AN ASSESSMENT OF THE ORAL HEALTH SYSTEM IN NIGERIA: A CASE STUDY OF MAITAMA DISTRICT HOSPITAL

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Approximately 50% of the global population suffers from untreated dental caries, edentulousness, or periodontitis. However, these oral disorders are often disregarded as a public health concern (Ahmed & Ekarika, 2022). Oral health knowledge is lacking in low- and middle-income countries (LMICs) like Nigeria, and it is estimated that only approximately 25% of the Nigerian population has used dental treatments (Sifon, 2020). There is a paucity of up-to-date data that represents the entire nation about the prevalence of oral disorders. However, a report by Olusile (2017) indicates that oral diseases affect between 8% and 15% of the Nigerian population. The occurrence of dental caries varies from 4% to 30% in different populations, and in Nigeria, up to 90% of these populations do not receive treatment for dental caries (Orebanjo, 2017). Periodontal disorders affect a significant portion of the adult population, with prevalence rates ranging from 15% to 58%.

Dental health disorders are considered a global public health concern that requires increased attention. While poor dental health is not fatal, it diminishes the general well-being and efficiency of those afflicted (Ahmed & Ekarika, 2022). If left unaddressed, inadequate oral hygiene can ultimately have detrimental consequences on society as a whole. As per the World Health Organisation (WHO) in 2023, oral health refers to the condition of the mouth, teeth, and structures related to the mouth that allow individuals to carry out necessary functions like eating, breathing, and speaking. It also includes psychological aspects such as self-assurance, overall wellness, and the ability to interact and work without experiencing pain, discomfort, or embarrassment. The organisation and administration of the oral health care system are crucial determinants of the oral health status of any community (Vos, 2019).

Oral health care systems refer to the collective arrangements of financial resources, workforce training and organisation, legal framework, rules, and established practices that aim to enhance the oral health of individuals and the community (Umeizudike et al., 2022). An oral health system often integrates rules, training, financial resources, and organisation to enhance the dental health of individuals and entire populations (Orebanjo, 2019). The primary goal of any oral health care system is to achieve a state of good oral health. Intermediate outcomes, as defined by Cardoso et al. (2019), pertain to the oral health behaviours that are related with this goal. Nevertheless, these results are not solely a result of the oral health care system, but are also influenced by other factors, including the general health care system and the societal value system (Ayanbadejo et al., 2019). 

In Nigeria, developing countries typically lack a distinct system for oral health care, and the activities related to research, administration, and policy in the field of oral health are largely restricted. A significant section of the population in many developing countries is neglected in terms of oral health care, as the focus is mostly on providing treatment for orofacial discomfort and dental emergency (Akaj et al., 2023). There are indications that this method of oral health management has led to decreased levels of treatment and subsequently, subpar oral health in those residing in underdeveloped nations. Although there is a large amount of information available on health care systems, there is a scarcity of analysis on oral health care systems, particularly in poor countries like Nigeria (Akaj et al., 2023).

In Nigeria, as in other developing nations, oral health care relies heavily on the general health system, and oral health treatments are inadequately provided in the majority of Primary Health Centres (PHCs) throughout the country (Smith, 2021). Adeniyi et al. (2023) observed that the oral health system in Nigeria has made progress, but it still has shortcomings in terms of efficacy, efficiency, and exact description. Furthermore, the Nigerian oral health system continues to suffer from a scarcity of resources and is greatly overburdened. Dental care is typically costly and is not readily accessible in remote areas. The incorporation of oral health care into existing primary health care centres, as advocated in the National Oral Health Policy (NOHP), has been progressing slowly due to various factors, including the lack of necessary resources to fully execute the policy (Reynolds, 2023).

Oral health is an essential aspect of one's entire health and state of being. Oral health systems that are efficient and productive are crucial in the prevention and treatment of oral disorders, which can greatly affect an individual's overall health and quality of life (Fleming, 2020). The oral health system in Nigeria encounters several obstacles, such as inadequate infrastructure, restricted access to care, and insufficient public health activities. Okuku (2022) states that a well-functioning oral health system guarantees that patients receive preventive, diagnostic, and therapeutic dental treatment. It includes a variety of services, ranging from regular dental examinations and cleanings to intricate surgeries and treatments. Sixtus (2023) argues that a comprehensive oral health system should encompass public health campaigns that focus on advocating oral cleanliness, avoiding oral diseases, and tackling the social factors that influence health outcomes. 

Prior studies on Nigeria's oral health system have identified numerous significant concerns, including the necessity for a greater number of dental practitioners, enhanced infrastructure, and more effective public health campaigns (Anthony et al., 2020). Ahmed & Ekarika (2022) highlighted the significance of enhancing public knowledge and education regarding oral hygiene habits and the advantages of routine dental examinations. This study aims to evaluate the oral health system specifically at Maitama District Hospital, with the goal of obtaining valuable information that may be used to make broader enhancements throughout the country. The Maitama District Hospital, situated in the Federal Capital Territory of Nigeria, caters to a heterogeneous population with a wide range of healthcare requirements. Being a public hospital, it offers a variety of medical services, including dental care. This hospital is an excellent example to analyse the advantages and disadvantages of the oral health system in a particular setting. Therefore, the necessity for this investigation arises.

1.2 Statement of the problem

Notwithstanding the notable progress in global healthcare, Nigeria still encounters substantial obstacles in delivering comprehensive and easily obtainable oral health treatments. Oral disorders, such as dental caries, periodontal disease, and oral malignancies, continue to be widespread and have a significant impact on individuals and the healthcare system. Maitama District Hospital, a prominent healthcare provider in the Federal Capital Territory of Nigeria, serves as a prime example of the underlying problems within the country's oral healthcare system.

