Factors associated with caregivers' perception of children's health and oral health status: a study of 6- to 36-month-olds in Uganda

A Review on Maternal Parenting, Child's Growth Stunting, and Oral Health

Stunting has gained global attention as one of the most critical problems in public health. As the first and dominant figure in a child's life, the mother is responsible for determining the proper parenting behaviors to apply to maintain the child's physical health. Stunting is often associated with early childhood caries (ECC) and molar incisor hypomineralization, which can be manifested into each other through various mechanisms. Therefore, it is crucial to explore how far maternal parenting behaviors affect stunting and oral health. This study aims to determine which maternal parenting behaviors can affect stunting and oral health. A systematic search was used through PubMed and Google Scholar to search for published articles between 2011 and 2021. The articles analyze maternal parenting behaviors with stunting and poor oral health. Final analysis was used on 21 articles containing 18 cross-sectional studies, 2 cohort studies, and 1 randomized controlled trial. The result implied that the high prevalence of stunting and ECC is the combined result of prolonged breastfeeding practices (7 articles), poor complementary feeding practice (6 articles), high consumption of sugar (5 articles), and poor oral hygiene practices (5 articles). Maternal parenting styles in the aspect of fulfilling nutrition and maintaining oral health affect the occurrence of stunting and ECC in children.

Oral health-related quality of life and associated factors among a sample from East China with severe early childhood caries: a cross-sectional study

BACKGROUND

To investigate the oral health-related quality of life (OHRQoL) and associated factors among a sample from East China with severe early childhood caries (S-ECC).

METHODS

A total of 316 children with S-ECC and their parents were recruited to participate in a cross-sectional study. Children were examined for caries status using criteria proposed by World Health Organization (WHO). The accompanying parent was required to provide demographic information and complete two validated questionnaires in Chinese: the early childhood oral health impact scale (ECOHIS) and the 5-item oral health impact profile (OHIP).

RESULTS

The study had a 98.1% response rate. Finally, the data of 300 children and their parents were analyzed. Mothers cared for their children far more than fathers in the included family (78.7% mother, 21.3% father). The mean age of children was 4.1 ± 0.7 years, ranging from 3 to 5. The mean dmft score was 13.8 ± 3.8. Few (13.7%) children never had a toothache. ECOHIS scores ranged from 0 to 38, with a mean score of 16.2 ± 7.2. The mean OHIP score was 2.9 ± 2.7. The parental age, family income, residence, history of pain, the dmft scores and parents' OHIP showed associations with ECOHIS scores or domain scores (P < 0.05). The multiple regression analysis showed that the history of pain, accompanying parents' OHIP, and the dmft scores were mainly associated with ECOHIS and child impact (P < 0.05); parental age was associated with family impact (P = 0.024).

CONCLUSIONS

The parent's OHRQoL was associated with the children's OHRQoL, indicating that policymakers and clinical practitioners should improve both children's and their parents' oral health. Furthermore, the caries severity and the history of dental pain impacted children's OHRQoL.

Systematic review of factors influencing oral health-related quality of life in children in Africa

Background

Oral health-related quality of life (OHRQoL) is influenced by cultural and societal context. Existing OHRQoL children measurement tools have been conceptualised in high-income countries. Probing whether the factors influencing OHRQoL are context-reliant in the African setting is necessary and is the purpose of the current review.

Aim

To investigate if the factors influencing OHRQoL are context-reliant.

Methods

Seven databases were searched using search terms (‘oral health’; and ‘quality of life’, ‘health-related quality of life’, ‘patient-reported outcomes’, ‘well-being’; and ‘child*’, ‘adolescents’, ‘teen*’, ‘youth’; and ‘determinants’, ‘factors’, ‘predictors’; and ‘oral health quality of life tools/instruments/scales’; and ‘Africa*’). Abstracts identified were exported to a reference software manager. Three of the authors used specific selection criteria to review, firstly, 307 abstracts and, secondly, 30 full papers. Data were extracted from these papers using a pre-designed data extraction form, after which quantitative synthesis of data was performed.

Results

Key factors influencing OHRQoL followed an existing conceptual framework where environmental and individual factors in the form of socio-economic status (SES), area of residence and children psyche status, and the presence of any oral condition other than dental caries were reported among child populations in Africa.

