Oral health is integral to general health and supports individuals in participating in society and achieving their potential. Yet, oral diseases are among the most common noncommunicable diseases (NCDs) in the World Health Organization (WHO) African region. The WHO African Regional Oral Health Strategy and the WHO Global Strategy on Oral Health were endorsed in 2016 and 2022, respectively, to address the current alarming situation by integrating oral diseases as part of NCDs toward universal health coverage (UHC). Both strategies highlighted the importance of research, especially the necessity to create and continuously update context- and needs-specific research; however, there is a paucity of information regarding research supporting evidence-informed oral health policies in the region. In this context, the University of Pennsylvania, African universities led by the University of Nairobi, and the WHO Regional Office for Africa initiated an "Evidence to Policy" project. This project consists of 3 phases: (1) preparation: stakeholder analysis; (2) co-creation: online needs assessment survey with oral health academia in the region and 2 scoping literature reviews to identify oral health research and barriers and facilitators for the development, dissemination, implementation, monitoring, and evaluation of oral health policies; and (3) validation: sharing findings from phase 2 through the stakeholder meetings. This executive summary presents the results of phase 3, the stakeholder in-person meeting held in November 2023 in Nairobi, Kenya. About 70 participants, including oral health educators and representatives from the Ministry of Health and WHO in the region, discussed and identified actionable recommendations based on findings from phase 2. Then, participants assessed their alignment with the WHO Global Strategy. At the end of the meeting, participants pledged to maintain the relationships between academia and policy makers and will work collectively toward UHC for oral health for all in the region based on the "Nairobi Declaration." Knowledge Transfer Statement: This executive summary can be used by all key stakeholders involved in creating, disseminating, implementing, monitoring, and evaluating oral health policies in the African region to leverage research and accelerate the implementation of the WHO Global and African Regional Strategies on Oral Health.

Background Globally, oral health training has shown positive influence on knowledge, competency and practices for both oral and non-oral health-care workers towards integration of oral health into primary health care (PHC). Sub-Saharan Africa has very divergent social-cultural-political-economic settings. Since healthcare is contextual, it is necessary to review oral health training programs in this region to establish if their formulation, implementation and evaluation are context-reliant. Objective To assess if oral health trainings aimed at integrating oral health into PHC in sub-Saharan Africa were context-reliant. Methodology The reviewers searched five electronic databases and WHO sites. Selection of publications was done using the PRISMA framework. Oral health training programs for oral and non-oral health-care workers in sub-Saharan Africa published in English language between year 2001 and 2020 were included in the study. Findings Only 4 (0.8%) of the original 512 publications for oral health-care workers and 9 (1.5%) of the 613 for non-oral health-care workers publications met the inclusion criteria. Countries established and/or increased number of dental schools, 1 university adopted competency-based curriculum and 2 introduced community rotations. Dental auxiliaries varied by cadre, training duration and scope of practice. Non-oral health-care workers training programs used diverse approaches like pre-service, workshops and printed materials. Target groups for the trainings varied from nurses, traditional healers, health promotion officers to community health volunteers. Evaluations were done mainly using pre-post or quasi-experimental studies. Outcomes of interest varied from level of knowledge, services provision, early childhood caries, oral health seeking behavior and oral hygiene practices. Conclusion Oral health training for integration of oral health into PHC in sub-Saharan Africa varied by targeted cadre, training methods and evaluation method and scope. It was thus context-reliant. More programs are necessary to accommodate other training approaches, evaluation methods and other health-care cadres in the region.

