RESEARCH PRIORITIES FOR ORAL HEALTH IN AFRICA

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University of the West Indies, Trinidad
RESEARCH PRIORITIES FOR ORAL HEALTH IN
AFRICA AFRICAN AND MIDDLE EASTERN FEDN. IADR 1ST
KUWAIT, SEPTEMBER 2005 2nd MOMBASA, SEPTEMBER
2009 INDIAN SOCIETY FOR DENTAL RESEARCH,
HYDERABAD, Dec 2007 Newell Johnson Foundation
Dean, School of Dentistry and Oral
Health Professor of Dental Research, Griffith
Institute for Health Medical Research Griffith
University, Queensland, Australia
University of the Western Cape
University of Nairobi
n.johnson_at_griffith.edu.au
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INTERNATIONAL COLLABORATIVE RESEARCHSTRENGTHS
OPPORTUNITIES

• LOCAL PROBLEMS OR INCREASED UNDERSTANDING FROM
  DIFFERENCES eg Kaposi sarcoma oral cancer
  fluorosis noma resistance to periodontal
  disease
• COMPLEMENTARY SKILLS RESOURCES eg case mix
  clinical skills laboratory technology
• TECHNOLOGY TRANSFERS a two way street
• COMPANIONSHIP/COLLEGIALITY/CO-OPERATION

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WEAKNESSES CONSTRAINTS

• INEFFICIENCIES, even with e-comms
• MULTIPLE AGENCIES REGULATORY AUTHORITIES
  ethics customs safety
• EXPENSIVE
• TRAVEL Time, energy, carbon footprint
• LACK OF CONTROL
• CONFLICT/COMPETITION Author order!!

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INTERNATIONAL COLLABORATIVE RESEARCHWHAT DOES IT
TAKE?

• PASSION, COMPASSION
• ENERGY, DRIVE, ENTHUSIASM
• INSIGHT
• PATIENCE, RESILIENCE
• MUTUAL RESPECT TRUST
• CULTURAL SENSITIVITIES Africa Aboriginal
  Torres Straight Islanders
• RESOURCES, but observations, their recording and
  analysis can be cheap but far-reaching eg.
  Burkett lymphoma KS fluorosis tooth retention
  

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INTERNATIONAL COLLABORATIVE RESEARCHWHAT TO BE
WARY OF!!

• ARROGANCE SELF AGGRANDISMENT
• PATRONISATION
• JEALOUSY
• CONCEIT
• IGNORANCE
• INSENSITIVITY CULTURAL, SOCIAL, PERSONAL
• MALARIA HIV SCHISTOSOMIASIS, DIARROHEA.
• ROAD TRAFFIC OTHER ACCIDENTS

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What are the needs, opportunities and priorities
for Africa/ME??

• Being part of co-ordinated health professionals
• Oral cancer
• The Mouth AIDS
• Noma
• Trauma
• Destructive periodontits
• ?Fluorosis more than caries?