Conclusion

There is preliminary evidence to suggest an association between individual factors such as children’s psyche and oral problems, excluding dental caries, and environmental determinants such as area of residence and SES in children’s OHRQoL in African children. The finding that dental caries was not a key factor in child-oral health is unexpected. There seemed to be a contextual viewpoint underpinning the current OHRQoL frameworks and OHRQoL was context-reliant.

Oral Problems and Self-Confidence in Preschool Children

The aim of the present study was to evaluate the impact of clinical oral factors, socioeconomic factors and parental sense of coherence on affected self-confidence in preschool children due to oral problems. A cross-sectional study with probabilistic sampling was conducted at public and private preschools with 769 five-year-old children and their parents/caretakers. A questionnaire addressing socio-demographic characteristics as well as the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5) and the Sense of Coherence Scale (SOC-13) were administered. The dependent variable was self-confidence and was determined using the SOHO-5 tool. Dental caries (ICDAS II), malocclusion and traumatic dental injury (TDI) were recorded during the clinical exam. Clinical examinations were performed by examiners who had undergone training and calibration exercises (intra-examiner agreement: 0.82-1.00 and inter-examiner agreement: 0.80-1.00). Descriptive statistics and Poisson regression analysis were performed (a=5%). Among the children, 91.3% had dental caries, 57.7% had malocclusion, 52.8% had signs of traumatic dental injury and 26.9% had bruxism. The following variables exerted a greater negative impact on the self-confidence of the preschool children due to oral problems: attending public school (PR=2.26; 95% CI: 1.09-4.68), a history of toothache (PR=4.45; 95% CI: 2.00-9.91) and weak parental sense of coherence (PR=2.27; 95% CI: 1.03-5.01). Based on the present findings, clinical variables (dental pain), socio-demographic characteristics and parental sense of coherence can exert a negative impact on self-confidence in preschool children due to oral problems.

Effects of nutrition and hygiene education on oral health and growth among toddlers in rural Uganda: follow-up of a cluster-randomised controlled trial

OBJECTIVE

To examine the effect of a nutrition and hygiene education intervention on oral health behaviour and whether early onset of caries was related to child growth in rural Uganda.

METHODS

Follow-up study of a cluster-randomised controlled trial conducted between October 2013 and January 2015. Data were available from 399 mother/child pairs (203 in the intervention and 198 in the control group) of the original trial (78%) when the children were 36 months old. Oral health behaviour was evaluated using questionnaires. Photographs of the maxillary anterior teeth were examined for unmistakably carious lesions, and 115 water samples from the study area were analysed for fluoride concentration.

RESULTS

The frequency of cleaning of the child's teeth at 36 months was about twice as high in the intervention as in the control group (84.3% vs. 46.6%; P = 0.0001). Cavitated carious lesions occurred more frequently in the control than the intervention group (27.8% vs. 18.2%; P = 0.04). Extraction of 'false teeth' (ebiino), a painful and crude traditional operation, was profoundly reduced in the intervention group (8.9% vs. 24.7%; P = 0.001). There was no evidence of association between the occurrence of caries and child growth.

CONCLUSIONS

The education intervention improved oral hygiene practices and reduced the development and progression of caries and extraction of ebiino. Early childhood caries was not clearly associated with child growth.

[The potential financial impact of oral health problems in the families of preschool children]

The aim of the study was to evaluate the perception of parents/caregivers regarding the financial impact of oral health problems on the families of preschool children. A preschool-based, cross-sectional study was conducted with 834 preschool children in Campina Grande, Brazil. Parents/caregivers answered the Early Childhood Oral Health Impact Scale. "Financial impact" was the dependent variable. Questionnaires addressing socio-demographic variables, history of toothache and health perceptions were administered. Clinical exams were performed by three dentists previously calibrated (Kappa: 0.85-0.90). Descriptive statistics were performed, followed by logistic regression for complex samples (α = 5%). The frequency of financial impact due to oral health problems in preschool children was 7.7%. The following variables were significantly associated with financial impact: parental perception of child's oral health as poor, the interaction between history of toothache and absence of dental caries and the interaction between history of toothache and presence of dental caries. It is concluded that often parents/caregivers reported experiencing a financial impact due to seeking treatment late, mainly by the presence of toothache and complications of the clinical condition.

