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 ( ISSN: 2814-2098 )                                                                       Rafalimino Holy Nasandratra1* 

https://ijojournals.com/                                                     Volume 07 || Issue 04 || April, 2024 || 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR 

 

 
 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION 
OF MAHAJANGA I, MADAGASCAR 

Rafalimino HN1,2, Ratsimandresy NN3, 2Randriamalala NC1,5, Rakotonirina 
FP1,4,Andrianjafinoro TH1,, Ranjarisoa LN6, Ramaroson J1. 

1Sub-section of Conservative Odontology Endodontic at the Tropical Odonto-Stomatological Institute 
of Madagascar (IOSTM), University of Mahajanga 

² University Hospital Profesora Zafisaona Gabriel Androva Mahajanga Madagascar, 
3 Sub-section of Prosthodontics at the Tropical Odonto-Stomatological Institute of Madagascar 

(IOSTM), University of Mahajanga, Madagascar 
4 Oral Health Center, Ministry of Industrialization, Trade and Consumption Antananarivo, 

Madagascar, 
5 University Hospital Joseph Dieudonné Rakotovao, Befelatanana Antananarivo, 

6 Public Health Mention at Tropical Odonto-Stomatological Institute of Madagascar (IOSTM), 
University of Mahajanga  

 
Corresponding author: Rafalimino Holy Nasandratra1, 2 

   
Abstract  

The aim of this research study was to determine the factors influencing the choice of the type 

of oral health care center attended by the population of the city of Mahajanga I in 

Madagascar. Methods based in a cross-sectional observational-analytical study, conducted 

in the city of Mahajanga I in 2019. Surveys were carried out among the class of population 

aged over 18 years, residing more than six months in the city of Mahajanga I, visiting an oral 

health center more than once. The questionnaires were based on a description of the factors 

motivating patients to choose an oral health center. Uni-variate and bivariate analyses were 

carried out. The bivariate analysis was conducted to identify the association between the 

variables studied and the type of oral health center attended. The Pearson Chi² test was used 

to test the significance of the results and a value of p< 0, 05 was considered significant. 

Results managing, socio-economic factors and factors for assessing the quality of services 

influence the choice of the type of oral health care center by the population of Mahajanga I. 

Gender, age, profession and the type of approach and motivation offered at Oral Health Care 

Centers were factors associated with the choice of type of oral health care center by the 

population of Mahajanga. 

Key words: factors influencing, choice, dental service, cross-sectional analytical study. 

 

1.Introduction  

In the world, the Global Burden of Disease study showed that 50% of the world's population 

suffers from oral diseases [1].In Madagascar, in 2016, the prevalence of oral and periodontal 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                       Rafalimino Holy Nasandratra1* 

https://ijojournals.com/                                                     Volume 07 || Issue 04 || April, 2024 || 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR 

 

 
 

diseases ranged from 80% to 98%. So, the attendance rate at public oral health care centers 

in Madagascar is only 10.5 [2].The aim of this research study was to determine the factors 

influencing the choice of the type of oral health care center attended by the population of 

the city of Mahajanga. 

 

2.Methods 

A cross-sectional observational-analytical study was conducted in the city of Mahajanga, 

Madagascar I, in 2019. Our target was to investigate the class of population aged over 18 

years, residing more than six months in the city of Mahajanga I. Included in our study was 

the entire population of the city of Mahajanga, aged over 18, regardless of gender, residing 

for more than six months in the city of Mahajanga I, attending an oral health center more 

than once in Mahajanga. Excluded from our study was the entire population of the city of 

Mahajanga, aged over 18th, regardless of gender, residing for more than six months in the 

city of Mahajanga I, presenting either a deafness or mental handicap, or those who refused 

to take part in the survey. Using Andersen's formula, and based on the prevalence of use of 

oral care in Madagascar (10, 5), the sample size was 145. To ensure that our sample was 

heterogeneous with regard to the type of oral health center, we adopted a stratified random 

sampling method based on all twenty-four non-school oral health centers in the city of 

Mahajanga. Sample selection in each stratum was random. The interviewers were randomly 

selected.Respecting ethical considerations, previously tested questionnaires were used 

during the survey. The survey was conducted between January 1 and December 4, 2019. 

