International Dental Journal (2004) 54, 8389

2004 FDI/World Dental Press

0020-6539/04/02083-07
Oral health status of children and
adults in urban and rural areas of
Burkina Faso, Africa
Benot Varenne
Paris, France
Poul Erik Petersen
Geneva, Switzerland
Seydou Ouattara
Ouagadougou, Burkina Faso
Objectives: To analyse the oral health status of children and adults in rural
and urban areas of Burkina Faso; to provide epidemiological data for
planning and evaluation of oral health care programmes. Design: Cross-
sectional survey including different ethnic and socio-economic groups.
Sample and methods: Multistage cluster sampling of households in
urban areas and random samples of participants selected based on the
recent population census in rural areas. The final study population covered
four age groups: 6 years (n = 424), 12 years (n = 505), 18 years (n = 492)
and 3544 years (n = 493). Clinical oral health data collected according to
WHO methodology and criteria. Results: At age 6, 38% of children had
caries, with prevalence higher in urban than rural areas. At age 12, the
mean DMFT was 0.7 with prevalence significantly higher among urban than
rural children. Mean DMFT was 1.9 in 18-year-olds and 6.3 in 3544-year-
olds and figures were higher for women than men. In adults, no differences
in caries experience were found by location whereas the caries index was
significantly affected by ethnic group and occupation. CPI score 2 (gingivitis
and calculus) was dominant for all ages: 6 years (58%), 12 years (57%), 18
years (58%), 3544 years (49%). In addition, 10% of 3544-year-olds had
CPI score 4. Rural participants had more severe periodontal scores than did
urban individuals. Conclusions: Health authorities should strengthen the
implementation of community-based oral disease prevention and health
promotion programmes rather than traditional curative care.
Key words: Oral health, caries, periodontal diseases, Burkina Faso
Correspondence to: Dr. Professor Poul Erik Petersen, World Health Organisation, Non-
Communicable Disease Prevention and Health Promotion, Oral Health Programme, 20
Avenue Appia, CH-1211 Geneva, Switzerland. E-mail: petersenpe@who.int
At the global leel, marked changes
in oral disease patterns hae been
obsered oer the past decades. In
seeral industrialised countries the
adult population maintain unc-
tional dentitions and signiicant
reductions in rates o edentulous-
ness are noted
1-3
. lurthermore, the
prealence and seerity o dental
caries o children hae declined
substantially in those countries
4
, and
the trend parallels the implemen-
tation o preentie oral care
programmes and changing liing
conditions and liestyles. lor
deeloping countries and especially
in sub-Saharan Arica, the trend
oer-time in dental caries prea-
lence is not particularly clear. In the
1980s, some authors
5-
reported
that the situation was alarming or
countries o this region due to
growing prealence rates and
seerity o oral disease. More
recently, meta-analyses o oral health
reports on studies carried out in
Arica oer the past 40 years
reealed contrasting disease trends
depending on country, population
groups and socio-economic condi-
tions
8-10
. Inormation on the prea-
lence o periodontal disease is more
limited and the diagnostic criteria
applied in sureys also show some
ariation
11
. Meanwhile, some studies
84
International Dental Journal (2004) Vol. 54/No.2
suggested changing patterns o peri-
odontal disease in parallel to the
obserations that more adults
presere their natural teeth
11
.
In seeral Vest Arican coun-
tries, introduction o oral health
programmes has not been gien
high priority by public health
authorities. Oral health has mostly
been considered through the estab-
lishment o emergency care acilities
and sometimes supported by tradi-
tional curatie care. Meanwhile, the
majority o people liing in rural
areas hae limited access to essential
oral health care due to geographical
and economic barriers. Preentie
oral care programmes are rare and
not made an integral part o public
health serices. As regards many
countries o Vest Arica, oral
epidemiological data are scarce and
data are oten not alid or cross-
national comparisons
12
. In Burkina
laso, preiously known as Upper
Volta, three local sureys were
conducted in 1983, 198 and 1993.
1he studies on adults
13,14
showed
that the standard o oral hygiene
was poor, gingial problems were
requent whereas the prealence
rates o adanced periodontal
disease and dental caries were low.
More recently, in 1993, a local
urban surey o schoolchildren
showed a mean o 1. DMl1 at
the age o 12
15
.
Like many deeloping countries,
Burkina laso is now in the process
o establishing oral health systems
based on the primary health care
approach. Strategies are in line with
the Bamako Initiatie
16
, which the
goernment o Burkina laso
adopted in 198. 1he Bamako
Initiatie launched by UNICLl and
the Vorld lealth Organisation
,VlO, aimed at improing access
to essential health care and on
contributions by the community
to sharing o health serices costs.