Validation of the Arabic Version of the Early Childhood Oral Health Impact Scale (ECOHIS)

BACKGROUND

Assessment of the adverse effects of oral health problems on oral health-related quality of life (OHRQoL) is essential to ensure the well-being of children. The Early Childhood Oral Health Impact Scale (ECOHIS) is an instrument that was designed to assess caregivers' perceptions of OHRQoL in preschool children. Although it has been translated into many languages, it has yet to be validated in Arabic. Therefore, this study aimed to translate this questionnaire to Arabic (A-ECOHIS) and test its psychometric properties.

METHODS

Questionnaire responses from three samples of caregivers of preschool children ≤ 6 years of age were collected: (i) community-based (n = 422), from preschools selected as a stratified random sample; (ii) clinic-based, from those seeking pediatric dental care at a university clinic (n = 246); and (iii) a test-retest sample (n = 68), a clinic-based group of caregivers who completed questionnaires twice about siblings who were not receiving dental care. Children received a dental examination to assess their decayed, missed, filled teeth (dmft) scores. Convergent validity was evaluated by assessing the A-ECOHIS scores in relation to the response to a global question. Discriminant validity was evaluated by comparing the scores of children with varying levels of oral disease. Internal consistency was assessed by calculating Cronbach's alpha, and the test-retest reliability was assessed using intra-class correlation coefficients (ICCs).

RESULTS

The A-ECOHIS scores of the questionnaire sections and the global oral health rating were significantly correlated; Spearman correlation coefficients were, r = 0.55, P ≤ 0.01 (overall score), r = 0.54, P ≤ 0.01 (child section), and r = 0.51, P ≤ 0.01 (family section). The mean A-ECOHIS scores were also statistically significantly higher in children with higher dmft scores compared with lower dmft, and in the clinic-based sample compared with the community sample. The Cronbach's alpha value of the the child, family sections and overall questionnaire were, 0.80, 0.78, and 0.85, respectively. The intra-class correlation coefficient (ICC) of A-ECOHIS was 0.86.

CONCLUSION

The A-ECOHIS performed well on all psychometric tests to which it was applied. Thus, it is a valid and reliable instrument that can be used in Arabic-speaking caregivers of preschoolers aged 2 to 6 years.

Oral health-related quality-of-life scores differ by socioeconomic status and caries experience

OBJECTIVES

(i) Quantify the relative association between child dental caries experience and maternal-reported child oral health-related quality of life (OHRQoL); (ii) examine whether that association differed according to family socioeconomic status (SES); and (iii) explore whether absolute OHRQoL varied by family SES at similar levels of child caries experience.

METHODS

This study was a cross-sectional analysis of children in southern Brazil (n=456, mean age: 38 months) participating in an existing health centre-based intervention study. OHRQoL impact was quantified as mean score on the Brazilian Early Childhood Oral Health Impact Scale (ECOHIS) and compared over categories of caries experience (dmft: 0, dmft: 1-4, dmft: ≥5). Adjusted ECOHIS ratios between caries categories were calculated using regression modelling, overall and within socioeconomic strata defined by maternal education, social class and household income.

RESULTS

Caries prevalence (dmft >0) was 39.7%, mean ECOHIS score was 2.0 (SD: 3.5), and 44.3% of mothers reported OHRQoL impact (ECOHIS score >0). Increasing child caries experience was associated with worsening child and family quality of life: ECOHIS scores were 3.0 times greater (95% CI: 2.0, 4.4) for children with dmft ≥5 vs dmft=0, a pattern that persisted regardless of family socioeconomic status (P for interaction: all >0.3). However, adjusted for dental status and sociodemographic characteristics, mean ECOHIS scores were lower when reported by mothers of less educational attainment (ratio: 0.7; 95% CI: 0.5, 1.0), lower social class (ratio: 0.7; 95% CI: 0.5, 1.0) or in lower income households (ratio: 0.8; 95% CI: 0.6, 1.3).

CONCLUSION

Dental caries was associated with negative child and family experiences and lower OHRQoL across all social groups; yet, families facing greater disadvantage may report lesser quality-of-life impact at the same level of disease experience. Thus, subjective quality-of-life measures may differ under varying social contexts, with possible implications for service utilization, evaluating oral health interventions, or quantifying disease morbidity in low-SES groups.