Using SPSS 20.0 software, Uni-variate and bivariate statistical analyses were carried out. The 

Uni-variate analysis was developed to describe the Socio-demographic profile of the study 

population. The bi-variate analysis was conducted to identify the association between the 

variables studied and the type of oral health center attended. The Pearson Chi² test was 

used to test the significance of the results. A value of p< 0.05 was considered significant. 

There is strong significance when the p-value <0.001, moderate significance when the p-

value = 0.001, and barely significant when p<0.05 - 0.001. 

 

3.Results 

3.1 Uni-variate analyses  

3.1.1 Sociodemographic profile 

The study population was predominantly female (73.1%), with a sex ratio of 0.36. In terms of 

age, the 50+ age group constituted forty-five point five percent (45.5%) of the sample. 

Individuals with an occupation in the tertiary sector were predominantly represented 

(45.5%). Most of the individuals surveyed were married (73.1%). In terms of distance 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                       Rafalimino Holy Nasandratra1* 

https://ijojournals.com/                                                     Volume 07 || Issue 04 || April, 2024 || 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR 

 

 
 

between home and the oral health care center attended, forty-three point four percent 

(43.4%) lived between 6km and 10km from the health care center (table I). 

 

3.1.2 Socioeconomic profile 

Surveyed individuals with a monthly income ≥ 200,000 equivalent to $43.83 or €40.77 made 

up fifty-six point six percent (56.6%) of the sample. And seventy-five point two percent 

(75.2%) of the individuals surveyed declared that they had no savings allocated to oral health 

care (table II). 

Table I: Distribution of individuals by Sociodemographic profile 

Socio-demographic profile 
n 

 N=145) 
%  

Gender    

Male  39 26,9 Sex-ratio = 0,36 

Female 106 73,1  

Total 145 100,0  

Age range    

18 to 29 age 35 24,8  

30  to 49 age 52 29,7  

50 to age 58 45,5  

Total 145 100  

Profession    

Primary sector 36 24,8  

Secondary sector 43 29,7  

Tertiary  sector 66 45,5  

Total 145 100  

Marital status    

Married 106 73,1  

Unmarried  39 26,9  

Total 145 100  

Distance between home and 

dental services 
   

0 to 5km 55 38,0  

6 to 10km 63 43,4  

Over 10km 27 18,6  

Total  145 100  

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                       Rafalimino Holy Nasandratra1* 

https://ijojournals.com/                                                     Volume 07 || Issue 04 || April, 2024 || 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR 

 

 
 

Table II: Distribution of individuals by socioeconomic profiles 

Socio-economic profiles 
n 

 (N=145) 
% 

 

Monthly income     
<200 000 Ariary 63 43,4  
 ≥ 200 000 Ariary 82 56,6  
Total 145 100,0  
 
Possession savings allocated  
for dental care 

   

yes 36 24,8  
No 109 75,2  
Total  145 100  

3.1.3 Type of dental care center visited 

The majority of individuals surveyed frequented the type of liberal oral health center 

(62.8%). Twenty point seven percent (20.7%) of the individuals used to attend 

denominational to attend faith-based oral health centers. Only a proportion sixteen point six 

percent (16.6%) of the individuals surveyed frequented public oral health centers (table III). 

 

Table III: Distribution of individuals by type of oral care center chosen 

 

Type of oral health center 
chosen 

n 
 (N=145) 

% 
 

 
Public  

 
24 

 
16,6 

 

Denominational  30 20,7  
Liberal  91 62,7  
Total  145 100 

 
 

 

3.2 Bivariate analysis 

3.2.1 Type of oral health care attended and gender 

Between the type of oral health center attended and gender, a significant difference was 

found. Male patients (79.5%) were more likely to attend a private liberal dental structure 

(**p=0.01<0.05) in relation to women patients attended less (17%) public oral health care 

centers (**p=0.01<0.05) (table IV).  

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                       Rafalimino Holy Nasandratra1* 

https://ijojournals.com/                                                     Volume 07 || Issue 04 || April, 2024 || 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR 

 

 
 

Table IV: Distribution of individuals by type  

of oral health care centerattended and gender 

 

Type of oral  
health center chosen 

Gender       Khi² Test 

 Male Female  
 n 

(N=39) 
% n 

(N=106) 
%  

Public  6 15,4 18 17,0 *p = 0,01<0,05 
Denominational  2 5,1 28 26,4  
Liberal dental  31 79,5* 60 56,6  
 39  100 106 100  

 

3.2.2 Type of oral health care attended and age 

The result showed a highly significant difference in relation to age group and type of dental 

type of dental facility attended. Subjects aged between 30 and 49 years (78.9%) usually 

attended public dental facilities (**p=0.006<0.05) (table V).  

