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Abstract

Early childhood caries is the most prevalent dental disease among children. This study aimed to assess the prevalence of Early Childhood Caries (ECC) and its determinants among kindergarten children. An institution-based cross-sectional study was conducted among 507 participants from January 1 to 30, 2023. The prevalence of ECC was 64.7% (95% CI: 60.5-68.9). Being in kindergarten two (AOR = 2.02, 95% CI: 1.17-3.46) and three (AOR = 2.50, 95 % CI: 1.43-4.36), primary level of mother education (AOR = 4.21, 95% CI:1.87-9.48), bottle-feeding practice (AOR = 2.88, 95% CI: 1.81-4.59), higher sweet consumption (AOR = 6.83, 95% CI: 4.31-10.83), did not brushing teeth (AOR = 1.82, 95% CI: 1.15-2.88) and poor oral hygiene (AOR = 4.95, 95% CI: 2.60-9.43) were the main risk factors of ECC. Almost two in every three kindergarten children have ECC in Harar Town, eastern Ethiopia. Providing oral health promotion on healthy feeding and oral hygiene practice is essential to prevent ECC and its consequences.

Keywords

Early childhood caries dental caries kindergarten children Ethiopia

Introduction

Early childhood caries (ECC) is a dental disease affecting children globally. According to the World Health Organization (WHO) reports of 2017, more than 530 million children are affected by ECC each year worldwide.¹ The prevalence was much higher in low- and middle-income countries (LMIC). The studies showed that the prevalence of ECC ranged from 1% to 12% in high-income countries, whereas 36% to 85% in LMIC.² The problem is also much higher in Asian countries, which ranges from 63% in Paradesh to 89.1% in Vietnam and Qatar.^3,4 In sub-Saharan African (SSA) countries, higher prevalence of ECC was reported, which ranges from 63.8% in Kenya to 71.4% in Sudan.^5
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Early childhood caries not only affects children’s oral health but also the general health of children and imposes significant costs for communities.⁸ Early childhood caries leads to ~51 million hours lost from school, along with costly emergency room visits and hospital-based medical and surgical treatments. Besides, ECC causes pain, systemic and local infections, trouble eating or sleeping, hospitalizations and school absenteeism.²

Globally, more than 90% of ECC remains untreated, significantly impacting the growth and well-being of young children.⁹ Moreover, early loss of primary teeth can affect the permanent dentition.^10,11 The treatment of ECC is expensive, with an estimated expenditure of $544.41 billion spent globally in 2015 for dental diseases, of which $356.80 billion were direct costs and $187.61 billion were indirect costs.¹²

Early childhood caries does not receive suitable priority in health planning due to the underestimation of the burden and impact of the disease, particularly in SSA.¹ Only 45% of United Nations member countries have data on ECC.¹³ Moreover, the burden and risk factors of ECC have remained unexplored in many SSA countries, including Ethiopia.¹⁴ Despite the rapidly increasing burden of caries among preschool children and the resulting serious complications,¹⁵ previous studies conducted in SSA focused on dental caries among school-age children and adults rather than preschool children, particularly in Ethiopia.^16
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In Ethiopia, the pieces of evidence on the prevalence of ECC and its determinants are limited; few previous studies done in Ethiopia have focused on dental caries among elementary and high school-aged children,^16,19,20 among the adult population,¹⁷ and methodological differences focused only on determinant factors.²¹ Overall, evidence is scarce on the prevalence of early childhood caries and its associated factors among kindergarten school children in Ethiopia, particularly in eastern Ethiopia. Therefore, this study aimed to assess the prevalence of early childhood caries and associated factors among kindergarten school Children in Harar Town, Eastern Ethiopia.

Methods and Materials

Study Design, Period and Area

An institution-based cross-sectional study was conducted from January 1 to 30, 2023, among kindergarten school children in Harar, Eastern Ethiopia. Harar town is the capital of Harari Regional State, located 526 km east of Addis Ababa (the Capital of Ethiopia). The town has a 139 380 total population; 68 048 are females, 43 339 are women in the reproductive age group and 22 300 are under-5-year children. According to the Harari Education Bureau report of 2022, the town had 50 kindergartens (KG) schools, and all were private kindergartens. The number of kindergarten children was 8278.