Oral health projects hae been
initiated jointly by the Ministry o
lealth and Aide Odontologique
Internationale ,lrench NGO,. 1he
project actiities are organised
within the rame o the National
Oral lealth Programme and imple-
mented in ie proinces o the
south-west region o the country.
Lpidemiological and sociological
oral health data were collected at
baseline in order to proide or
situation analysis and the compari-
son o oral disease leels across
social and ethnic groups. 1he
objectie o the present report is
to ealuate the oral health status o
well-deined population groups o
the ollowing ages: 6, 12, 18 and
35-44 years. 1he results o this
study were to be used in the plan-
ning and ealuation o oral health
promotion actiities being part o
the general health care action plan
at district leel.
Study population and methods
Burkina laso is a landlocked country
located in Sahelian Vestern Arica
and coers an area o 24,000km
2
.
In 1996, the population was 10.3
million people with a growth rate
o 2.4 per year. Most people ,85,
lie in rural areas and are mainly
engaged in arming
1
. 1he oicial
language is lrench but seeral local
languages are spoken. 1he domi-
nant religion is Islam, ollowed
by Christianity and Animism. 1he
country is ranked as one o the
poorest deeloping countries o the
world. In 2001, the ratio o dental
practitioners per population was
estimated at 1:200,000 inhabitants.
1here are 33 unctional dental chairs
in the country and dental care is
oered by the 42 public health
dentists working with the assist-
ance o dental nurses trained at the
National School o Public lealth.
Most dentists and dental nurses
practice in the major two towns o
the country where only about 10
o the total population reside
1
. 1he
ew priate dentists are accessible
only to rich people.
1he actual surey was completed
in 1999 and included ie pro-
inces o the south-west region o
Burkina laso coering a popula-
tion o 1.5 million inhabitants
,|igvre 1,. In this region, 25. o
people are literate, 55 o the
population are less than 1-years-
old and the rate o schooling at the
leel o primary school is 42.8.
1he most important ethnic groups
o the country lie in the study
area, i.e. the groups o Mossis
,31.,, Snouos ,15.6,, Bobo
,14.5, and Mand ,8.5,. 1he
economy o the region mainly
depends on the primary sector and
the workers are occupied by cash
crops ,cotton,, ood crops ,corn,
sorghum, rice, and ruit gardens
,mangoes, oranges,
18
.
1he surey was carried out in
both urban and rural areas and
participants were chosen by multi-
stage cluster sampling. In urban
areas, the two main towns o the
region were selected: Bobo-
Dioulasso ,309,1 inhabitants, and
Banora ,62,548 inhabitants,. In
Bobo-Dioulasso, the 25 districts
were diided into our zones in
order that the sample would
include participants o dierent
socio-economic status. In parallel,
the six districts o Banora were
diided into two zones. 1hen, one
district o each zone was randomly
selected and within each district
systematic selection o households
took place as applied by the LPI 5
,Lxpanded Programme on Immu-
nization,
19
. lie proinces were
identiied or the surey o partici-
pants in rural areas and the ocal
points or sampling were: louet
,34 sites,, Como ,16 sites,,
Kndougou ,29 sites,, Leraba ,14
sites,, and 1uy ,13 sites,. One site
was then randomly selected rom
each o the ie proinces and
random samples o people o the
VlO standard ages were selected
based on the recent population
census. 1hus eleen sampling sites
were chosen or this study ,six in
urban areas and ie in rural areas,
and ity persons were selected
rom each site and age group. 1he
inal sample included our age
groups: 6 years ,n ~ 424,, 12 years
,n ~ 505,, 18 years ,n ~ 492, and
35-44 years ,n ~ 493,.
Data were collected by clinical
85
Varenne et al.: Oral health status in Burkina Faso
analysed by use o the Statistical
Package or the Social Sciences
,SPSS-PC-, or Vindows. 1he
presence o dental caries in primary
and permanent dentitions was meas-
ured by the prealence proportion
rates. Means o decayed, missing
and illed teeth ,DMl1, were
calculated and the Community
Periodontal Index scores were
computed according to the VlO
recommendations
21
. Biariate and
multiariate requency distributions
were used to analyse the data. 1he
Student`s t-test or ANOVA were
applied or statistical ealuation o
means and the Chi-Square test
was used or comparisons o
proportions.
