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Oral health is a major public health issue in West Africa, yet it has gotten little attention. Individual and group disparities in health status are influenced by social determinants of health (SDH), which also affect oral health. Adolescence is a significant transition into adulthood, a time when the SDH can contribute to lifelong health status. This article explored the SDH associated with oral health behaviour, perception, and oral health development amongst adolescents in West Africa. This article engaged articles published in peer-reviewed journals relating to adolescents' oral health and West Africa. The authors undertook this desk review to determine the social determinants of adolescents' oral health in West Africa. The literacy levels and oral health awareness of adolescents, family and social circle influences, socioeconomic status, nutritional levels, and cultural and environmental factors have been identified as important social determinants. Adequate policy implementation with the integration of oral health in schools' curriculum, health systems reorientation with the adoption of oral health delivery in primary health care and expansion in oral health research with the assessment of cultural influences on oral health development have been recommended as interventions to reduce oral health inequalities in West Africa.

Background Childhood obesity is a pertinent public health problem in the UK. Consumption of free sugars has been associated with the development of obesity. In 2018, the Change 4Life (C4L) 100 cal snack campaign was launched with the slogan ‘100 calorie snacks, two a day max’, aiming to encourage parents to choose lower sugar, fat and calorie snacks for their children. This study aimed to examine how the campaign has been perceived by parents. Methods An online survey was developed to explore parent awareness, perceptions and understanding of the C4L 100 cal snack campaign. Respondents were recruited via Leeds City Council, posters displayed at primary schools and children’s centres across Leeds and via social media. Paper surveys were also shared with voluntarily led playgroups. Survey data was analysed using descriptive statistics. Thematic analysis was performed on open text responses. Results Three hundred forty-two 342 respondents completed the survey. Just over half of the respondents had come across the campaign, most seeing the leaflet or a television advert. Over two-thirds of respondents ‘agreed’ or ‘strongly agreed’ that the campaign caught their attention. A similar proportion ‘agreed’ or ‘strongly agreed’ that the campaign informed them about 100 cal snacks and just over a half thought it was memorable. Most respondents used positive language to describe the campaign, but there was no clear consensus of a perceived positive impact on healthier snack purchasing, nor preparing more 100 cal snacks at home. Respondents provided examples of how the campaign could be improved to positively impact eating behaviours: better publicity and information delivery; healthier snack examples made more visible; improved nutritional labelling and access to healthier products in supermarkets (availability, promotion, display, choice). Conclusions The C4L 100 cal snack campaign was perceived positively by parents and carers, with many agreeing that the campaign was informative and memorable. However, there was no agreement in terms of the parents reporting an impact of the campaign on behaviour change and healthier snack habits. Future social marketing campaigns could be improved through more formal pilot testing to assess the understanding and acceptance of the campaign amongst the target audience.

Background Practical links between health systems and health security are historically prevalent, but the conceptual links between these fields remain under explored, with little on health system strengthening. The need to address this gap gains relevance in light of the COVID-19 pandemic as it demonstrated a crucial relationship between health system capacities and effective health security response. Acknowledging the importance of developing stronger and more resilient health systems globally for health emergency preparedness, the WHO developed a Health Systems for Health Security framework that aims to promote a common understanding of what health systems for health security entails whilst identifying key capacities required. Methods/ results To further explore and analyse the conceptual and practical links between health systems and health security within the peer reviewed literature, a rapid scoping review was carried out to provide an overview of the type, extent and quantity of research available. Studies were included if they had been peer-reviewed and were published in English (seven databases 2000 to 2020). 343 articles were identified, of those 204 discussed health systems and health security (high and medium relevance), 101 discussed just health systems and 47 discussed only health security (low relevance). Within the high and medium relevance articles, several concepts emerged, including the prioritization of health security over health systems, the tendency to treat health security as exceptionalism focusing on acute health emergencies, and a conceptualisation of security as ‘state security’ not ‘human security’ or population health. Conclusion Examples of literature exploring links between health systems and health security are provided. We also present recommendations for further research, offering several investments and/or programmes that could reliably lead to maximal gains from both a health system and a health security perspective, and why these should be explored further. This paper could help researchers and funders when deciding upon the scope, nature and design of future research in this area. Additionally, the paper legitimises the necessity of the Health Systems for Health Security framework, with the findings of this paper providing useful insights and evidentiary examples for effective implementation of the framework.

Oral health is embedded in overall health and contributes to physical, social and mental wellbeing. Most diseases are preventable, and yet, oral diseases pose a significant public health problem and an economic burden globally. Poor oral health is a risk factor for certain systemic diseases, such as cardiovascular disease, diabetes and lung pathologies. Rural populations are disproportionately affected by oral disease, with higher levels of periodontal disease, caries and the loss of teeth. These issues are worsened by barriers in access to oral healthcare services and minimal promotion of healthy behaviours in rural communities. Certain interventions, including mobile dental clinics, teledentistry, dental outreach camps and educational initiatives, have been successful in addressing rural challenges. Policies and action plans should be considered by public health officials to reduce the disparities in oral health among rural communities, reduce the overall burden of oral health and promote health equity.Key pointsMost oral diseases are preventable, but if left untreated can negatively impact the wellbeing of individuals and have high societal costs.Rural populations are disproportionately affected by oral disease due to limited access to oral healthcare services and limited support to maintain healthy behaviours.Interventions, such as mobile dental clinics and teledentistry initiatives, could improve oral health outcomes for rural communities. Policies to strengthen and expand oral health promotion and access to care should be implemented.

