Dental hygiene therapy service readiness and avoidable periodontal emergency visits in Ugandan districts: a multilevel analysis of readiness-threshold effects

Ugandan district health systems allocate scarce dental hygiene therapy resources without an evidence-based threshold for when a district's service readiness becomes sufficient to suppress avoidable periodontal emergency visits. The protocol specifies a two-level structure in which 176 country-survey observations from 38 African countries (DHS Program indicator CM_HRFB_C_ANY, 1986-2025; mean 56.739, SD 8.634) calibrate the distributional behaviour of a periodontal risk proxy, and district-level readiness scores are then modelled as a threshold predictor of emergency visit rates. The protocol defines readiness as a composite of staffing, consumables, equipment and referral capacity, and specifies sensitivity analyses for threshold uncertainty, confounding by oral health literacy and spatial autocorrelation. The contribution is a transferable estimation architecture that converts readiness scores into a policy-relevant threshold, enabling Ugandan districts to target dental hygiene therapy investment at the margin where avoidable emergency demand is most responsive. The protocol does not report empirical estimates; it specifies the design, assumptions and inferential boundaries that a future district-level study must satisfy.