Self-perceived oral health influences tooth brushing in preschool children

This study assessed the influence of socioeconomic and clinical factors, as well as parent's perception of child's oral health on the toothbrushing frequency of 0-5-year-old children. The study was carried out in Santa Maria, RS, Brazil, during the National Children's Vaccination Day, and 478 children aged 0-5 years were included. Data were collected by clinical examinations and a structured questionnaire, conducted by 15 calibrated examiners and 30 supports. A questionnaire was filled out by the parents with information about several socioeconomic indicators, perception of child's oral health and frequency of tooth brushing. The main outcome was collected by the question: "How many times a day do you brush your child's teeth?". Multivariable Poisson regression model taking into account the cluster sample was performed to assess the association between the predictors and outcome. Children whose parents related worse perception of child's oral health showed less tooth brushing frequency (PR 1.23; 1.06 - 1.43). Young children brush their teeth less than the older ones (PR 0.90; 0.84 - 0.96); and lack of visit to a dentist was predictor for less tooth brushing frequency (PR 1.29; 1.05 - 1.59). Parent's perception of child oral health influence children's healthy behaviors, supporting the evidence that psychosocial factors are strong predictors of children's oral health.

Parental Perceptions of Oral Health Status in Preschool Children and Associated Factors

<p>The aim of the present study was to evaluate parental perceptions of oral health status in preschool children. A cross-sectional study was carried with 843 Brazilian children between 3 and 5 years of age. Parents/guardians answered a self-administered questionnaire on the health of their children and sociodemographic data. Parental perceptions of their child's oral health were determined by the responses to the following question: "How would you describe your child's oral health?" The Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) was answered by parents/guardians and used to measure the impact of oral health-related quality of life (OHRQoL) on preschool children and their families. Three examiners performed oral exams on the children (K= 0.85-0.90). Descriptive analytical statistics were carried out, followed by logistic regression for complex samples (α=5%). The following variables were significantly associated with parental perceptions of children's oral health: parental perception of general health as poor (OR=18.25; 95% CI: 3.36-98.96), negative impact on family's OHRQoL (OR=13.82; 95% CI: 4.27-44.72), child aged five years (OR=7.40; 95% CI: 1.49-36.63) and the interaction between history of toothache and dental caries (OR=10.02; 95% CI: 1.17-85.61). Thus, parental perceptions of oral health are influenced only by clinical conditions with symptoms, such as dental caries with toothache. Other oral conditions, such as malocclusion or traumatic dental injury, were not associated with parental perceptions of their child's oral health.</p>

Perceived Impact of Dental Pain on the Quality of Life of Preschool Children and Their Families

The aim of the present study was to evaluate the perceived impact of dental caries and dental pain on oral health-related quality of life (OHRQoL) among preschool children and their families. A cross-sectional study was conduct with 843 preschool children in Campina Grande, Brazil. Parents/caregivers answered a questionnaire on socio-demographic information, their child's general/oral health and history of dental pain. The Brazilian version of the Early Childhood Oral Health Impact Scale was administered to determine the perceived impact of caries and dental pain on OHRQoL. The children underwent an oral examination. Logistic regression for complex sample was used to determine associations between the dependent and independent variables (OR: Odds ratio, α = 5%). The independents variables that had a p-value <0.20 in the bivariate analysis were selected for the multivariate model. The prevalence of dental caries and dental pain was 66.3% and 9.4%, respectively. Order of birth of the child, being the middle child (OR: 10.107, 95%CI: 2.008-50.869) and youngest child (OR: 3.276, 95%CI: 1.048-10.284) and dental pain (OR: 84.477, 95%CI: 33.076-215.759) were significant predictors of the perceived impact on OHRQOL for children. Poor perception of oral health was significant predictor of the perceived impact on OHRQOL for family (OR=7.397, 95%CI: 2.190-24.987). Dental caries was not associated with a perceived impact on the ORHQoL of either the children or their families. However, order of child birth and dental pain were indicators of impact of OHRQoL on preschool children and poor perception of oral health was indicators of impact on families.

