Study Design This is a multi-centre retrospective study. Objective To determine the prevalence of blindness and pattern of facial trauma associated with blindness among Nigerians. Methods A multi-centre retrospective study of all patients with facial trauma resulting in blindness, that were co-managed by maxillofacial surgeons and ophthalmologists in 4 Nigerian public tertiary hospitals between January 2010 and December 2019 was undertaken. Data was analysed by IBM SPSS Statistics (version 21.0 for windows, IBM© Inc, Chicago, IL). Results Of 2070 patients who presented with major facial injuries during the study period, 61 eyes of 56 (2.7%) patients were blind. Blindness was bilateral and unilateral in 5 (8.9%) and 51 (92.1%) patients, respectively. The mean age (SD) at presentation was 36.2 (16.6) years, and 47 (83.9%) of these patients were males. Road traffic accident (n = 27; 48%) was the commonest mechanism of facial trauma, the cheek (n = 18; 40.9%) was the commonest site of associated soft tissue injury and zygomatic complex fracture (n = 19; 24.1%) was the commonest related fracture. Globe rupture (n = 34; 55.7%) was the leading cause of blindness. Enucleation (n = 7; 13.2%) and evisceration (n = 22; 41.5%) were performed on 29 eyes of which 12 (41.4%) patients had ocular prosthesis post-operatively. Conclusions Blindness was recorded in 2.7% of Nigerians with facial trauma. The commonest mechanism of trauma and cause of blindness in at least one eye were road traffic accident and globe rupture, respectively. Eye removal surgery was necessary in about half of the blind eyes.

Aim: The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria. Methodology: This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes. Results: More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership. Conclusion: Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.

Providing equitable access to health care for every Nigerian is central in the country's National Health Act. But the Nigerian Health System ranks poorly in terms of access and quality just as the country also ranks poorly on Transparency International's Corruption Perception Index. The problem of lack of access to quality health care is linked with wasteful use of primary care services at referral centres. In the rural communitieswhere the burden of disease morbidity and mortality is high, efficient health expenditure and service utilization is plagued by the absence of adequately functioning Primary Health Centers (PHCs), poor or inadequate cost sharing schemes and due to corrupt practices in the health sector. In order to curb these issues, policy options such as revamping the PHC and prioritizing the delivery of a basic minimum package of health care are useful to consider. Furthermore, the implementation of strong actions to tackle corruption in the health sector will improve access to care and health outcomes and it does not incur extra financial investment. This is achievable through improvement in public financial management and limiting corruption by making right choices in resource allocation towards pro-poor interventions. Similarly, well designed package of services and prioritization of primary care making best use of human resource will be beneficial. This is relevant to the Nigerian health system, leveraging the country's decentralized administration and strengthening community health committees' role in ensuring accountability and transparency at the PHCs. Finally, considering the role community health committees play in driving demand in rural communities, the National Primary Health Care Development Agency (NPHCDA) can coordinate the development of a joint action plan for health care delivery between these committee(s) and each respective PHC facility. This will promote efficient use of resources and facilitate access to quality health care at each facility.

Aim: To analyse options for maximising the capacity of human resources for health to achieve Universal Health Coverage (UHC) in Africa. Methods: Articles were retrieved from a Pubmed search and additional snowballing was conducted to provide other relevant sources. Further utilizations were made of Campbell's modified framework of the Human Resources for Health (HRH) and Universal Health Coverage with the WHO labour market dynamics framework for Universal Health Coverage. Four sub-themes viz improved HRH performance, Labour Market Factors, Rural Health Workers Retention Factors, and Information Technology Factors were analysed. Results: Labour market factors such as the dynamics of demand and supply of health workers determine the availability of health workers. Supportive supervision enables the health workers to improve in their performance and enhance optimised utilisation of available resources. This supervision can be more effective by complementing it with tools such as information technology that focus on improving the quality of health care, considering the growth in the number of internet and broadband users in the continent. Conclusion: Expanding the training opportunities for health workers and also increasing the funding to human resources for health are useful policy options to consider. Cost-effective approaches such as a focus on community health committees which stimulate the demand for health services in rural communities to tackle the disproportionate distribution of health workers should be considered in the context of the uncertain economic aftermath of the covid-19 outbreak. Sources of Funding Nil Acknowledgement We express profound gratitude to Prof Flavia Senkubuge for providing technical help and writing assistance during the preparation of this manuscript. We also appreciate Dr. Aborisade Adetayo for assisting with editing of the manuscript. Conflicts of Interest The authors declare no conflict of interest. Author Contributions MIA drafted the entire manuscript. ICE provided a critical review and made substantial contributions to the design of the manuscript.

