2022-11-17-世界卫生组织-Oral_Health_Eswatini_2022_country_profile_2页_662kb

Esuatini Oral Health Country Profile Summary

Overview

• Oral Disease Burden: High prevalence rates exist, particularly concerning untreated dental caries (most common) and periodontal disease, significant enough to impact public data captures were based on studies from 2019 (caries, periodontal disease prevalence) and mortality data from 2020 (L & OaCancer incidence).
• Health System Response: Significant weaknesses are noted across multiple domains, including policy absence/access, workforce capacity, preventive services availability, essential/advanced care inclusion, affordability, and finance.
• Risk Factors: Smoking (notably male prevalence) and sugar consumption are identified risk factors. Alcohol consumption is higher at older ages.
• Economic Impact: There are economic losses associated with oral disease treatment and prevention. The affordability of essential oral health items like fluoride toothpaste is likely a barrier (metric indicates labor days needed).
• Data/Citation: Data sourced primarily from WHO and global studies (GBD, IHME, UniFAO) with most data points from 2021 assessments unless otherwise noted (e.g., 2019 for some disease prevalence).

Detailed Summary by Section

1. Oral Disease Burden

• Caries: High prevalence is reported for both untreated deciduous (children 1-9: ~44% affected) and permanent teeth (persons >5: roughly 40% have decayed permanent teeth). Severity and impact are greatest in older populations (>60 years).
• Periodontal Disease: Severe periodontal disease is common among adults aged 15+. Treatment needs identification via indices exists.
• Edentulism: Affecting approximately 6.8% of the population aged 20+.
• Lip and Oral Cavity Cancer: This is a known cancer type, with a low incidence rate but tracked.

2. Health System Response & Policy

• Policy: No national oral health policy/strategy or action plan operational or even in drafting.
• Taxation: No effective tax on sugar-sweetened beverages (SSB).
• Financing: Essential (curative) and advanced oral health care are not covered by the largest government health financing scheme (inpatient care might be intended). Routine and preventive care is also excluded.
• Oral Health Interventions in Benefit Packages: No routine, No essential, and No advanced preventive/curative oral health interventions are included, though subject to interpretation based on underlying data sections (poor resource allocation explicitly noted elsewhere).

3. Risk Factors

• Smokeless tobacco use and alcohol consumption are particularly high among adult males (smokeless tobacco >90%, male population >50L alcohol/year).

4. Health System Capacity

• Workforce: A very limited workforce exists. Data shows only 14 dentists, 19 dental assistants/therapists, and 3 dental technicians reported in 2019 (numbers are extremely low for a population of over 2 million). The availability of oral health professionals is significantly below recommended standards (no services available = <50% need met).
• Procedures & Screening:
  • Available: Oral health screening for early detection is available.
  • Available/Urgent Care: Urgent oral/emergency treatment is available.
  • Available: Basic restorative procedures are available for existing decay in primary care settings (public sector).
  • Not Available: Preventive oral health care measures are not available/effectively implemented/capitalised.
• Availability and Affordability:
  • Fluoride toothpaste is tracked only for affordability, not quantitative use availability. The index for affordability requires 1 labor day per person, indicating high affordability for FD toothpaste (≤1 day needed).

5. Risk Factor Data

• Specifically quantified diet index: High sugar availability (raw refined equivalent ~66g/day).
• Quantified current tobacco use (Smoked/Smokeless – defined daily patterns).
• Quantified alcohol consumption (pure alcohol).
• Total estimated population exposure for NCD factors included.

6. Economic Impact

• Estimated Expenditure: Total spending on dental healthcare was ~US$14 million (probably underestimated, perhaps includes public only). Per capita dental healthcare expenditure ~US$12.
• Lost productivity due to oral diseases is estimated at ~US$14 million.
• Given: Limited interventions/financing coverage and workforce capacity, the economic impact is underweight relative to disease burden.

7. Notes

• Noma (cancrum oris) is not recognized as a national public health problem.
• Data completeness and recency vary (noted).

Overall Conclusions

• Esuatini faces a substantial burden of oral diseases (caries, periodontology), especially among key age groups.
• The health system response is severely underdeveloped and ineffective.
• Key system failures include lack of strategic direction, workforce shortages, crucial services not available (primary/secondary prevention/urgent care) or in finance (no/limited oral contained in national packages), absence of key policy levers (SSB tax), and limited understanding/impact on economic burden.

Disclaimer: This summary is based on the provided text data. Context and underlying data assumptions should be considered.