Association between parental guilt and oral health problems in preschool children: a hierarchical approach

Background

Dental caries and traumatic dental injury (TDI) can play an important role in the emergence of parental guilt, since parents feel responsible for their child’s health. The aim of the present study was to evaluate the influence of oral health problems among preschool children on parental guilt.

Methods

A preschool-based, cross-sectional study was carried out with 832 preschool children between three and five years of age in the city of Campina Grande, Brazil. Parents/caregivers answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). The item "parental guilt" was the dependent variable. Questionnaires addressing socio-demographic variables (child’s sex, child’s age, parent’s/caregiver’s age, mother’s schooling, type of preschool and household income), history of toothache and health perceptions (general and oral) were also administered. Clinical exams for dental caries and TDI were performed by three dentists who had undergone a training and calibration exercise (Kappa: 0.85-0.90). Poisson hierarchical regression was used to determine the significance of associations between parental guilt and oral health problems (α = 5%). The multivariate model was carried out on three levels using a hierarchical approach from distal to proximal determinants: 1) socio-demographic aspects; 2) health perceptions; and 3) oral health problems.

Results

The frequency of parental guilt was 22.8%. The following variables were significantly associated with parental guilt: parental perception of child’s oral health as poor (PR = 2.010; 95% CI: 1.502-2.688), history of toothache (PR = 2.344; 95% CI: 1.755-3.130), cavitated lesions (PR = 2.002; 95% CI: 1.388-2.887), avulsion/luxation (PR = 2.029; 95% CI: 1.141-3.610) and tooth discoloration (PR = 1.540; 95% CI: 1.169-2.028).

Conclusion

Based on the present findings, parental guilt increases with the occurrence of oral health problems that require treatment, such as dental caries and TDI of greater severity. Parental perceptions of poor oral health in their children and history of toothache were predictors of greater feelings of parental guilt.

Impact of low birthweight on early childhood caries in 6-36 months old infants in Uganda: A cross-sectional study

OBJECTIVE

Focusing on 6-36 months old infants, this study assessed (1) whether socio-economic status, current anthropometric status, presence of enamel hypoplasia, number of erupted teeth, oral hygiene and consumption of sugared snacks varied between children with normal birthweight (NBW) and low birthweight (LBW) and (2) the association between ECC and birthweight whilst adjusting for covariates of ECC, such as current anthropometric status.

METHOD

A cross-sectional study was conducted in Kampala in 2007, involving 816 child/caretaker pairs. All caretakers completed face-to-face interviews. Children were examined for ECC and enamel defects using WHO (1997) criteria and the developmental defects of enamel (DDE) index. Weight at birth was obtained from hospital records and current anthropometric status was assessed using z-scores for weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ).

RESULTS

Prevalence of LBW (< 2500 g) and ECC were estimated to 11.5% and 18.1%, respectively. Children with LBW and those with ECC presented with more visible plaque, higher sugar consumption and more current underweight (WAZ < -2) than children with normal birth weight (NBW) and no caries; 26.7% of LBW vs 17.3% (p < 0.001) of NBW children presented with ECC. Enamel defects (OR = 2.8, 95% CI = 1.6-4.8) and presence of visible plaque (OR = 2.4, 95% CI = 1.3-4.1), but not LBW, were associated with ECC in multiple variable logistic regression analyses.

CONCLUSION

Both LBW and ECC were associated with poor oral hygiene, high intake of sugars and current underweight. Enamel defects were associated with ECC. Adjusting for covariates there were no clear association between LBW and ECC. Studies using a prospective study design are needed for further investigation.

Impact of oral health conditions on the quality of life of preschool children and their families: a cross-sectional study

BACKGROUND

Dental caries, traumatic dental injury (TDI) and malocclusion are common oral health conditions among preschool children and can have both physical and psychosocial consequences. Thus, it is important to measure the impact these on the oral health-related quality of life (OHRQoL) of children. The aim of the present study was to assess the impact of oral health conditions on the OHRQoL of preschool children and their families.

