Oral health conditions and correlates: a National Oral Health Survey of Rwanda

Figures & data

Figure 1. The Oral Healthcare Continuum

Table 1. Definitions of Selected Variables

Independent Variable	Definition
Sex	Male or female
Age Groups	In Years (2–5, 6–11, 12–19, 20–39, 40+)
Education	Participants (age ≥20 years) indicate their highest level of education attended (None, Any primary, Some secondary, Secondary or more)
Geographic Location	Live in urban or rural area as defined by National Institute of Statistics Rwanda
Medical Insurance	Medical coverage that pays for medical or surgical care (Yes, No)
Occupation	Participants (age ≥20 years) indicate the kind of work they mainly do (Agriculture and Unskilled manual; Skilled, Technical, Professional; Student or Not working)
Oral Health Indicators	Definition
Untreated Caries	Visually detectable cavitated carious lesion on at least one deciduous or one permanent tooth (Yes, No)
Calculus	Calcified dental plaque noted by visual inspection only (Yes, No)
Frequency of cleaning	Frequency with which participant reported cleaning his/her teeth at least once per day (Yes, No)
Pain	Felt painful aching in the mouth within the 12 months preceding the survey (Yes, No)
Treatment urgency	Presence of oral pain, infection, or swelling or any condition that is life threatening (Yes, No)
Use of toothbrush	Participant indicated using a toothbrush to clean his/her teeth (Yes, No)
Use of toothpaste	Participant indicated using toothpaste to clean his/her teeth (Yes, No)
Quality of Life Indicators	Definition
Difficulty chewing	Difficulty chewing in the past 12 months because of problems with teeth, mouth or dentures (Yes, No)
Difficulty working	Difficulty doing usual jobs, attending school or participating in social activities in the past 12 months because of problems with teeth, mouth or dentures (Yes, No)
Feel self-conscious	Felt self-conscious or embarrassed within the preceding year because of teeth, mouth or dentures (Yes, No)

Table 2. Oral health indicators by demographic indicators

		Oral health indicators
Demographic Characteristics		Untreated Caries			Calculus
		Yes (n) %	No (n) %	p-value ^§	Yes (n) %	No (n) %	p-value ^§
Total		1138 (54.3)	959 (45.7)	NA	623 (29.7)	1474 (30.3)	NA
Sex	Male	439 (53.8)	377 (46.2)	.73	226 (27.7)	590 (72.3)	.11
	Female	699 (54.6)	582 (45.4)		397 (31.0)	884 (69.0)
Age (Years)	2–5	199 (49.8)	201 (50.3)	<.0001	0 (0.0)	400 (100.0)	<.0001
	6–11	239 (56.2)	186 (43.8		23 (5.4)	402 (94.6)
	12–19	177 (43.1)	234 (56.9)		83 (20.2)	328 (79.8)
	20–39	250 (56.2)	195 (43.8)		227 (51.0)	218 (49.0)
	40+	273 (65.6)	143 (34.4)		290 (69.7)	126 (30.3)
Geographic Location	Urban	271 (49.3)	279 (50.7)	.006	137 (24.9)	413 (75.1)	.004
	Rural	867 (56.0)	680 (44.0)		486 (31.4)	1061 (68.6)
Medical Insurance*	Yes	928 (54.0)	789 (46.0)	.73	504 (29.4)	1213 (70.7)	.47
	No	208 (55.0)	170 (45.0)		118 (31.2)	260 (68.8)
Education**	None	173 (65.5)	91 (34.4)	.18	191 (72.4)	73 (27.7)	<.0001
	Any primary	287 (59.5)	195 (40.5)		271 (56.2)	211 (43.8)
	Some secondary	34 (53.1)	30 (46.9)		33 (51.6)	31 (48.4)
	Secondary or more	28 (56.0)	22 (44.0)		21 (42.0)	29 (58.0)
Occupation**	Agriculture and Unskilled	400 (61.0)	256 (39.0)	.86	410 (62.5)	246 (37.5)	.002
	Skilled, Technical and Professional	72 (58.5)	51 (41.5)		56 (45.5)	67 (54.5)
	Not working and Student	50 (61.7)	31 (38.3)		50 (61.7)	31 (38.3)

^§All p values derived from χ2 tests.

*Total n = 2097. Missing data represents less than 1%.