Prior research indicates that a significant number of persons, particularly those residing in rural and underserved urban regions, face restricted availability of dental healthcare services (Akaj et al., 2023). The limited accessibility can be attributed to a scarcity of dental practitioners, insufficient healthcare facilities, and financial obstacles. According to Anthony et al. (2020), the dental workforce in Nigeria is inadequate to adequately serve the population's requirements. The training, retention, and distribution of dental professionals provide challenges that result in geographical differences in the accessibility of dental care.

Furthermore, Nigeria's oral health system is confronted with the issue of insufficient infrastructure and resources (Anthony et al., 2020). The dental facilities of Maitama District Hospital, similar to many others in Nigeria, frequently suffer from a lack of essential equipment and resources required to deliver complete oral healthcare. This encompasses obsolete or inadequate dental equipment, restricted dental supplies, and a deficiency of contemporary diagnostic tools. Furthermore, the Nigerian populace suffers from a widespread lack of awareness and education on oral health. Consequently, there is a manifestation of inadequate oral hygiene practices, a tendency to delay seeking treatment, and a significant occurrence of preventable oral diseases. Ahmed & Ekarika (2022) emphasised the importance of improving public awareness and education about oral hygiene practices and the benefits of regular dental check-ups. Furthermore, there is a lack of study on the specific obstacles and possibilities within Nigeria's oral health system. Many studies have primarily examined the frequency of oral diseases rather than doing a thorough evaluation of the broader factors that impact the delivery of oral healthcare. Comprehensive case studies, such as the one conducted on Maitama District Hospital, are necessary to offer practical insights into the specific obstacles and possible remedies for enhancing the oral healthcare system in Nigeria. Therefore, the necessity for doing this investigation arises.

1.3 Objectives of the study

The primary objective of this study is to critically assess the oral health system in Nigeria: a case study of Maitama District Hospital. Specific objectives of this study are to:

To evaluate the availability and quality level of dental services provided at Maitama District Hospital

To assess the infrastructure and resources available for oral health services in Maitama District Hospital

To identify barriers to accessing dental care for patients in Maitama District Hospital

To providing recommendations for improving the oral health system at Maitama District Hospital and potentially replicating successful strategies in other regions of Nigeria.

1.4 Research Questions

The following research questions will be answered in this study:

What is the level of accessibility and quality of dental services provided at Maitama District Hospital?

What is the extent of infrastructure and resources available for oral health services in Maitama District Hospital?

What are the barriers to accessing dental care for patients in Maitama District Hospital?

What are the recommendations for improving the oral health system at Maitama District Hospital and potentially replicating successful strategies in other regions of Nigeria?

1.5 Research Hypotheses

The following research null hypotheses are formulated to guide the study:

Ho: There are no infrastructure and resources available for oral health services in Maitama District Hospital.

Ha: There are infrastructure and resources available for oral health services in Maitama District Hospital

1.6 Significance of the study

This study is of great importance as it will conduct a comprehensive evaluation of the oral health system at Maitama District Hospital, providing valuable insights that can be utilised to enhance services and achieve better outcomes. The study aims to analyse the specific issues and opportunities present at this hospital in order to provide valuable insights that can be used to improve the oral health system throughout Nigeria. The results can assist policymakers, healthcare professionals, and public health officials in creating specific interventions to tackle the identified deficiencies and enhance oral health for the entire Nigerian population.

Moreover, the results of the assessment can provide valuable insights for the formulation and execution of policies to enhance the oral health system in Nigeria. This may entail promoting for enhanced allocation of resources in oral healthcare infrastructure, fostering the growth and training of the personnel, and incorporating oral health into primary healthcare services.

Furthermore, undertaking a case study on the oral health system at Maitama District Hospital adds to the existing knowledge on healthcare systems in Nigeria. The empirical data it provides can be utilised for subsequent research, comparative analyses, and evidence-based initiatives in the field of oral health.

1.7 Scope of the study

Broadly, this study focus is to critically assess the oral health system in Nigeria: a case study of Maitama District Hospital. Specifically, this study seeks evaluate the availability and quality of dental services provided at hospitals in Nigeri, assess the infrastructure and resources available for oral health services in Nigeria, identify barriers to accessing dental care for patients in Nigeria and provide recommendations for improving the oral health system at hospitals in Nigeria.

The study is carried out in Maitama District Hospital, Abuja. The respondents of this study consist of patients, staff, and healthcare professionals at Maitama District Hospital in Abuja.

1.8 Limitations of the study

As with any human endeavour, the researchers faced many minor constraints during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data regarding assess the oral health system in Nigeria: a case study of Maitama District Hospital. Hence, a significant allocation of time and exertion was necessary to ascertain the appropriate materials, books, or information and amass data. 

Furthermore, this study is constrained by its small sample size and narrow geographical scope, focusing solely on Maitama District Hospital, Abuja. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation. 

Moreover, the researcher's restrictions were mostly due to financial constraints, as they are a student without any source of income to sustain themselves. The exorbitant transportation costs at the research location, exacerbated by the prevailing inflation in Nigeria, posed a significant challenge in meeting the expenses associated with transportation.

Finally, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities.

1.9 Definition of terms

Oral disease: Oral diseases encompass a range of diseases and conditions that include dental caries, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, noma and birth defects such as cleft lip and palate.

Oral health: Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompasses psychosocial dimensions such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment.

Oral practice: This is an activity undertaken by people in order to protect, promote, or maintain oral health and prevent dental diseases. The practices include tooth brushing and sugar consumption practice among others.

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