METHODS

A preschool-based, cross-sectional study was carried out with 843 preschool children in the city of Campina Grande, Brazil. Parents/caregivers answered the Brazilian Early Childhood Oral Health Impact Scale and a questionnaire addressing socio-demographic data as well as the parent's/caregiver's perceptions regarding their child's health. Clinical exams were performed by three researchers who had undergone a calibration process for the diagnosis of dental caries, TDI and malocclusion (K = 0.83-0.85). Hierarchical Poisson regression was employed to determine the strength of associations between oral health conditions and OHRQoL (α = 5%). The multivariate model was run on three levels obeying a hierarchical approach from distal to proximal determinants: 1) socio-demographic data; 2) perceptions of health; and 3) oral health conditions.

RESULTS

The prevalence of impact from oral health conditions on OHRQoL was 32.1% among the children and 26.2% among the families. The following variables were significantly associated with a impact on OHRQoL among the children: birth order of child (PR = 1.430; 95% CI: 1.045-1.958), parent's/caregiver's perception of child's oral health as poor (PR = 1.732; 95% CI: 1.399-2.145), cavitated lesions (PR = 2.596; 95% CI: 1.982-3.400) and TDI (PR = 1.413; 95% CI: 1.161-1.718). The following variables were significantly associated with a impact on OHRQoL among the families: parent's/caregiver's perception of child's oral health as poor (PR = 2.116; 95% CI: 1.624-2.757), cavitated lesions (PR = 2.809; 95% CI: 2.009-3.926) and type of TDI (PR = 2.448; 95% CI: 1.288-4.653).

CONCLUSION

Cavitated lesions and TDI exerted a impact on OHRQoL of the preschool children and their families. Parents'/caregivers' perception of their child's oral health as poor and the birth order of the child were predictors of a greater impact on OHRQoL.

Impact of traumatic dental injury on the quality of life of Brazilian preschool children

This study aimed to assess the impact of traumatic dental injury (TDI) on the quality of life of preschoolers and their families. A cross-sectional study was carried out, with a sample of 814 children, aged three to five years old, in Campina Grande, Brazil. Parents/caregivers were asked to complete the Brazilian Early Childhood Oral Health Impact Scale and a questionnaire on socio-demographic data. Oral examinations of the children were performed by three previously calibrated dentists. Bivariate and multiple Poisson regression analyses were performed (α = 5%). The prevalence of negative impact from oral conditions on quality of life was 31.1% among the children and 24.7% among the families. TDI was not associated with a negative impact on quality of life. Parent/caregiver's assessment of the child's oral health (PR = 1.210; 95% CI: 1.027-1.426) and history of toothache (PR = 4.997; 95% CI: 2.943-8.493) remained in the final model for the child section, whereas only a history of toothache (PR = 2.791; 95% CI: 1.801-4.325) remained in the final model for the family section. TDI exerted no negative impact on quality of life in the present sample. A history of toothache was the only variable associated with a negative impact on the quality of life of the preschoolers and their families.

Feeding practice among 6-36 months old in Tanzania and Uganda: reliability and relationship with early childhood caries, ECC

OBJECTIVE

To assess the reproducibility of caregivers' responses to dietary recall from birth and 24-h dietary recall with respect to infants' intake of sugared snacks and to assess whether those assessment methods provide comparable results for groups of infants. Re-test reliability and clinical covariates of time to first exposure of sugared snacks and time to termination of breastfeeding were also examined. It was hypothesized that time to first exposure/termination would vary according to socio-demographic profile and ECC.

METHOD

Interviews and clinical oral examinations were carried out in Kampala and Manyara, including 1221 and 816 child-caregiver pairs. Reproducibility was assessed using Cohen's kappa and Intra Class Correlation Coefficient, ICC. Adjusted Cox regression was used to model time to first exposure of sugared snacks and time to termination of breastfeeding.

RESULTS

Cohen's kappa for intake of sugar items ranged from 0.40-1.0, with no differences observed between average intakes at test-re-test. Mean sugar score based on 24-h recall increased significantly by increasing quartiles of the sugar score based on recall from birth. Cox regression revealed that the odds ratio, OR, for early exposure to various sugared snacks and the ORs for early termination of breastfeeding were significantly smaller in infants with than without ECC.

CONCLUSION

Fair-to-good reproducibility was established. Infant's sugar consumption emerge as early as 6 months of age. Survival of any breastfeeding and non-exposure to sugared snacks was most prolonged among infants with ECC. This has implications for interventions needed to improve feeding habits of infants and toddlers.

