{"paper_id":"0d63290d-ee76-4ec2-aa57-beef7823849d","body_text":"Raising harmony in the face of challenges: a study on dental medical services in Africa during two missions of Chinese Navy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Raising harmony in the face of challenges: a study on dental medical services in Africa during two missions of Chinese Navy Guangjie Xu, Rui Hou, Situo Wang, Chunxiu Qiu, Hongfang Liu, Li Zhang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8819427/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Oral diseases remain a major public health challenge in Africa. During the “Harmonious Mission 2017” and “Harmonious Mission 2024” deployments, the Chinese naval hospital ship Peace Ark provided humanitarian medical services in multiple African countries. This study analyzed dental diagnosis and treatment data collected during these two missions to characterize patient profiles, disease spectrum, and treatment patterns, and to inform future overseas dental medical support in Africa. Materials and Methods Demographic characteristics, diagnostic categories, and treatment modalities were extracted from routine clinical records of the Department of Stomatology on the hospital ship’s main platform during both missions. Comparative analyses were performed to describe patient distribution by country, the oral disease spectrum, and diagnostic and treatment patterns across visited countries. For countries visited in both missions, service volume and disease composition were compared between 2017 and 2024. Differences in disease composition and treatment modality distribution were assessed statistically, with P < 0.05 considered significant. Results Across the two missions, 6,654 dental patients from 13 African countries were treated, accounting for approximately 6% of all patients seen on board. The mean patient age was 37.82 ± 18.01 years, and sex ratios varied markedly by country. The disease spectrum was concentrated: the cumulative proportion of the five leading categories—dental caries, non-carious diseases of hard dental tissues, diseases of the pulp and periapical tissues, retained roots, and gingival/periodontal diseases—exceeded 80%. Among the six countries visited in both missions, dental service volume increased significantly in Angola but decreased significantly in Djibouti and Gabon. Disease composition in these six countries changed to varying degrees between 2017 and 2024 ( P < 0.05). In 2024, the proportions of restorative treatments and surgical procedures increased significantly, whereas medication-based treatments decreased significantly ( P < 0.05). Conclusion The burden of oral diseases among populations in the visited African countries was high, with a concentrated disease spectrum and substantial unmet treatment needs. Future medical assistance should strengthen collaboration with local health institutions, refine treatment protocols and referral pathways, and expand oral health education. For similar missions, optimizing clinical workflows and appropriately increasing dental staffing are recommended to improve service efficiency and capacity. Harmonious Mission overseas medical service African oral health epidemiological characteristics Figures Figure 1 Figure 2 Figure 3 Introduction The naval hospital ship Peace Ark is the first purpose-built, ocean-going medical vessel independently designed and constructed by China. Since its commissioning, it has completed ten \"Harmonious Mission\" deployments, delivering humanitarian medical services to populations in more than 50 countries and regions across Africa, Asia, the Americas, and Oceania. From July to December 2017 and from June 2024 to January 2025, Peace Ark conducted two \"Harmonious Mission\" voyages to Africa (hereinafter referred to as the two circumnavigation-of-Africa missions). Oral diseases are highly prevalent in many low- and middle-income countries, and Africa bears a disproportionately heavy burden [1]. World Health Organization (WHO) surveys indicate that nearly half of the African population is affected by oral disorders, with dental caries, periodontal disease, and tooth loss ranking among the most common and debilitating conditions. Nevertheless, access to dental care in many African countries remains severely limited owing to shortages of oral-health professionals, inadequate infrastructure, and financial constraints [2]. Hospital-ship medical missions can provide temporary relief from the disease burden while simultaneously offering valuable insight into local oral-health needs. This study retrospectively analyzes the distribution of patients, patterns of dental diseases, and treatment modalities recorded by the Department of Stomatology during the two circumnavigation-of-Africa missions. The aim is to characterize dental-service utilization and the disease spectrum in the visited African countries, thereby providing an evidence-based reference for optimizing future overseas medical missions. Materials and Methods General Information The hospital ship Peace Ark is equipped with two stomatology consulting rooms housing two comprehensive dental treatment units (chairs) and one digital dental X-ray machine. Typically, the ship berths in each visited country for seven days and provides clinical services over six consecutive days. Overseas medical services under the \"Harmonious Mission\" program are delivered primarily through two modalities: main-platform clinics aboard the ship and forward mobile medical teams ashore. The Department of Stomatology principally provides dental treatments and oral-surgical procedures on the main platform. Patient chief complaints generally fall into three categories: active treatment-seeking for existing conditions, disease consultation, and routine oral-health check-ups. Classification and methods Patient data—including number of visits, age, sex, diagnosed diseases, and treatment measures—were extracted from the main-platform electronic registration system of the hospital ship for both \"Harmonious Mission—2017\" and \"Harmonious Mission—2024.\" A retrospective analysis was then conducted to examine disease distribution, treatment patterns, and clinical management approaches. With reference to the International Classification of Diseases, 11th Revision (ICD-11) [3], dental diseases were classified on the basis of chief complaints, medical history, symptoms, signs, and clinical examination findings into the following categories: dental caries (DA08.0), non-carious diseases of hard dental tissues (DA08.1, DA08.2, DA08.3), diseases of the pulp and periapical tissues (DA09), retained dental roots (DA0A.3), gingival and periodontal diseases (DA0B, DA0C), disorders of tooth development and eruption (DA07), exfoliation or loss of teeth (DA0A.0, DA0A.1), disorders of the oral mucosa (DA01), oral and maxillofacial tumors (2E90, 2E91, 2E60), other oral diseases (DA0Y, DA0Z). In accordance with the Clinical Technical Operation Specifications—Stomatology Volume [4] and the practical conditions encountered during the missions, treatment measures were categorized as follows: restorative treatment (management of tooth-structure defects), surgical management, preventive care, pharmacotherapy, and diagnostic evaluation. Statistical analysis All statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages. Normally distributed continuous variables were reported as mean ± standard deviation (x̄ ± s), whereas non-normally distributed variables were reported as median with interquartile range [M (Q₂₅, Q₇₅)]. Comparisons of unordered categorical variables between groups were conducted using the chi-square test or Fisher's exact test, as appropriate. Ordered categorical variables were compared using the Wilcoxon rank-sum test. All tests were two-sided, and a P value < 0.05 was considered statistically significant. Results General situation During “Harmonious Mission-2017,” the Department of Stomatology was staffed by three doctors and one nurse, using two standard dental chairs on the main platform. A total of 2,436 patient visits were recorded across seven African countries (1,157 males and 1,279 females). Angola had the highest proportion of female patients (56.94%), whereas Djibouti had the lowest (31.68%). The mean age of patients was 38.40 ± 17.01 years. The average daily caseload per chair was 29 patients. During “Harmonious Mission-2024,” staffing was adjusted to three doctors and two nurses. A total of 4,218 patient visits were recorded across 12 African countries (2,022 males and 2,196 females). Seychelles had the highest proportion of female patients (62.32%), whereas Djibouti remained the lowest (29.84%). The mean age was 37.64 ± 15.64 years. The average daily caseload per chair was 29.29 patients. In 2024, the doctor-to-nurse ratio improved from 3:1 to 3:2, increasing the coverage of four-handed dentistry by 50%. The theoretical maximum daily reception capacity per chair increased from 34 to 38 patients, and the work intensity decreased from 85.29% to 77.08%. Six countries were visited during both missions: Djibouti, Tanzania, Mozambique, Angola, the Republic of Congo (CG), and Gabon (Fig. 1 ). Patient volume and proportions of dental visits The total numbers of main-platform outpatient visits during the two missions were 42,095 in 2017 and 69,271 in 2024. In 2017, dental visits (2,436) accounted for 5.79% of all main-platform visits. Tanzania had the lowest proportion of dental visits (2.77%) and Djibouti the highest (9.39%). In 2024, dental visits (4,218) accounted for 6.09% of the total. Tanzania again had the lowest proportion (3.79%), whereas South Africa had the highest (9.42%). Detailed data are presented in Table 1 . Table 1 Proportional Changes in oral medicine outpatient visits across the six countries visited during the two Circumnavigation of Africa missions Total number of treatments on the main platform (n) Number of dental treatments (n) Proportion (%) 2017 2024 2017 2024 2017 2024 Djibouti 5442 5352 511 305 9.39 5.70 Tanzania 5061 6684 140 253 2.77 3.79 Mozambique 8224 7117 459 375 5.58 5.27 Angola 6189 6667 269 396 4.35 5.94 Congo(CG) 5220 4224 326 242 6.22 5.73 Gabon 6092 6567 503 416 8.26 6.33 Cameroon / 6274 / 395 / 6.30 Benin / 6094 / 360 / 5.91 Mauritania / 6010 / 386 / 6.42 South Africa / 3611 / 340 / 9.42 Seychelles / 4675 / 345 / 7.38 Madagascar / 5996 / 405 / 6.75 Sierra Leone 5867 / 228 / 3.89 / Total 42095 69271 2436 4218 5.79 6.09 Among the six countries visited twice, the proportion of dental visits in Angola increased significantly, whereas the proportions in Djibouti and Gabon decreased significantly (Fig. 2 ). Distribution characteristics of oral diseases During both missions, oral diseases in all visited African countries were mainly concentrated in five categories: dental caries, non-carious diseases of hard dental tissues, diseases of the pulp and periapical tissues, retained dental roots, and gingival or periodontal diseases. Detailed data are shown in Table 2 . Table 2 Distribution of Oral Diseases across African Countries Visited during the Two Missions Dental Caries Non-caries diseases of hard tissues of teeth Diseases of pulp or periapical tissues Retained dental root Gingival or Periodontal diseases Disorders of tooth development or eruption Disorders of oral mucosa Exfoliation or Loss of teeth Oral and maxillofacial tumors Other oral diseases 2017 2024 2017 2024 2017 2024 2017 2024 2017 2024 2017 2024 2017 2024 2017 2024 2017 2024 2017 2024 Djibouti 47 31 82 37 74 44 160 96 75 55 23 12 7 3 7 5 12 2 24 20 Tanzania 11 46 16 57 29 18 44 49 24 36 5 14 2 5 3 8 2 5 4 15 Mozambique 78 53 59 75 72 31 157 68 31 46 12 28 11 24 6 11 16 6 17 33 Angola 31 69 48 56 21 35 88 115 46 39 9 31 3 12 3 3 13 2 7 34 Congo(CG) 41 18 50 14 23 18 101 130 53 17 9 16 10 3 4 4 21 11 14 11 Gabon 49 21 86 44 74 46 149 224 75 23 23 15 8 9 7 5 17 3 15 26 Cameroon / 37 0 54 / 43 0 182 / 30 / 16 / 3 / 5 / 4 / 21 Benin / 31 0 38 / 42 0 143 / 42 / 13 / 13 / 6 / 12 / 20 Mauritania / 27 0 41 / 34 0 179 / 41 / 25 / 7 / 4 / 4 / 24 South Africa / 54 0 65 / 31 0 73 / 77 / 11 / 9 / 4 / 2 / 14 Seychelles / 55 0 94 / 21 0 34 / 69 / 12 / 19 / 2 / 4 / 35 Madagascar / 45 0 49 / 43 0 174 / 41 / 16 / 7 / 3 / 8 / 19 Sierra Leone 33 / 24 / 19 / 94 / 23 / 11 / 0 / 3 / 16 / 5 / Total 290 487 365 624 312 406 793 1467 327 516 92 209 41 114 33 60 97 63 86 272 Proportion (%) 11.90 11.55 14.99 14.80 12.81 9.63 32.56 34.79 13.42 12.23 3.78 4.95 1.68 2.70 1.35 1.42 3.98 1.49 3.53 6.45 n 2017, the top five disease categories were: retained dental roots (32.56%), non-carious diseases of hard dental tissues (14.99%), gingival or periodontal diseases (13.42%), diseases of the pulp and periapical tissues (12.81%), and dental caries (11.90%).In 2024, the top five were: retained dental roots (34.79%), non-carious diseases of hard dental tissues (14.80%), gingival or periodontal diseases (12.23%), dental caries (11.55%), and diseases of the pulp and periapical tissues (9.63%). Changes in disease composition in repeatedly visited countries Using the Wilcoxon rank-sum test to analyze the six countries visited during both missions, significant changes were observed in 2024 compared with 2017: Djibouti: non-carious diseases of hard dental tissues (Z = − 2.23, P < 0.05) and oral/maxillofacial tumors (Z = − 2.52, P < 0.05) decreased significantly. Tanzania: dental caries (Z = 2.39, P < 0.05) and non-carious diseases of hard dental tissues (Z = 2.52, P < 0.05) increased significantly, whereas diseases of the pulp and periapical tissues decreased (Z = − 2.02, P < 0.05). Mozambique: disorders of tooth development or eruption increased (Z = 2.23, P < 0.05), whereas retained dental roots (Z = − 2.52, P < 0.05) and diseases of the pulp and periapical tissues (Z = − 2.39, P < 0.05) decreased. Angola: dental caries (Z = 2.52, P < 0.05) and developmental disorders (Z = 2.39, P < 0.05) increased, whereas tumors decreased (Z = − 2.52, P < 0.05). Republic of Congo: dental caries, non-carious diseases, and gingival or periodontal diseases all decreased significantly (P < 0.05). Gabon: dental caries and gingival or periodontal diseases decreased, whereas retained dental roots increased significantly (Z = 2.52, P < 0.05). These changes are illustrated in Fig. 3 . Analysis of treatment measures In 2017, the distribution of treatment measures was as follows: medication (40.39%), restorative treatment (26.31%), diagnostic evaluation (17.61%), surgical management (11.57%), and preventive care (4.12%). In 2024, the distribution shifted to: restorative treatment (37.23%), medication (24.15%), surgical management (21.12%), diagnostic evaluation (10.58%), and preventive care (6.92%).Chi-square analysis revealed a significant change in the overall composition of treatment measures: restorative and surgical treatments increased markedly, whereas medication use decreased significantly (χ² = 215.32, P < 0.001). Preventive care showed a modest increase (Table 3 ). Table 3 Oral treatment measures during the two missions (n/%) Treatment measures 2017 2024 Dental treatment 641 (26.31%) 1570 (37.22%) Surgical procedures 281 (11.54%) 891 (21.12%) Preventive care 100 (4.11%) 292 (6.92%) Drug therapy 984 (40.39%) 1018 (24.13%) Diagnostic evaluation 430 (17.65%) 447 (10.60%) Total 2436 (100%) 4218 (100%) Chi-square test χ 2 = 215.32 p < 0.001 Discussion Oral diseases remain a major public health challenge in Africa. According to WHO surveys, nearly half of the African population suffers from oral disorders [1, 2]. The dentist density in most African countries is low (0.44 per 10,000 population), with marked regional disparities and pronounced maldistribution between urban and rural areas. In addition, only a small proportion of governmental health budgets is allocated to oral health. Influenced by local economic conditions and traditional culture, oral health is often perceived as a low priority, leading to a high incidence of oral diseases but low consultation and treatment rates [5]. Based on the chief complaints of patients from the 13 African countries visited during the two missions, the spectrum of oral diseases was broad but predominantly concentrated in five common categories: dental caries, non-carious diseases of hard dental tissues, diseases of the pulp and periapical tissues, retained dental roots, and gingival or periodontal diseases, together accounting for more than 80% of all cases. Retained dental roots were the most prevalent condition in all visited countries; the mean proportion in 2024 (34.79%) was higher than in 2017 (32.56%), and in the Republic of the Congo and Gabon the proportion reached 53.72% and 53.85%, respectively. The principal reason is that dental hard tissue diseases such as caries and non-carious lesions do not receive timely and effective treatment, resulting in progressive disintegration and loss of dental tissue until only the root remains. This is an important contributor to high rates of tooth loss and severe impairment of masticatory function [6,7]. This pattern also reflects insufficient resource allocation and inadequate emphasis on oral health maintenance, disease prevention, and timely treatment in some African countries, leading to a large number of teeth ultimately requiring extraction. In addition, pulp and periapical diseases and gingival or periodontal diseases were common and are closely associated with oral hygiene practices, dietary patterns, and limited public health coverage [4,6]. Dental diagnosis and treatment require specialized equipment, instruments, and consumables, and must be delivered by professionally trained dental personnel. Dental care is relatively expensive worldwide, and this problem is even more pronounced in economically underdeveloped African countries [8]. The African countries visited generally lacked adequate dental equipment; facilities in primary hospitals were often obsolete, poorly maintained, and supported by scarce and low-quality consumables. As a result, only basic procedures such as simple fillings, extractions, and emergency care could routinely be provided. More complex treatment typically required referral to higher-level hospitals or private clinics, where the cost is high and many procedures are not covered by insurance. Human resources for oral healthcare are also in short supply. Approximately 80% of dentists and oral health workers are concentrated in capital cities or private clinics, leading to “zero-dentist” situations in many rural and remote areas [5]. In some countries, we observed that although hospitals were equipped with dental chairs, the absence of dentists meant that equipment remained idle and eventually fell into disrepair, further exacerbating the poor state of local oral health. In previous “Harmonious Mission” deployments, the Department of Stomatology has consistently been among the specialties with the highest service demand and workload [9]. During the two circumnavigation-of-Africa missions, the hospital ship operated two dental clinics on the main platform each day, providing high-quality dental services to a total of 6,654 local residents. Each mission was staffed with three dentists; with one dentist on rotational rest or dispatched to mobile clinics, two dentists typically worked on the main platform, treating approximately 30 patients per dentist per day. However, with only one or two dental nurses, coverage of four-handed dentistry was limited, resulting in a heavy workload. Although staffing improved in 2024, the department’s efficiency was still markedly affected whenever personnel were dispatched for off-ship duties, making it difficult to meet the high local demand. To ensure medical safety and maintain service quality, increased patient volume could only be achieved by extending working hours, leading to high work intensity and fatigue among staff. Therefore, we recommend appropriately increasing dental staffing in future missions and implementing reasonable limits on daily patient numbers to further improve the quality and efficiency of dental services. Among the 6,654 patients treated in the two missions, the overall sex ratio was roughly balanced. However, likely influenced by economic development and traditional culture, the proportion of female patients was higher in relatively more developed and open countries such as Seychelles and Angola, whereas Djibouti, which is less developed and more conservative, had the lowest proportion of female patients in both missions. Future missions should pay closer attention to the oral health needs of local women [6,10]. The mean age of patients in both missions was below 40 years, suggesting a trend toward younger onset of oral disease. This may be related to multiple factors, including insufficient preventive efforts, dietary transitions, and limited medical resources; alternatively, it may reflect greater oral health awareness and higher care-seeking willingness among younger adults, while older people may be less likely to seek care due to traditional beliefs and economic constraints [11,12]. During the two missions, dental outpatients accounted for approximately 6% of all main-platform visits. The lowest proportion was in Tanzania (2.77% in 2017), and the highest was in South Africa (9.42% in 2024). Higher proportions in countries such as Djibouti and Gabon (2017) and South Africa and Seychelles (2024) may be associated with national economic development, health investment, and cultural attitudes; in general, better-resourced countries with more developed health systems tend to place greater emphasis on oral health, resulting in higher dental attendance. Among the six countries visited twice, Angola showed a significant increase in both the absolute number of dental patients and the proportion of dental visits. This is likely related to increased governmental investment in oral health and health promotion campaigns in recent years, as well as shifting public awareness [13]. By contrast, four countries exhibited decreases in overall main-platform volume, dental visit volume, and dental proportion, with notable declines in Djibouti and Gabon. These changes may reflect improvements in domestic oral health services and public health measures [3,4], or adjustments in the hospital ship’s service model and volume control. When patients were limited to choosing only one department, dentistry was not always the first choice. Comparing 2024 with 2017 in the six repeatedly visited countries, the proportions of non-carious diseases of hard dental tissues and oral/maxillofacial tumors in Djibouti decreased significantly. This may be attributed to recent governmental emphasis on oral health and implementation of policies to reduce sugary beverage intake and thereby decrease acid erosion and tooth wear, coupled with strengthened health education and promotion of fluoride toothpaste to enhance enamel resistance to acid [14]. Furthermore, with support from France and China, initiatives such as “Oral Precancer Screening Day” have been implemented to provide free removal of suspicious lesions, and stricter controls on tobacco and betel nut use have reduced carcinogen exposure and precancerous lesions. The increase in gingival or periodontal diseases in Djibouti may be related to factors such as high temperature and drought, a high-sugar diet, high tobacco consumption, khat (“Qat”) chewing, poor access to dental services, and lack of preventive interventions, all of which contribute to plaque accumulation, proliferation of periodontal pathogens, and severe periodontal tissue destruction [15]. In Tanzania, the recent removal of import tariffs on sugar and implementation of the “Sugary Breakfast Porridge” program have increased the consumption frequency of sugary foods and drinks, whereas coverage of caries-preventive measures such as fluoride toothpaste remains low. In rural areas, consumption of high-fiber staple foods such as maize and long-term chewing habits accelerate tooth wear. In addition, the use of traditional cleansing sticks (“Miswak”) and improper brushing techniques may contribute to increased rates of caries and non-carious diseases of hard dental tissues [16]. Conversely, aid programs such as the China–Tanzania “Bright Journey” oral health project have completed 14,100 root canal treatments, contributing to a 37% reduction in hospitalizations for acute periapical periodontitis. This project has been rated by the Tanzanian Ministry of Health as the most cost-effective foreign-aid oral health project, and the government has increased insurance reimbursement for root canal treatment and improved treatment capacity in primary hospitals, which are key factors underlying the marked decline in pulp and periapical diseases [17]. In Mozambique, traditional diets are relatively low in sugar and high in fiber, and some residents use Salvadora persica twigs for oral cleaning. Combined with water fluoridation, promotion of fluoride toothpaste, and active international collaboration, caries incidence has decreased, resulting in lower rates of pulp and periapical diseases and retained dental roots. However, the wider availability of imaging modalities such as panoramic radiography has increased the detection rate of previously asymptomatic developmental abnormalities (e.g., impacted canines, root curvature, abnormal tooth germ positions), leading to more patients seeking care [18,19]. Angola has strengthened public health policies and preventive measures for oral health, improved dental infrastructure and service capacity, and enhanced international cooperation. Media campaigns and community education have increased public awareness of oral hygiene, resulting in more patients presenting for caries and developmental abnormalities, whereas most maxillofacial tumors are now identified and treated through local hospital screening programs [20,21]. In the Republic of the Congo and Gabon, limited medical resources, inadequate public health investment, high costs and limited availability of dental services, and low oral health awareness contribute to high caries prevalence but low treatment rates. This leads to further tooth destruction and a markedly higher proportion of retained dental roots [22,23]. With respect to treatment measures, substantial changes were observed in 2024 compared with 2017. The proportions of restorative treatment and surgical management increased from 26.31% and 11.57% to 37.23% and 21.12%, respectively. This indicates that during the second mission, the Department of Stomatology placed greater emphasis on early treatment of hard tissue diseases such as caries and non-carious lesions. Procedures such as fillings, pit and fissure sealants, fluoride application, and