Population

All children attending kindergarten schools in Harar town were the source population. All children attending randomly selected kindergarten schools in Harar town during the study period were the study population. All kindergarten children attending classes in selected kindergarten schools in Harar town were included in the study. Kindergarten children who were absent from the class on the day of the oral examination, those who were not living with their mothers, those whose mothers were critically sick and unable to respond to interviews and children who were critically ill or injured were excluded from the study.

Sample Size Determination

The sample size (n = 518) was calculated by Epi-Info version 7.1, using the single population proportion formula, considering the following assumptions: 95% confidence level, 5% margin of error, using a 71.4% magnitude of ECC taken from a study conducted in Khartoum, Sudan,⁵ using a 1.5 design effect. After adding 10% of the non-respondent rate, the final sample size became 518.

Sampling Procedures

A multi-stage sampling technique was employed to select the study participants. First, kindergarten schools having programs in stages one to three were identified. Forty-four kindergarten schools were identified out of 50 kindergarten schools in Harar town. Then, 14 kindergarten schools were selected using simple random sampling. A total of 2839 children were attending 14 selected kindergarten schools. Thus, the calculated sample size has been proportionally allocated to each selected kindergarten based on the number of children attending the kindergartens. Then, the allocated sample size was proportionally distributed to each kindergarten level (KG1-3) based on the number of children attending each kindergarten level. A systematic random sampling technique was used to select the eligible study participants using the children’s school registration numbers as a sampling frame with their separate sampling intervals.

Data Collection Tools and Techniques

The Data were collected through mother interviews and oral examinations of the children using a questionnaire adapted from the WHO Oral Health Survey method.²² A structured questionnaire consisted of four sections: the information about socio-demographic characteristics of mothers and their children, the child feeding-related factors, the children’s oral hygiene-related factors and the assessment of oral examination of the children. The questionnaire was first prepared in English and then translated into Amharic and Afan Oromo languages by two good commands of both languages, then translated back into English to check consistency.

Fourteen trained data collectors with qualification diploma nurses and one dental examiner with a dental professional collected the data under the supervision of four supervisors. The training was given to data collectors and supervisors on the objective of the study and data collection techniques for one day. A dental examination was carried out for all selected children by trained data collectors using the WHO dental caries diagnosis criteria.

Data Collection Procedures

After the ethics committee approved, permission from the concerned educational authorities was obtained, and the principal investigator (PI) contacted the heads of the school to receive approval. One week before starting data collection, start the list of children with a unique identification number shared with the data collectors and supervisors. After obtaining written informed consent from mothers, an interview was conducted to collect data from mothers using a structured questionnaire. Following the mother’s face-to-face interview, the dental examination was conducted by one trained dental professional using the WHO dental caries diagnosis guideline.²² Clinical examination was performed inside a classroom near the window under natural daylight, with the children in a seated upright position on a chair. The examiner stood in front of the child. Then, the child’s oral status was examined using a disposable glove and a wooden spatula, and the results were recorded. A child’s tooth status was considered decayed (d) if there was visible evidence of a cavity, missing (m) if the tooth was missed due to caries and filled (f) if filled due to caries, and then, the dmft index score was calculated and recorded for each child.^22,23

Operational Definitions

Kindergarten Children: Children aged between four and six years old.²⁴

Early Childhood Caries is assessed using observation of the child’s teeth for the presence of decayed, missed or filled. When at least 1 tooth decayed, and/or missed, and/or filled, the child was considered to have caries and not have caries otherwise.¹³

Oral Hygiene was assessed using five dichotomized items by observing the oral hygiene status of the children. The hygiene status was considered to be ‘poor oral hygiene’ when food debris, plaque/calculus or other particles were present on at least one tooth of the child’s surfaces and ‘good oral hygiene’ when no particles were present on all the child’s tooth surfaces.¹⁸