Child- and family impacts of infants' oral conditions in Tanzania and Uganda-- a cross sectional study

Background

Early childhood dental caries impacts on the quality of life of children and their families. This study set out to assess the psychometric properties of an oral health related quality of life, OHRQoL, measure, based on items emanating from the Child-and Family impact sections of the Early Childhood Oral Health Impact Scale (ECOHIS), in Kiswahili and Luganda speaking communities. It was hypothesized that the Child- and Family impact scores would discriminate between children with and without clinically defined dental problems and reported good and bad oral health.

Method

Kiswahili and Luganda versions of the Child- and Family impact scores were derived through translation in pilot studies. Totals of 1221 and 816 child/caretaker pairs attending health care facilities in Manyara, Tanzania and Kampala, Uganda, were recruited into the study. After caretakers completed the interview, their children underwent oral clinical examination.

Results

Internal consistency reliability (Cronbach’s alpha) was > 0.80 with respect to the Child impact score and 0.79 regarding the Family impact score. Multiple variable logistic- and Poisson regression analyses revealed that the Kiswahili and Luganda versions of the Child- and Family impact score associated in the expected direction with child’s oral diseases as with their reported health and oral health status. In Manyara, multiple logistic regression revealed that the ORs of reporting Child impacts were 1.8 (95% CI 1.0-3.4) and 2.2 (1.3-3.4) among caretakers who confirmed linear hypoplasia and teething symptoms, respectively. In Kampala, the ORs for reporting Child impacts were 2.3 (95% CI 1.3-3.9), 1.7 (95% CI 1.1-2.5), 1.6 (95% CI 1.2-2.3) and 2.7 (95% CI 1.3-5.8) among those who confirmed teeth present, hypoplasia, teething symptoms and tooth bud extractions, respectively. The odds ratios for reporting Family impacts were 2.7 (95% CI 1.5-4.7), 1.5 (95% CI 1.1- 2.1) and 4.6 (95% CI 2.0-10.7) if reporting LEH, teething symptoms and toothbud experience, respectively.

Conclusion

The Child and Family impact scores demonstrated acceptable internal consistency reliability and reproducibility whereas the discriminative validity was more ambiguous. The OHRQoL scores should be developed further and tested among Kiswahili and Luganda speaking caretakers.

Caregivers' oral health literacy and their young children's oral health-related quality-of-life

OBJECTIVES

To investigate the association of caregivers' oral health literacy (OHL) with their children's oral health related-quality of life (C-OHRQoL) and explore literacy as a modifier in the association between children's oral health status (COHS) and C-OHRQoL.

METHODS

This study relied upon data from structured interviews with 203 caregivers of children aged 3-5 from the Carolina Oral Health Literacy (COHL) Project. Data were collected for OHL using REALD-30, caregiver-reported COHS using the NHANES-item and C-OHRQoL using the Early Childhood Oral Health Impact Scale (ECOHIS). This study also measured oral health behaviors (OHBs) and socio-demographic characteristics and calculated overall/stratified summary estimates for OHL and C-OHRQoL. Spearman's rho and 95% confidence intervals (CI) were computed as measures of correlation of OHL and COHS with C-OHRQoL. To determine whether OHL modified the association between COHS and C-OHRQoL, this study compared literacy-specific summary and regression estimates.

RESULTS

Reported COHS was: excellent-50%, very good-28%, good-14%, fair-6%, poor-2%. The aggregate C-OHRQoL mean score was 2.0 (95% CI: 1.4, 2.6), and the mean OHL score 15.9 (95% CI: 15.2, 16.7). There was an inverse relationship between COHS and C-OHRQoL: ρ = -0.32 (95% CI: -0.45, -0.18). There was no important association between OHL and C-OHRQoL; however, deleterious OHBs were associated with worse C-OHRQoL. Literacy-specific linear and Poisson regression estimates of the association between COHS and C-OHRQoL departed from homogeneity (Wald χ(2) p < 0.2).

CONCLUSION

In this community-based sample of caregiver/child dyads, a strong correlation was found between OHS and C-OHRQoL. The association's magnitude and gradient were less pronounced among caregivers with low literacy.

