Affordability of essential medicines: The case of fluoride toothpaste in 78 countries

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Affordability of essential medicines : The case of fluoride toothpaste in 78 countries

Background Fluoride toothpaste (FT) has recently been included in the WHO Model List of Essential Medicines. Whereas it is essential for preventing dental caries, its current affordability around the globe remains unclear. This study aimed to analyse the affordability of FT in as many as possible countries worldwide, to capture the extent of variations in FT affordability between high-, middle- and low-income countries. Methods A standardized protocol was developed to collect country-specific information about the characteristics of the cheapest available FT at a regular point of purchase. 82 members of the WHO Global Oral Health Network of Chief Dental Officers (CDOs), directors of WHO Collaborative Centres and other oral health experts collected data using mobile phone technology. In line with established methodologies to assess affordability, the Fluoride Toothpaste Affordability Ratio (FTAR) was calculated as the expenditure associated with the recommended annual consumption of FT relative to the daily wage of the lowest-paid unskilled government worker (FTAR >1 = unaffordable spending on fluoride toothpaste). Results There are significant differences in the affordability of FT across 78 countries. FT was strongly affordable in high-income countries, relatively affordable in upper middle-income countries, and strongly unaffordable in lower middle-income and low-income countries. The affordability of FT across WHO Regions was dependent upon the economic mix of WHO Regions’ member states. Conclusion FT is still unaffordable for many people, particularly in low-income settings. Strategies to improve the universal affordability of FT should be part of health policy decisions in order to contribute to reducing dental caries as a global public health problem

Political priority of oral health in Italy: an analysis of reasons for national neglect

Purpose Oral health remains a neglected area and its political priority on most national agendas is low. This analysis aimed to identify the political priority of oral health in Italy. Background Italian public health services are decentralised at the regional level and are financed by both central and local authorities. Despite certain legally guaranteed public oral health services, access to oral health care seems to be inhomogeneous. Methods Appraisal of the political priority of oral health in Italy uses the Political Power Framework as proposed by Shiffman and Smith. Results and Discussion There is no clear mandate for leadership or coordination within the oral health sector, resulting in fragmentation and in dominance of the private sector. As a consequence, oral diseases are mainly addressed through a curative rather than a preventive public health approach. Current, systematic and representative data are lacking. Therefore, the real burden of oral diseases is unknown and thus cannot be addressed adequately. Evidence-based, cost-effective and sustainable population-wide public dental health interventions are not implemented on a large scale, and growing inequities in terms of access to care are not seen as a concern. Conclusion Lack of relevant policies with a public health focus, absence of systematic oral health surveillance and limited access to care for large population groups are strong indicators that oral health is not a political priority. However, opportunities in the wider political environment could be used to facilitate analysis, discussion and change in order to improve political priority of oral health in Italy

Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention

This study evaluated the impact of packaged interventions for operation and maintenance (O&M) on the usability and cleanliness of toilets in public schools in the Philippines. In this cluster-randomized controlled trial, the divisions of Roxas City and Passi City were randomly assigned to the intervention or control group. Schools in Roxas City (n = 14) implemented the packaged O&M interventions; schools in Passi City (n = 16) formed the control group. Outcome variables were toilet usability-defined as accessible, functional and private-and toilet cleanliness, measured using the Sanitation Assessment Tool (SAT) and the Cleaner Toilets, Brighter Future (CTBF) instruments at baseline and at four months follow-up through direct observation of school toilets. SAT results showed that intervention schools had a 32.0% (4.6%; 59.3%) higher percentage of usable toilets than control schools at follow-up after full adjustment (p = 0.024). CTBF results found a similar result, although this was not statistically significant (p = 0.119). The percentage of toilets that were fully clean was 27.1% (3.7%; 50.6%) higher in intervention schools than in control schools after adjustment (p = 0.025). SAT results also showed an improvement in cleanliness of toilets in intervention schools compared to those in controls, but this did not remain significant after adjustment. The findings indicate that the additional implementation of O&M interventions can further stimulate progress towards reaching Water, Sanitation and Hygiene service levels aligned with the Sustainable Development Goals

A competency matrix for global oral health.

The Lancet Commission on Education of Health Professionals for the 21(st) Century calls for enhancing health education for the needs and challenges of the 21st century to improve health status globally. To complement the Lancet report, this article makes recommendations for including core global health competencies in the education of health care professionals and specific groups of the public who are relevant to oral health in a global context in order to tackle the burden of oral diseases. Experts from various professional backgrounds developed global oral health competencies for four target groups: Group 1 was defined as dental students, residents/trainee specialists (or equivalent), and dentists; Group 2 was community health workers, dental hygienists, and dental therapists (or the equivalent); Group 3 was health professionals such as physicians, physician assistants, nurses, nurse practitioners, and pharmacists; and Group 4 was non-health professionals in the public arena such as parents, teachers, decision makers, key opinion leaders, and health and consumer advocates. Key competencies for members of each of the four target groups are presented in a matrix. The suggested competency matrix shows that many other health professions and groups in society have potentially crucial roles in the prevention, control, and management of oral diseases globally. Workforce models including a wider range of professionals working together as a team will be needed to tackle the burden of oral diseases in an integrated way in the broader context of non-communicable diseases. Further discussion and research should be conducted to validate or improve the competencies proposed here with regard to their relevance, appropriateness, and completeness

Nutritional status, dental caries and tooth eruption in children: a longitudinal study in Cambodia, Indonesia and Lao PDR

Abstract Background Untreated dental caries is reported to affect children’s nutritional status and growth, yet evidence on this relationship is conflicting. The aim of this study was to assess the association between dental caries in both the primary and permanent dentition and nutritional status (including underweight, normal weight, overweight and stunting) in children from Cambodia, Indonesia and Lao PDR over a period of 2 years. A second objective was to assess whether nutritional status affects the eruption of permanent teeth. Methods Data were used from the Fit for School - Health Outcome Study: a cohort study with a follow-up period of 2 years, consisting of children from 82 elementary schools in Cambodia, Indonesia and Lao PDR. From each school, a random sample of six to seven-year-old children was selected. Dental caries and odontogenic infections were assessed using the World Health Organization (WHO) criteria and the pufa-index. Weight and height measurements were converted to BMI-for-age and height-for-age z-scores and categorized into weight status and stunting following WHO standardised procedures. Cross-sectional and longitudinal associations were analysed using the Kruskal Wallis test, Mann Whitney U-test and multivariate logistic and linear regression. Results Data of 1499 children (mean age at baseline = 6.7 years) were analyzed. Levels of dental caries and odontogenic infections in the primary dentition were significantly highest in underweight children, as well as in stunted children, and lowest in overweight children. Dental caries in six to seven-year old children was also significantly associated with increased odds of being underweight and stunted 2 years later. These associations were not consistently found for dental caries and odontogenic infections in the permanent dentition. Underweight and stunting was significantly associated with a lower number of erupted permanent teeth in children at the age of six to seven-years-old and 2 years later. Conclusions Underweight and stunted growth are associated with untreated dental caries and a delayed eruption of permanent teeth in children from Cambodia, Indonesia and Lao PDR. Findings suggest that oral health may play an important role in children’s growth and general development. Trial registration The study was restrospectively registered with the German Clinical Trials Register, University of Freiburg (trial registration number: DRKS00004485; date of registration: 26th of February, 2013)