Sub-Saharan Africa (SSA) is at a crossroad. Over the last decade, successes in the scale up of HIV care and treatment programs has led to a burgeoning number of people living with HIV (PLHIV) in care. At the same time, an epidemiologic shift has been witnessed with a concomitant rise in non-communicable diseases (NCD) related morbidity and mortality. Against low levels of domestic financing and strained healthcare delivery platforms, the NCD-HIV syndemic threatens to reverse gains made in care of people living with HIV (PLHIV). NCDs are the global health disruptor of the future. In this review, we draw three proposals for low and middle-income countries (LMICs) based on existing literature, that if contextually adopted would mitigate against impending poor NCD-HIV care outcomes. First, we call for an adoption of universal health coverage by countries in SSA. Secondly, we recommend leveraging on comparably formidable HIV healthcare delivery platforms through integration. Lastly, we advocate for institutional-response building through a multi-stakeholder governance and coordination mechanism. Based on our synthesis of existing literature, adoption of these three strategies would be pivotal to sustain gains made so far for NCD-HIV care in SSA.

INTRODUCTION:People Living with HIV (PLHIV) bear a disproportionate burden of non-communicable diseases (NCDs). Despite their significant toll across populations globally, the NCD burden among key populations (KP) in Kenya remains unknown. The burden of four NCD-categories (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) was evaluated among female sex workers (FSWs) and men who have sex with men (MSM) at the Sex Workers Outreach Program (SWOP) clinics in Nairobi Kenya.METHODS:A retrospective medical chart review was conducted at the SWOP clinics among KP clients ≥15 years living with HIV enrolled between October 1, 2012 and September 30, 2015. The prevalence of the four NCD-categories were assessed at enrollment and during subsequent routine quarterly follow-up care visits as per the Ministry of Health guidelines. Prevalence at enrollment was determined and distributions of co-morbidities assessed using Chi-square and t-tests as appropriate during follow-up visits. Univariate and multivariate analysis were conducted to identify factors associated with NCD diagnoses.RESULTS:Overall, 1,478 individuals' records were analyzed; 1,392 (94.2%) were from FSWs while 86 (5.8%) were from MSM over the three-year period. FSWs' median age was 35.3 years (interquartile range (IQR) 30.1-41.6) while MSM were younger at 26.8 years (IQR 23.2-32.1). At enrollment into the HIV care program, most KPs (86.6%) were at an early WHO clinical stage (stage I-II) and 1462 (98.9%) were on first-line anti-retroviral therapy (ART). A total of 271, 18.3% (95% CI: 16.4-20.4%), KPs living with HIV had an NCD diagnosis in their clinical chart records during the study period. Majority of these cases, 258 (95.2%) were noted among FSWs. Cardiovascular disease that included hypertension was present in 249/271, 91.8%, of KPs with a documented NCD. Using a proxy of two or more elevated blood pressure readings taken < 12 months apart, prevalence of hypertension rose from 1.0% (95% CI: 0.6-1.7) that was documented in the charts during the first year to 16.3% (95% CI: 14.4-18.3) in the third year. Chronic respiratory disease mainly asthma was present in 16/271, a prevalence of 1.1% (95% CI: 0.6-1.8) in the study population. Cancer in general was detected in 10/271, prevalence of 0.7% (95% CI: 0.3-1.2) over the same period. Interestingly, diabetes was not noted in the study group. Lastly, significant associations between NCD diagnosis with increasing age, body-mass index and CD4 + cell-counts were noted in univariate analysis. However, except for categories of ≥ BMI 30 kg/m2 and age ≥ 45, the associations were not sustained in adjusted risk estimates.CONCLUSION:In Kenya, KP living with HIV and on ART have a high prevalence of NCD diagnoses. Multiple NCD risk factors were also noted against a backdrop of a changing HIV epidemic in the study population. This calls for scaling up focus on both HIV and NCD prevention and care in targeted populations at increased risk of HIV acquisition and transmission. Hence, KP programs could include integrated HIV-NCD screening and care in their guidelines.