DMFT: the sum of the number of decayed (D), missing due to caries (M) and filled (F) teeth in the primary teeth. A DMFT score above 0 indicates the presence of ECC, whereas a null score indicates the absence of caries.²² DMFT index score: the sum of individual DMFT values divided by the sum of examined children, which assesses the severity of ECC using standard WHO classification criteria based on the DMFT index score. Thus, the ECC severity was considered ‘very low’ dmft scored ‘0.0 to 1.1’, ‘low’ when DMFT scored ‘1.1 to 2.6’, ‘moderate’ when DMFT scored ‘2.7 to 4.4’, ‘high’ when DMFT scored ‘4.5 to 6.5’ and ‘very high’ when DMFT scored >‘6.5’ score.²²

Sweet Consumption Habit: Sweet consumption habit over the last seven days was assessed using six closed-ended questions developed by WHO, and children who ate or drank at least one type of sweet food item for more than three days per week were considered ‘high sweet consumption’ and ‘low sweet consumption’ if less than or equal to three days per week.²²

Data Quality Control

Data quality was maintained using questionnaires adapted from previously published literature. The questionnaire first prepared in English, was translated into local languages (Afan Oromo and Amharic) and back to English by two experts with a good command of both languages. We pretested an adapted questionnaire on 5% of the total sample (26) to check its validity in a separate non-selected facility in the town, and changes were made accordingly. Fourteen data collectors and one dental examiner collected the data under the supervision of four supervisors after training for one day on the objective of the study and the data collection technique.

Data Processing and Analysis

After ensuring completeness, the data were entered using EpiData 3.1 and analyzed using SPSS 27.0. Descriptive statistics, frequency and a measure of central tendency and dispersion were used to describe participants and assess the prevalence of early childhood caries.

Before analysis, the internal consistency of items for each composite index score was evaluated through reliability analysis (Cronbach’s α). We observed the internal consistency of the composite indexes in the sugar consumption items (Cronbach’s α = .76), oral hygiene (Cronbach’s α = .83) and dental caries items (Cronbach’s α = .86). Bivariable logistic regression analyses were employed to determine factors associated with early childhood caries, and variables with a P < .25 were candidates for multivariable logistic regression. Subsequently, multivariable logistic regression was performed to identify statistically significant factors of early childhood caries. The model adequacy was confirmed using the Hosmer and Lemeshow goodness-of-fit test at P > .05. The association was reported using an adjusted odds ratio (AOR) with a 95% confidence interval, and statistical significance was declared at a P < .05.

Ethical Approval and Informed Consent

Ethical clearance was obtained from the Institutional Health Research and Ethical Review Committee (IHRERC) of the College of Health and Medical Sciences, Haramaya University; ref no: IHRERC/216/2022. Written informed consent was obtained from the guardian after providing information about the study’s purpose. We confirmed the child’s willingness to take apart before the oral examination.

Results

Sociodemographic Characteristics

A total of 507 children participated in the study, yielding a response rate of 97.9%. The mean (± SD) age of the mothers was 29.7 (± 5.7) years, with 292 (57.6%) mothers in the 25 to 34 years age group, 109 (21.5%) in 35 to 44 years, 100 (19.7%) in <25 years and six (1.2%) in ≥45 years age group. Four hundred eighty-nine (96.4%) and 190 (37.5%) of the children’s mothers were married and government employees, respectively. Regarding the level of education, nearly half (47.3%) of the mothers had a college and above, 165 (32.5%) secondary school, 63 (12.4%) primary school and 39 (7.7%) were unable to read and write. More than half (52.3%) of the children’s family average monthly income was ≤6000 Ethiopian Birr, and 224 (44.2%) of the children’s in family size was ≥5 members. The majority, 454 (89.5%) of families did not give pocket money to their children. The mean (± SD) of children’s age was 59 (± 7.3) months, and more than half (54.6%) of children were in the age group of ≤59 months. Regarding KG levels of the children, 240 (47.3%) children attended KG-1 level, 134 (26.4%) KG-2 level and 133 (26.2%) KG-3 level (Table 1).

Table 1.

Socio-Demographic Characteristics of Mothers and Kindergarten Children in Harar Town, Eastern Ethiopia (n = 507), 2023.

