | Models * | aMMP-8 Test Results | |||
---|---|---|---|---|---|
Negative (n = 189) | Weak Positive (n = 192) | Strong Positive (n = 80) | p-Value (Test of Model Effects) | ||
Number of teeth with ABL | Adjusted marginal means | 1.3 (1.0–1.5) | 2.5 (2.1–3.0) | 3.5 (2.7–4.4) | <0.001 |
Pairwise comparison (mean difference) | - | 1.3 (0.7–1.9) | 2.2 (1.1–3.3) | ||
p-value(pairwise comparison) | - | <0.001 | <0.001 | ||
Number of teeth with PAL | Adjusted marginal means | 0.3 (0.3–0.5) | 0.6 (0.5–0.7) | 0.5 (0.4–0.8) | <0.05 |
Pairwise comparison (mean difference) | - | 0.2 (0.0–0.4) | 0.2 (−0.1–0.5) | ||
p-value (pairwise comparison) | - | <0.05 | >0.05 |
Outcome: aMMP-8 Test Result * | Adjusted Model (n = 461) | ||
---|---|---|---|
Explaining factors and covariates | Odds ratio (95% CI) | p-Value | |
Radiological finding | No ABL or PAL (n = 270) | 1 (ref) | <0.001 |
ABL but no PAL (n = 64) | 2.7 (1.4–5.1) | <0.05 | |
PAL but no ABL (n = 75) | 0.98 (0.59–1.7) | Ns | |
Both ABL and PAL (n = 52) | 5.7 (2.4–13.4) | <0.001 | |
Mother age | 1.00 (0.99–1.01) | Ns |
aMMP-8 Test | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Age Group | ABL Case | Negative | Positive | Measures of Diagnostic Screening Utility | ||||||
Count | Count | Sens. | Spec. | PPV | NPV | LR+ | LR– | Accuracy | ||
15–24 years | No | 114 | 111 | |||||||
Yes | 8 | 27 | 77 (60–90)% | 51 (44–57)% | 20 (16–23)% | 93 (88–96)% | 1.56 (1.25–1.96) | 0.45 (0.24–0.84) | 54% | |
25–34 years | No | 42 | 63 | |||||||
Yes | 10 | 43 | 81 (68–91)% | 40 (31–50)% | 41 (36–46)% | 81 (70–89)% | 1.35 (1.10–1.66) | 0.47 (0·26–0.86) | 54% | |
35–46 years | No | 10 | 5 | |||||||
Yes | 5 | 23 | 82 (63–94)% | 67 (38–88)% | 82 (69–91)% | 67 (46–83)% | 2.46 (1.18–5.15) | 0.27 (0.11–0.64) | 77% | |
Total | No | 166 | 179 | |||||||
Yes | 23 | 93 | 80 (72–87)% | 48 (42–54)% | 34 (31–37)% | 88 (83–91)% | 1.55 (1.35–1.77) | 0.41 (0.28–0.60) | 56% |
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Leppilahti, J.M.; Harjunmaa, U.; Järnstedt, J.; Mangani, C.; Hernández, M.; Tervahartiala, T.; Lopez, R.; Ashorn, U.; Ashorn, P.; Gieselmann, D.-R.; et al. Diagnosis of Newly Delivered Mothers for Periodontitis with a Novel Oral-Rinse aMMP-8 Point-of-Care Test in a Rural Malawian Population. Diagnostics 2018, 8, 67. https://doi.org/10.3390/diagnostics8030067
Leppilahti JM, Harjunmaa U, Järnstedt J, Mangani C, Hernández M, Tervahartiala T, Lopez R, Ashorn U, Ashorn P, Gieselmann D-R, et al. Diagnosis of Newly Delivered Mothers for Periodontitis with a Novel Oral-Rinse aMMP-8 Point-of-Care Test in a Rural Malawian Population. Diagnostics. 2018; 8(3):67. https://doi.org/10.3390/diagnostics8030067
Chicago/Turabian StyleLeppilahti, Jussi M., Ulla Harjunmaa, Jorma Järnstedt, Charles Mangani, Marcela Hernández, Taina Tervahartiala, Rodrigo Lopez, Ulla Ashorn, Per Ashorn, Dirk-Rolf Gieselmann, and et al. 2018. "Diagnosis of Newly Delivered Mothers for Periodontitis with a Novel Oral-Rinse aMMP-8 Point-of-Care Test in a Rural Malawian Population" Diagnostics 8, no. 3: 67. https://doi.org/10.3390/diagnostics8030067