**Data reported for participants ≥20 years of age (n = 860).

Table 3. Personal oral hygiene indicators by demographic characteristics

		Personal Oral Hygiene Practices
Demographic Characteristics		Frequency of cleaning^±			Use of toothbrush			Use of toothpaste
		≥1x/d	<1x/d	p-value ^§	Yes	No	p-value ^§	Yes	No	p-value ^§
Characteristic		n (%)	n (%)		n (%)	n (%)		n (%)	n (%)
Total		938 (44.7)	1159 (55.3)	NA	781 (37.2)	1315 (62.7)	NA	671 (32.0)	1423 (70.0)	NA
Sex*	Male	327 (40.2)	487 (59.8)	<.0001	286 (35.1)	529 (64.0)	.09	252 (30.9)	563 (69.1)	.39
	Female	611 (47.7)	669 (52.3)		495 (38.6)	786 (61.4)		419 (32.8)	860 (67.2)
Age* (Years)	2-5	83 (20.8)	316 (79.2)	<.0001	69 (17.3)	331 (82.8)	<.0001	56 (14.0)	343 (86.0)	<.0001
	6-11	137 (32.3)	287 (67.7)		106 (24.9)	319 (75.1)		95 (22.4)	330 (77.6)
	12-19	219 (53.3)	192 (46.7)		178 (43.3)	233 (56.7)		151 (36.8)	259 (63.2)
	20-39	288 (64.8)	156 (35.1)		260 (58.4)	185 (41.6)		222 (50.0)	222 (50.0)
	40+	211 (50.7)	205 (49.3)		168 (40.5)	247 (59.5)		147 (35.3)	269 (64.7)
Geo. Loc.*	Urban	391 (71.1)	159 (28.9)	<.0001	391 (71.2)	158 (28.8)	<.0001	365 (66.4)	185 (33.6)	<.0001
	Rural	547 (35.4)	1000 (64.6)		390 (25.2)	1157 (74.8)		306 (19.8)	1238 (80.2)
Med.Ins.*	Yes	766 (44.6)	951 (55.4)	.75	656 (38.2)	1060 (61.8)	.06	567 (33.1)	1147 (66.9)	.04
	No	172 (45.5)	206 (54.5)		125 (33.1)	253 (66.9)		104 (27.5)	274 (72.5)
Ed.**	None	111 (42.1)	153 (58.0)	<.0001	67 (25.4)	197 (74.6)	<.0001	53 (20.1)	211 (79.9)	<.0001
	Any primary	292 (60.6)	190 (39.4)		263 (54.6)	219 (45.4)		224 (46.6)	257 (53.4)
	Some secondary	55 (85.9)	9 (14.1)		54 (84.4)	10 (15.6)		50 (78.1)	14 (21.9)
	Secondary or more	41 (82.0)	9 (18.0)		44 (89.8)	5 (10.2)		42 (84.0)	8 (16.0)
Occ.**	Agriculture and Unskilled	326 (49.7)	330 (50.3)	<.0001	262 (39.9)	394 (60.1)	<.0001	215 (32.8)	440 (67.2)	<.0001
	Skilled, Technical and Professional	112 (91.1)	11 (8.9)		111 (91.0)	11 (9.0)		105 (85.4)	18 (14.6)
	Not working and Student	61 (75.3)	20 (24.7)		55 (67.9)	26 (32.1)		49 (60.5)	32 (39.5)

^±Frequency of cleaning ≥1x/d = participant reported cleaning their teeth one time per day or more; < 1x/d = participant reported cleaning their teeth less than one time per

^§All p values derived from χ2 tests.

*Total n=2097. Missing data represents less than 1% (Geo. Loc. = Geographic Location; Med. Ins. = Medical Insurance).

**Data reported for participants ≥20 years of age (n=860). (Ed. = Education; Occ. = Occupation).

day or not at all.