Results
At age 6, the prealence rate o
dental caries was 38 and the
igure was somewhat higher among
urban than rural children ,0.01,
,1abe 1,. About two thirds o the
young children had gingial bleed-
ing and,or calculus, and one tenth
needed immediate care. Among 6-
year-olds, no signiicant dierences
were ound in oral health status by
gender while some eect o ethnic
group was obsered as regards the
need or immediate care and the
prealence o CPI score 2 ,1abe
2,. 1abe presents the prealence
proportion rates o dental caries
and the mean caries experience or
the participants aged 12, 18 and
35-44 years. lor all age groups,
the D-component constituted most
o the caries index. 1he prealence
rates and the seerity o dental
caries are shown according to
location and gender in 1abe 1. At
age 12, both disease indicators were
signiicantly higher or urban than
rural children while signiicant
dierences by gender were ound
or the two adult groups only.
1abe : describes the distribution
o participants by maximum CPI
score according to location. 1he
proportion o indiiduals with
seere CPI-scores was somewhat
similar or people liing in rural or
Figure 1. Map of study area
oral examinations. Inormation
about oral health status, location,
ethnic group and occupation was
registered according to the VlO
Oral lealth Surey Basic Methods
using the simpliied oral health
record orm or children and the
standard oral health record orm
or adults
20,21
. Dental status, dental
caries and the Community Perio-
dontal Index ,CPI, were the
conditions recorded. 1he scores o
the CPI index are: score 0 ~ healthy,
score 1 ~ gingial bleeding, score
2 ~ calculus, score 3 ~ shallow
pocketing o 4-5mm and score 4
~ deep pockets o 6mm or more.
As regards the 6-year-olds, the
presence o dental caries per indi-
idual was registered only and the
periodontal examination included
scores 0-2. 1he clinical examina-
tions were carried out in daylight
using plane mouth mirrors and the
VlO recommended periodontal
probe. 1he examinations were
conducted by a team o our cali-
brated examiners. Calibration trials
were perormed initially to ensure
inter-examiner reliability
21
and the
Kappa consistency coeicient as
regards dental caries was 89.
Samples o drinking water were
selected rom one well and rom
one drilling at each site. 1he leel
o luoride was analysed at the
Noartis Sant lamiliale S.A. Labo-
ratory in Rueil Malmaison ,lrance,
using ligh Perormance Liquid
Chromatography processing. 1he
concentration o luoride aried
between 0.0024-0.2ppml with an
aerage o 0.10ppm.
1he data were processed and
86
International Dental Journal (2004) Vol. 54/No.2
Table 1 Children aged 6 years distributed (Pct) by prevalence proportion
rate of dental caries (PP), need for immediate care and maximum CPI score
in relation to location.
Oral health indicator Urban Rural Total
(n = 181) (n = 243) (n = 424)
PP caries (Pct) 46 ** 32 38
Need for immediate care (Pct) 8 9 9
Maximum CPI score (Pct)
Score 0 37 31 33
Score 1 8 10 9
Score 2 55 60 58
** p < 0.01
Table 2 Children aged 6 years distributed (Pct) by prevalence proportion rate
of dental caries (PP), need for immediate care and maximum CPI score in
relation to ethnic group.
Oral health indicator Mossi Mande Bobo Senoufo
(n = 71) (n = 129) (n = 81) (n = 100)
PP caries (Pct) 44 33 35 43
Need for immediate care (Pct) 4 5 10 16 *
Maximum CPI score (Pct)
Score 0 38 36 28 24
Score 1 11 7 17 4
Score 2 51 57 54 72 **
* p < 0.05 ** p < 0.01
Table 3 The prevalence proportion rate of dental caries (PP Pct) and
mean dental caries experience (DMFT) of 12-, 18- and 3544-year-
olds in Burkina Faso (Standard Error of Mean in brackets).
Oral health indicator 12 years 18 years 3544 years
(n = 505) (n = 492) (n = 493)
PP caries (Pct) 28.5 53.9 72.8
DT 0.7 1.8 4.2
MT 0.01 0.06 1.9
FT 0.02 0.2
DMFT 0.7 1.9 6.3
(SEM) (0.06) (0.12) (0.28)
Table 4 The Prevalence Proportion rate (PP) of dental caries (Pct)
and mean caries experience (DMFT) by location, gender and age
group.
PP caries (Pct) DMFT
12 years Urban (n = 293) 33.8* 0.9*
Rural (n = 212) 21.2 0.5
Male (n = 267) 26.6 0.6
Female (n = 238) 30.7 0.8
18 years Urban (n = 294) 53.1 1.8
Rural (n = 198) 55.1 1.9
Male (n = 228) 46.1 1.5
Female (n = 264) 60.6*** 2.2*
3544 years Urban (n = 247) 71.3 6.1
Rural (n = 246) 74.4 6.4
Male (n = 236) 63.1 4.4
Female (n = 257) 81.7*** 8.0***
* p < 0.05 *** p < 0.001
87
Varenne et al.: Oral health status in Burkina Faso
Table 5 The distribution (Pct) of participants by Maximum CPI score in relation to age group and
location.
