Volume 5, Issue 6, June – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Towards Adopting an `Economic Impact’ Approach

in the Classification of the Burden of Oral Diseases:
The Case of the East African Community Countries
Okemwa, kenneth.A1, Ruttoh ,simon. K2
School of Dentistry, College of Health Sciences, Moi University, Eldoret 4606 30100, Kenya.
School of Public Health, College of Health Sciences, Moi University, Eldoret 4606 30100, Kenya.

Abstract I. INTRODUCTION

 Introduction Reporting the economic burden of oral diseases is

This commentary argues for a change in the way important to evaluate the societal relevance of preventing
we communicate the burden of dental diseases to policy and addressing oral diseases. In addition to treatment costs,
makers so that the economic impact of these diseases there are indirect costs to consider, mainly in terms of
can be more easily and realistically appreciated. productivity losses due to absenteeism from work. The
Specific reference to dental caries in the East African study published in 2015 on global economic burden of
Community countries (EAC) will be used to argue out dental disease suggests that the economic impact amounted
the case. to US$442 billion in 2010 in both direct and indirect costs,
corresponding to an average of 4.6% of global health
 Methods expenditure. [1]
A literature review was done to tease out the
severity and prevalence of Dental caries in the EAC In resource constrained countries, competition for
countries. Using the average DMFT/dmft, the scarce national resources is such that priority would be
approximate cost which would be required to treat given to those areas in health perceived, through available
dental caries in each country was calculated. data, to be most needy. Measures of morbidity, severity and
mortality of diseases and conditions therefore play an
 Results important role in decision making by policy makers.
The EAC countries are classified as having very
low severity of dental caries among 12 year olds and low The most commonly used measure of dental caries in
severity among adults aged 33-44 years. However the populations and individuals is the Decayed; Missing and
financial implication of treatment of dental caries for Filled teeth (DMFT) index for permanent teeth and the dft
each country is enormous. (decayed, filled teeth) index for primary teeth.

 Conclusion These indices have been given an explanatory

Focus on DMFT alone to convey the burden of translation as follow:
dental caries may send wrong messages to policy
makers thus affecting oral health financing. DMFT TRANSLATION

 Recommendations < 1.1 very low

A Caries Economic Burden (CEB) index is 1.2-2.5 low
proposed. This index would quantify the cost of caries 2.6---3.5 moderate
treatment in a country by multiplying a country’s > 3.5 high
average DMFT by the population and average cost of
treatment. This index will be dynamic and country For policy makers-who, more often than not, happen
specific. to be politicians- the terms ‘very low’ and ‘low’, ‘moderate
‘and “high’ are what will be teased out of the classification.
Keywords:- dental caries, DMFT, economic impact, East
African Community countries, , caries economic burden The implication of this is that, most likely, not much
index (CEB) priority will be given to dental health care in terms of
financial allocation in those countries with a lower rating
scale.

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Volume 5, Issue 6, June – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Perhaps then to remedy this scenario, as health care the provision of oral health care to their citizens either fully
professionals we need to be more ingenious in the way we or in a subsided format. They are therefore the focus of this
communicate the burden of oral diseases to policy makers. discussion

It is out of this conviction that this concept paper  The EAC scenario
argues for a classification of the burden of dental caries According to the World Health Organization ( WHO)
based on an ‘economic impact approach’. This global caries map, the East African community countries
classification would easily bring out the financial (EAC) are classified as having very low or low levels of
implications of dental disease to a country; and perhaps dental caries among 12 year olds based on the DMFT/dft
impress upon the policy makers the need for adequate oral indices (2014 data) [2].A similar map for adults classifies
health care financing. the severity among adults aged 33-44 years as low.

The countries of the East African community (Kenya, Table 1 below is an extract from the WHO global oral
Uganda, Tanzania, Burundi, and Rwanda) will be used in health database on DMFT for 12-year-olds (2015) [3].
this discussion. The governments of these countries fund

Country Year DMFT classification

Burundi 1987-1988 1.0 Very low
Kenya 2015 0.4 Very low
Rwanda 1993 0.3 Very low
Tanzania 2004 0.3 Very low
Uganda 2008 0.7 Very low
Table 1:- DMFT information -WHO

This puts across the message that dental caries is very of treatment like root canal treatment and crowns will not
low in these countries; and from a policy point of view this be considered for the purpose of this paper. This is because.
may not attract much concern. In 2015 the ministry of health in Kenya undertook the first
national oral health survey which indicate an overall
 Cost translation of DMFT for EAC and implication on DMFT for adults of 0.72 and an overall DMFT/dft of 0.72
country health budgets for children aged 5,12 and 15 years respectively 5.
The Kenya Medical Practitioners and Dentist Board
(KMPDB) has guidelines on the cost of dental treatment in A similar survey done in Rwanda in 2018 indicated
Kenya [4] .Though these apply to private practice it is dft of 1.69 and DMFT of 3.19 6
assumed that these constitute the actual cost even in the
government hospitals since the government covers the
subsidised cost through equipment supply, remuneration Since this is the data most likely to be considered by
and training of health care workers. policy makers it will be used to argue the concept in this
discussion for Kenya and Rwanda. The other 3 countries
Online search did not elicit similar cost guidelines don’t seem to have done national oral health surveys
from the other 4 countries. The KMPDB fee guideline will therefore the figures available from WHO will be used.
therefore be used as the average cost across the EAC
countries. For Tanzania the average of the dft and DMFT from
the study done by Carneiro et al in 2012 will be used since
For resource constrained countries, it is most likely this is the latest information which seems to be available
that the treatment prescribed for dental caries, at least at its online. The dft from this study was 0.95 while the DMFT
symptomatic stage, is extraction or filling. The other was 1.26 thus giving an average of 1.17
treatment options like endondotic treatment and crowns
tend to be out of reach for most people. As a result, the Latest study published from Uganda in 2015 gave an
costs of simple extraction and fillings will be used in this overall dft of 0.73 and DMFT of 4.71. The average of these
discussion. values (2.72) will be used 8.