This study investigated access to quality services influence on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The study was founded on the theory of constraint and adopted a pragmatism paradigm. It applied descriptive research method using mixed method approach to investigate the influence of access to quality services on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The target population in the study was women of reproductive age in 33,482 households distributed in the four Wards of Kuresoi North Sub-County and 19 health management leaders in-charge of all government health facilities offering family planning services in the Sub-County. A sample size of 400 of women of reproductive age and 19 nursing officers in-charge of government health facilities was utilized. The data collection tools used were questionnaire, interview guide, and observation checklist for women of reproductive age and the interview guide for the health facility managers. The research study adopted stratified sampling method. Qualitative data was analyzed according to themes and patterns, and then summarizing the data and linking it to objectives and hypothesis. The study findings exhibited that there was a significant and strong positive individual correlation between access to quality services and performance of family planning program in Kuresoi North Sub-County. The study findings also displayed that there is a significant positive relationship between access to quality services and performance of family planning program in Kuresoi North Sub-County and it predicted the performance of family planning programmes. in Kuresoi North Sub-County.

This study investigated management competency influence on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The study was founded on the theory of constraint and adopted a pragmatism paradigm. It applied descriptive research method using mixed method approach to investigate the influence of management competency on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The target population in the study was women of reproductive age in 33,482 households distributed in the four Wards of Kuresoi North Sub-County and 19 health management leaders in-charge of all government health facilities offering family planning services in the Sub-County. A sample size of 400 of women of reproductive age and 19 nursing officers in-charge of government health facilities was utilized. The data collection tools used were questionnaire, interview guide, and observation checklist for women of reproductive age and the interview guide for the health facility managers. The research study adopted stratified sampling method. Qualitative data was analyzed according to themes and patterns and then summarizing the data and linking it to objectives and hypothesis. The study findings indicate that there is moderate management efficiency, exhibited pertaining to family planning in the dispensaries and health centers located in Kuresoi North Sub-County. Further findings exhibited that there was a significant and strong positive individual correlation between management competency and performance of family planning program in Kuresoi North Sub-County. Finally, the study findings also exhibited that there is a significant positive relationship between management competency and performance of family planning program in Kuresoi North Sub-County and it predicted the performance of family planning programmes. in Kuresoi North Sub-County.

Over the last decade, the Kenyan HIV treatment program has grown exponentially, with improved survival among people living with HIV (PLHIV). In the same period, noncommunicable diseases (NCDs) have become a leading contributor to disease burden. We sought to characterize the burden of four major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) among adult PLHIV in Kenya. We conducted a nationally representative retrospective medical chart review of HIV-infected adults aged ≥15 years enrolled in HIV care in Kenya from October 1, 2003 through September 30, 2013. We estimated proportions of four NCD categories among PLHIV at enrollment into HIV care, and during subsequent HIV care visits. We compared proportions and assessed distributions of co-morbidities using the Chi-Square test. We calculated NCD incidence rates and their confidence intervals in assessing cofactors for developing NCDs. We analyzed 3170 records of HIV-infected patients; 2115 (66.3%) were from women. Slightly over half (51.1%) of patient records were from PLHIVs aged above 35 years. Close to two-thirds (63.9%) of PLHIVs were on ART. Proportion of any documented NCD among PLHIV was 11.5% (95% confidence interval [CI] 9.3, 14.1), with elevated blood pressure as the most common NCD 343 (87.5%) among PLHIV with a diagnosed NCD. Despite this observation, only 17 (4.9%) patients had a corresponding documented diagnosis of hypertension in their medical record. Overall NCD incidence rates for men and women were (42.3 per 1000 person years [95% CI 35.8, 50.1] and 31.6 [95% CI 27.7, 36.1], respectively. Compared to women, the incidence rate ratio for men developing an NCD was 1.3 [95% CI 1.1, 1.7], p = 0.0082). No differences in NCD incidence rates were seen by marital or employment status. At one year of follow up 43.8% of PLHIV not on ART had been diagnosed with an NCD compared to 3.7% of patients on ART; at five years the proportions with a diagnosed NCD were 88.8 and 39.2% (p < 0.001), respectively.  PLHIV in Kenya have a high prevalence of NCD diagnoses. In the absence of systematic, effective screening, NCD burden is likely underestimated in this population. Systematic screening and treatment for NCDs using standard guidelines should be integrated into HIV care and treatment programs in sub-Saharan Africa.

