Integrating Oral Health into Primary Health Care: A Systematic Review of Oral Health Training in Sub-Saharan Africa

Figures & data

Figure 1 Source selection process using PRISMA framework.

Notes: Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.³¹ doi: https://doi.org/10.1136/bmj.n71. Creative Commons Attribution (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/legalcode).

Table 1 Oral Health Training Programs for Oral Health Workers

Program	Targeted Group(s)	Intervention(s)	Outcomes	Limitations/ Suggested Improvement
Curricular transformation of health professions education in Tanzania^Citation30	Dental school	● Restructure the training curriculum to include competencies in provision of primary oral health care	↑ Contact hours in the community	Absence of follow up and evaluation
Dental education in the rural community in Nigeria^Citation8	Undergraduate Dental students	● 6- weeks rural immersion experience for students	↑Acceptance to participate in the community oral health activities	Limited funding
Training primary oral health care providers^Citation10	Universities and middle level medical colleges	● Train dental hygienist serving as primary oral health care providers	↑Number of countries training dental hygienist	Legislative restriction for scope of practice
Dental therapist training^Citation10	Universities and middle level medical colleges	● Training program for dental therapist	↑Number of countries training dental therapist or their equivalent	Legislative restriction for scope of practice

Table 2 Oral Health Training Programs for Non-Oral Health Workers

Program	Targeted Group(s)	Intervention(s)	Outcomes	Limitations/ Suggested Improvement
Training on Atraumatic Restorative Treatment (ART), Gambia^Citation14	Community oral health workers (state enrolled nurse and state registered nurse)	3-month training curriculum with Didactic, Workshop and Supervised treatment components	↑Providers trained on oral health ↑Screening services ↑ART application	Long term effects not assessed
Training traditional healers in oral health in the Bui Division, Cameroon^Citation11	Traditional healers	Workshop	↑ Provider knowledge	Limited Follow- up after training.
Training on Management of the oral manifestations of HIV/AIDS, South Africa^Citation12	Traditional healers	2- day workshop	↑recognition of oral HIV/AIDS lesions ↑ proper use of toothbrush by caregivers	No follow-up indicated
Oral Health Training for Community and Professional Health Care Workers, Kenya^Citation16	Community health volunteers, nurses, clinical officers	1-day Didactic workshop, mentorship and printed training materials	↑knowledge on OHL ↑Oral examination ↑ Diagnosis of OHL ↑ Referrals of OHL	Retrospective extraction of secondary data
Oral health promotion services in MCH, South Africa^Citation15	Nurses	Non-specific oral health training in the nursing curriculum	Oral health education given as part of health education (63%)	Non- defined oral health package No follow up
Nutrition and hygiene education, Uganda^Citation17	Nutritionist educators	Non-specific pre-service oral health training	↑ frequency of tooth brushing ↓ECC ↓Tooth bud mutilation	Presumed oral health training
Oral health promotion in Gauteng, South Africa^Citation18	Health Promotion Officers	Change of curriculum to include oral health promotion	No significant change in oral health messaging	Non- specified period of follow up Very low sample size
Interdisciplinary Educational Intervention on Nurses’ Knowledge of Perinatal and Infant Oral Health Care, Nigeria^Citation19	Primary health care Nurses	2-day workshop on perinatal and pediatric oral health (PPOH)	Increased knowledge on PPOH Inclusion of PPOH in routine health education	No follow up mentorship program therefore decay of knowledge with time
Health education intervention conducted by Primary Health Care workers on oral health knowledge and practices of nursing mothers in Lagos, Nigeria^Citation13	Community Health Officers	Non- specified intervention plus printed educational material supplements	Successful delivery of health education with increased knowledge and improved oral practices among the mothers	Use of secondary intervention through printed education material may have acted as a confounder

Notes: ↑, increase; ↓, decrease.

Abbreviations: ART, atraumatic restorative treatment; HIV/AIDS, human immunodeficiency virus/acquired immunodeficiency syndrome; OHL, oral HIV/AIDS related lesions; ECC, early childhood caries; MCH, mother and child health clinic; PPOH, perinatal and pediatric oral health.

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