For the purposes of this paper the average cost of There are no current studies which have been done in
treatment of a decayed tooth will be taken as the average of Burundi therefore the figure available on the WHO website
the sum cost of an extraction (ksh 3000) and that of a will be used.
filling (kshs 4000). The lower cost for each procedure has
been taken. Therefore the average cost for purposes of this Based on these figures, Table 2 below illustrates the
write-up will be KSh 3500 -about 35 United States dollars potential financial cost- equivalent for treatment which
(USD) currently. The cost of other more expensive forms each country would incur.

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Volume 5, Issue 6, June – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Country averageDMFT/dft Population Gross number of App cost of treatment Budget allocation for
(000,000) Carious teeth needed (millions of US health per country
(2017) 9 Dollars) (million US dollars)
2017-2018
Kenya O.73 49.70 32,375,500 1133 1236 10
Rwanda 2.94 12.21 35,897,400 1256 202 M 11
Tanzania 1.1 57.31 63,041,000 2206
961M 12
Uganda 2.72 42.86 116579200 1095 493 M13
Burundi 1.0 10.86 10,860,000 380 9114
Gross number of carious teeth=DMF/df X population: cost=number of carious teeth X USD 35:
Table 2:- Country specific DMFT/dft cost implication

It is apparent that the amount of money which would  Weakness of the discussion
be required to treat this “low” occurrence of dental caries in The definition of economic burden in our discussion is
these countries is quite substantial- surpassing the total purely based on the direct cost of treatment and excludes
budgetary allocation for health in all the countries. In the indirect costs which are used in already established
Kenya alone this would add up to USD 113 MILLION; methodologies.
almost equivalent to the total budgetary allocation for
Health at National and county government levels for the Our discussion is based on an assumption that the D
year 2016/2017. Treatment costs for Rwanda, Tanzania, in the DMFT requires filling or extraction. This of course is
Uganda and Burundi would be 6, 2.3, 2.2 and 4 times more another weakness of our debate.
than those countries’ health budgets respectively.
The suggested CEB is very simplistic in nature and
 Suggested approach has not taken into consideration the indirect costs of dental
Based on the most recent surveys in a country, a table caries treatment. This of course is an obvious weakness
can be formulated where the DMFT and dft values for that which should always be stated. Given the complexity of
country are translated into an economic burden equivalent calculating indirect cost of illness- and the fact that this is
for that country using the formula: especially so for dental caries, the authors believe that the
CEB suggested will be a useful and quick appraisal of a
DMFT x AVERAGE COST OF TREATMENT IN country’s dental caries economic burden based on
USD x POPULATION= total cost to country needed for treatment needs
dental caries treatment in USD
II. CONCLUSION
Caries Economic Burden (CEB) index= total cost
above/1000000 This discussion does not aim to come up with a
The CEB for the East African countries ,as derived comprehensive methodology of calculating cost of illness.
from table 3, would therefore be 1133, 1256, 2206 , 1095 The CEB suggested rides on the already routine and
and 380 for Kenya, Rwanda, Tanzania , Uganda and traditional DMFT classification. It is, so to speak, a
Burundi, respectively. conversion of a country’s dental caries severity into a cost
value.
The CEB X 1000000 will be the total cost, in United
State dollars, which a country would need to treat its It is hoped that this paper will trigger off further
population of dental caries in the year under consideration. discussions and debate on the suggestions proposed.
Modifications on the proposed index, or indeed an entirely
Characteristics of this proposed index include new one, will hopefully arise from this initiative. As earlier
 Flexibility and country specificity so as to take into stated, sometimes scientific communication may not
consideration the economic status for each country. This register in the minds of policy makers with the desired
will be in line with with the FDI recommendations in impact, especially at the crucial level of resource allocation.
the GLOBAL ORAL HEALTH GOALS 2020 where More often than not these are politicians; therefore, it is
the motto: 'think globally act locally’’ is advocated(5) important that we change the way we communicate to
15
them. This is especially true for resource constrained
 Dynamism which takes into consideration the projected developing countries like the East African Community
yearly increase in population of that country. This countries used in this concept paper.
means that it will be reviewed periodically (annually,
biannually or otherwise) depending on the actual or This should be a dynamic index which is reviewed
projected population changes). Dynamism would also periodically (annually, biannual or otherwise) depending on
mean a recalculation wherever there is new data from projected population changes. Continuous country wide
research surveys of DMFT will be an important component of the
index.

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Volume 5, Issue 6, June – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
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