Dental hygiene therapy–delivered silver diamine fluoride versus atraumatic restorative treatment and treatment completion in Mozambican rural clinics: a comparative effectiveness analysis of provider-mix constraints

Rural Mozambican clinics face a persistent mismatch between the burden of untreated caries and the supply of clinicians authorised to perform restorative work. The analysis is a comparative effectiveness synthesis: it combines a decision-theoretic model of completion with a secondary analysis of the DHS Program indicator 'Percentage receiving injection given by health care provider' (FP_SPUS_W_SPH), drawn from 14 African country surveys fielded between 2021 and 2025. Across those 14 observations the indicator had a mean of 91.964 and a standard deviation of 12.468, ranging from 60.90 in Malawi to 99.70 in Kenya. The model predicts that SDF completion exceeds ART completion whenever the hygiene-therapist share of the dental workforce exceeds a threshold that falls as patient travel distance rises; the DHS distribution is used to characterise the plausible range of provider-contact reliability within which that threshold is crossed. The contribution is a bounded, testable proposition about task-shifting in caries control, not a claim of clinical superiority. Completion, rather than restoration longevity, is the outcome that should govern provider-mix decisions in rural Mozambican clinics.