 

 

Table V: Distribution of individuals  

by type of oral health care center attended and age group 

 

Type of dental 
 center chosen 

Age range    Khi² test 

 18 to 29 age 30 to 49 age 50 age +  
 n 

(N=35) 
% n 

(N=52) 
% n 

(N=58) 
%  

 
Public  

 
9 

 
25,7 

 
1 

 
1,9 

 
14 

 
24,1 

**p = 
0,006<0,05 

Denominational  6 17,1 10 19,2 14 24,1  
Liberal  20 57,2 41 78,9** 30 51,8  
 35 100 52 100 58 100  

 

 

3.2.3 Type of oral health care attended and profession 

According to the type of oral health care center attended and profession, this study has 

found a significant difference. The majority of the population with an occupation in the 

tertiary sector (74.2%) opted for private oral health care centers (*p=0.02<0.05) (table VI).  

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                       Rafalimino Holy Nasandratra1* 

https://ijojournals.com/                                                     Volume 07 || Issue 04 || April, 2024 || 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR 

 

 
 

Table VI: Distribution of individuals  

by type of oral health care center and profession 

 

Type of dental 
center chosen 

Profession sector 
 

Khi² test 

 Primary 
sector 

Secondary 
sector 

Tertiary 
sector 

 

 n 
(N=36) 

% n 
(N=43) 

% n 
(N=66) 

%  

 
Public  

 
8 

 
22,2 

 
7 

 
16,3 

 
9 

 
13,7 

*p = 
0,02<0,05 

Denominational  13 36,1 9 20,9 8 12,1  
Liberal  15 41,7 27 62,8 49 74,2*  
 36 100 43 100 66 100  

 

 

3.2.4 Type of oral health care attended and satisfaction with approach offered by the 

dentist 

According to the type of oral health care center attended and satisfaction with the approach 

offered by the dentist during oral health care, a highly significant difference was found. The 

majority of patients surveyed (65.5%) attending the type of liberal oral health center 

mentioned their satisfaction with the therapeutic approach opted for by the practitioner 

(***p=0.000<0.05) (table VII). 

Table VII: Distribution of individuals according to type of oral health care center  

chosen and satisfaction with practitioner's therapeutic approach 

 

Type of dental 
center chosen 

satisfaction with practitioner's 
therapeutic approach 

Khi² test 

 yes No  
 n 

(N=139) 
% n 

(N=6) 
%  

Public  23 16,5 1 16,7 ***p = 0,000<0,05 
Denominational 25 18,0 5 83,3  
Liberal  91 65,5*** 0 0,0  
 138 100 6 100  

 

4. Discussion 

4.1 Discussion of the methodology 

The urban commune of Mahajanga I was served by six types of school-based oral health care 

centers and twenty-eight non-school-based oral health care centers [3].The six types of 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                       Rafalimino Holy Nasandratra1* 

https://ijojournals.com/                                                     Volume 07 || Issue 04 || April, 2024 || 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR 

 

 
 

school-based oral health care centers were excluded from our survey site due to the age of 

the individuals attending these facilities being under 18. In relation to the type of oral health 

care center, the sampling method adopted enabled us to obtain a heterogeneous sample. 

The sample size in each stratum respected the proportion of each stratum (table VIII). 

 

4.2 Type of oral health center and gender: gender-related factors 

Male individuals (79.5%) were more likely to visit private oral health centers (Table 4).  

This result differs from the study by Diouf M et al. in 2010. They reported a rate of 62.6%  

for women attending liberal oral health centers. As an interpretation, they pointed  

out that women greatly appreciate the high standard of service, where as there is no luxury 

in public health centers, so they frequent them less frequently [4]. 

 

4.3 Type of oral health center and age: age-related factors 

Males (79.5%) were more likely to frequent private oral health centers. Compared to age, 

there was a significant difference between age and the choice of the type of oral health 

center attended (***p=0.006<0.05) (table 5).   Age is a determining factor in the choice of 

oral health center. This result corroborates with Fernandez R and collaborator’s study on 

2020. They evocated a high school level showed high significance (p=.002) towards choosing 

private clinics for dental treatment. Most patients other the age of 60 have chosen private 

clinics for dental treatment [5].  