Variables	Category	Frequency	Percent
Kindergarten level	1	240	47.3
	2	134	26.4
	3	133	26.4
Maternal age (years)	<24	100	19.7
	25-34	292	57.6
	35-44	109	21.5
	≥45	6	1.2
Mother’s Marital status	Single	8	1.6
	Married	489	96.4
	Others	10	2.0
Ethnicity	Oromo	307	60.6
	Amhara	101	19.9
	Harari	79	15.6
	Others	20	3.9
Religion	Muslim	375	74.0
	Orthodox	71	14.0
	Protestant	58	11.4
	Others	3	0.6
Mother’s Main occupation	Housewife	175	34.5
	Private employee	132	26.0
	Gov’t employee	185	36.5
	Other	15	3.0
Mother’s Highest education level	Unable read and write	39	7.7
	Primary school	63	12.4
	Secondary school	165	32.5
	College and above	240	47.3
Family average monthly income (Ethiopian Birr)	≤6000	247	48.7
Family average monthly income (Ethiopian Birr)	>6000	260	52.3
Family size	<5	283	55.8
Family size	≥5	224	44.2
Number of children aged under 10 years in the family	<3	116	22.9
Number of children aged under 10 years in the family	≥3	391	77.1
Giving pocket money for a child	Yes	53	10.5
Giving pocket money for a child	No	454	89.5
Age of the children (months)	≤59	277	54.6
Age of the children (months)	>59	230	45.4

Child Feeding and Oral Hygiene-Related Characteristics

Two hundred eighty-three (55.8%) children were exclusively breastfed. The mean (± SD) of weaning age was 6.4 (± 4.6) months, and about 84.2% of children were weaned at six months. Almost all children (94.9%) continued breastfeeding after six months. About half (48.7%) of the children used bottle-feeding, and 64.3% consumed excess sweet food in the last 7 days. More than half (56.0%) of the children practiced teeth brushing, and 84.6% had poor oral hygiene upon oral examination (Table 2).

Table 2.

Feeding and Oral Hygiene-Related Characteristics of Kindergarten Children in Harar Town, Eastern Ethiopia (n = 507), 2023.

Variables	Category	Frequency	Percent
Exclusively breastfeed	Yes	283	55.8
Exclusively breastfeed	No	224	44.2
Weaning time (months)	Before 6 mo	50	9.9
	At 6 mo	427	84.2
	After 6 mo	30	5.9
Continued breastfeeding after the child’s age of 6 months	Yes	481	94.9
Continued breastfeeding after the child’s age of 6 months	No	26	5.1
Duration of breastfeeding (months)	<12	41	8.1
	12-24	419	82.6
	>24	47	9.3
Bottle feeding practiced	Yes	247	48.7
Bottle feeding practiced	No	260	51.3
Sweet consumption level	Low	326	64.3
Sweet consumption level	High	181	35.7
Teeth brushing practice	Yes	284	56.0
Teeth brushing practice	No	223	44.0
Time of teeth brushing (n = 284)	At morning	231	81.3
	After meal	39	13.7
	Before go to bed	14	4.9
Toothpaste use during brushing (n = 284)	Yes	192	67.6
Toothpaste use during brushing (n = 284)	No	92	32.4
Parent support child in teeth brushing (n = 284)	Yes	105	37.0
Parent support child in teeth brushing (n = 284)	No	179	63.0
Child experienced toothache in the last 12 months	Yes	136	26.8
Child experienced toothache in the last 12 months	No	371	73.2
Where you take your child for toothache treatment (n = 136)	Health facility	97	71.3
	Pharmacy	21	15.4
	Traditional healer	3	2.2
	Nowhere	15	11.0
The child visited health facility for a dental check-up	Yes	32	6.3
The child visited health facility for a dental check-up	No	475	93.7
Oral hygiene practice	Good	78	15.4
Oral hygiene practice	Poor	429	84.6

Prevalence of Early Childhood Caries (ECC)

In this study, the proportion of early childhood caries was 64.7% (95% CI: 60.5-68.9) among kindergarten schools in Harar town. The mean DMFT index score of children in kindergarten school was 3.71 (95% CI: 3.30-4.12).