12 years 18 years 3544 years
Max CPI Urban Rural Total Urban** Rural Total Urban*** Rural Total
Score 0 26 17 22 19 12 16 4 2 3
Score 1 10 18 13 5 12 8 1 2 2
Score 2 58 56 57 60 55 58 58 39 49
Score 3 6 8 7 12 15 13 32 41 36
Score 4 0 1 1 4 6 5 5 16 10
** p < 0.01 *** p < 0.001
Table 6 Mean number of sextants per person with specific CPI scores according to
age group.
CPI scores 12 years (n = 505) 18 years (n = 492) 3544 years (n = 493)
Score 0 3.3 3.1 1.8
Score 1 0.9 0.7 0.4
Score 2 1.7 1.8 2.4
Score 3 0.1 0.3 1.0
Score 4 0.01 0.1 0.4
Table 7 The Prevalence Proportion (PP) rate (Pct) and mean DMFT of children and
adults in relation to age and ethnic group in Burkina Faso.
Age Indicator Mossi Mande Bobo Snoufo Others
12 years PP (Pct) 39.1 * 22.4 22.6 31.1 24.1
DMFT 0.8 0.6 0.4 0.9 0.8
(n =) (115) (143) (84) (109) (54)
18 years PP (Pct) 39.4 45.7 54.5 43.9 49.3
DMFT 2.1 1.9 1.4 2.2 1.4
(n =) (94) (129) (88) (114) (67)
3544 years PP (Pct) 74.6 68.3 83.3 * 73.5 64.5
DMFT 6.4 5.4 6.5 6.8 6.2
(n =) (67) (145) (102) (98) (62)
* p < 0.05
Table 8 Mean DMFT and mean number of sextants with specific CPI scores of 3544-
year-olds according to occupation.
Indicator Government Shopkeepers Professionals/ Farmers/ Housewives
employees craftsmen breeders
(n = 49) (n = 46) (n = 61) (n = 142) (n = 176)
DMFT*** 3.6 6.6 5.8 4.5 8.3
CPI scores
Score 0 2.4 1.4 1.7 1.8 1.8
Score 1 0.4 0.3 0.2 0.3 0.5
Score 2* 2.8 2.6 2.8 2.1 2.4
Score 3*** 0.3 1.3 0.8 1.3 0.8
Score 4 0.04 0.1 0.1 0.3 0.2
* p < 0.05 *** p < 0.001
urban areas. In all age groups, about
hal o the indiiduals examined
had gingial bleeding and calculus.
1he mean number o sextants with
speciic CPI scores is shown in
1abe . linally, 1abe. ava indi-
cate the association between oral
health status and ethnic group and
occupation. Shopkeepers had the
highest mean caries experience
index and had also high scores o
seere periodontal conditions.
Discussion
1he intention o the study was to
proide systematic inormation on
the oral health situation o children
and adults in a region o Burkina
laso and that the results would aid
the planning and ealuation o oral
health promotion programmes. In
deeloping countries, random
sampling is mostly impossible due
to lack o census lists or alid popu-
lation registers and alternatie
procedures are needed to achiee
representatie samples. lor the
present study a modiied VlO
pathinder approach was chosen,
i.e. representatie ocal points o
urban and rural areas were identi-
ied in order to ensure the partici-
pation o the dominant ethnic
groups o the country. A national
pathinder surey incorporates
suicient examination sites to coer
all important subgroups o the
population that may hae diering
disease leels or needs or care,
and at least three o the index age
groups
20,21
. In light o the coerage
o important population groups,
the size o the inal study popula-
tion and the high response rates the
surey results may be considered
releant at national leel. 1he
epidemiological data were collected
according to the VlO standard
methods and criteria
20,21
and the
recordings included dental caries
and periodontal symptoms since
these are highly releant conditions
in the planning o community oral
health programmes. It is a global
experience that this recording
system may proide reliable data
on the occurrence o oral disease.
1he VlO recommended leel o
inter-examiner reliability in regis-
tration o dental caries
21
was
obtained in this study, meanwhile,
the use o daylight during exami-
nations could hae resulted in an
underestimation o caries.