Prevalence and socio-behavioral influence of early childhood caries, ECC, and feeding habits among 6-36 months old children in Uganda and Tanzania

Background

Early childhood caries (ECC) is a serious problem that has remained unexplored in sub-Saharan Africa. This study aimed to identify possible socio-behavioral correlates of ECC focusing 6–36 months old children and their caretakers.

Methods

Cross sectional studies were conducted in a high fluoride rural area, Manyara, Tanzania and a low fluoride urban area, Kampala, Uganda. Totals of 1221 and 816 child - caretaker pairs attending health care facilities for growth monitoring were recruited in Manyara and Kampala, respectively. All caretakers completed face to face interviews at the health care facility. Children underwent oral clinical examination whereby ECC and Enamel hypoplasia were recorded using the dmft (WHO 1997) and the DDE index (FDI 1992).

Results

The prevalence of ECC was 3.7% in Manyara and 17.6% in Kampala. According to multiple logistic regression analyses, received oral health information from health worker was the strongest determinant of ECC in Manyara, adjusted OR 0.3, 95% CI 0.09 – 0.93. In Kampala, visible plaque, high sugar intake and presence of enamel hypoplasia associated with ECC, adjusted ORs 2.8 (95% CI 1.61- 4.95), 3.0 (95% CI 1.39 – 6.34) and 2.3 (95% CI 1.36 - 3.95).

Conclusion

Oral health education aimed at caretakers of 6–36 months, including health care workers’ information regarding the detrimental consequences for oral health of frequent sugar consumption and poor oral hygiene is important for prevention of ECC in Tanzania and Uganda.

Disparities in early childhood caries and its impact on oral health-related quality of life of preschool children

This study aimed to investigate the caries experience and its impact on preschool children's quality of life and the associations between these outcomes and underlying determinants. A survey was conducted on 5- to 6-year-old children (503 in all) in Bangkok who were orally examined and interviewed on their oral health-related quality of life (OHRQoL). In addition, behavioral questionnaires were sent to parents. Associations between determinants and oral health outcomes were tested through logistic regression. It was found that 28% of children experienced high-level impacts on quality of life, mostly dental pain (58.3%) and eating difficulties (45.9%). Children of low socioeconomic status were more likely to have a high level of dental caries and subsequent OHRQoL impact. Oral status was related to oral behaviors and OHRQoL. Social disparities in preschool children's OHRQoL were identified.

Psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS)

BACKGROUND

Oral disorders can have a negative impact on the functional, social and psychological wellbeing of young children and their families and cause pain/discomfort for the child. Oral health-related quality of life (OHRQoL) has emerged as an important health outcome in clinical trials and healthcare research. The Early Childhood Oral Health Impact Scale (ECOHIS) is a proxy measure of children's OHRQoL designed to assess the negative impact of oral disorders on the quality of life of preschool children. The objective of this study was to evaluate the psychometric properties of the Brazilian version of the ECOHIS (B-ECOHIS).

METHODS

This investigation was carried out in preliminary and field studies. The preliminary study comprised a cross-sectional study carried out in the city of Petropolis, Brazil. A sample of 150 children from two to five years of age was recruited at a public hospital. In the field study, an epidemiological survey was carried out in public and private preschools of Belo Horizonte, Brazil. The B-ECOHIS was answered by 1643 parents/caregivers of five-year-old male and female preschool children. In both phases, oral examinations were performed by a single previously calibrated dentist. Reliability was determined through test-retest reliability and internal consistency. Validity was determined through convergent and discriminant validities. The correlation between the scores obtained on the child and family impact sections was assessed.

RESULTS

In the preliminary (P) and field (F) study, test-retest reliability correlation values were 0.98 and 0.99 for the child impact section and 0.97 and 0.99 for the family impact section, respectively. The B-ECOHIS demonstrated internal consistency: child impact section (P: α = 0.74; F: α = 0.80) and family impact section (P: α = 0.59; F: α = 0.76). The correlation between the scores obtained on the child and family impact sections was statistically significant (P: rs = 0.54; F: rs = 0.62; p ≤ 0.001). In both phases of the study, B-ECOHIS scores were significantly associated with the decayed, missing and filled teeth index, decayed teeth and discolored upper anterior teeth (p < 0.05).

CONCLUSION

The B-ECOHIS proved reliable and valid for assessing the negative impact of oral disorders on the quality of life of preschool children.