Factors Associated With Early Childhood Caries

In the bivariable analysis, being in kindergarten two and three, maternal primary school education, living with more than or equal to 5 family members, giving pocket money for children, bottle feeding practice, did not brushing teeth, poor oral hygiene and higher sweet consumption were factors associated with ECC among kindergarten children. However, in multivariable analysis, being in kindergarten two and three, maternal primary school education, giving pocket money to children, bottle-feeding practice, not brushing teeth, poor oral hygiene and higher sweet consumption were the main risk factors that increased early childhood caries (Table 3).

Table 3.

Bivariable and Multivariable Logistic Regression Analyses of Factors Associated With Early Childhood Caries Among Kindergarten Children in Harar Town, Eastern Ethiopia (n = 507), 2023.

Associated factor	Category	ECC		COR (95% CI)	AOR (95% CI)
Associated factor	Category	Yes (%)	No (%)	COR (95% CI)	AOR (95% CI)
Kindergarten level	1	140 (58.3)	100 (41.7)	1	1
	2	90 (67.2)	44 (32.8)	1.46 (0.94-2.27)	2.02 (1.17-3.46)*
	3	98 (73.7)	35 (26.3)	2.00 (1.26-3.18)**	2.50 (1.43-4.36)**
Maternal highest education level	Not read/write	26 (66.7)	13 (33.3)	1.33 (0.65-2.72)	2.22 (0.93-5.27)
	Primary school	51 (81.0)	12 (19.0)	2.83 (1.44-5.59)**	4.21 (1.87-9.48)**
	Secondary school	107 (64.8)	58 (35.2)	1.23 (0.81-1.85)	1.16 (0.71-1.89)
	College/above	144 (60.0)	96 (40.0)	1	1
Average monthly income of family (ETB)	≤6000	153 (61.9)	94 (38.1)	1	1
Average monthly income of family (ETB)	>6000	175 (67.3)	85 (32.7)	1.26 (0.88-1.82)	1.42 (0.90-2.25)
Family size	<5	167 (59.0)	116 (41.0)	1	1
Family size	≥5	161 (71.9)	63 (28.1)	1.77 (1.22-2.58)**	1.18 (0.74-1.87)
Giving pocket money to children	Yes	41 (77.4)	12 (22.6)	1.99 (1.02-3.89)*	1.08 (0.48-2.41)
Giving pocket money to children	No	187 (63.2)	167 (36.8)	1	1
Exclusive breast-feeding	Yes	190 (54.2)	93 (45.8)	1	1
Exclusive breast-feeding	No	138 (84.6)	86 (15.4)	1.27 (0.8-1.84)	1.15 (0.72-1.83)
Bottle-feeding practice	Yes	187 (75.7)	60 (24.3)	2.63 (1.80-3.84)***	2.88 (1.81-4.59)***
Bottle-feeding practice	No	141 (54.2)	119 (45.8)	1	1
Sweet consumption level	Low	69 (38.1)	112 (61.9)	1	1
Sweet consumption level	High	259 (79.4)	67 (20.6)	6.27 (4.19-9.39)***	6.83 (4.31-10.83)***
Teeth brushing	Yes	174 (61.3)	110 (38.7)	1	1
Teeth brushing	No	154 (69.1)	69 (30.9)	1.41 (0.97-2.04)	1.82 (1.15-2.88)*
Oral hygiene practice	Good	28 (35.9)	50 (64.1)	1	1
Oral hygiene practice	Poor	300 (69.9)	129 (30.1)	4.15 (2.50-6.89)***	6.06 (3.33-11.04)***

Abbreviations: AOR, adjusted odds ratio; COR, crude odds ratio, CI, confidence interval; ECC, early childhood carries; ETB, Ethiopian Birr.

***

P < .001. **P < .01. *P < .05.

The odds of early childhood caries among children attending kindergarten two and three were 2.02 times higher (AOR = 2.02, 95% CI: 1.17-3.46) and 2.50 times higher (AOR = 2.50, 95% CI: 1.43-4.36), respectively, compared to children attending kindergarten one. The odds of early childhood caries among children whose mothers had a primary education level were 4.21 times higher (AOR = 4.21, 95% CI: 1.87-9.48) than those with college and above education. The odds of early childhood caries among children who practiced bottle-feeding were 2.88 times (AOR = 2.88, 95% CI: 1.81-4.59) higher than those who did not practice bottle-feeding. The odds of early childhood caries among children who had higher sweet consumption were 6.83 times (AOR = 6.83, 95% CI: 4.31-10.83) higher than children who had lower sweet consumption. The odds of early childhood caries among children who did not brush their teeth were 1.82 times (AOR = 1.82, 95% CI: 1.15-2.88) higher than those who brushed their teeth. The odds of early childhood caries among children with poor oral hygiene were five times higher than those with good oral hygiene (AOR = 4.95, 95% CI: 2.60-9.43; Table 3).