Oerall, the present surey has
proided a alid oeriew o the
oral health status at the population
leel. According to the VlO
classiication criteria
22
, low to
moderate leels o dental caries
were ound or all age groups
examined. 1he dierences in
dental caries experience by ethnic
groups were moderate whereas the
eect o occupation was promi-
nent among adults. Shopkeepers
and proessionals,cratsmen had
relatie high scores o dental caries
against the lower caries experience
o goernment employees. Such
a pattern is in agreement with
obserations made in seeral
industrialised countries
3
. 1he need
or systematic care was clearly
demonstrated, in children and
adolescents the D-component
constituted most o the dental
caries experience while the M-
component contributed about one
third o the caries index in adults.
1his disease pattern highly relects
the act that the population in
Burkina laso has poor access to
restoratie dental care and that radi-
cal treatment in terms o tooth
extraction is mostly oered in case
o symptoms rom teeth.
Published studies
8-10
carried out
in dierent countries south o the
Sahara and north o the Republic
o South Arica hae shown that
caries experience in the permanent
dentition around the ages o 10-14
years ranges mainly rom about 0.2
to 2.0 DMl1. 1he present ind-
ings on dental caries prealence in
12-year-old children o Burkina
laso corresponds to results o simi-
lar studies in Vestern Arica
23-2
.
loweer, the leel o dental caries
in children as well as in adults
seemed somewhat low in Burkina
laso as compared with the ind-
ings o a national oral health surey
conducted recently in the Republic
o Niger
26
. As regards the adult
population, the present study
conirmed the preious obsera-
tions o a relatiely high caries
index among women
26
and the
higher caries experience score or
women was primarily ascribed to
more teeth haing been extracted
due to caries. In contrast to the
study carried out in Niger only
minor dierences in prealence
rates o dental caries were obsered
between urban and rural adult
groups examined in Burkina laso,
meanwhile, dental caries was more
requent among children o urban
than rural areas. linally, the actual
oral epidemiological data are in
agreement with oral health surey
results rom seeral countries o
Last Arica
28-31
but the dental caries
igures are signiicantly lower than
those ound or children and adults
in Madagascar
32
.
1he Community Periodontal
Index ,CPI, is an established meas-
ure or the assessment o periodon-
tal problems in populations or
which interention programmes
might be considered and the system
records the treatable conditions.
1he major adantages o the CPI
are simplicity, speed, reproducibil-
ity and international uniormity. In
deeloping countries, the age
proile implies that the age groups
15-19 years and 35-44 years are
most important or assessment o
periodontal health status. Consist-
ent with CPI data reported or
Arican children and adults o simi-
lar ages
11,14
the present surey
demonstrated high leels o gingi-
al bleeding and calculus and low
scores o adanced periodontal
symptoms. 1hese prealent condi-
tions are preentable, primarily
through proper oral hygiene and
improed sel-care practices. 1he
periodontal conditions tended to
be relatiely poor among people
liing in rural areas and armers
and this may be explained by some-
what irregular oral hygiene practices.
In conclusion, the surey has
indicated that the actual leel o
dental caries among children and
adults in Burkina laso is relatiely
low. Unortunately, the epidemio-
logical data aailable or the
country
13-15
do not allow or alid
time-trend analysis due to dierent
principles o sampling and dier-
ent criteria o recording oral
disease. At present, the proportion
o 6-year-old children being ree
o dental caries is signiicantly higher
than the VlO goal or the year
2000 ,i.e. at least 50 o children
shall be caries ree at age 6, and, in
parallel, the caries experience o 12-
year-olds is well within the VlO
global goal o no more than 3
DMl1
33
. loweer, the need or
dental care was eidenced or all
age groups examined and the oral
hygiene standard should be
improed. In light o the scarce
health resources and the current
pattern o oral disease in Burkina
laso, health policy that emphasises
oral health promotion and preen-
88
International Dental Journal (2004) Vol. 54/No.2
tion would seem more adanta-
geous than traditional curatie care.
Aordable luoridated toothpaste
is highly recommended in order
that the population may become
appropriately exposed to luoride
and deelopment o sel-care
capacity in oral health may be
encouraged through establishment
o community-based oral health
education. It seems apparent that
the oral health problems cannot be
resoled i the deliery o health
care is proided by dentists alone.
1hus, the eectie inclusion o
primary health workers would play
an important role in the deliery o
preentie serices. 1he health
authorities o the country hae gien
priority to improed oral health o
children and seeral community
demonstration projects are imple-
mented. 1he results o the present
surey may sere as a baseline or
ealuation o such projects.
Acknowledgements
1he study was supported by grants
rom Aide Odontologique Interna-
tionale, lrench Ministry o loreign
Aairs, Luropean Commission,
Ministry o lealth, Burkina laso,
and the VlO Collaborating Centre
or Community Oral lealth Pro-
grammes and Research, Uniersity
o Copenhagen, Denmark.
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