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Birth Control Could Head Off Climate Crunch
Date 10-Sep-09Country UKAuthor Gerard Wynn
and Nina Chestney
LONDON - Birth control and new technologies --
not lifestyle change alone -- needed to head off
a combined climate, food and energy crunch, said
head of Britain's science academy Martin Rees
September 21, 2009. The world's population is
expected to rise by one third to more than 9
billion people by 2050, fuelling concern about
food energy shortages and greenhouse
gases. "There should not be any stigma against
stronger efforts to give women in Africa more
empowerment. There will be more than 1 billion
extra people in Africa by 2050. The Chinese
government estimates its population was 300-400
million smaller in 2008 as a result of a
one-child policy introduced in 1979. Its
population now is about 1.3 billion. The group of
eight leading developed countries committed in
Italy in July to cut their greenhouse gas
emissions by 80 percent by 2050 -- but gave no
detail of how. Politicians and economists are
reluctant to suggest that fighting climate change
will be expensive and require painful behavior
change, for example to walk more, fly less.
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Br Dent J. 2003 Jan 25194(2)91-6 Oral diseases
and socio-economic status (SES). Hobdell MH,
Oliveira ER, Bautista R, Myburgh NG, Lalloo R,
Narendran S, Johnson NW. OBJECTIVE To determine
the association between social, economic and
behavioural risk factors and national prevalences
of oral cancer, dental caries (12-year-olds) and
destructive periodontal disease
(35-44-year-olds). DATA SOURCES Sources for the
social and economic parameters were the UN
Development Program the behavioural risk
factors' source was the World Health
Organization, the UN Food and Agricultural
Organization and the World Atlas of History. Oral
diseases data came from UICC Globocan and the
World Health Organization databases. DATA
EXTRACTION Data were extracted by hand from
official publications. DATA SYNTHESIS Data were
synthesized and analyzed in sequence using SPSS,
Pearson's correlation coefficient and multiple
regression analyses. CONCLUSIONS There is a
discernable association between the three oral
diseases and the variables selected, which varies
in strength, being strongest for chronic
destructive periodontitis and weakest for oral
cancer. Dental caries lies in between. The degree
to which variables account for differences in the
three oral diseases between the countries studied
is striking, being insignificant for oral cancer
incidence, modest for oral cancer mortality,
stronger for dental caries and strongest for
destructive periodontal disease. Removing
variables with strong co-linearity with the Human
Development Index has little effect on the
regression coefficients.
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Mouth Cancer Deaths
International Classification of Diseases-10
codes C00-C14,
Territories are sized in proportion to the
absolute number of people who died from mouth and
oropharynx in one year. IARC 2002 data
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HIV/AIDS Deaths
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Source National surveillance reports and
UNAIDS/WHO/UNICEF, Epidemiological Fact Sheets on
HIV and AIDS.  July 2008.
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Annual domestic spending top 20 countries (US
2.73 billion) UNGASS reports, latest data
available (US million)
DOMESTIC PUBLIC EXPENDITURE (US Millions)
DOMESTIC PUBLIC EXPENDITURE PER CAPITA (US)
Brazil
South Africa
Russian Federation
Mexico
Thailand
Argentina
Botswana
China
UR Tanzania
Australia
Colombia
Japan
Zimbabwe
Turkey
Chile
Poland
Angola
Cuba
Iran
Ukraine
80
60
40
20
Partial data
E
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The global increase in dental caries. A pending
public health crisis ROBERT A. BAGRAMIAN,
FRANKLIN GARCIA-GODOY, ANTHONY R. VOLPE A
current review of the available epidemiology data
from many countries clearly indicates that there
is a marked increase in the prevalence of dental
caries. This global increase in dental caries
prevalence affects children as well as adults,
deciduous as well as permanent teeth, and coronal
as well as root surfaces. This prevalence
increase in dental caries clearly signals a
pending public health crisis. Although there are
differences of opinion regarding the cause of
this global dental caries increase, the remedy is
well known a return to the public health
strategies that were so successful in the past, a
renewed campaign for water fluoridation, topical
fluoride application and the use of fluoride
rinses, a return to school oral health
educational programs, and an emphasis on proper
tooth brushing with a fluoride dentifrice, as
well as flossing and a proper diet and regular
dental office visits. If these remedies are not
initiated, there could be a serious negative
impact upon the future oral health (and systemic
health) of the global community, as well as a
strain on the dental profession and a major
increase in the cost of dental services. (Am J
Dent 2009223-8). CLINICAL SIGNIFICANCE A
current review of the available epidemiology data
from many countries clearly indicates that there
is a marked increase in the prevalence of dental
caries. If remedies are not initiated, there
could be a serious negative impact upon the
future oral health (and systemic health) of the
global
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The WHO Consultative Meeting New Approaches in
Oral Health Training and Education in Africa,
Cape Town, 2002. Every head of dental training
from the continent of Africa agreed (i) To
establish a database of training institutions
(ii) To establish an African database of research
resources and infrastructure, disease profiles
and current research efforts identify
collaborative interdisciplinary research teams
identify publication opportunities (iii) To
establish an electronic listserve An African
Oral Health Education Association was formed part
of the International Federation of Dental
Education Associations. new set of Global
Goals for Oral Health by a joint working group of
the FDI World Dental Federation, WHO and the
International Association for Dental Research
(IADR) (Hobdell et al, 2003b). Appointment of
a new WHO Regional Director of Oral Health for
the Afro region, Dr Charlotte Ndyai, is
formulating implementation plans (See
http//www.afro.who.int/) new global strategy
for oral health by the new Responsible Officer at
WHOHeadquarters, (Petersen, 2004).
www.who.int/oral_health/publications/report03/en/
Preparation of an Oral Health Policy Manual
for Africa, FDI World Dental Federation and
WHO, in Nairobi, Kenya April 2004.
http//www.fdiworldental.org).
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Global Goals for Oral Health 2020Hobdell M,
Clarkson J, Petersen PE. and Johnson N(W) (2003)
Global goals for oral health 2020. International
Dental Journal 53 285-288

