Determinants and Inequities in the Utilization of Routine Oral Health Care Services in Southeast Nigeria

Introduction: In many developing countries, equitable access to and utilization of appropriate oral health services remains a major problem. This study provides information on inequities, determinants and barriers of utilization of routine dental services in Nigeria. Method: This was aquantitative cross-sectional study undertaken in Enugu State, southeast Nigeria. An interviewer administered questionnaire was used to obtain responses from 329 patients from two dental clinics. A systematic sampling technique was used to select the respondents from the sample frame, where every 3 rd patient starting from the first patient that attended the dental clinic during the period of data collection was interviewed. Analysis was done using cross-tabulations and multiple regression analysis. A socio-economic status (SES) index was created, divided into quintiles (Q1 to Q5) and used to examine the occurrence of inequities in some of the key variables. Results: Majority of the respondents (72%) visited a dental clinic only when they had a tooth ache. The next common cause of dental visit was when clients had an obvious cavity in one or more teeth (36%). The average cost of treatment per case was 4,274.26 Naira (28.49 USD). With no difference in cost by SES.Attendance at clinics for routine checkup was higher in SES groups Q4 and Q5. Regression analysis shows that a highlevel of education, perceived severity of the problem and experience of dental staff were positively associated with utilization of dental clinic while cost of treatment was negatively associated with utilization.(P<0.05) Conclusion: The major barrier to utilization of routine dental services is cost, affecting mainly the lower SES groups. Although low educational level and poor awareness were important factors. The institution of a comprehensive health insurance package which covers oral diseases as well as increased awareness and integration of preventive dental care at the primary care level will help reduce the cost of dental treatment and also enhance utilization of dental care.