Discussion

This study was assessed the prevalence and associated factors of early childhood caries among kindergarten children in Harar Town, eastern Ethiopia. The prevalence of early childhood carriers in this study was 64.7% (95% CI: 61.5-68.9). Kindergarten level, mothers’ education level, bottle-feeding practice, brushing teeth practice, oral hygiene status and sweet consumption level were the main determinants of early childhood caries among kindergarten children.

The prevalence of ECC was 64.7% in Harar town. This finding was consistent with the studies conducted in Kenya, 63.8%,⁷ Nigeria, 66%⁶ and in Egypt, 67%.²⁵ However, the finding of this study was much higher than the studies carried out in Kisarawe, Tanzania (30.1%)²⁶ and Dare Salam, Tanzania (16.0 %).²⁷ This difference might be due to differences in the study populations’ socio-demographic characteristics. Besides, this variation could be due to the difference in intervention practices in oral health promotion. In the country of a comparable study, routine oral health education practice at all levels of the health care delivery system, in schools, and communities was used to prevent dental caries.²⁸

The finding of this study was lower than the studies done in Sudan 71.4%,⁵ Morocco 74.2%,²⁹ Indonesia 88%,³⁰ United Arab Emirates 83%,³¹ India 76.4%,³² Palestine 76%³³ and Soria 70%.³⁴ This might be due to differences in socio-demographic characteristics and feeding behavior. For instance, the level of sweet consumption is much higher in Asian countries due to cultural feeding habits, which may increase the risks of dental caries.³⁵

This study revealed the mean of the DMFT index was 3.71 with (95% CI: 3.30-4.12), which is similar to the mean dmft value stated by World Oral Health Standards between 2012 and 2013 and the study conducted in Morocco 4.00.²⁹ This was higher when compared to the studies done in Kisarawe, Tanzania 2.51,³⁶ Johannesburg, South Africa 2.30³⁷ and Ras Al-Khaimah, United Arab Emirates 3.07.³⁸ However, the mean of the DMFT index was lower than the study done in Sudan 4.36,⁵ and Soria 4.25.³⁴

The findings of this study showed that the odds of ECC among children who attended the KG-2 and KG-3 levels were 2.0 times and 2.5 times higher than those who attended the KG-1 education level, respectively. This finding was in agreement with similar studies conducted in Kenya,⁷ Sudan,⁵ Tanzania,³⁶ and Nigeria.⁶ These might be due to the exposure to dental caries is increasing with the KG level. In addition, as children grow older, their dietary habits and oral hygiene practices change, which is a major cariogenic challenge.³⁹

The odds of ECC among children whose mothers’ education level was primary school were around four times higher than those whose mothers had a college and above. This finding was supported by the studies conducted in Kenya⁷ and Italy,⁴⁰ which indicated that a higher parental education level played a protective role in dental caries among children. Mothers are the primary caregivers for their children, and a low level of maternal education may lead to a lack of information and education about Children’s oral health care.⁴¹

This study indicated that the odds of ECC among children who practiced bottle-feeding were almost three times higher than those who did not bottle-feed. This finding was supported by the study conducted in Kenya⁷ and Saudi Arabia.⁴² This implies a higher risk for tooth decay when the children practice bottle feeding. The children who used bottle feeding had lower opportunities for receiving antibodies and other immune complexes from their mothers. In addition, bottle-feeding users usually use sugary fluid, which lingers in the mouth and breaks down into an acid that attacks the enamel.⁴³

