Title: Comparing the oral health profiles of 14 African countries: An analysis of WHO STEPS
Abstract:
Rationale and Objectives: Oral diseases affect 3.7 billion people worldwide and are disproportionately burdensome in low- and middle-income countries, many being in the African Region. Despite this, surveillance data from the African region remains underused. This study aimed to describe and compare oral health indicators and social gradients in oral health across several African countries.
Methods: Oral health data from cross-sectional WHO STEPS surveys for adult participants from 14 African countries (2014-2023) were analysed. Weighted and age-standardised prevalence of oral health outcomes (number of natural teeth, self-rated oral health, dental pain, functional limitations) and behaviours (toothbrushing frequency, fluoride toothpaste use, dental visits) was assessed. Educational attainment was used to examine social gradients.
Results: There were important variations in the prevalence of oral conditions across the included countries. The proportion of adults retaining 20+ natural teeth ranged from 67% in Algeria to 97% in Ghana. Good self-rated oral health was reported by only 34% of respondents in Cape Verde, whereas in Benin the prevalence was 78%. Dental pain was most common in Algeria (43 %) and least common in Benin (17 %). In many of the examined countries, over 80 % of respondents had never received dental care. The prevalence of twice-daily brushing varied widely, from 91% in Cape Verde to 18 % in Rwanda. Fluoridated toothpaste use was highest in Ghana (97 %) and lowest in Cape Verde (35 %). In most of the included countries, tooth retention, self-rated oral health, and dental pain all showed stepwise gradients by educational level, with higher attainment linked to more favourable outcomes. However, this was not always uniform, with Algeria and Cape Verde showing markedly steep gradients in tooth retention by educational level, while Uganda showed a mixed gradient in the same category, with less retention at the highest educational level compared to the level before.
Conclusion: This analysis revealed high levels of poor oral health and unmet needs across the included African countries. Untreated pain, poor self-rated oral health, and limited access to care were common. Also, there were consistent educational gradients in outcomes. These findings highlight the need to integrate oral health into national NCD policies, prioritise equity-driven service delivery, and use tools like STEPS to monitor progress towards Universal Health Coverage.