 

4.4 Type of oral health center and profession: factors related to profession 

Individuals with occupations in the tertiary sector were the most frequent (74.2%) private 

oral health care centers (table 6). Individuals with occupations in the tertiary sector were 

generally considered to be "higher-paid" professions, and able to afford the more expensive 

care offerings. This finding corroborates with Ndame Dieng S and collaborators’study on 

2016. They reported that the majority of civil servants used private dental facilities (54%) [6]. 

 

4.5 Type of oral health center and satisfaction with the practitioner's approach: factors 

related to the quality of the practitioner's approach 

The majority of patients surveyed (65.5%) who attended the type of liberal oral health 

center reported satisfaction with the therapeutic approach chosen by the practitioner 

(***p=0.006<0.05). According to Fernandez R and collaborators on 2019, a dentist’s 

reputation and personality played a positive role in influencing a patient’s decision in 

choosing them for treatment (34,8%) (p < 0.005) [7]. According to the study of Alhabib S and 

coll, dental professionals play a crucial role in shaping their patients' experience. In the 

dental field of their study, patients were mainly satisfied with the dentist's attention (77.2%) 

[8]. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                       Rafalimino Holy Nasandratra1* 

https://ijojournals.com/                                                     Volume 07 || Issue 04 || April, 2024 || 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR 

 

 
 

 

Conclusion  

In this study, the hypothesis was verified. Socio-economic factors and factors for assessing 

the quality of services influence the choice of the type of oral health care center by the 

population of Mahajanga I. Despite the study's limitations, four significant results were 

found.Gender, age, profession and the type of approach and motivation offered at oral 

health care centers were factors associated with the choice of type of oral health care center 

by the population of Mahajanga. Private oral health care centers were attended mainly by 

men. Public oral health care centers are mainly frequented by the over-50s. The type of 

approach and therapeutic motivation offered by the dentist within the oral health care 

center is a factor strongly associated with conditioning the choice of which type of oral 

health care center to attend. As a perspective, would the design of oral health care rooms 

influence patients' motivation to seek treatment? 

 

Acknowledgement 

None 

 

Conflict of interest 

No conflict of interest 

 

References 
[1]. World Health Organization. Management of Noncommunicable Diseases, Noncommunicable 

Diseases, Rehabilitation and Disability. Global oral health status report: Towards universal 

health coverage for oral health by 2030. America, 2023 : 1-40. 

[2]. Ranivoharilanto E. Santé bucco-dentaire à Madagascar : état des lieux et perspectives. Aide 

Odontologique International. Madagascar, 2016 : 1-38. 

[3]. Ordre National des Odonto-stomatologistes de Madagascar. Annuaire National dentaire. 

Madagascar, 2019 : 1-55. 

[4]. Diouf M , Cisse D , Lo CMM , Faye D , Traoré R.  Évaluation de la satisfaction des patients admis 

en service d’odontologie à Dakar. s Pratiques et Organisation des Soins. 2010 (Vol 41) : 225-30  

[5]. Ragna Lamprecht, Julia Struppek, Guido Heydecke, Daniel R. Reissmann. Patients’ criteria for 

choosing a dentist: Comparison between a university-based setting and private dental 

practices. International Journal of Dental and Health Sciences.Original Article. Volume 03, Issue 

06. 2020: 1-7. 

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https://www.who.int/teams/noncommunicable-diseases
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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                       Rafalimino Holy Nasandratra1* 

https://ijojournals.com/                                                     Volume 07 || Issue 04 || April, 2024 || 

FACTORS INFLUENCING THE CHOICE OF ORAL HEALTH CARE CENTER BY THE POPULATION OF MAHAJANGA I, MADAGASCAR 

 

 
 

[6]. Ndame Dieng S, Cissé d, Lomrail P, Azougui-Levy S. État de santé, offre et recours aux soins 

bucco-dentaires chez les enfants sénégalais : synthèse des données disponibles. Santé publique 

.2016 : 257-65 

[7]. Fernandez R , Eisa E, Alqattan A , Aldayel A , Alkhalefah O , Alanazi F , Karshe B , Alsulayyim A. 

Factors influencing patients' decisions while choosing a dental care provider. International 

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[8]. Alhabib S, Albarikan O. Impact of Dental Services on Patients' Perception at Private Dental 

Clinics in Riyadh, Saudi Arabia. IUGJEPS Islamic University of Gaza 2021 (Vol 29): 262 -75. 

 

 
 

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