root canal therapy were used to restore tooth morphology, function, and aesthetics, protect remaining tooth structure, and prevent further damage. At the same time, surgical management (primarily extraction) was performed for severely compromised teeth that could not be saved, thereby relieving pain and preventing complications. The proportions of medication use and diagnostic-only visits decreased, reflecting a strategic shift from “drug-based control” toward “active restoration and surgical intervention.” In 2024, the focus shifted to solving more problems through fillings, extractions, and scaling, with medication used mainly as an adjunct. The demand for preventive care also increased, likely related to gradual improvements in local oral hygiene practices and health awareness. Regarding the service model, the Department of Stomatology primarily provided outpatient treatments and surgeries on the main platform. This model effectively met the major needs of the visited populations and provided timely, effective dental care [24]. Data from the two missions show that the proportion of dental visits among all main-platform visits increased from 5.79% in 2017 to 6.09% in 2024. This may be associated with timely strategic adjustments, including combined initial and follow-up visit systems, integration of appointments and on-site registration, and use of a primary–assistant dentist model, allowing more patients to receive care. It is also related to increasing public awareness of oral health and the growing impact of the hospital ship’s medical services. Analysis of dental diagnosis and treatment data from the two circumnavigation-of-Africa missions not only delineates the distribution characteristics of oral diseases in the visited African countries but also reflects the current status and challenges of local oral health [3–5]. On the one hand, the high burden of oral diseases is closely linked to residents’ lifestyles, oral hygiene awareness, and scarcity of medical resources. On the other hand, with the implementation of overseas medical aid projects such as the Peace Ark hospital ship, more African people are able to access high-quality dental care, which is important for improving oral health. However, to fundamentally address the widespread oral health problems in African countries, comprehensive, multidimensional interventions are needed. This involves not only safeguarding individual health rights but also represents a key component in strengthening regional public health and promoting social development. In many parts of Africa, due to traditional beliefs and low educational levels, public awareness of oral health remains limited, and misconceptions such as “dental caries are untreatable” persist. It is essential to promote knowledge of proper tooth-brushing techniques, dietary control, and regular check-ups through school curricula, community outreach, and media campaigns, with particular attention to high-risk groups such as children and pregnant women. For example, Kenya has recently introduced school-based oral health education through the “Smile Action” initiative; preliminary data indicate a significant decline in caries prevalence among participating students, demonstrating the effectiveness of educational interventions [12,25]. The shortage of safe drinking water is another fundamental driver of oral health problems in Africa [26]. Inadequate fluoride levels in drinking water contribute to high caries prevalence, while contaminated water sources may cause other oral infections. Promoting fluoride toothpaste is a low-cost strategy, but issues of product accessibility and affordability must be addressed. Some countries have attempted to provide fluoride toothpaste to low-income groups via government subsidies or partnerships with multinational companies, but coverage remains insufficient. Furthermore, given the lack of clean water in many rural areas, infrastructure development (e.g., well drilling and water purification systems) must be integrated with hygiene education to achieve systematic improvements. Data show that the number of dentists per million population in Africa is far below the global average and extremely unevenly distributed, with most dentists located in urban areas [5]. Governments therefore need to prioritize the establishment of dental clinics at the primary-care level and improve stomatology training in medical schools. Increasing the number and skills of dentists through targeted training and in-service education is essential. For example, South Africa’s “Rural Oral Health Plan” deploys dentists to remote areas, which has not only alleviated resource shortages but also strengthened local residents’ trust in dental care [27]. African countries can make use of platforms such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to introduce advanced diagnostic technologies and management experience. At the same time, cooperation with developed countries and non-governmental organizations (NGOs) can provide financial support, equipment, and training. International aid projects in dentistry often contribute through equipment donation, free clinics, and remote education, helping African countries narrow the resource gap [3–5,14]. However, such cooperation should respect local health systems, avoid creating “technology dependence,” and focus on sustainable capacity-building. Addressing Africa’s oral health challenges requires education as the foundation, improvement of basic conditions as support, resource investment as the core, and international cooperation as an important driver, forming a multi-stakeholder, long-term mechanism to realize the transition from “passive treatment” to “active prevention” [8,28]. Based on the experience and lessons from the two circumnavigation-of-Africa missions, the following recommendations are proposed for future overseas dental medical services: First, diagnosis and treatment workflows and service models should be further optimized to improve efficiency and quality. Forward triage or dockside triage can be used to screen suitable patients for ship-based treatment, and on-site registration or appointment systems can be implemented according to the Department of Stomatology’s maximum daily capacity. A model in which primary dentists focus on initial visits and assistant dentists on follow-up visits can be adopted, with appointment slips issued to patients requiring follow-up to prioritize their care. When the number of initial visits is high, timely triage should be implemented, with brief preliminary inquiries to identify patients requiring treatment and arrange them in order, thereby reducing waiting time and improving efficiency. Second, cooperation and exchange with local medical institutions should be strengthened to jointly improve dental care capacity. Joint diagnosis and treatment can be carried out by inviting local dental staff to work on board with the ship’s team, while shipboard dentists may also be dispatched to local hospitals for clinical work and academic exchange. Third, oral health education and health promotion should be emphasized to enhance residents’ awareness and self-care ability. While alleviating pain, the hospital ship can use posters, animation displays, and on-site demonstrations to deliver oral health education. Mobile clinics and health lectures can also be conducted in local communities, schools, and welfare institutions to expand coverage. Fourth, research and technological innovation should be strengthened to explore treatment methods and materials more suitable for the characteristics of oral diseases in African populations. Given the high prevalence of tooth defects and tooth loss, it is recommended that the Department of Stomatology be equipped with CAD/CAM systems and 3D printing technology, enabling rapid fabrication of dentures and other prostheses to effectively restore patients’ masticatory function. Declarations Consent for publication Not applicable in the declarations section. Declaration of competing interest The authors declare no competing interests. Human Ethics and Consent to Participate declarations This study was approved by the Academic Frontier Ethics Committee of the Naval Medical Center of the PLA (approval number: AF-HEC-009). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The requirement for informed consent was waived by the Academic Frontier Ethics Committee of the Naval Medical Center of the PLA because this study used anonymised retrospective data. Funding Self-funded. Author Contribution G.X. and S.W. wrote the main manuscript text and prepared the figures. C.Q., H.L., L.Z., X.X and T.G. collected the data and conducted the analysis. R.H. and C.O. designed the research topics and revised the articles. All authors reviewed the manuscript. Acknowledgments The article describes a retrospective analysis of dental medical services conducted during humanitarian missions by the Chinese Navy hospital ship Peace Ark, with no indication of any commercial interests, funding from commercial entities, or competing interests that would require disclosure. Data Availability The datasets generated and/or analysed during the current study are not publicly available due to institutional and military confidentiality restrictions but are available from the corresponding author on reasonable request and with permission from the Naval Medical Center of the PLA. References Foláyan MO, Ishola AG, Bhayat A, et al. Strengthening health systems to tackle oral diseases in Africa: Africa centers for disease control and prevention's role. Front Public Health. 2025; 13:1539805. World Health Organization Africa. Africa burdened with largest global increase of oral diseases. 2023. World Health Organization. ICD-11 Implementation or Transition Guide. Geneva: World Health Organization; 2019. Chinese Stomatological Association. Clinical Technical Operation Specifications: Stomatology Volume. Beijing: People's Medical Publishing House; 2017. Gallagher JE, Mattos Savage GC, Crummey SC, et al. Oral Health Workforce in Africa: A Scarce Resource. Int J Environ Res Public Health. 2023; 20:2328. Teshome A, Muche A, Girma B. Prevalence of Dental Caries and Associated Factors in East Africa, 2000–2020: Systematic Review and Meta-Analysis. Front Public Health. 2021; 9:645091. Kimmie-Dhansay F, Pontes CC, Chikte UME, et al. Impacts of Tooth Loss on OHRQoL in an Adult Population in Cape Town, South Africa. Int J Environ Res Public Health. 2021; 18:4989. Foláyan MO, Bhayat A, Mikhail SS, et al. Resources for oral health in Africa. Front Oral Health. 2025; 6:1540944. Xu Guangjie, Qian Zhijun, Ye Xiaofei, et al. Practice and reflection of overseas medical services in the nine \"Mission Harmony\" missions. Chin J Naut Med Hyperbar Med. 2025; 32:489-95. Noshir CYS, Brijlal P. Health policy and regulations in Seychelles - barriers and opportunities for oral health inclusion. BMC Oral Health. 2024; 24:604. Shomuyiwa DO, Bridge G. Oral health of adolescents in West Africa: prioritizing its social determinants. Glob Health Res Policy. 2023; 8:28. Sharkawy MN, Shaalan O. Oral health knowledge, attitudes, and behaviors of adult patients attending a dental school hospital in Egypt: a cross-sectional study. Sci Rep. 2025; 15: 43274. Kafera G, Kalimbira R, Bagg J, et al. Knowledge, Attitude and Practices of Primary School Teachers Towards Oral Health in Mchinji District, Malawi. Clin Cosmet Investig Dent. 2025; 17:549-61. Labarca TF, Ortuño D, Neira L, et al. Oral Health Research in the WHO African Region between 2011 and 2022: A Scoping Review. J Dent Res. 2024; 103:1209-17. Mohamed AF, Ainane A, Merito A, et al. The Effects of Khat Chewing among Djiboutians: Dental Chemical Studies, Gingival Histopathological Analyses and Bioinformatics Approaches. Bioengineering. 2024; 11:716. Mbawalla H, Masalu JR, Masatu M, et al. Changes in adolescents' oral health status following oral health promotion activities in Tanzania. Acta Odontol Scand. 2013; 71:333-42. Majani Edward, Daniel Agyapong, Innocent Kitandu Paul, et al. Oral Health in Tanzania: Unmasking Its Neglected Dimension. Public Health Challenges. 2024; 3: e70000. Mepatia AI, Myburgh N, Barrie R, et al. Self-assessment of dental health status, behaviours and oral health risk factors among adolescents from public schools in Maputo City-Mozambique. BMC oral health. 2024; 24:145-7. Sales-Peres SHC. Oral Health Status and Anthropometric Conditions among HIV Infected Adolescents on Antiretroviral Therapy in Mozambique. J HIV Clin Sci Res. 2014; 12:21-6. Songa MAS, Saliba NA, Saliba TA, et al. Analysis of the Dental Caries Epidemiological Profile in Children of Benguela city, Angola. Oral Health Prev Dent. 2022; 20:141-8. Songa MAS, Saliba TA, Saliba NA, et al. Prevalence of Dental Caries and Periodontal Disease, Access to Dental Services and Perception of Oral Health in Adolescents and Adults from a Rural Community in Angola. Oral Health Prev Dent. 2024; 22: 665-70. Poaty CW, Deng Qianyi, Lebeka C, et al. Knowledge of Parents Regarding Early Childhood Caries Prevention among Preschool Children in Brazzaville, Republic of Congo: A Cross-Sectional Study. J Clin Pediatr Dent. 2025; 49:172-80. Hildebrandt TR, Ramharter H, et al. Recurring Transient Tooth Pain as Newly Described Symptom of Migratory Loiasis: A Mixed-Methods Study in Rural Gabon. Am J Trop Med Hyg. 2024; 111:826-8. Tang B, Han YY, Liu X, et al. Medical services provided on the 'Harmonious Mission-2017' peace ark from China. BMJ Mil Health. 