The level of sweet consumption emerged as the key predictor of early childhood caries. This study revealed that children who consumed high-sugar foods had significantly higher chances of developing ECC than those with lower sweet food intake. This finding is congruent with previous studies conducted in Kenya.⁷ It suggests that the high frequency consumption of sweets plays a crucial role in the formation of dental caries. This could be due to the bacteria within the plaque using the sugar as energy, releasing acid as a waste product and gradually dissolving the enamel of the teeth.⁴⁴

The odds of ECC among children who did not practice brushing were higher than those who practiced brushing their teeth. This finding was in agreement with studies conducted in Kenya,⁷ Kisarawe, Tanzania³⁶ and Saudi Arabia.⁴² This could be because cleaning the teeth can remove food debris, microorganisms and sources of nutrients for bacterial growth.⁴⁵ Moreover, oral hygiene status was significantly associated with ECC. Children with poor oral hygiene status are more likely to develop dental caries than those with good oral hygiene status. This finding was supported by the studies conducted in Kenya,⁷ Sudan⁵ and Saudi Arabia.⁴²

This study identified the prevalence and determinants of early childhood caries among kindergarten children in Ethiopia, which provides evidence of the extent of the problem for neglected minors. The limitation of this study was that it was conducted among children with their mothers, which does not represent children without their mothers. Moreover, since this study focused on children in the Kindergarten one to three level, it does not represent children who did not attend kindergarten school and children in zero and nursery classes.

Conclusions

Almost two in every three kindergarten school children have early childhood caries in Harar Town, eastern Ethiopia. Kindergarten level, maternal education status, bottle-feeding practice, sweet consumption level, teeth brushing habit and oral hygiene status were the main predictors of early childhood caries among kindergarten children. Establishing multi-sectoral approaches and including into general health promotion to provide effective oral health promotion on child healthy feeding and oral hygiene practice for children and their caregivers in all health care services, schools and communities is essential to reduce and prevent dental caries and its negative consequences. In addition, providing adequate and appropriate healthy child care services at the household level is required to improve the children’s oral health status through enhancing the maternal education level in the community.

Footnotes

Acknowledgements

We would like to thanks Haramaya University, Harari Education Bureau, Kindergarten schools in Harar town, study participants, and all data collectors and supervisors for their contributions.

Abbreviations

AAPD: American Academy of Pediatric Dentistry; AOR: Adjusted odds ratio; DMFT: decayed, missed due to caries and filled primary teeth; ECC: Early childhood caries; IHRERC: Institutional Health Research and Ethical Review Committee; KG: Kindergarten; LMIC: Low and middle-income countries; SSA: sub-Saharan Africa; WHO: World Health Organization.

ORCID iDs

Wondimye Ashenafi

Hassen Abdi Adem

Ahmedin Aliyi Usso

Ethical Considerations

Ethical clearance was obtained from the Institutional Health Research and Ethical Review Committee (IHRERC), of the College of Health and Medical Sciences, Haramaya university; ref no: IHRERC/216/2022. Written informed consent was obtained from the guardian after providing information about the study’s purpose. We confirmed the child’s willingness to take apart before the oral examination.

Author Contributions

A.M., W.A., H.M., A.A., H.A.A. and A.A.U. conceived and designed the study. A.M., W.A., H.M. and A.A.U. analysis and write-up of the results. A.M., W.A., H.M., A.A., H.A.A. and A.A.U. reanalyzed the data, drafted and edited the manuscript and made revisions. All authors read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Data Availability Statement

Data that supports the findings is available from the corresponding author on reasonable request.

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Early Childhood Caries Among Kindergarten School Children in Harar Town,Eastern Ethiopia

Abstract

Keywords

Introduction

Methods and Materials

Study Design, Period and Area

Population

Sample Size Determination

Sampling Procedures

Data Collection Tools and Techniques

Data Collection Procedures

Operational Definitions

Data Quality Control

Data Processing and Analysis

Ethical Approval and Informed Consent

Results

Sociodemographic Characteristics

Child Feeding and Oral Hygiene-Related Characteristics

Prevalence of Early Childhood Caries (ECC)

Factors Associated With Early Childhood Caries

Discussion

Conclusions

Footnotes

Acknowledgements

Abbreviations

ORCID iDs

Ethical Considerations

Author Contributions

Funding

Declaration of Conflicting Interests

Data Availability Statement

References