Postpartum oral health counselling delivered through midwife–dental hygienist task-sharing in Ethiopia: a cluster non-inferiority evaluation of maternal caries and therapy uptake

Ethiopia's postpartum period concentrates repeated maternal health contacts that could carry oral health counselling, yet dental hygienist supply is scarce and midwives already manage most postnatal visits. the present analysis evaluates whether task-shared postpartum oral health counselling delivered by midwives, with dental hygienist supervision, is non-inferior to hygienist-delivered counselling for maternal caries increment and therapy uptake. The design is a cluster non-inferiority evaluation with a prespecified margin, using published DHS Program data on maternal HIV testing and post-test counselling as a calibration benchmark for task-shared counselling coverage across 29 African countries between 2010 and 2020. The 45 country-survey observations yielded a mean of 45.542 (SD 25.002), ranging from 5.00 in Mauritania to 88.67 in Rwanda. These values bound the plausible coverage ceiling for a midwife-delivered counselling platform and inform the non-inferiority margin. The analysis specifies the estimand, the cluster-level intraclass correlation, the margin justification, and the decision rule. The contribution is a defensible evaluation architecture for task-shared oral health counselling in a low-supply setting, not a claim of completed trial evidence. Non-inferiority is the appropriate inferential frame when the comparator is unattainable at scale, and that coverage benchmarks from adjacent maternal health programmes should discipline the margin rather than clinical intuition alone.