2023; 169: e44-50. Pengpid S, Peltzer K. Self-rated oral health status and social and health determinants among community dwelling adults in Kenya. Afr Health Sci. 2019; 19:3146-53. Kwame A, Siiba A, Apatinga GA, et al. Water (In)Accessibility, Healthcare Delivery, and Patients' Health Outcomes in Ghana: Perspectives from the Yendi Hospital. Nurs Rep. 2025; 15:418-22. Boachie MK, Molete M, Hofman K, et al. Cost-effectiveness of dental caries prevention strategies in South African schools. BMC Oral Health. 2023; 23:814. WHO African Region. Oral Health. 2025. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 27 Apr, 2026 Reviews received at journal 26 Mar, 2026 Reviews received at journal 24 Mar, 2026 Reviews received at journal 20 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 13 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers invited by journal 05 Mar, 2026 Editor invited by journal 13 Feb, 2026 Editor assigned by journal 13 Feb, 2026 Submission checks completed at journal 12 Feb, 2026 First submitted to journal 12 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8819427\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":602443594,\"identity\":\"ae43453d-f95c-4d80-bae8-d86f4cbe6f2f\",\"order_by\":0,\"name\":\"Guangjie Xu\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYNACHgkgwXzgwIcK0rSwJR6ccYZEq4wP87YQoU4+IvnZwy8yFnIGN3I+HOBtYJDnFzuAX4vhjTRzYxkeCWPJGbkbDkjuYDCcOTuBgJYZCWbSEjwSif0SQC2GZxgSDG4T1JL+DaSlvk0i58GBxDYitMhL5JhJfuCRSOCXyGE4cJAYLQY8b8qkgYFsOLPnmcHBhjMShP0i356+TfJnT528wfHkx5//VNjI80sTsuUAMNp5e+B8CfzKwbY0MDAw/vhBWOEoGAWjYBSMYAAAh+xD8xNaTjwAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Naval Medical Center of PLA, Naval Medical University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Guangjie\",\"middleName\":\"\",\"lastName\":\"Xu\",\"suffix\":\"\"},{\"id\":602443595,\"identity\":\"ab1b79d8-9d5a-4562-a344-520ec2532bc2\",\"order_by\":1,\"name\":\"Rui Hou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Fourth Military Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Rui\",\"middleName\":\"\",\"lastName\":\"Hou\",\"suffix\":\"\"},{\"id\":602443596,\"identity\":\"33eb6923-fbeb-4ebb-9b0d-8aa27c8604cb\",\"order_by\":2,\"name\":\"Situo Wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Naval Medical Center of PLA, Naval Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Situo\",\"middleName\":\"\",\"lastName\":\"Wang\",\"suffix\":\"\"},{\"id\":602443597,\"identity\":\"62033bc6-afa9-4116-abff-14f61298b6a7\",\"order_by\":3,\"name\":\"Chunxiu Qiu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Naval Medical Center of PLA, Naval Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Chunxiu\",\"middleName\":\"\",\"lastName\":\"Qiu\",\"suffix\":\"\"},{\"id\":602443598,\"identity\":\"f4dfff43-5599-44b0-bc7f-54960c9170e4\",\"order_by\":4,\"name\":\"Hongfang Liu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Naval Medical Center of PLA, Naval Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hongfang\",\"middleName\":\"\",\"lastName\":\"Liu\",\"suffix\":\"\"},{\"id\":602443599,\"identity\":\"8a59b6c7-6d84-41e9-9fad-c7c29d524da2\",\"order_by\":5,\"name\":\"Li Zhang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Naval Medical Center of PLA, Naval Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Li\",\"middleName\":\"\",\"lastName\":\"Zhang\",\"suffix\":\"\"},{\"id\":602443600,\"identity\":\"912fcd68-4f91-4abf-9acb-0e4e63e8711f\",\"order_by\":6,\"name\":\"Xiangyang Xu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Naval Hospital of the Eastern Theater Command\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xiangyang\",\"middleName\":\"\",\"lastName\":\"Xu\",\"suffix\":\"\"},{\"id\":602443601,\"identity\":\"7ad26824-967f-4c6a-b626-3bcad1fb9a0f\",\"order_by\":7,\"name\":\"Tian Gao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Naval Medical Center of PLA, Naval Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tian\",\"middleName\":\"\",\"lastName\":\"Gao\",\"suffix\":\"\"},{\"id\":602443602,\"identity\":\"f1b4396b-ea4e-4b26-b97b-062cdd6db4f6\",\"order_by\":8,\"name\":\"Chongyang Ou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Naval Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Chongyang\",\"middleName\":\"\",\"lastName\":\"Ou\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-02-08 06:08:10\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8819427/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8819427/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":104343978,\"identity\":\"0d5c8567-325d-4e10-92ec-541b069f3323\",\"added_by\":\"auto\",\"created_at\":\"2026-03-10 17:17:18\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":403496,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTrack map of the two Circumnavigation of Africa missions\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8819427/v1/58d0ed69cef8a31899b7d1c5.jpeg\"},{\"id\":104780007,\"identity\":\"51b1fc8c-ac6c-4c00-9fb4-da16826c71f6\",\"added_by\":\"auto\",\"created_at\":\"2026-03-17 07:49:03\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":37463,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eChanges in the proportion of dental treatments in the six countries visited in both Circumnavigation of Africa missions\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8819427/v1/c9d4089d98217d62a1971766.png\"},{\"id\":104343979,\"identity\":\"f02b4d37-94ca-49c1-95cc-456db13b6350\",\"added_by\":\"auto\",\"created_at\":\"2026-03-10 17:17:18\",\"extension\":\"jpeg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":215065,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eComparative composition ratios of oral diseases identified in Recurring six Countries during the two missions\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage3.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8819427/v1/9191d29289865b919adf442f.jpeg\"},{\"id\":104784240,\"identity\":\"e8c0c59d-00d7-4741-91fd-3a93ccc8fef0\",\"added_by\":\"auto\",\"created_at\":\"2026-03-17 08:06:11\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1704954,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8819427/v1/206cf0d3-da69-4a0a-9926-1c840f4693a2.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Raising harmony in the face of challenges: a study on dental medical services in Africa during two missions of Chinese Navy\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe naval hospital ship \\u003cem\\u003ePeace Ark\\u003c/em\\u003e is the first purpose-built, ocean-going medical vessel independently designed and constructed by China. Since its commissioning, it has completed ten \\\"Harmonious Mission\\\" deployments, delivering humanitarian medical services to populations in more than 50 countries and regions across Africa, Asia, the Americas, and Oceania. From July to December 2017 and from June 2024 to January 2025, \\u003cem\\u003ePeace Ark\\u003c/em\\u003e conducted two \\\"Harmonious Mission\\\" voyages to Africa (hereinafter referred to as the two circumnavigation-of-Africa missions).\\u003c/p\\u003e \\u003cp\\u003eOral diseases are highly prevalent in many low- and middle-income countries, and Africa bears a disproportionately heavy burden [1]. World Health Organization (WHO) surveys indicate that nearly half of the African population is affected by oral disorders, with dental caries, periodontal disease, and tooth loss ranking among the most common and debilitating conditions. Nevertheless, access to dental care in many African countries remains severely limited owing to shortages of oral-health professionals, inadequate infrastructure, and financial constraints [2]. Hospital-ship medical missions can provide temporary relief from the disease burden while simultaneously offering valuable insight into local oral-health needs.\\u003c/p\\u003e \\u003cp\\u003eThis study retrospectively analyzes the distribution of patients, patterns of dental diseases, and treatment modalities recorded by the Department of Stomatology during the two circumnavigation-of-Africa missions. The aim is to characterize dental-service utilization and the disease spectrum in the visited African countries, thereby providing an evidence-based reference for optimizing future overseas medical missions.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eGeneral Information\\u003c/h2\\u003e \\u003cp\\u003eThe hospital ship \\u003cem\\u003ePeace Ark\\u003c/em\\u003e is equipped with two stomatology consulting rooms housing two comprehensive dental treatment units (chairs) and one digital dental X-ray machine. Typically, the ship berths in each visited country for seven days and provides clinical services over six consecutive days. Overseas medical services under the \\\"Harmonious Mission\\\" program are delivered primarily through two modalities: main-platform clinics aboard the ship and forward mobile medical teams ashore. The Department of Stomatology principally provides dental treatments and oral-surgical procedures on the main platform. Patient chief complaints generally fall into three categories: active treatment-seeking for existing conditions, disease consultation, and routine oral-health check-ups.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eClassification and methods\\u003c/h3\\u003e\\n\\u003cp\\u003ePatient data\\u0026mdash;including number of visits, age, sex, diagnosed diseases, and treatment measures\\u0026mdash;were extracted from the main-platform electronic registration system of the hospital ship for both \\\"Harmonious Mission\\u0026mdash;2017\\\" and \\\"Harmonious Mission\\u0026mdash;2024.\\\" A retrospective analysis was then conducted to examine disease distribution, treatment patterns, and clinical management approaches.\\u003c/p\\u003e \\u003cp\\u003eWith reference to the \\u003cem\\u003eInternational Classification of Diseases, 11th Revision\\u003c/em\\u003e (ICD-11) [3], dental diseases were classified on the basis of chief complaints, medical history, symptoms, signs, and clinical examination findings into the following categories: dental caries (DA08.0), non-carious diseases of hard dental tissues (DA08.1, DA08.2, DA08.3), diseases of the pulp and periapical tissues (DA09), retained dental roots (DA0A.3), gingival and periodontal diseases (DA0B, DA0C), disorders of tooth development and eruption (DA07), exfoliation or loss of teeth (DA0A.0, DA0A.1), disorders of the oral mucosa (DA01), oral and maxillofacial tumors (2E90, 2E91, 2E60), other oral diseases (DA0Y, DA0Z). In accordance with the \\u003cem\\u003eClinical Technical Operation Specifications\\u0026mdash;Stomatology Volume\\u003c/em\\u003e [4] and the practical conditions encountered during the missions, treatment measures were categorized as follows: restorative treatment (management of tooth-structure defects), surgical management, preventive care, pharmacotherapy, and diagnostic evaluation.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eAll statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages. Normally distributed continuous variables were reported as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (x̄ \\u0026plusmn; s), whereas non-normally distributed variables were reported as median with interquartile range [M (Q₂₅, Q₇₅)]. Comparisons of unordered categorical variables between groups were conducted using the chi-square test or Fisher's exact test, as appropriate. Ordered categorical variables were compared using the Wilcoxon rank-sum test. All tests were two-sided, and a \\u003cem\\u003eP\\u003c/em\\u003e value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was considered statistically significant.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eGeneral situation\\u003c/h2\\u003e \\u003cp\\u003eDuring \\u0026ldquo;Harmonious Mission-2017,\\u0026rdquo; the Department of Stomatology was staffed by three doctors and one nurse, using two standard dental chairs on the main platform. A total of 2,436 patient visits were recorded across seven African countries (1,157 males and 1,279 females). Angola had the highest proportion of female patients (56.94%), whereas Djibouti had the lowest (31.68%). The mean age of patients was 38.40\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;17.01 years. The average daily caseload per chair was 29 patients. During \\u0026ldquo;Harmonious Mission-2024,\\u0026rdquo; staffing was adjusted to three doctors and two nurses. A total of 4,218 patient visits were recorded across 12 African countries (2,022 males and 2,196 females). Seychelles had the highest proportion of female patients (62.32%), whereas Djibouti remained the lowest (29.84%). The mean age was 37.64\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.64 years. The average daily caseload per chair was 29.29 patients.