Objective: To describe some factors that may influence the use of the incisive papilla as reference to maxillary anterior tooth positions.Design: Descriptive cross-sectional study.Setting: The Department of Conservative and Prosthetic Dentistry, School of Dental Sciences, University of Nairobi.Results: 112 maxillary casts generated from participants aged 18-35 years, with well aligned arches were studied. The distance from the posterior limit of the incisive papilla and the most labial aspect of maxillary central incisor (pap11) did not vary with the gender, facial profile, or somatotype. There was a weak correlation between pap11 and age. Pap11 varied with arch form. There was weak correlation between age and the distance from the posterior margin of the incisive papilla to the inter-canine line (papintcan). There was no variation in the relationship between papintcan and gender, facial profile or somatotype. Papintcan varied with the arch form. There was no variation in the inter-canine width with age, facial profile or somatotype. There were correlations between the inter-canine width and papintcan, between the intercanine width and pap11, and between papintcan and pap11.Conclusion: Arch form is a significant factor to consider while using incisive papilla as reference to maxillary anterior tooth positions. Age, gender, facial profile and somatotype have no effect on the relationship between the incisive papilla and maxillary anterior teeth.

Objective: To describe the relationship between the incisive papilla and the maxillary anterior teeth among Kenyans of African descent.Design: Descriptive cross-sectional study conducted over six months.Setting: The Department of Conservative and Prosthetic Dentistry, School of Dental Sciences, University of Nairobi.Subjects: One hundred and twelve students of African descent studying at the College of Health Sciences, University of Nairobi, Kenya.Results: One hundred and twelve maxillary casts generated from participants aged 18-35 years (mean age 22.39±2.00 years), with well aligned arches were studied. The maxillary central incisor exhibited a mean of 14.93±1.52mm from the posterior limit of the incisive papilla while the inter-canine line scored a mean of 4.73±1.73mm anterior to the most posterior limit of the incisive papilla. The mean inter-canine width was 35.44±1.79mm.Conclusion: This study brings out salient unique features in the relationship between the incisive papilla and maxillary anterior teeth among Kenyans of African descent, which may guide placement of maxillary central incisors and canines during complete denture construction.

Welcome to Annals of Global Health,Annals of Global Health is a peer-reviewed, fully open access, online journal dedicated to publishing high quality articles dedicated to all aspects of global health. The journal's mission is to advance global health, promote research, and foster the prevention and treatment of disease worldwide. Its goals are to improve the health and well-being of all people, advance health equity, and promote wise stewardship of the earth's environment. The latest journal impact factor is 3.64.Annals of Global Health is supported by the Program for Global Public Health and the Common Good at Boston College. It was founded in 1934 by the Icahn School of Medicine at Mount Sinai as the Mount Sinai Journal of Medicine. It is a partner journal of the Consortium of Universities for Global Health. Authors of articles accepted for publication in Annals of Global Health will be asked to pay an Article Publication Charge (APC) to cover publication costs. This charge can normally be sourced from your funder or institution. We are committed to supporting authors from all countries to publish their work in Annals of Global Health regardless of national income level, and to achieve this goal, we waive the Article Publication Charge for manuscripts where all authors are from low-income or lower-middle-income countries (as defined by the World Bank). From time to time, Annals of Global Health publishes Special Collections, a series of articles organized around a common theme in global health. Recent Special Collections have included “Strengthening Women’s Leadership in Global Health”, “Decolonizing Global Health Education”, and “Capacity Building for Global Health Leadership Training”. Global health workers interested in developing a Special Collection are strongly encouraged to contact the Managing Editor in advance to discuss the project.