Table 4. Quality of life indicators by oral health outcomes and selected demographic characteristics

		Quality of Life Indicators
Oral Health Outcomes and Selected Demographic Characteristics		Difficulty Working^+			Difficulty Chewing			Feel Self Conscious
		Yes n (%)	No n (%)	p-value ^§	Yes n (%)	No n (%)	p-value ^§	Yes n (%)	No n (%)	p-value ^§
Total		740 (35.4)	1353 (64.6)	NA	882 (42.2)	1206 (57.8)	NA	755 (36.2)	1330 (63.8)	NA
Pain*	Yes	699 (52.2)	639 (47.8)	<.0001	831 (62.3)	504 (37.8)	<.0001	715 (53.7)	616 (46.3)	<.0001
	No	41 (5.4)	714 (94.6)		51 (6.8)	702 (93.2)		40 (5.3)	714 (94.7)
Untreated Caries*	Yes	537 (47.3)	598 (52.7)	<.0001	625 (55.3)	505 (44.7)	<.0001	555 (49.1)	576 (50.9)	<.0001
	No	203 (21.2)	755 (78.8)		257 (26.8)	701 (73.2)		200 (21.0)	754 (79.0)
Location*	Urban	144 (26.2)	406 (73.8)	<.0001	179 (32.7)	369 (67.3)	<.0001	159 (29.0)	390 (71.0)	<.0001
	Rural	596 (38.6)	947 (61.4)		703 (45.7)	837 (54.4)		596 (38.8)	940 (61.2)
Medical Insurance*	Yes	593 (34.6)	1120 (65.4)	.12	706 (31.3)	1003 (58.7)	.07	606 (35.5)	1103 (64.5)	.11
	No	147 (38.9)	231 (61.1)		175 (46.4)	202 (53.6)		149 (39.8)	225 (60.2)
Education** (≥ 20 years)	None	175 (66.5)	88 (33.5)	.02	189 (72.1)	73 (27.9)	.04	173 (65.8)	90 (34.2)	.01
	Any primary	285 (59.3)	196 (40.8)		319 (66.3)	162 (33.7)		281 (58.7)	198 (41.3)
	Some secondary	30 (46.9)	34 (53.1)		36 (56.3)	28 (43.8)		28 (43.8)	36 (56.3)
	Secondary or more	27 (54.0)	23 (46.0)		29 (58.0)	21 (42.0)		26 (52.0)	24 (48.0)
Occupation** (≥ 20 years)	Agriculture and Unskilled	414 (63.3)	240 (36.7)	.0003	448 (68.6)	205 (31.4)	.11	403 (61.7)	250 (38.3)	.02
	Skilled, Technical and Professional	70 (56.9)	53 (43.1)		78 (63.4)	45 (36.6)		68 (55.3)	55 (44.7)
	Not working and Student	33 (40.7)	48 (59.3)		47 (58.0)	34 (42.0)		37 (46.3)	43 (53.8)

+Difficulty doing usual jobs, attending school or participating in social activities.

^§All p values derived from χ2 tests.

*Total n=2097. Missing data represents less than 1%.

**Data reported for participants ≥20 years of age (n=860).

Table 5. Oral health outcomes by personal oral hygiene practices and pain

		Oral Health Outcomes
Personal Oral Hygiene Practices and Pain		Untreated Caries			Calculus
		Yes n (%)	No n (%)	p-value ^§	Yes n (%)	No n (%)	p-value ^§
Total*		1137 (54.2)	959 (45.8)	NA	622 (29.7)	1474 (60.3)	NA
Use of Toothbrush*	Yes	379 (48.5)	402 (51.5)	<.0001	238 (30.5)	543 (69.5)	.54
	No	758 (57.6)	557 (42.4)		384 (29.2)	931 (70.8)
Use of Toothpaste*	Yes	333 (49.6)	338 (50.4)	.004	212 (31.6)	459 (68.4)	.18
	No	803 (56.4)	620 (43.6)		409 (28.7)	1014 (71.3)
Frequency of cleaning*	≥ 1x/day^±	451 (48.1)	487 (51.9)	<.0001	311 (33.2)	627 (66.8)	.002
	<1x/day	687 (59.3)	472 (40.7)		312 (26.9)	847 (73.1)
Pain	Yes	865 (64.6)	475 (35.4)	<.0001	513 (38.3)	827 (61.7)	<.0001
	No	273 (36.1)	484 (63.9)		110 (14.5)	647 (85.5)

^§All p values derived from χ2 tests.

*Total n = 2097. Missing data represents less than 1%.

(±) Frequency of cleaning ≥1x/d = participant reported cleaning their teeth one time per day or more; < 1x/d = participant reported cleaning their teeth less than one time per day or not at all.