\\u003c/p\\u003e \\u003cp\\u003eIn 2024, the doctor-to-nurse ratio improved from 3:1 to 3:2, increasing the coverage of four-handed dentistry by 50%. The theoretical maximum daily reception capacity per chair increased from 34 to 38 patients, and the work intensity decreased from 85.29% to 77.08%. Six countries were visited during both missions: Djibouti, Tanzania, Mozambique, Angola, the Republic of Congo (CG), and Gabon (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePatient volume and proportions of dental visits\\u003c/h2\\u003e \\u003cp\\u003eThe total numbers of main-platform outpatient visits during the two missions were 42,095 in 2017 and 69,271 in 2024. In 2017, dental visits (2,436) accounted for 5.79% of all main-platform visits. Tanzania had the lowest proportion of dental visits (2.77%) and Djibouti the highest (9.39%). In 2024, dental visits (4,218) accounted for 6.09% of the total. Tanzania again had the lowest proportion (3.79%), whereas South Africa had the highest (9.42%). Detailed data are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eProportional Changes in oral medicine outpatient visits across the six countries visited during the two Circumnavigation of Africa missions\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eTotal number of treatments on the main platform (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eNumber of dental treatments (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e \\u003cp\\u003eProportion (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e2017 2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003e2017 2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e \\u003cp\\u003e2017 2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDjibouti\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5442\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5352\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e511\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e305\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e9.39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5.70\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTanzania\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5061\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6684\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e140\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e253\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.77\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e3.79\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMozambique\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8224\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7117\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e459\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e375\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e5.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAngola\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6189\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6667\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e269\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e396\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5.94\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCongo(CG)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5220\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4224\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e326\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e242\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e6.22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5.73\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGabon\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6092\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6567\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e503\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e416\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e8.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e6.33\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCameroon\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6274\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e395\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e6.30\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBenin\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6094\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e360\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5.91\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMauritania\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6010\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e386\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e6.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSouth Africa\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3611\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e340\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e9.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSeychelles\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4675\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e345\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e7.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMadagascar\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5996\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e405\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e6.75\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSierra Leone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5867\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e228\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.89\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e42095\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e69271\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2436\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4218\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e5.79\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e6.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eAmong the six countries visited twice, the proportion of dental visits in Angola increased significantly, whereas the proportions in Djibouti and Gabon decreased significantly (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eDistribution characteristics of oral diseases\\u003c/h3\\u003e\\n\\u003cp\\u003eDuring both missions, oral diseases in all visited African countries were mainly concentrated in five categories: dental caries, non-carious diseases of hard dental tissues, diseases of the pulp and periapical tissues, retained dental roots, and gingival or periodontal diseases. Detailed data are shown in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDistribution of Oral Diseases across African Countries Visited during the Two Missions\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"21\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c13\\\" colnum=\\\"13\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c14\\\" colnum=\\\"14\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c15\\\" colnum=\\\"15\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c16\\\" colnum=\\\"16\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c17\\\" colnum=\\\"17\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c18\\\" colnum=\\\"18\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c19\\\" colnum=\\\"19\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c20\\\" colnum=\\\"20\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c21\\\" colnum=\\\"21\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eDental Caries\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eNon-caries diseases of hard tissues of teeth\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e \\u003cp\\u003eDiseases of pulp or periapical tissues\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e \\u003cp\\u003eRetained dental root\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eGingival or Periodontal diseases\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e \\u003cp\\u003eDisorders of tooth development or eruption\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e \\u003cp\\u003eDisorders of oral mucosa\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e \\u003cp\\u003eExfoliation or Loss of teeth\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c19\\\" namest=\\\"c18\\\"\\u003e \\u003cp\\u003eOral and maxillofacial tumors\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c21\\\" namest=\\\"c20\\\"\\u003e \\u003cp\\u003eOther oral diseases\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDjibouti\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e47\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e82\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e74\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e160\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e96\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e75\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e55\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTanzania\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e46\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e57\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e36\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMozambique\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e78\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e75\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e157\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e68\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e46\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e33\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAngola\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e69\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e56\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e88\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e115\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e46\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e34\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCongo(CG)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e41\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e101\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e130\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGabon\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e74\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e46\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e149\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e224\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e75\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCameroon\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e182\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBenin\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e143\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMauritania\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e41\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e179\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e41\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSouth Africa\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e65\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e73\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e77\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSeychelles\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e55\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e94\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e69\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e35\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMadagascar\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e174\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e41\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSierra Leone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e94\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e/\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e290\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e487\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e365\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e624\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e312\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e406\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e793\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1467\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e327\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e516\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e92\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e209\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e41\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e114\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e33\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e97\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e63\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e272\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProportion (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e11.90\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e11.55\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e14.99\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e14.80\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e12.81\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e9.63\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e32.56\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e34.79\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e13.42\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e12.23\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3.78\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e4.95\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1.68\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2.70\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1.35\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1.42\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3.98\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c19\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1.49\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c20\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3.53\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c21\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e6.45\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003en 2017, the top five disease categories were: retained dental roots (32.56%), non-carious diseases of hard dental tissues (14.99%), gingival or periodontal diseases (13.42%), diseases of the pulp and periapical tissues (12.81%), and dental caries (11.90%).In 2024, the top five were: retained dental roots (34.79%), non-carious diseases of hard dental tissues (14.80%), gingival or periodontal diseases (12.23%), dental caries (11.55%), and diseases of the pulp and periapical tissues (9.63%).