Factors Influencing Oral Health Service Utilization in Lusaka: A Case of Kalingalinga Health Centre

doi:10.21203/rs.3.rs-8266739/v1

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Research Article

Factors Influencing Oral Health Service Utilization in Lusaka: A Case of Kalingalinga Health Centre

https://doi.org/10.21203/rs.3.rs-8266739/v1

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Purpose

This study evaluated factors influencing oral health service utilization at Kalingalinga Health Centre in Lusaka, Zambia. Oral diseases are among the most neglected public health issues in low- and middle-income countries despite their significant burden on quality of life.

Materials and Methods

A descriptive cross-sectional study design was adopted. Data were collected using structured questionnaires and interviews from 130 participants, 110 patients and 20 dental professionals. Quantitative data were analyzed using descriptive statistics, while qualitative data were thematically analyzed.

Findings:

The study found that only 38% of patients sought preventive dental care, while 62% sought services only during pain. The main barriers to service utilization included high treatment costs (58%), fear of dental procedures (46%), and long waiting times (40%). Health system challenges such as inadequate staffing (60%) and shortages of dental equipment (55%) also hindered access. Awareness of oral health was moderate (68%), though preventive behavior remained low.

Implications to Theory, Practice and Policy:

The findings align with the Health Belief Model, indicating that perceived barriers and low self-efficacy significantly affect health-seeking behavior. The study recommends community-based oral health promotion, affordable dental services, and strengthened public oral health systems.

Health Economics & Outcomes Research

Dentistry

Oral Health

Service Utilization

Preventive Care

Health Systems

Zambia

Oral health is defined as a state of being free from mouth and facial pain, oral and throat cancers, oral birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay, tooth loss, and other conditions that affect the oral cavity (WHO, 2010). Globally, oral diseases are a significant public health burden, with dental caries and periodontal diseases remaining the two most prevalent conditions (Petersen et al., 2005). Tooth decay is the most common chronic disease across all ages, while periodontal disease, which begins as reversible gingivitis, continues to affect 5%–20% of adults worldwide (FDI, 2015; Petersen, 2009).

Reliable global data on oral health remain limited, as most low- and middle-income countries lack integrated surveillance systems (FDI, 2015). In Zambia, although oral diseases are largely preventable, over 80% of the population is affected by dental caries, periodontal disease, malocclusion, and oral infections (Ministry of Health [MOH], 2012). The high HIV prevalence has further compounded the burden of oral lesions and infections (Shary et al., 2018). Despite the country’s growing non-communicable disease (NCD) challenge, oral health remains a neglected aspect of health care planning.

Globally, about 3.5 billion people experience oral pain or tooth-related conditions (WHO, 2020). In Europe, over 50% of adults have periodontitis, and more than 10% suffer severe disease (Patel, 2020). Sub-Saharan Africa, already heavily affected by HIV/AIDS, faces a dual burden of infectious and oral diseases. Periodontal disease is now linked with systemic conditions such as cardiovascular disease and diabetes, further amplifying public health risks (Petersen et al., 2005).

In Zambia, oral health services are mainly provided at referral and district hospitals, with little to no coverage at primary health centres where most citizens seek care (MOH, 2012). Dental clinics are often under-resourced, lacking essential equipment, materials, and skilled personnel. The few existing dental practitioners are concentrated in urban areas, leaving peri-urban and rural populations underserved. Kalingalinga Health Centre, located in a densely populated urban settlement in Lusaka, reflects this national challenge. The facility faces shortages of dental staff and equipment, while patients tend to seek care only for emergencies such as extractions.

Oral health services, by definition, include curative, preventive, promotive, and rehabilitative interventions delivered by qualified professionals to relieve pain, restore function, and prevent disease (MOH, 2012). However, the high cost of treatment, user fees, and limited access to preventive education continue to limit utilization. In contrast to general outpatient services, which are free at health centres, dental care often carries a charge, discouraging early health-seeking behavior.

Therfore, this study examined the factors influencing oral health service utilization at Kalingalinga Health Centre. By identifying the barriers from both patient and provider perspectives, it aims to inform targeted interventions and strengthen Zambia’s oral health delivery system.

1.1 Problem Statement

Across much of Africa, access to proper oral health care remains severely limited. Dental professionals are few and largely concentrated in urban centers, while the majority of the population, particularly those in peri-urban and rural areas—lack affordable, accessible, and preventive dental services (Vanek, 2017). In Zambia, although the national oral health program aims to provide curative, preventive, promotive, and rehabilitative care, service utilization remains extremely low. Most patients seek care only when dental problems have advanced to severe stages, often requiring tooth extraction as the only option.