Table 6. Binary logistic regression models^§.

Characteristics	Oral Health Outcomes
	Untreated Caries n = 2094	Calculus n = 2094	Pain n = 2094
Demographics	OR [95% CI]	OR [95% CI]	OR [95% CI]
Sex
Male	1.03 [0.86–1.24]	1.89 [1.46–2.45]*	0.94 [0.77–1.15]
Female	1.00	1.00	1.00
Age (Years)
2–5	0.43 [0.32–0.58]*	<.001 [<.001–0.01]*	0.09 [0.06–0.13]*
6–11	0.60 [0.45–0.80]*	0.02 [0.01–0.03]*	0.18 [0.13–0.25]*
12–19	0.40 [0.30–0.53]*	0.09 [0.07–0.13]*	0.22 [0.15–0.31]*
20–39	0.74 [0.56–0.98]*	0.50 [0.37–0.67]*	0.42 [0.29–0.61]*
40+	1.00	1.00	1.00
Geographic Location
Urban	0.95 [0.76–1.19]	0.82 [0.61–1.11]	0.77 [0.60–0.98]*
Rural	1.00	1.00	1.00
Medical Insurance
Yes	-**	1.23 [0.91–1.67]	1.17 [0.91–1.51]
No	-**	1.00	1.00
Personal Oral Hygiene Practices
Cleaning Freq. < 1^±	1.56 [1.25–1.95]*	1.12 [0.84–1.49]	0.87 [0.68–1.11]
Cleaning Freq. ≥ 1	1.00	1.00	1.00
No use of Toothbrush	1.20 [0.94–1.52]	2.01 [1.48–2.72]*	0.74 [0.57–0.98]*
Use of Toothbrush	1.00	1.00	1.00
Characteristics	Quality of Life Indicators
Oral health Outcomes	Difficulty Working n = 2090	Difficulty Chewing n = 2085	Feel Self-conscious n = 2082
No Untreated Caries	0.40 [0.31–0.51]*	0.40 [0.32–0.51]*	0.34 [0.28–0.46]*
Untreated Caries	1.00	1.00	1.00
No Pain	0.08 [0.06–0.12]*	0.07 [0.05–0.09]*	0.08 [0.06–0.11]*
Pain	1.00	1.00	1.00
Geographic Location
Urban	0.44 [0.32–0.59]*	0.41 [0.31–0.56]*	0.53 [0.40–0.71]*
Rural	1.00	1.00	1.00
Medical Insurance
Yes	1.34 [0.99–1.79]	1.40 [1.04–1.88]*	1.33 [0.99–1.77]
No	1.00	1.00	1.00
Sex
Male	0.79 [0.62–1.01]	0.86 [0.68–1.10]	0.84 [0.67–1.07]
Female	1.00	1.00	1.00
Age (Years)
2–5	0.10 [0.07–0.16]*	0.14 [0.09–0.21]*	0.14 [0.10–0.21]*
6–11	0.16 [0.11–0.22]*	0.15 [0.10–0.21]*	0.16 [0.11–0.22]*
12–19	0.19 [0.13–0.27]*	0.19 [0.13–0.27]*	0.22 [0.15–0.31]*
20–39	0.73 [0.53–1.01]	0.54 [0.38–0.78]*	0.55 [0.40–0.75]*
40+	1.00	1.00	1.00
Personal Oral Hygiene Practices
Cleaning Freq. < 1^±	2.14 [1.60–2.87]*	1.44 [1.08–1.93]	1.25 [0.94–1.66]
Cleaning Freq. ≥ 1	1.00	1.00	1.00
No use of Toothbrush	0.50 [0.37–0.69]*	0.62 [0.45–0.84]*	0.70 [0.50–0.95]*
Use of Toothbrush	1.00	1.00	1.00

^§All results derived from multivariable logistic regression. All odds ratios presented are adjusted odds ratios; for each outcome in the table, the multivariable logistic regression model included all covariates listed underneath that outcome.

*Statistically significant (p < .05).

**Medical Insurance was not included in the multivariable logistic regression model for untreated caries.

^±Frequency of cleaning ≥1x/d = participant reported cleaning their teeth one time per day or more; < 1x/d = participant reported cleaning their teeth less than one time per day or not at all.