\\u003c/p\\u003e\\n\\u003ch3\\u003eChanges in disease composition in repeatedly visited countries\\u003c/h3\\u003e\\n\\u003cp\\u003eUsing the Wilcoxon rank-sum test to analyze the six countries visited during both missions, significant changes were observed in 2024 compared with 2017: Djibouti: non-carious diseases of hard dental tissues (Z\\u0026thinsp;=\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.23, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) and oral/maxillofacial tumors (Z\\u0026thinsp;=\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.52, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) decreased significantly. Tanzania: dental caries (Z\\u0026thinsp;=\\u0026thinsp;2.39, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) and non-carious diseases of hard dental tissues (Z\\u0026thinsp;=\\u0026thinsp;2.52, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) increased significantly, whereas diseases of the pulp and periapical tissues decreased (Z\\u0026thinsp;=\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.02, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Mozambique: disorders of tooth development or eruption increased (Z\\u0026thinsp;=\\u0026thinsp;2.23, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05), whereas retained dental roots (Z\\u0026thinsp;=\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.52, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) and diseases of the pulp and periapical tissues (Z\\u0026thinsp;=\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.39, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) decreased. Angola: dental caries (Z\\u0026thinsp;=\\u0026thinsp;2.52, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) and developmental disorders (Z\\u0026thinsp;=\\u0026thinsp;2.39, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) increased, whereas tumors decreased (Z\\u0026thinsp;=\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.52, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Republic of Congo: dental caries, non-carious diseases, and gingival or periodontal diseases all decreased significantly (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Gabon: dental caries and gingival or periodontal diseases decreased, whereas retained dental roots increased significantly (Z\\u0026thinsp;=\\u0026thinsp;2.52, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). These changes are illustrated in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eAnalysis of treatment measures\\u003c/h2\\u003e \\u003cp\\u003eIn 2017, the distribution of treatment measures was as follows: medication (40.39%), restorative treatment (26.31%), diagnostic evaluation (17.61%), surgical management (11.57%), and preventive care (4.12%). In 2024, the distribution shifted to: restorative treatment (37.23%), medication (24.15%), surgical management (21.12%), diagnostic evaluation (10.58%), and preventive care (6.92%).Chi-square analysis revealed a significant change in the overall composition of treatment measures: restorative and surgical treatments increased markedly, whereas medication use decreased significantly (χ\\u0026sup2; = 215.32, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Preventive care showed a modest increase (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eOral treatment measures during the two missions (n/%)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTreatment measures\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDental treatment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e641 (26.31%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1570 (37.22%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSurgical procedures\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e281 (11.54%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e891 (21.12%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePreventive care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e100 (4.11%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e292 (6.92%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDrug therapy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e984 (40.39%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1018 (24.13%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiagnostic evaluation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e430 (17.65%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e447 (10.60%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2436 (100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4218 (100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eChi-square test\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eχ\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026thinsp;=\\u0026thinsp;215.32 p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eOral diseases remain a major public health challenge in Africa. According to WHO surveys, nearly half of the African population suffers from oral disorders [1, 2]. The dentist density in most African countries is low (0.44 per 10,000 population), with marked regional disparities and pronounced maldistribution between urban and rural areas. In addition, only a small proportion of governmental health budgets is allocated to oral health. Influenced by local economic conditions and traditional culture, oral health is often perceived as a low priority, leading to a high incidence of oral diseases but low consultation and treatment rates [5].\\u003c/p\\u003e \\u003cp\\u003eBased on the chief complaints of patients from the 13 African countries visited during the two missions, the spectrum of oral diseases was broad but predominantly concentrated in five common categories: dental caries, non-carious diseases of hard dental tissues, diseases of the pulp and periapical tissues, retained dental roots, and gingival or periodontal diseases, together accounting for more than 80% of all cases. Retained dental roots were the most prevalent condition in all visited countries; the mean proportion in 2024 (34.79%) was higher than in 2017 (32.56%), and in the Republic of the Congo and Gabon the proportion reached 53.72% and 53.85%, respectively. The principal reason is that dental hard tissue diseases such as caries and non-carious lesions do not receive timely and effective treatment, resulting in progressive disintegration and loss of dental tissue until only the root remains. This is an important contributor to high rates of tooth loss and severe impairment of masticatory function [6,7]. This pattern also reflects insufficient resource allocation and inadequate emphasis on oral health maintenance, disease prevention, and timely treatment in some African countries, leading to a large number of teeth ultimately requiring extraction. In addition, pulp and periapical diseases and gingival or periodontal diseases were common and are closely associated with oral hygiene practices, dietary patterns, and limited public health coverage [4,6].\\u003c/p\\u003e \\u003cp\\u003eDental diagnosis and treatment require specialized equipment, instruments, and consumables, and must be delivered by professionally trained dental personnel. Dental care is relatively expensive worldwide, and this problem is even more pronounced in economically underdeveloped African countries [8]. The African countries visited generally lacked adequate dental equipment; facilities in primary hospitals were often obsolete, poorly maintained, and supported by scarce and low-quality consumables. As a result, only basic procedures such as simple fillings, extractions, and emergency care could routinely be provided. More complex treatment typically required referral to higher-level hospitals or private clinics, where the cost is high and many procedures are not covered by insurance. Human resources for oral healthcare are also in short supply. Approximately 80% of dentists and oral health workers are concentrated in capital cities or private clinics, leading to \\u0026ldquo;zero-dentist\\u0026rdquo; situations in many rural and remote areas [5]. In some countries, we observed that although hospitals were equipped with dental chairs, the absence of dentists meant that equipment remained idle and eventually fell into disrepair, further exacerbating the poor state of local oral health.\\u003c/p\\u003e \\u003cp\\u003eIn previous \\u0026ldquo;Harmonious Mission\\u0026rdquo; deployments, the Department of Stomatology has consistently been among the specialties with the highest service demand and workload [9]. During the two circumnavigation-of-Africa missions, the hospital ship operated two dental clinics on the main platform each day, providing high-quality dental services to a total of 6,654 local residents. Each mission was staffed with three dentists; with one dentist on rotational rest or dispatched to mobile clinics, two dentists typically worked on the main platform, treating approximately 30 patients per dentist per day. However, with only one or two dental nurses, coverage of four-handed dentistry was limited, resulting in a heavy workload. Although staffing improved in 2024, the department\\u0026rsquo;s efficiency was still markedly affected whenever personnel were dispatched for off-ship duties, making it difficult to meet the high local demand. To ensure medical safety and maintain service quality, increased patient volume could only be achieved by extending working hours, leading to high work intensity and fatigue among staff. Therefore, we recommend appropriately increasing dental staffing in future missions and implementing reasonable limits on daily patient numbers to further improve the quality and efficiency of dental services.\\u003c/p\\u003e \\u003cp\\u003eAmong the 6,654 patients treated in the two missions, the overall sex ratio was roughly balanced. However, likely influenced by economic development and traditional culture, the proportion of female patients was higher in relatively more developed and open countries such as Seychelles and Angola, whereas Djibouti, which is less developed and more conservative, had the lowest proportion of female patients in both missions. Future missions should pay closer attention to the oral health needs of local women [6,10]. The mean age of patients in both missions was below 40 years, suggesting a trend toward younger onset of oral disease. This may be related to multiple factors, including insufficient preventive efforts, dietary transitions, and limited medical resources; alternatively, it may reflect greater oral health awareness and higher care-seeking willingness among younger adults, while older people may be less likely to seek care due to traditional beliefs and economic constraints [11,12].\\u003c/p\\u003e \\u003cp\\u003eDuring the two missions, dental outpatients accounted for approximately 6% of all main-platform visits. The lowest proportion was in Tanzania (2.77% in 2017), and the highest was in South Africa (9.42% in 2024). Higher proportions in countries such as Djibouti and Gabon (2017) and South Africa and Seychelles (2024) may be associated with national economic development, health investment, and cultural attitudes; in general, better-resourced countries with more developed health systems tend to place greater emphasis on oral health, resulting in higher dental attendance. Among the six countries visited twice, Angola showed a significant increase in both the absolute number of dental patients and the proportion of dental visits. This is likely related to increased governmental investment in oral health and health promotion campaigns in recent years, as well as shifting public awareness [13]. By contrast, four countries exhibited decreases in overall main-platform volume, dental visit volume, and dental proportion, with notable declines in Djibouti and Gabon. These changes may reflect improvements in domestic oral health services and public health measures [3,4], or adjustments in the hospital ship\\u0026rsquo;s service model and volume control. When patients were limited to choosing only one department, dentistry was not always the first choice.