According to the Ministry of Health (2018), more than 80% of Zambians are affected by oral health problems such as dental caries, periodontal disease, malocclusion, facial injuries, halitosis, and oral tumors. However, only a small fraction utilize available dental clinics in their communities. Oral health, though closely linked to general well-being and non-communicable diseases such as diabetes and cardiovascular conditions, continues to receive minimal attention compared to diseases like HIV/AIDS, tuberculosis, and malaria (Ndiaye, 2010).

The lack of a clear national oral health policy (Mukena, 2010), inadequate dental infrastructure, high treatment costs, and insufficient community awareness exacerbate this situation. Consequently, most dental services in Zambia are reactive rather than preventive. The populations most affected are low-income communities, such as those served by Kalingalinga Health Centre, where delayed treatment often leads to preventable tooth loss, pain, and infection.

Despite the visible burden of disease, the underlying reasons for poor oral health service utilization have not been systematically studied in Zambia. This knowledge gap limits policymakers’ ability to design effective, equitable, and sustainable interventions. Therefore, this study investigated the factors influencing oral health service utilization at Kalingalinga Health Centre by exploring the perspectives of both patients and oral health providers, with the goal of informing strategies to improve service access and utilization across the country

Oral health is an essential component of general health and well-being, affecting nutrition, communication, and quality of life. Poor oral health can lead to pain, infection, tooth loss, and systemic complications, while also contributing to social and economic disadvantage. The global distribution of oral diseases reveals sharp disparities between and within countries, largely influenced by income, education, and access to preventive care. Understanding these disparities helps contextualize Zambia’s situation within the broader public health framework.

Global Perspective

Globally, oral diseases remain among the most prevalent non-communicable diseases, collectively affecting 3.5 to 4 billion people, more than half of the world’s population (WHO, 2020). Dental caries in permanent teeth remains the single most common health condition worldwide. Periodontal disease, severe tooth loss, and oral cancers also contribute significantly to disability-adjusted life years (DALYs). The Global Burden of Disease Study (Marcenes et al., 2013) showed that oral health problems increased in absolute numbers between 1990 and 2010 due to population growth and ageing, even though their proportional burden declined slightly.

High-income countries have seen marked improvements in oral health because of fluoride use, improved hygiene, preventive programs, and better access to care. In contrast, most developing countries continue to face a double burden, rising rates of dental decay alongside limited access to professional dental care. The cost of dental treatment often exceeds the total health expenditure available per person in many low- and middle-income settings, making prevention the most practical approach (FDI, 2015).

Regional Perspective (Africa)

In Africa, oral health problems remain a neglected public health issue. Studies across the continent reveal a consistent pattern of low service coverage, shortage of dental professionals, and limited preventive care (Thorpe, 2006; Petersen, 2003). The African region is characterized by an overall low to moderate prevalence of dental caries, but this is expected to rise due to increased urbanization, higher sugar consumption, and reduced natural fluoride exposure (Moynihan & Petersen, 2004). Rural and peri-urban communities often have no access to dental services other than emergency extractions.

Serious oral conditions such as noma (cancrum oris), acute necrotizing gingivitis, and oral manifestations of HIV/AIDS still occur in many parts of Sub-Saharan Africa (Thorpe, 2006). Oral cancers are also on the rise, often diagnosed at advanced stages due to lack of screening and awareness. The shortage of dental professionals is severe: some countries have ratios as low as 1 dentist per 150,000 people, compared to 1:2,000 in high-income nations (Vanek, 2017). Oral health ranks low among government priorities, with most available resources directed toward life-threatening diseases such as HIV/AIDS, tuberculosis, and malaria (Ndiaye, 2010).

Cultural reliance on traditional healers further complicates service utilization. In many communities, herbal remedies are used to treat oral pain or infections, delaying professional intervention (Agbor & Naidoo, 2015).

Zambia’s Context

In Zambia, oral health services remain limited and concentrated in urban referral and district hospitals. Over 80% of the population is estimated to suffer from oral conditions such as dental caries, gum disease, malocclusion, facial trauma, halitosis, and oral tumors (MOH, 2012). Despite this high prevalence, most people only visit dental clinics when pain becomes severe, resulting in high extraction rates and very few preventive or restorative procedures (Mukena, 2010).

There is no standalone national oral health policy, and oral health is integrated only superficially within the broader primary health care framework. Most health centres, particularly in peri-urban and rural areas, lack dental equipment, materials, and trained personnel. Oral health education and community outreach are minimal. The HIV epidemic has also compounded the oral disease burden, with increased prevalence of oral lesions among immunocompromised individuals (Shary et al., 2018).

The Kalingalinga Health Centre in Lusaka exemplifies these challenges: high patient volumes, limited staff, inadequate equipment, and services mainly restricted to extractions. Preventive and promotive programs are rare, reflecting the general national pattern of low oral health service utilization.