INTRODUCTIONThere have been claims that dental caries experience and prevalence in Kenya has been increasing as a result of increased sugar consumption. A review of the literature in 1986 failed to link dental caries experience with an increase in gross national sugar consumption. Subsequently, a number of studies were conducted, necessitating further review to examine trends in dental caries experience and to relate this to changes in per capita sugar consumption.METHODSStudies conducted since 1980 for children 3-15 years of age were examined. Dental caries prevalence and experience for 3-5 years' (deciduous teeth) and 12 years' (permanent teeth) age groups were analysed. Calculation of per capita sugar consumption was performed using gross national annual sugar consumption for 1969-2009 national population census years.RESULTSThere was a gradual increase in per capita sugar consumption, from 35.5 g/day in 1969 to 60.8 g/day in 2009. Dental caries experience in deciduous teeth for children 3-5 years of age increased from a decayed, missing and filled teeth/decayed and filled teeth (dmft/dft) index of 1.5 in the 1980s to 2.95 in the 2000s. At 12 years of age, caries experience for permanent teeth increased from a DMFT of 0.2 to a DMFT of 0.92 over the same period. Dental caries prevalence for both deciduous and permanent teeth also increased with time.CONCLUSIONThese observations suggest that dental caries prevalence and experience increased with time, in parallel to an increase in per capita sugar consumption. However, a clearer understanding can be derived from longitudinal studies, based on actual household age-specific sugar consumption and dental caries incidence.

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.

Objective: To determine the clinico-histopathologic variations and etiological factors associated with oral squamous cell carcinoma (OSCC). Methods: A descriptive cross-sectional hospital based study was conducted at the University of Nairobi Dental Hospital (UNDH) and Kenyatta National Hospital (KNH) between September 2008 and February 2009. Eighty-two (82) patients presenting with lesions confirmed as OSCC were evaluated for habits identified as risk factors such as tobacco use, alcohol use and betel quid chewing. Demographic features including age and gender as well as clinical parameters such as site of the primary lesion, tumour size and nodal involvement were documented. Incisional biopsies were performed for all patients to confirm the diagnosis and histopathological features noted. Results: The mean age of the patients was 58.49 (range = 14 to 90 years), with a male to female ratio of 1.6:1. Remarkably, 13.4% of the patients were aged 40 years and below. The peak incidence was found to have been in the 6th - 7th decades. Tobacco use was the main associated etiological factor (73.2%) followed by alcohol use (57.3%). Notably, 25.6% of the cases had no identifiable risk factor. The tongue was the most common site (35%) followed by the palate (22%) (p = 0.03). The least commonly affected site was the floor of the mouth (10%). The most common stage at presentation was stage IV (52.4%) and; the poorly differentiated OSCC was the most common histopathologic variant (48.8%) followed by the well differentiated (30.5%) and moderately differentiated OSCC (20.7%). Conclusion: In the present investigation it is evident that OSCC has a male predilection with a peak incidence in the 6th - 7th decades and most commonly manifests in the tongue at stage IV with the poorly differentiated subtype being the most common. Of the cases diagnosed 13.4% were aged 40 years and below.

Objective: Dental wastes are material that has been utilized in dental clinics, which are no longer wanted for use and therefore discarded. Improper disposal of these dental wastes can cause harm to the dentist, the people in immediate vicinity of the dentist, waste handlers and general public and the environment through production of toxins or as by products of the destruction process. This study aims to determine the knowledge, attitudes and practice on management of dental wastes among dental practitioners in Nairobi, Kenya. Methods: Descriptive cross-sectional study of 70 dental practitioners practicing in Nairobi, Kenya. Results: A total of 50 dental practitioners were included in the study. Majority had graduated between 1991-1995. 47.5% had only a bachelors degree, 25% had masters 7.5% had PhD and 12.5% had postgraduate diploma. Forty five percent of the respondents indicated they have attended training on management of dental waste while 89.5% had been attending continuous dental education. Forty-two percent of the respondents worked in public institution while the rest were in private practice. Only 48.7% of the practitioners were aware of the existence of waste management guidelines. Only 64% felt it was important to follow the set guidelines, 5% thought it was tedious, 2% said they were not practical and the rest were not interested in the guidelines. Eighty-two percent of the respondents said that amalgam was toxic if disposed improperly with only 10.7% indicating pollution to be a consequence of improper disposal of amalgam. Seventyseven percent of the respondents did not know the hazardous effects of improper disposal of amalgam. Only half of the respondents stored waste amalgam under water, 25% said they did not know how to dispose amalgam. All (100%) knew about occurrence of cross-infection with improper disposal of bloody waste but only 56.1% said they incinerated bloody body waste while 24.4% disposed off bloody waste with general waste 35.7% of the respondents indicated that sharps were hazardous if improperly disposed. Only 52.4% incinerated their pathological wasted. On expired drugs, 7.3% disposed them off as part of general wastes. Conclusion: There is need for continuous professional development on waste management among dentists in Kenya. Key words : Access, Oral health, HIV, Physician, Dental waste.

