International healthcare volunteering: lessons learned from efforts to put a sustainable model for emergency dentistry and oral health education into rural tanzania

Paterson, Andrew James; Milne, John; Kazimoto, J; Bagg, J.

doi:10.12968/denu.2019.46.3.197

Cited by 7 publications

(9 citation statements)

References 10 publications

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“…The observed trends in dental caries, particularly the notable reduction among adolescents and teens, alongside the decline in the number of missing teeth due to caries, are indicative of the positive impact of continuous dental outreach programs, including the one conducted in 2019 by the authors of this paper. This reduction in dental caries observed in 2023, as compared to 2019, could be attributed in part to the strategic initiatives outlined in Tanzania's Strategic Oral Health Plan (2012-2017) [18]. Despite initial challenges in implementation, the involvement of non-dentally trained health workers in providing emergency dental services in rural areas with limited oral health services has been a crucial step towards meeting oral health needs in Tanzania.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Dental Health Outcomes from Two Outreach Camps in Zanzibar, Tanzania: 2019 and 2023

Al Harthy,

Al Ismaili,

Qutieshat

2024

Oral

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Background: In low- and middle-income countries, oral health is frequently marginalized due to limited dental care access. This cross-sectional study assesses the outcomes of dental outreach camps in Zanzibar, Tanzania, organized in 2019 and 2023, to understand their impact on addressing local oral health needs over a four-year span. Methods: The study involved a thorough examination and analysis of clinical dental health data from both outreach camps. In 2019, 224 patients were examined, and in 2023, the number increased to 354. The assessment covered various dental health parameters, including dental caries, DMFT/dmft indices, enamel fluorosis, dental trauma, oral mucosa lesions, and non-carious tooth surface loss. Results: The analysis demonstrated a significant reduction in dental caries among adolescents and teens, decreasing from 62.5% in 2019 to 35.59% in 2023 (p < 0.0001). Similarly, the prevalence of teeth missing due to caries showed marked reductions from 40.2% to 9.04% in adolescents and teens (p < 0.0001) and from 25.89% to 11.86% among preschool and school-aged children (p = 0.004). Moreover, a significant change was observed in the Basic Erosive Wear Examination (BEWE) scores, with cases showing no erosive tooth wear (BEWE = 0) decreasing from 49.1% to 33.3% (p = 0.016), and cases with initial loss of enamel surface texture (BEWE = 1) increasing from 47.3% to 61% (p = 0.044). Conclusions: The outreach camps conducted in 2019 and 2023 showed tangible improvements in certain dental health metrics, particularly a reduction in dental caries and missing teeth due to caries among adolescents and teens. However, the uptick in non-carious tooth surface loss points to emerging dental health concerns. These results underline the importance of sustained and targeted dental health interventions to improve oral health outcomes in underserved communities such as Zanzibar.

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Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Dental Health Outcomes from Two Outreach Camps in Zanzibar, Tanzania: 2019 and 2023

Al Harthy,

Al Ismaili,

Qutieshat

2024

Oral

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“…Thus, these findings suggest that to achieve UHC, innovation on tackling the OHWF distribution to support rural areas is crucial [ 17 , 45 ] with the potential for models of care beyond the traditional focus of dentists with greater use of skill mix [ 17 , 23 , 24 , 46 ]. Examples include the use of dental therapists and dental health aids in Alaska [ 47 ] and Tanzania [ 48 ], and using community health workers in AFR [ 49 ]. In addition, the WHO Regional Office for Africa has been supporting the development of an e-Learning course to facilitate task-sharing of oral health promotion, oral disease prevention, early detection and referral, between oral health professionals and community health workers in order to respond to the population needs [ 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Health workforce for oral health inequity: Opportunity for action

Gallagher,

Mattos Savage,

Crummey

et al. 2024

PLoS ONE

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Oral health is high on the global agenda following the adoption of the 2022 global strategy on oral health at the 75th World Health Assembly. Given the global burden of oral disease, workforce development to achieve universal health coverage [UHC] is crucial to respond to population needs within the non-communicable disease agenda. The aim of this paper is to present an overview of the oral health workforce [OHWF] globally in relation to key contextual factors. Data from the National Health Workforce Accounts and a survey of World Health Organization [WHO] member states were integrated for analysis, together with country-level data on population and income status. Data are presented using the WHO categorisation of global regions and income status categories established by the World Bank. Workforce densities for key OHWF categories were examined. Multiple regression was used to model workforce density and contextual influences. Challenges and possible solutions were examined by country income status. There are approximately 3.30 dentists per 10,000 population globally, and a combined OHWF [dentists, dental assistants/therapists and dental prosthetic technicians] of 5.31 per 10,000. Marked regional inequalities are evident, most notably between WHO European and African regions; yet both make greater use of skill mix than other regions. When adjusted by region, ‘country income status’ and ‘population urbanization’ are strong predictors of the workforce density of dentists and even more so for the combined OHWF. Maldistribution of the workforce [urban/rural] was considered a particular workforce challenge globally and especially for lower-income countries. Strengthening oral health policy was considered most important for the future. The global distribution of dentists, and the OHWF generally, is inequitable, with variable and limited use of skill mix. Creative workforce development is required to achieve the global oral health agenda and work towards equity using innovative models of care, supported by effective governance and integrated policies.

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“…Evidence suggests that mid-level providers (such as DTs) can deliver significant primary care [67,68], and could prove a more appropriate option especially in LICs [69], where there can be difficulties in developing, and retaining, highly skilled workers like doctors and dentists [70,71]. The importance of using task-shifting and developing dental skill-mix to expand capacity in health care within Africa [72], and dental care in general, is increasingly recognized [68,69], and has been undertaken in a number of countries including Cameroon [73], and Tanzania [74]. This would seem to be the most appropriate route in SL, and therefore, the OR modelling is based on DTs and, where possible, use of NDPs rather than dentists.…”

Section: The Role Of Mid-level Providers (Dts) and Non-dental Personnel (Ndps)mentioning

confidence: 99%

Needs-led human resource planning for Sierra Leone in support of oral health

Ghotane

Don-Davis

Kamara³

et al. 2021

Hum Resour Health

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Background In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL. Methods A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the ‘International Caries Classification and Management System (ICCMS)’ tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need. Results To meet the needs of a single year-group of childrens’ needs, an average of 163 DTs (range: 133–188) would be required to deliver Conventional care (CC); 39 DTs (range: 30–45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38–68); and 27 DTs (range: 25–32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565–6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255–1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590–2236) for more extended Surgical and Preventive care (S5&6P) (range 1590–2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016–1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251–488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586–1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted. Conclusion The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.

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International healthcare volunteering: lessons learned from efforts to put a sustainable model for emergency dentistry and oral health education into rural tanzania

Cited by 7 publications

References 10 publications

Comparative Analysis of Dental Health Outcomes from Two Outreach Camps in Zanzibar, Tanzania: 2019 and 2023

Comparative Analysis of Dental Health Outcomes from Two Outreach Camps in Zanzibar, Tanzania: 2019 and 2023

Health workforce for oral health inequity: Opportunity for action

Needs-led human resource planning for Sierra Leone in support of oral health

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