In terms of GFATM, lasting critiques include claims that conditional funding often distorts country health priorities, undermining health system strengthening,2 while imposing external agendas resulting from asymmetrical power between global health funders on the GFATM Board and country implementors.3 4 This can result in policies that are misaligned with national priorities, creating duplicated human resources, disjointed monitoring and evaluation systems, with increased transactional, opportunity and direct costs to implementors.5 Regarding sustainability, the GFATM has been accused of inadvertently creating an overreliance on foreign aid, with an associated shifting of responsibility for health to funders and non-governmental organisations (NGOs).6 The lack of self-reliance is compounded in Africa by a lack of government direction and weak regional governance, diluted power and financial uncertainty,1 escalated by limited GFATM support to improve local financial management or capacity building within implementing countries. [...]a reliance on external expertise rather than leading from within impacts on sustainability. In terms of disease burden and ‘most affected’, the two African constituencies account for 81% of Global Fund allocations for malaria, 76% for HIV/AIDS and 39% for tuberculos. [...]the mortality statistics for the two African constituencies demonstrate that they combine to embody 95% of all deaths associated with global malaria, 60% of global HIV and 33% of global tuberculosis, which are each accompanied by high social and economic impacts. National ownership and aid effectiveness Evidence suggests that nationally owned programmes result in greater aid effectiveness.10 Moreover, enhanced local and national ownership improves needs-based indicator selection and performance, as well as better system alignment and health prioritisation,11 which also reduces fragmentation.12 Well-designed local programmes with high levels of national ownership improve country capacities and resiliency in addition to improved accountability and leadership.13 14 In terms of the effectiveness of financial results, programmes that have high perceptions of national ownership result in improved additionality toward national health and financial targets,5 15 increased value for money and return on investment, while also improving partnership and perceptions of legitimacy.16 Finally, national ownership supports a decolonisation agenda,17 while improving the sustainability of programmes.6 18 What this indicates is that national ownership is crucial to aid effectiveness, which GHIs must advance.

Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment-and has specific relevance with SDF/ SF treatments. The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared. Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the \"best interest\" of the patient. It is recommended that it is clarified globally when a dentist may act in the \"best interest\" of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries.

Background Insufficient and above WHO-recommended levels of iodine intake during pregnancy can lead to serious health outcomes. This study aimed to assess median urine iodine concentration and its associated risk factors among pregnant women in the Mbeya region, Tanzania. Method A cross sectional survey involving 420 pregnant women (n=420) aged 15-49, registered in Reproductive and Child Health Clinics was conducted. Socio-demographic and dietary factors were assessed by structured questionnaire and the urine samples were analyzed using the ammonium persulfate digestion method. Results Median urinary iodine concentration (mUIC) was 279.4μg/L and it ranged from 26.1 to 1915μg/L. Insufficient mUIC (below 150μg/L) was observed in 17.14% of participants, sufficient mUIC was 24.29% and 58.57% had mUIC above the recommended level (>250μg/L). Sample women who reported consuming fish in the last 24 hours had an increased risk of insufficient mUIC [Adjusted OR= 2.60 (95%CI 1.31-5.15)] while the risk was lower for those who attended at least primary education [AOR= 0.29 (CI 0.08-0.99)]. Further, sample women resident in Mbarali district, in the oldest age group (35-49) and having a higher socio-economic status were associated with an increased risk of having MUIC above recommended level [AOR=4.09 (CI 1.85-9.010], [AOR=2.51 (CI 0.99-6.330] and, [AOR=2.08 (CI 0.91-4.71) respectively. Conclusion This study demonstrated a significant association between geographical, age and socio-economic factors and median urine iodine concentration above the WHO-recommended level. Further, this study found association between inadequate iodine in diet and insufficient median urine iodine concentration. Therefore, educational programs on iodine intake should be strengthened.

Infant oral mutilation (IOM) is a traditional practice involving extraction of an infant's unerupted primary tooth buds. IOM has implications for oral and overall health due to blood loss, infection or transmission of bloodborne diseases, such as human immunodeficiency virus. IOM also leads to long-term dental complications, such as malformation of the child's permanent dentition. IOM is practised primarily in East Africa but can also be seen among immigrant populations in other countries. Currently, there are no tools for a comparative IOM diagnosis and reporting. The aim of this paper is to describe a data collection tool for healthcare practitioners, which was created based on the existing literature and a clinical consultation with senior clinical and public health physicians working in the field. The tool can be used to record IOM-related data for appropriate diagnosis, management and treatment, as well as for monitoring preventive interventions on a community level. Furthermore, this article also summarises clinical guidelines to support practitioners with the management of acute IOM cases. The article concludes by providing recommendations and examples of community education and engagement programmes that could guide the development of interventions to eradicate IOM globally. Key points Infant oral mutilation (IOM) involves extraction of an infant's unerupted primary tooth buds and has acute and chronic implications for both oral and overall health. As presented in this paper, a comprehensive data collection is pivotal in diagnosing, managing, monitoring and preventing IOM, thereby reducing the associated morbidity and mortality. Through advocacy, community engagement, and education and involvement of dental and other healthcare professionals, IOM can be addressed locally and globally.

Increasing rates of non-communicable diseases (NCDs) (obesity, type 2 diabetes, and dental caries) are positively associated with the consumption of added sugars, particularly in sugar-sweetened beverages (SSB). Governments worldwide have implemented SSB taxes to reduce the consumption of sugars added to beverages to reduce the prevalence of NCDs. There is a tax on manufactured products, including SSBs in Brazil. However, in 2016 and 2018, the Brazilian federal government decreased the tax rate, bucking global trends. The SSB industry has criticised such policies, and current tax levels are too low to reduce consumption sufficiently to prevent harm. Research supports positive public health impact potential for a higher SSB tax in Brazil. Sharing experience among countries and complementary policies (nutrition education and front of pack labelling) could increase the positive impacts of an SSB tax. We describe the history of SSB taxes in Brazil and the rationale it provides for specific SSB taxes across the country.