Oral health in lower middle-income African societies - surprising outcomes and strategic consequences

Abstract

Objective: To assess the oral health status of the population in selected African countries and compare the outcomes with emerging and highly developed countries worldwide using quantifiable results. Method: By means of a composite indicator - the Dental Health Index (DHI) - the dental status of a country´s entire population is measured to arrive at a ranking of oral health performance. This performance is then compared with countries belonging to other development stages. The present study is descriptive and, whenever possible, uses existing epidemiological data from national representative surveys. Results: With the exception of Rwanda, the Sub-Saharan African countries performed better than the three North African countries of Egypt, Morocco and Tunisia, although the Arabic-speaking countries have higher Human Development Indices by comparison. Within Sub-Saharan Africa, the best rankings were achieved by Uganda, Kenya and Nigeria. However, the other Sub-Saharan countries studied also exhibited similarly low DHIs. Rwanda, Egypt, Tunisia and Morocco ranked last. One striking finding is that the Sub-Saharan countries studied show more favourable DHI outcomes than emerging or high-income countries. As large parts of the African population have been widely untouched for decades by dental services, the relatively favourable outcomes in African societies are difficult to explain and contradict conventional dental theory. The reasons behind this finding are not fully understood. It is only in the area of untreated oral diseases that the African countries perform much worse than the more developed countries. Conclusion: If African countries were to concentrate their scarce resources on a few vital segments of oral health, they would have the opportunity, in light of favourable morbidity structures, to gradually improve the oral health status of large parts of the population. Should they choose this route, priority should be given to the young generation. Three key action fields are decisive: mobilising oral self-care, enlarging the dental workforce by training sufficient mid-level personnel and creating a true primary oral health care system which is community-centred and complemented by strictly preventive, minimally invasive and tooth-retaining treatments under the guidance of a strong public sector.