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Studies around the world showed the importance of the relationship between juvenile oral diseases and socio-economic environment. In general children's health is precarious in Africa especially and particularly in disadvantaged rural areas. Environment, poverty and health interact in a closed circle mutually aggravate their condition.
Diourbel health district is the western part of Diourbel Region, in Senegal. It is the only operational health structure of Diourbel department which covering an area of 1352 km². According to the 2002 census, this sanitary district has 19,203 households for a population of about 252 862 inhabitants split up between the Diourbel Municipality, and the other districts of the Department. The town of Diourbel urban and its rural community have provided the framework for this study. The rate of scholarized children between 6 and 7 years was one of the lowest of the country: 35%. In 1995, 3352 children were registered in primary schools. Agriculture is the main economic activity, with an annual average household income of US dollars: 300. Poverty has led to the mass exodus of residents of several villages to other areas of the country, Touba and Dakar, or to Europe and America. Health facilities consist of one health center located in urban areas, 19 health posts: 1 urban and 18 rural, and 73 health centers among which 59 functional. Health staff count 01 physician for 125,000 inhabitants, one dentist for 125 000 inhabitants, 1 nurse for 16,000 inhabitants, 1 midwife for 24,000 women of childbearing age.
In a recent work, Daouda Faye, Aida Kanouté and Cheikh Mbacké Lo show a relationship between socioeconomic environment and oro dental health of children. The objective of this paper was to evaluate the socio economic environment influence on oral health of children in the sanitary district of Diourbel to formulate recommendations for its improvement by conducting a descriptive cross-section study. The prevalence of oral pathology was statistically higher in rural areas: 29.1% than in urban areas: 20.3%. Oral diseases were higher in anscholarized young children under 9 years from poor families. The children of the rural area in the sample were significantly young, more educated and from poorer families than those of urban areas.
The study population was younger in rural than in urban areas. The enrollment rate, higher in rural areas, may be related to arabic and coranic teaching only found in rural areas, as described in the report of the 1992 census. The annual average income per household in the district of Diourbel is one of the lowest in Senegal. It was estimated at 288 US dollars for a family of 12 people. Families whose annual income is less than 600 US dollars are 2.25 times more frequent in rural areas. Indeed, in rural areas, the income derived from the exploitation of natural resources which, added to the effect of drought, leads every year to the destruction of 80,000 hectares of forest. Poor paradoxically appear both agents and direct brunt of environmental degradation, in 1992, 30-50% of the population in Senegal lived below the poverty line. However, poverty is not simple food inaccessibility. It extends to other deprivations such as lack of access to basic social services: health, education, training, access to drinking water and electricity that often deteriorate the living conditions of populations. Thus, the decline in rural incomes increases health spending in a much higher proportion than the growth of national wealth.
Oral disease was 1.6 times more common in children from rural area, underpinned by the lowest level of poverty in this environment.
In this study Daouda Faye, Aida Kanouté and Cheikh Mbacké Lo show that the greater frequency of gingivitis in urban areas is due to the significant predominance of older children in this environment. The level of health indicators is inversely proportional to the degree of poverty; which confirms the correlation between poor health and poverty in one hand and between the healthy and development in the other hand. In developing countries, people are often sick because they are poor; they are getting poorer because they are sick and have their evil worse due to the increased misery. Thus, children in families with lower socioeconomic status are more likely to have their caries left untreated or are likely to incomplete dental care.
Daouda Faye, Aida Kanouté and Cheikh Mbacké Lo, in order to improve oral health in children of Diourbel District, go on to suggest three recommendations:
- Improving the living conditions of families by strengthening the fight against poverty through the promotion of micro-enterprise and income-generating activities.
- Introduce into the school curriculum and literacy a schedule of prevention of diseases related to poor hygiene and the promotion of oral health.
- Strengthen prevention of oral disease strategies at the community level by training the relay for information, education and communication (IEC) in support of the strategy forward for better monitoring.
Author:Daouda Faye, Aida Kanouté, Cheikh Mbacké Lo
Public Health Dentistry Office, Faculty of Medicine, Pharmacy and Dentistry, Dakar, Senegal