\\u003c/p\\u003e \\u003cp\\u003eComparing 2024 with 2017 in the six repeatedly visited countries, the proportions of non-carious diseases of hard dental tissues and oral/maxillofacial tumors in Djibouti decreased significantly. This may be attributed to recent governmental emphasis on oral health and implementation of policies to reduce sugary beverage intake and thereby decrease acid erosion and tooth wear, coupled with strengthened health education and promotion of fluoride toothpaste to enhance enamel resistance to acid [14]. Furthermore, with support from France and China, initiatives such as \\u0026ldquo;Oral Precancer Screening Day\\u0026rdquo; have been implemented to provide free removal of suspicious lesions, and stricter controls on tobacco and betel nut use have reduced carcinogen exposure and precancerous lesions. The increase in gingival or periodontal diseases in Djibouti may be related to factors such as high temperature and drought, a high-sugar diet, high tobacco consumption, khat (\\u0026ldquo;Qat\\u0026rdquo;) chewing, poor access to dental services, and lack of preventive interventions, all of which contribute to plaque accumulation, proliferation of periodontal pathogens, and severe periodontal tissue destruction [15].\\u003c/p\\u003e \\u003cp\\u003eIn Tanzania, the recent removal of import tariffs on sugar and implementation of the \\u0026ldquo;Sugary Breakfast Porridge\\u0026rdquo; program have increased the consumption frequency of sugary foods and drinks, whereas coverage of caries-preventive measures such as fluoride toothpaste remains low. In rural areas, consumption of high-fiber staple foods such as maize and long-term chewing habits accelerate tooth wear. In addition, the use of traditional cleansing sticks (\\u0026ldquo;Miswak\\u0026rdquo;) and improper brushing techniques may contribute to increased rates of caries and non-carious diseases of hard dental tissues [16]. Conversely, aid programs such as the China\\u0026ndash;Tanzania \\u0026ldquo;Bright Journey\\u0026rdquo; oral health project have completed 14,100 root canal treatments, contributing to a 37% reduction in hospitalizations for acute periapical periodontitis. This project has been rated by the Tanzanian Ministry of Health as the most cost-effective foreign-aid oral health project, and the government has increased insurance reimbursement for root canal treatment and improved treatment capacity in primary hospitals, which are key factors underlying the marked decline in pulp and periapical diseases [17].\\u003c/p\\u003e \\u003cp\\u003eIn Mozambique, traditional diets are relatively low in sugar and high in fiber, and some residents use Salvadora persica twigs for oral cleaning. Combined with water fluoridation, promotion of fluoride toothpaste, and active international collaboration, caries incidence has decreased, resulting in lower rates of pulp and periapical diseases and retained dental roots. However, the wider availability of imaging modalities such as panoramic radiography has increased the detection rate of previously asymptomatic developmental abnormalities (e.g., impacted canines, root curvature, abnormal tooth germ positions), leading to more patients seeking care [18,19].\\u003c/p\\u003e \\u003cp\\u003eAngola has strengthened public health policies and preventive measures for oral health, improved dental infrastructure and service capacity, and enhanced international cooperation. Media campaigns and community education have increased public awareness of oral hygiene, resulting in more patients presenting for caries and developmental abnormalities, whereas most maxillofacial tumors are now identified and treated through local hospital screening programs [20,21]. In the Republic of the Congo and Gabon, limited medical resources, inadequate public health investment, high costs and limited availability of dental services, and low oral health awareness contribute to high caries prevalence but low treatment rates. This leads to further tooth destruction and a markedly higher proportion of retained dental roots [22,23].\\u003c/p\\u003e \\u003cp\\u003eWith respect to treatment measures, substantial changes were observed in 2024 compared with 2017. The proportions of restorative treatment and surgical management increased from 26.31% and 11.57% to 37.23% and 21.12%, respectively. This indicates that during the second mission, the Department of Stomatology placed greater emphasis on early treatment of hard tissue diseases such as caries and non-carious lesions. Procedures such as fillings, pit and fissure sealants, fluoride application, and root canal therapy were used to restore tooth morphology, function, and aesthetics, protect remaining tooth structure, and prevent further damage. At the same time, surgical management (primarily extraction) was performed for severely compromised teeth that could not be saved, thereby relieving pain and preventing complications. The proportions of medication use and diagnostic-only visits decreased, reflecting a strategic shift from \\u0026ldquo;drug-based control\\u0026rdquo; toward \\u0026ldquo;active restoration and surgical intervention.\\u0026rdquo; In 2024, the focus shifted to solving more problems through fillings, extractions, and scaling, with medication used mainly as an adjunct. The demand for preventive care also increased, likely related to gradual improvements in local oral hygiene practices and health awareness.\\u003c/p\\u003e \\u003cp\\u003eRegarding the service model, the Department of Stomatology primarily provided outpatient treatments and surgeries on the main platform. This model effectively met the major needs of the visited populations and provided timely, effective dental care [24]. Data from the two missions show that the proportion of dental visits among all main-platform visits increased from 5.79% in 2017 to 6.09% in 2024. This may be associated with timely strategic adjustments, including combined initial and follow-up visit systems, integration of appointments and on-site registration, and use of a primary\\u0026ndash;assistant dentist model, allowing more patients to receive care. It is also related to increasing public awareness of oral health and the growing impact of the hospital ship\\u0026rsquo;s medical services.\\u003c/p\\u003e \\u003cp\\u003eAnalysis of dental diagnosis and treatment data from the two circumnavigation-of-Africa missions not only delineates the distribution characteristics of oral diseases in the visited African countries but also reflects the current status and challenges of local oral health [3\\u0026ndash;5]. On the one hand, the high burden of oral diseases is closely linked to residents\\u0026rsquo; lifestyles, oral hygiene awareness, and scarcity of medical resources. On the other hand, with the implementation of overseas medical aid projects such as the \\u003cem\\u003ePeace Ark\\u003c/em\\u003e hospital ship, more African people are able to access high-quality dental care, which is important for improving oral health. However, to fundamentally address the widespread oral health problems in African countries, comprehensive, multidimensional interventions are needed. This involves not only safeguarding individual health rights but also represents a key component in strengthening regional public health and promoting social development.\\u003c/p\\u003e \\u003cp\\u003eIn many parts of Africa, due to traditional beliefs and low educational levels, public awareness of oral health remains limited, and misconceptions such as \\u0026ldquo;dental caries are untreatable\\u0026rdquo; persist. It is essential to promote knowledge of proper tooth-brushing techniques, dietary control, and regular check-ups through school curricula, community outreach, and media campaigns, with particular attention to high-risk groups such as children and pregnant women. For example, Kenya has recently introduced school-based oral health education through the \\u0026ldquo;Smile Action\\u0026rdquo; initiative; preliminary data indicate a significant decline in caries prevalence among participating students, demonstrating the effectiveness of educational interventions [12,25].\\u003c/p\\u003e \\u003cp\\u003eThe shortage of safe drinking water is another fundamental driver of oral health problems in Africa [26]. Inadequate fluoride levels in drinking water contribute to high caries prevalence, while contaminated water sources may cause other oral infections. Promoting fluoride toothpaste is a low-cost strategy, but issues of product accessibility and affordability must be addressed. Some countries have attempted to provide fluoride toothpaste to low-income groups via government subsidies or partnerships with multinational companies, but coverage remains insufficient. Furthermore, given the lack of clean water in many rural areas, infrastructure development (e.g., well drilling and water purification systems) must be integrated with hygiene education to achieve systematic improvements.\\u003c/p\\u003e \\u003cp\\u003eData show that the number of dentists per million population in Africa is far below the global average and extremely unevenly distributed, with most dentists located in urban areas [5]. Governments therefore need to prioritize the establishment of dental clinics at the primary-care level and improve stomatology training in medical schools. Increasing the number and skills of dentists through targeted training and in-service education is essential. For example, South Africa\\u0026rsquo;s \\u0026ldquo;Rural Oral Health Plan\\u0026rdquo; deploys dentists to remote areas, which has not only alleviated resource shortages but also strengthened local residents\\u0026rsquo; trust in dental care [27].\\u003c/p\\u003e \\u003cp\\u003eAfrican countries can make use of platforms such as the World Health Organization (WHO) and the United Nations Children\\u0026rsquo;s Fund (UNICEF) to introduce advanced diagnostic technologies and management experience. At the same time, cooperation with developed countries and non-governmental organizations (NGOs) can provide financial support, equipment, and training. International aid projects in dentistry often contribute through equipment donation, free clinics, and remote education, helping African countries narrow the resource gap [3\\u0026ndash;5,14]. However, such cooperation should respect local health systems, avoid creating \\u0026ldquo;technology dependence,\\u0026rdquo; and focus on sustainable capacity-building. Addressing Africa\\u0026rsquo;s oral health challenges requires education as the foundation, improvement of basic conditions as support, resource investment as the core, and international cooperation as an important driver, forming a multi-stakeholder, long-term mechanism to realize the transition from \\u0026ldquo;passive treatment\\u0026rdquo; to \\u0026ldquo;active prevention\\u0026rdquo; [8,28].\\u003c/p\\u003e \\u003cp\\u003eBased on the experience and lessons from the two circumnavigation-of-Africa missions, the following recommendations are proposed for future overseas dental medical services:\\u003c/p\\u003e \\u003cp\\u003eFirst, diagnosis and treatment workflows and service models should be further optimized to improve efficiency and quality. Forward triage or dockside triage can be used to screen suitable patients for ship-based treatment, and on-site registration or appointment systems can be implemented according to the Department of Stomatology\\u0026rsquo;s maximum daily capacity. A model in which primary dentists focus on initial visits and assistant dentists on follow-up visits can be adopted, with appointment slips issued to patients requiring follow-up to prioritize their care. When the number of initial visits is high, timely triage should be implemented, with brief preliminary inquiries to identify patients requiring treatment and arrange them in order, thereby reducing waiting time and improving efficiency.\\u003c/p\\u003e \\u003cp\\u003eSecond, cooperation and exchange with local medical institutions should be strengthened to jointly improve dental care capacity. Joint diagnosis and treatment can be carried out by inviting local dental staff to work on board with the ship\\u0026rsquo;s team, while shipboard dentists may also be dispatched to local hospitals for clinical work and academic exchange.\\u003c/p\\u003e \\u003cp\\u003eThird, oral health education and health promotion should be emphasized to enhance residents\\u0026rsquo; awareness and self-care ability. While alleviating pain, the hospital ship can use posters, animation displays, and on-site demonstrations to deliver oral health education. Mobile clinics and health lectures can also be conducted in local communities, schools, and welfare institutions to expand coverage.\\u003c/p\\u003e \\u003cp\\u003eFourth, research and technological innovation should be strengthened to explore treatment methods and materials more suitable for the characteristics of oral diseases in African populations. Given the high prevalence of tooth defects and tooth loss, it is recommended that the Department of Stomatology be equipped with CAD/CAM systems and 3D printing technology, enabling rapid fabrication of dentures and other prostheses to effectively restore patients\\u0026rsquo; masticatory function.\\u003c/p\\u003e \"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e \\u003ch2\\u003eConsent for publication\\u003c/h2\\u003e \\u003cp\\u003eNot applicable in the declarations section.