The reviewed literature highlights that oral health is a global concern, with low- and middle-income countries bearing a disproportionate share of the burden. In Africa, and particularly in Zambia, oral health remains an overlooked component of public health, constrained by limited policy attention, inadequate human resources, and economic barriers. Despite the preventable nature of most oral diseases utilisation of available services is low.

2.1 Theoretical Review

Two behavioural theories principally underpin this study: the Health Belief Model (HBM) and the Andersen Behavioral Model of Health Services Use.

Health Belief Model (HBM)- Rosenstock (1974)

The HBM posits that health-seeking behaviour is determined by individuals’ perceptions of: (a) susceptibility to a health problem, (b) severity of the condition, (c) benefits of the recommended action, and (d) barriers to action. Self-efficacy (confidence in one’s ability to act) and cues to action (triggers to prompt behaviour) were later added. Applied to oral health, HBM explains why many people delay dental visits until pain appears: perceived susceptibility and severity may be low, perceived barriers (cost, fear, time) are high, and cues to action (health education, screening) are weak. This model guided the present study’s exploration of patient beliefs, perceived barriers (economic, psychological, cultural) and the role of health promotion as a cue to preventive behaviour.

Andersen Behavioral Model of Health Services Use Andersen (1968)

Andersen’s model organizes determinants of service use into three domains: predisposing factors (demography, education, health beliefs), enabling resources (income, insurance, service availability), and need (perceived and evaluated need). The model emphasises that even when need exists, utilisation depends on enabling resources and socio-cultural predispositions. For Kalingalinga, Andersen’s framework helped structure investigation of how socio-economic status, service availability, and perceived need interact to produce low utilisation of preventive dental services.

Together, HBM and Andersen’s model provide a comprehensive lens: HBM focuses on individual cognitive drivers (beliefs, fears, perceived benefits/barriers), while Andersen situates those drivers within structural and resource contexts (availability, affordability, organization of services). The study uses HBM to probe individual attitudes and Andersen to interpret system-level constraints- enabling a mixed analysis of demand- and supply-side factors influencing oral health service utilization.

2.2 Conceptual Framework

INDEPENDENT VARIABLES

2.3 Research Gaps

Existing literature documents many drivers of low oral health service utilisation in low- and middle-income countries (cost, fear, access), but there is limited context-specific evidence for peri-urban Lusaka settings such as Kalingalinga. Notably, gaps exist regarding: (a) how community beliefs and reliance on traditional remedies interact with perceived need and affordability, (b) the relative weight of system-level constraints (equipment, staffing) versus individual barriers in public health centre contexts, and (c) actionable policy-relevant recommendations that reflect both patient and provider perspectives. This study addresses these gaps by collecting linked quantitative and qualitative data from patients and dental staff at Kalingalinga Health Centre.

This study adopted a descriptive cross-sectional design with both quantitative and qualitative approaches to assess factors influencing oral health service utilization at Kalingalinga Health Centre in Lusaka, Zambia. The study was conducted within the health centre’s catchment area, which serves a large peri-urban population with diverse socioeconomic backgrounds. The study population comprised adult patients aged between 18 and 65 years attending the dental clinic, and dental professionals providing oral health services at the facility. A total of 130 participants were included 110 patients and 20 dental professionals, selected using a convenience sampling technique based on availability and willingness to participate during the study period. Data collection was conducted using structured questionnaires for patients, capturing demographic details, knowledge, perceptions, and utilization patterns, while interview guides were used for dental professionals to obtain qualitative insights into health system challenges and service delivery constraints. All responses were checked for completeness prior to analysis. Quantitative data were analyzed using descriptive statistics such as frequencies and percentages and presented in tables and figures, whereas qualitative data were analyzed thematically to identify emerging patterns and explanations. Results from both data sources were integrated to provide a comprehensive understanding of the determinants influencing oral health service utilization at Kalingalinga Health Centre.

Questionnaire Origin

The questionnaire used in this study was developed specifically for this research to assess awareness, perceptions, barriers, and utilization of oral health services among patients attending Kalingalinga Health Centre and has never been used elsewhere. An English-language version of the questionnaire has been attached.

The results are organized based on responses from patients, health center nurses, and dental professionals.

Table 1
Response Rate
Response	Frequency	Percent
Returned	130	86.7%
Unreturned	20	13.3%
Total	150	100%
Research Survey Data-2025

Comment

The study achieved an 86.7% response rate, with 130 out of 150 questionnaires returned.

Table 2
Awareness of Oral Health Services
Level of Awareness	Frequency	Percent
Low Awareness	34	26%
Moderate Awareness	89	68%
High Awareness	7	6%
Total	130	100%
Research Survey Data-2025

Comment

Most respondents (68%) had moderate awareness of oral health services, while 26% had low awareness and 6% had high awareness.