Aim: The aim of the study was to determine the dental treatment needs and the level of dental service utilization among patients with mental disorders (PWMD).Setting: This was a cross-sectional study at a tertiary hospital in Nigeria conducted between March and November 2018.Methodology: The community periodontal index of treatment of needs and the Decayed, Missing and Filled Teeth index were used to determine the dental and periodontal treatment needs. Dental service utilization was determined using a self-reporting assessment questionnaire. All data analyses were carried out using the IBM SPSS® Statistics version 20 and the statistical significance was set at P < 0.05.Results: A total of 116 PWMD participated in the study with 51.7% being females. The age range was between 19 and 57 years and the mean age was 37.16 (±10.52). Dental treatment need was 40.8%, while 66% needed a range of periodontal interventions and this showed no statistically significant differences in terms of gender (P = 0.67, P = 0.15, respectively). While 32.7% had made previous dental visits, past caries experience, and other factors such as gender were significant predictors for dental visits.Conclusion: There was a high dental and periodontal treatment need among PWMD, yet the dental service utilization was low. More collaborations between oral and mental health specialists are needed to improve dental service utilization and promote holistic health care for PWMD.

Objective: The objective of this study was to determine and compare the oral health status of outpatients with mental disorders (OPMDs) and healthy controls (HCs) in a Nigerian tertiary hospital. Methodology: A comparative cross-sectional study among 140 OPMDs was consecutively recruited from the Mental Health Clinic of a Nigerian tertiary teaching hospital. Furthermore, 140 age- and sex-matched HCs screened using the 12-item General Health Questionnaire were recruited from the general outpatient clinic. Oral health status was assessed using the Decayed, Missing, and Filled Teeth (DMFT) index, the community periodontal index modified (CPI modified), the Oral Hygiene Index-Simplified (OHI-S), and the gingival index (GI). Bivariate analyses were carried out to make comparisons between the two groups, and the level of significance was set at P < 0.05. Results: A total of 280 participants were recruited. This comprised 68 male participants and 72 female participants in each group. The mean DMFT in the OPMD group was 0.50 (±1.09) and 0.17 (0.645) for the HC group. The prevalence of dental caries was 24.3% in the OPMD group and 10% in the HC group. The mean OHI-S score was 2.68 (±0.97) and 2.38 (±0.98) and GI score was 1.09 (±0.46) and 0.87 (±0.87), while clinical attachment loss was seen in 48.5% and 32.8% for the OPMD and HC groups, respectively. Conclusion: The prevalence of common oral diseases in OPMD was higher compared to HC, thus the study provides evidence on the poor oral health of OPMD. Furthermore, there is a need to incorporate preventive dental education into the management of OPMD.

It´s over 4 decades since the Alma-Ata declaration of comprehensive health care for all by a congregation of leaders from 67 nations across the world. Though this step was revolutionary, Primary Oral Health Care delivery is still lacking in many Primary Health Centres in Nigeria. The delivery of essential health services in the country has undergone many transitions. From a spread in just 52 local governments areas in the 80s to a ward system coverage in all the 774 local governments with over 30,000 facilities by the 90s. Despite this progress, only 20% of these facilities are functional and the delivery of primary oral health care in these centres is grossly limited. State governments have thus been encouraged to seize ownership and expand health care delivery. The burden of oral diseases remains high and has been linked with systemic conditions like diabetes, HIV and even delayed gravidity. The integration of oral health care with existing primary health care has been challenged by the limited number of human resources especially available at the rural communities. Poor funding has also hindered oral health care delivery because of the specialized nature of oral care. The National Oral Health Policy issued in 2012 stipulates the need for the integration of oral health services but lacked proper implementation guidelines and a revised edition is expected in 2020. Experts have advocated the need to have a higher proportion of dental auxiliaries to complement the demand for human resource for dental care delivery. Similarly, encouraging task-shifting at the grassroots will also provide an efficient route to expanding the coverage for oral health care in the Nigerian population. Finally, the goal of universal health coverage in Nigeria can be better served by prioritizing Primary oral health Care and full implementation of the National Oral Health Policy in Nigeria.

Although there have been major improvements in oral health, with remarkable advances in the prevention and management of oral diseases, globally, inequalities persist between urban and rural communities. These inequalities exist in the distribution of oral health services, accessibility, utilization, treatment outcomes, oral health knowledge and practices, health insurance coverage, oral health-related quality of life, and prevalence of oral diseases, among others. People living in rural areas are likely to be poorer, be less health literate, have more caries, have fewer teeth, have no health insurance coverage, and have less money to spend on dental care than persons living in urban areas. Rural areas are often associated with lower education levels, which in turn have been found to be related to lower levels of health literacy and poor use of health care services. These factors have an impact on oral health care, service delivery, and research. Hence, unmet dental care remains one of the most urgent health care needs in these communities. We highlight some of the conceptual issues relating to urban-rural inequalities in oral health, especially in the African and Middle East Region (AMER). Actions to reduce oral health inequalities and ameliorate rural-urban disparity are necessary both within the health sector and the wider policy environment. Recommended actions include population-specific oral health promotion programs, measures aimed at increasing access to oral health services in rural areas, integration of oral health into existing primary health care services, and support for research aimed at informing policy on the social determinants of health. Concerted efforts must be made by all stakeholders (governments, health care workforce, organizations, and communities) to reduce disparities and improve oral health outcomes in underserved populations.