OBJECTIVES:To determine the dental caries experience in relation to the severity of dental fluorosis and; to evaluate the dietary snacking habits of adolescents.DESIGN:A descriptive cross-sectional study.SETTING:A peri-urban primary school in Nairobi, Kenya.SUBJECTS:Two hundred and seventy five adolescents aged 13-15 years among whom 128 were males and 149 were females.RESULTS:Two hundred and seventy five adolescents were examined for varying degrees of dental fluorosis according to the Thylystrup Fejerskov Index (TFI) scores and the dental caries was determined in the four first permanent molars. One hundred and five individuals were found to have had a TFI score of zero with a corresponding decayed missing and filled teeth (DMFT) for dental caries of 1.30-1.03 and 88 (52%) individuals had mild to moderate severity of dental fluorosis (TF scores 1-4) and had a corresponding mean DMFT of 1.53 +/- 1.005 for dental caries. Furthermore, 82 (48.2%) adolescents had severe degrees of dental fluorosis of TFI scores 5-9 and had a corresponding DMTF value of 1.85 +/- 1.24 for dental caries. When the prevalence of dental caries was compared among individuals with TFI scores zero (non-fluorosed teeth) with those who had fluorosed first permanent molars the Chi square test showed that there was a high statistical significance with a p-value of 0.001 (P = 0.005). Amongst the 175 adolescents with varying degrees of severity of dental fluorosis it was noted that 44 (26%) did not like taking snacks and had a DMFT of 1.54 +/- 1:1.17 while 126 (74%) adolescents who enjoyed taking snacks had a DMFT of 1.64 +/- 1.08. However, there was no statistical significance.CONCLUSION:While there was a statistically significant association between the severity of dental fluorosis and caries experience among the participants in the present study, there was no co-relation between the caries experience and snacking habits among those who had varying degrees of dental fluorosis.

OBJECTIVE:To determine the range of ablative surgery and rehabilitative procedures performed on maxillofacial structures.DESIGN:A retrospective descriptive study.SETTING:University of Nairobi Dental Teaching Hospital.SUBJECTS:Patients operated on at the institutions theatre, and followed up at the University of Nairobi Dental Teaching Hospital Oral Surgery Outpatient Clinic during the period February 1996, August 1998.RESULTS:Forty four patients underwent ablative surgery during the study period. Complete records were available for 38 patients, 27 females and 11 males aged 10 to 79 years (mean 32.6 years). Surgical procedures performed included: partial mandibulectomy, marginal mandibular resection, subtotal maxillectomy, sequestrectomy and enucleation. Six (15.8%) patients who underwent mandibular resection had rigid bone plating. Five (13.2%) patients who had maxillary involvement were given surgical obturators post-operatively with one receiving a complete denture after full recovery. A total of 22 (57.9%) patients who would have reaped benefits from prostheses therapy received none. Individual patient follow-up periods ranged from seven days for two patients who had cyst enucleation to two years for three cases with ameloblastoma, and two cases with squamous cell carcinoma.CONCLUSION:It is concluded that prosthetic rehabilitation of patients undergoing extensive surgery at the University of Nairobi Dental Teaching Hospital is largely inadequate.