Factors associated with dental caries among children/youth in Mbeere district.

Abstract

Anecdotal reports from Compassion International assisted projects indicated that dental related conditions remained among the top five most prevalent conditions among the children/youth since 2009 despite implementation of interventions aimed at reducing their occurrence. Dental caries was the most reported dental condition. I sought out to establish the prevalence of dental caries among these children/youth and factors associated with dental caries occurrence.

Methods A descriptive cross-sectional study was conducted where dental caries prevalence was measured based on; World Health Organization (WHO) oral health assessment criteria which included a clinical examination. Socio-demographic factors, children/youth oral health behaviour, knowledge on dental caries prevention, caregiver’s knowledge on their children’s oral health behaviour and contextual/ system factors were assessed using structured open and closed ended interviewer administered questionnaires and key informant interview guides. The study population comprised of 280 children/youth aged 4- 22 years and their caregivers. Analysis for association was done using Chi square, Spearman’s rank-order correlation, linear regression model, Analysis of Variance (ANOVA) and Fisher’s exact test of association.

Results The overall prevalence of dental caries for both children and youth was 21.8% with children of age 6 – 12 years having a prevalence of 22.9% while youth of age >=13 years having axv prevalence of 20.3%. The overall mean for decayed missing filled teeth (dmft) was 0.58+1.24 SD with children of age 6 – 12 years having a mean of 0.74+1.45 SD while the youth of age >=13 years having a mean of 0.38+0.86 SD. An Independent-Samples t-test elicited a statistically significant difference in means of children’s dental caries and age p = 0.011. A Curve Estimation Linear Regression model elicited a statistically significant association between age and decayed, missing, filled teeth (DMFT) p < 0.001. It means that as one progresses in age, the likelihood of decay is high. Knowledge and practice factors that elicited a statistically significant association with caries included; frequency of brushing p=0.029, caregiver’s guidance during brushing p<0.001, knowledge of dental caries prevention p=0.015 and knowledge on remnants of food particles on the mouthy p=0.020. The knowledge of the children/ youth on dental caries and its prevention was low at an average of 59.28%. Younger children aged 6-12 years had a higher understanding of oral hygiene than the older ones aged 13 years and above. Contextual and health system factors cited to hamper oral health services delivery included; inaccessible oral health services due to limited facilities offering these services, the cost of oral health services was out of reach for most respondents, delay in accessing oral treatment related to distance from the facilities and congestion at the facilities. Additionally, inadequate number of trained personnel in dental care was also cited one of the major challenges in oral health care delivery. Lack of implementation of proper oral health care policy and inadequate budgetary allocations on dental care at the county level also hampers oral service delivery.

Conclusion The dental caries prevalence of the children/ youth was comparable with that of other studies within the country (21.8%) with boys recording a higher prevalence than girls. The younger children aged 6-12 years had a higher caries prevalence and DMFT than the older ones aged 13 years and above. Age was significantly associated with caries occurrence. Poor oral health practices that were statistically significantly associated with caries including not regularly brushing and brushing with the guidance of a caregiver. Some children/youth oral health knowledge factors were significantly associated with dental caries including; children/youth knowledge of preventability of dental caries and children/youth knowledge of remnants of food particles in the mouth. Younger children aged 6-12 years had a higher understanding of oral hygiene than the older ones aged 13 years and above. Caregiver factors were not statistically significantly associated with dental caries occurrence among their children. System factors of geographical access, affordability of services, inadequate oral health budgetary allocations at the county level, inadequate trained personnel, and slow implementation of the national policy on oral health hampers delivery of oral health services and are likely to contribute to high dental caries prevalence.

Recommendation Since dental caries prevalence has been shown to vary with age, age-graded oral health education curriculum needs to be developed and implemented. Older children and youth aged 13 years and above demonstrated lower knowledge of oral health hygiene, there should be special emphasis on oral health education for this age group including use of diverse methods to reach them with oral health messages. Oral health education in schools needs to be given greater emphasis particularly focusing on oral practices such as, consistent brushing of teeth, use of fluoride toothpaste and visiting a dentist for check-up. Parents or guardians play a key role in guiding children on brushing their teeth, it is important to equip them with the correct information on brushing so that they pass accurate information to their children. The county government should increase the number of public facilities offering affordable oral health care and facilitate provision of oral health education to the communities and schools. Budgetary allocation for oral health care at the county level needs to be prioritized and increased. There is need to also fast track implementation of the oral health policy to mitigate oral diseases burden, facilitate equitable cost-effective quality oral health care and adoption of good oral health related lifestyles through engagement with public, private and community partnerships.