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eDeclaration of competing interest\\u003c/strong\\u003e \\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e \\u003c/p\\u003e\\u003cp\\u003e \\u003ch2\\u003eHuman Ethics and Consent to Participate declarations\\u003c/h2\\u003e \\u003cp\\u003e This study was approved by the Academic Frontier Ethics Committee of the Naval Medical Center of the PLA (approval number: AF-HEC-009). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The requirement for informed consent was waived by the Academic Frontier Ethics Committee of the Naval Medical Center of the PLA because this study used anonymised retrospective data.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e \\u003cp\\u003eSelf-funded.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eG.X. and S.W. wrote the main manuscript text and prepared the figures. C.Q., H.L., L.Z., X.X and T.G. collected the data and conducted the analysis. R.H. and C.O. designed the research topics and revised the articles. All authors reviewed the manuscript.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgments\\u003c/h2\\u003e \\u003cp\\u003eThe article describes a retrospective analysis of dental medical services conducted during humanitarian missions by the Chinese Navy hospital ship Peace Ark, with no indication of any commercial interests, funding from commercial entities, or competing interests that would require disclosure.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eThe datasets generated and/or analysed during the current study are not publicly available due to institutional and military confidentiality restrictions but are available from the corresponding author on reasonable request and with permission from the Naval Medical Center of the PLA.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eFol\\u0026aacute;yan MO, Ishola AG, Bhayat A, et al. Strengthening health systems to tackle oral diseases in Africa: Africa centers for disease control and prevention\\u0026apos;s role. Front Public Health. 2025; 13:1539805.\\u003c/li\\u003e\\n\\u003cli\\u003eWorld Health Organization Africa. Africa burdened with largest global increase of oral diseases. 2023.\\u003c/li\\u003e\\n\\u003cli\\u003eWorld Health Organization. ICD-11 Implementation or Transition Guide. Geneva: World Health Organization; 2019.\\u003c/li\\u003e\\n\\u003cli\\u003eChinese Stomatological Association. Clinical Technical Operation Specifications: Stomatology Volume. Beijing: People\\u0026apos;s Medical Publishing House; 2017.\\u003c/li\\u003e\\n\\u003cli\\u003eGallagher JE, Mattos Savage GC, Crummey SC, et al. Oral Health Workforce in Africa: A Scarce Resource. Int J Environ Res Public Health. 2023; 20:2328.\\u003c/li\\u003e\\n\\u003cli\\u003eTeshome A, Muche A, Girma B. Prevalence of Dental Caries and Associated Factors in East Africa, 2000\\u0026ndash;2020: Systematic Review and Meta-Analysis. Front Public Health. 2021; 9:645091.\\u003c/li\\u003e\\n\\u003cli\\u003eKimmie-Dhansay F, Pontes CC, Chikte UME, et al. Impacts of Tooth Loss on OHRQoL in an Adult Population in Cape Town, South Africa. Int J Environ Res Public Health. 2021; 18:4989.\\u003c/li\\u003e\\n\\u003cli\\u003eFol\\u0026aacute;yan MO, Bhayat A, Mikhail SS, et al. Resources for oral health in Africa. Front Oral Health. 2025; 6:1540944.\\u003c/li\\u003e\\n\\u003cli\\u003eXu Guangjie, Qian Zhijun, Ye Xiaofei, et al. Practice and reflection of overseas medical services in the nine \\u0026quot;Mission Harmony\\u0026quot; missions. Chin J Naut Med Hyperbar Med. 2025; 32:489-95.\\u003c/li\\u003e\\n\\u003cli\\u003eNoshir CYS, Brijlal P. Health policy and regulations in Seychelles - barriers and opportunities for oral health inclusion. BMC Oral Health. 2024; 24:604.\\u003c/li\\u003e\\n\\u003cli\\u003eShomuyiwa DO, Bridge G. Oral health of adolescents in West Africa: prioritizing its social determinants. Glob Health Res Policy. 2023; 8:28.\\u003c/li\\u003e\\n\\u003cli\\u003eSharkawy MN, Shaalan O. Oral health knowledge, attitudes, and behaviors of adult patients attending a dental school hospital in Egypt: a cross-sectional study. Sci Rep. 2025; 15: 43274.\\u003c/li\\u003e\\n\\u003cli\\u003eKafera G, Kalimbira R, Bagg J, et al. Knowledge, Attitude and Practices of Primary School Teachers Towards Oral Health in Mchinji District, Malawi. Clin Cosmet Investig Dent. 2025; 17:549-61.\\u003c/li\\u003e\\n\\u003cli\\u003eLabarca TF, Ortu\\u0026ntilde;o D, Neira L, et al. Oral Health Research in the WHO African Region between 2011 and 2022: A Scoping Review. J Dent Res. 2024; 103:1209-17.\\u003c/li\\u003e\\n\\u003cli\\u003eMohamed AF, Ainane A, Merito A, et al. The Effects of Khat Chewing among Djiboutians: Dental Chemical Studies, Gingival Histopathological Analyses and Bioinformatics Approaches. Bioengineering. 2024; 11:716.\\u003c/li\\u003e\\n\\u003cli\\u003eMbawalla H, Masalu JR, Masatu M, et al. Changes in adolescents\\u0026apos; oral health status following oral health promotion activities in Tanzania. Acta Odontol Scand. 2013; 71:333-42.\\u003c/li\\u003e\\n\\u003cli\\u003eMajani Edward, Daniel Agyapong, Innocent Kitandu Paul, et al. Oral Health in Tanzania: Unmasking Its Neglected Dimension. Public Health Challenges. 2024; 3: e70000.\\u003c/li\\u003e\\n\\u003cli\\u003eMepatia AI, Myburgh N, Barrie R, et al. Self-assessment of dental health status, behaviours and oral health risk factors among adolescents from public schools in Maputo City-Mozambique. BMC oral health. 2024; 24:145-7.\\u003c/li\\u003e\\n\\u003cli\\u003eSales-Peres SHC. Oral Health Status and Anthropometric Conditions among HIV Infected Adolescents on Antiretroviral Therapy in Mozambique. J HIV Clin Sci Res. 2014; 12:21-6.\\u003c/li\\u003e\\n\\u003cli\\u003eSonga MAS, Saliba NA, Saliba TA, et al. Analysis of the Dental Caries Epidemiological Profile in Children of Benguela city, Angola. Oral Health Prev Dent. 2022; 20:141-8.\\u003c/li\\u003e\\n\\u003cli\\u003eSonga MAS, Saliba TA, Saliba NA, et al. Prevalence of Dental Caries and Periodontal Disease, Access to Dental Services and Perception of Oral Health in Adolescents and Adults from a Rural Community in Angola. Oral Health Prev Dent. 2024; 22: 665-70.\\u003c/li\\u003e\\n\\u003cli\\u003ePoaty CW, Deng Qianyi, Lebeka C, et al. Knowledge of Parents Regarding Early Childhood Caries Prevention among Preschool Children in Brazzaville, Republic of Congo: A Cross-Sectional Study. J Clin Pediatr Dent. 2025; 49:172-80.\\u003c/li\\u003e\\n\\u003cli\\u003eHildebrandt TR, Ramharter H, et al. Recurring Transient Tooth Pain as Newly Described Symptom of Migratory Loiasis: A Mixed-Methods Study in Rural Gabon. Am J Trop Med Hyg. 2024; 111:826-8.\\u003c/li\\u003e\\n\\u003cli\\u003eTang B, Han YY, Liu X, et al. Medical services provided on the \\u0026apos;Harmonious Mission-2017\\u0026apos; peace ark from China. BMJ Mil Health. 2023; 169: e44-50.\\u003c/li\\u003e\\n\\u003cli\\u003ePengpid S, Peltzer K. Self-rated oral health status and social and health determinants among community dwelling adults in Kenya. Afr Health Sci. 2019; 19:3146-53.\\u003c/li\\u003e\\n\\u003cli\\u003eKwame A, Siiba A, Apatinga GA, et al. Water (In)Accessibility, Healthcare Delivery, and Patients\\u0026apos; Health Outcomes in Ghana: Perspectives from the Yendi Hospital. Nurs Rep. 2025; 15:418-22.\\u003c/li\\u003e\\n\\u003cli\\u003eBoachie MK, Molete M, Hofman K, et al. Cost-effectiveness of dental caries prevention strategies in South African schools. BMC Oral Health. 2023; 23:814.\\u003c/li\\u003e\\n\\u003cli\\u003eWHO African Region. Oral Health. 2025.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-oral-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ohea\",\"sideBox\":\"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/ohea/default.aspx\",\"title\":\"BMC Oral Health\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Harmonious Mission, overseas medical service, African oral health, epidemiological characteristics\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8819427/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8819427/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eOral diseases remain a major public health challenge in Africa. During the \\u0026ldquo;Harmonious Mission 2017\\u0026rdquo; and \\u0026ldquo;Harmonious Mission 2024\\u0026rdquo; deployments, the Chinese naval hospital ship \\u003cem\\u003ePeace Ark\\u003c/em\\u003e provided humanitarian medical services in multiple African countries. This study analyzed dental diagnosis and treatment data collected during these two missions to characterize patient profiles, disease spectrum, and treatment patterns, and to inform future overseas dental medical support in Africa.\\u003c/p\\u003e\\u003ch2\\u003eMaterials and Methods\\u003c/h2\\u003e \\u003cp\\u003eDemographic characteristics, diagnostic categories, and treatment modalities were extracted from routine clinical records of the Department of Stomatology on the hospital ship\\u0026rsquo;s main platform during both missions. Comparative analyses were performed to describe patient distribution by country, the oral disease spectrum, and diagnostic and treatment patterns across visited countries. For countries visited in both missions, service volume and disease composition were compared between 2017 and 2024. Differences in disease composition and treatment modality distribution were assessed statistically, with \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 considered significant.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eAcross the two missions, 6,654 dental patients from 13 African countries were treated, accounting for approximately 6% of all patients seen on board. The mean patient age was 37.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.01 years, and sex ratios varied markedly by country. The disease spectrum was concentrated: the cumulative proportion of the five leading categories\\u0026mdash;dental caries, non-carious diseases of hard dental tissues, diseases of the pulp and periapical tissues, retained roots, and gingival/periodontal diseases\\u0026mdash;exceeded 80%. Among the six countries visited in both missions, dental service volume increased significantly in Angola but decreased significantly in Djibouti and Gabon. Disease composition in these six countries changed to varying degrees between 2017 and 2024 (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). In 2024, the proportions of restorative treatments and surgical procedures increased significantly, whereas medication-based treatments decreased significantly (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eThe burden of oral diseases among populations in the visited African countries was high, with a concentrated disease spectrum and substantial unmet treatment needs. Future medical assistance should strengthen collaboration with local health institutions, refine treatment protocols and referral pathways, and expand oral health education. For similar missions, optimizing clinical workflows and appropriately increasing dental staffing are recommended to improve service efficiency and capacity.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Raising harmony in the face of challenges: a study on dental medical services in Africa during two missions of Chinese Navy\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-03-10 17:17:14\",\"doi\":\"10.21203/rs.3.rs-8819427/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"reviewerAgreed\",\"content\":\"161856042791906462056706990271855185308\",\"date\":\"2026-04-27T08:33:54+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-26T05:50:39+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-24T18:53:41+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-20T16:27:54+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"157059842364701201728978156905868111719\",\"date\":\"2026-03-17T07:32:19+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"276040269154315523020140889733801111828\",\"date\":\"2026-03-16T08:00:40+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"248555457060397048552533370628306814220\",\"date\":\"2026-03-13T04:50:17+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"124077333053690938984015541572029381018\",\"date\":\"2026-03-05T12:39:13+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-03-05T12:21:58+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-02-13T12:35:54+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-02-13T07:32:59+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-02-12T14:15:32+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Oral Health\",\"date\":\"2026-02-12T14:08:28+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-oral-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ohea\",\"sideBox\":\"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/ohea/default.aspx\",\"title\":\"BMC Oral Health\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"4bc5242b-23f0-46a5-90bd-a674886b84b7\",\"owner\":[],\"postedDate\":\"March 10th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-10T17:17:14+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-03-10 17:17:14\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8819427\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8819427\",\"identity\":\"rs-8819427\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}