• Mission to Goals to Targets
• Locally relevant
• Expressed as proportional improvements
• Effect, not disease, oriented
• Include data acquisition and the evidence base
• Health systems
• Monitoring and Evaluation

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NATIONAL ORAL HEALTH POLICY AND STRATEGIC PLAN
2002-2012 EXECUTIVE SUMMARY The mission of
the Ministry of Health (MoH) is to provide
sustainable quality promotive, preventive,
curative and rehabilitative health care services
to all Kenyans. Oral health is included in this
purview. Oral health is not only the absence of
disease but also the optimal functioning of the
mouth and its tissues, in a manner, which
preserves the well being of the oral cavity and
the individuals highest level of self-esteem
(WHO 1999). The overall goal of the oral health
policy is to integrate into the National Health
Sector Strategic Plan (NHSSP, 1999-2004),
activities that ensure access to appropriate and
coordinated quality oral health care services
that aim to improve the oral health status of
Kenyans. Growing disparity in oral health status
between the urban and the rural populations, the
rich and the poor, the young and the elderly and
vulnerable groups, is the most .
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SOUTH AFRICAN NATIONAL ORAL HEALTH STRATEGY
PREAMBLE Most oral diseases are not
life-threatening but affect almost every
individual during his and her life time,
resulting in pain and discomfort, expenditure on
treatment, loss of school days, productivity and
work hours, and some degree of social stigma.
Oral conditions are important public health
concerns because of their high prevalence, their
severity, or public demand for services because
of their impact on individuals and society. Oral
disease levels appear to be increasing in major
sectors of the South African population,
especially the underserved, disadvantaged and
urbanising communities. Basic health and social
services are a human right and oral health is a
significant component thereof. Individual oral
health treatment options are not available to
most people, with few oral health promotive and
preventive activities. State dependent people
should have access to basic oral health treatment
services. Oral diseases are largely preventable
and therefore oral health promotion and primary
prevention are a top priority. Although national
goals are be of some value it is recognised that
communities and the circumstances in which they
live are extremely diverse. This strategy also
provides guidelines to oral health care workers
at district level to make the best decisions on
what oral health strategies to implement. It
allows for the most effective oral health
interventions to the specific needs,
infrastructure and resources available to each
community.
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THE REPUBLIC OF UGANDA NATIONAL ORAL HEALTH
POLICY Produced by Ministry Of Health In
collaboration with the World Health
Organization January 2007
.the importance of equity, integration,
community participation, gender, prevention and
promotion, and research as major tools to be used
in addressing the oral disease burden in Uganda.
The oral health policy outlines objectives and
suggests strategies to be followed and will
therefore improve the effectiveness and
efficiency of delivery of oral health care by
adopting safe and effective disease preventive
measures. The policy also addresses the
inequalities and disparities that affect those
least able to have resources to achieve optimal
oral health. However the success of this policy
will require the active involvement of the public
and private sector as well as the community.
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The Essential Package of Oral Health Care in
Tanzania includes Mariam J. Mwaffisi, Permanent
Secretary, Ministry of Health, Tanzania

• Emergency Oral Health Care Services in Health
  centres and dispensaries
• Prevention of Oral Diseases (School Dental
  Services and Oral Health Education at the
  Reproductive and Child Health Services Clinics)
• Oral health promotion in the communities
• Provision of curative and rehabilitative oral
  health care services at levels I,II, and III
  hospitals

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Determinants of oral health
Economic, Political Environmental Conditions
Social Community Context
Poverty Housing Sanitation Leisure
Facilities Shopping Facilities Employment Work/edu
cational environment Income Policy -
International - National -
Local Commercial Advertising
Oral Health Related Behaviour
Social norms Peer Groups Social Capital Cultural
Identity Social networks Self esteem
Individual
Sex Age Genes Biology
Diet Hygiene Smoking Alcohol Injury Service
Oral Health