Table 3
Purpose of Dental Visit
Reason for Visit	Frequency	Percent
Preventive Care	49	38%
Pain/Curative Treatment	81	62%
Total	130	100%
Research Survey Data-2025

Comment

A majority of patients (62%) sought dental care only when in pain, while 38% visited for preventive reasons.

Research Survey Data-2025

Comment

The leading barriers were high treatment costs (58%), fear of dental procedures (46%), and long waiting times (40%).

Table 5
Health System Challenges Identified by Providers
Health System Barrier	Frequency	Percent
Inadequate Staffing	12	60%
Shortage of Dental Equipment	11	55%
Limited-Service Range	7	35%
Total	20	100%
Research Survey Data-2025

Comment

The main system-related challenges reported were inadequate staffing (60%) and shortages of dental equipment (55%).

Research Survey Data-2025

Comment

Curative visits accounted for 62% of dental attendance, while preventive visits accounted for 38%.

5.1 Conclusion

This study aimed to evaluate the factors influencing oral health service utilization at Kalingalinga Health Centre in Lusaka, Zambia. The findings show that 62% of patients sought dental care only when experiencing pain, while only 38% utilized services for preventive purposes, indicating a predominantly curative pattern of health-seeking behavior. Although 68% of respondents reported moderate awareness of oral health services, this knowledge did not translate into preventive action. Several barriers contributed to low utilization of dental services. The most commonly reported obstacle was high treatment cost (58%), followed by fear of dental procedures (46%), and long waiting times (40%). From the health system perspective, 60% of dental professionals identified inadequate staffing as a major challenge, while 55% cited shortages of dental equipment as a barrier affecting both service delivery and patient access.

The results reveal that oral health service utilization at Kalingalinga Health Centre is significantly influenced by a combination of individual, socio-economic, and structural factors. Despite moderate awareness, preventive dental visits remain low, and the presence of financial, psychological, and system-related constraints continues to shape reactive rather than proactive oral health behaviors within the community.

5.2 Recommendations

Based on the findings of the study, several measures are needed to improve oral health service utilization at Kalingalinga Health Centre. First, sustained community education programs should be implemented to strengthen awareness of preventive dental care and promote early health-seeking behavior. Second, strategies to reduce financial barriers, such as subsidized services or flexible payment mechanisms, should be considered to make dental care more accessible to low-income households.

The health center should also prioritize improvements in staffing levels and ensure consistent availability of essential dental equipment to enhance service delivery efficiency. At the policy level, integrating oral health into routine primary health care activities and strengthening referral pathways may contribute to better oral health outcomes.

Ethics Approval and Consent to Participate

Ethical approval for this study was obtained from the Tropical Diseases Research Centre Research Ethics Committee (TDRC-REC). All procedures involving human participants were conducted in accordance with the Declaration of Helsinki (2013 revision). Written informed consent was obtained from all participants prior to data collection. Data confidentiality and anonymity were strictly maintained throughout the study.

Consent for Publication

Not applicable. The manuscript does not contain any individual person’s identifiable data (images, names, or personal details).

Availability of Data and Materials

The datasets generated and analyzed during the current study are available from the corresponding author upon request.

Competing Interests

The authors declare that they have no competing interests.

Funding

This research received no external funding.

Authors’ Contributions

Signal Ng’andu: Conceptualization, study design, data collection, data analysis, and drafting of the manuscript.
Luckson Muwandia: Methodological guidance, supervision, manuscript review and editing.
Salome Moyo: Data interpretation, validation, and critical revision of the manuscript.

All authors read and approved the final manuscript.

Acknowledgments

The authors would like to express gratitude to the management and staff of Kalingalinga Health Centre for their cooperation and support during data collection. Special thanks to the patients and dental professionals who participated in the study. Appreciation is also extended to colleagues and family members for their encouragement throughout the research process.

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The authors declare no competing interests.

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Factors Influencing Oral Health Service Utilization in Lusaka: A Case of Kalingalinga Health Centre

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Version 1

Abstract

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1.0 INTRODUCTION

1.1 Problem Statement

2.0 LITERATURE REVIEW

2.1 Theoretical Review

2.2 Conceptual Framework

2.3 Research Gaps

3.0 MATERIAL AND METHODS

4.0 FINDINGS

5.0 CONCLUSION AND RECOMMENDATIONS

5.1 Conclusion

5.2 Recommendations

Declarations

Ethics Approval and Consent to Participate

Consent for Publication

Availability of Data and Materials

Competing Interests

Funding

Authors’ Contributions

Acknowledgments

References

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