Fewer Children in Families Associated with Lower Odds of Early Childhood Caries: A Sample from Three Countries
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Data Collection
2.3. Data Analysis
3. Results
3.1. Family Demographic Characteristics
3.2. Oral Health Knowledge and Practices
3.3. Child Oral Health Status
3.4. Association between Number of Children and Early Childhood Caries
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total N = 1352 Children/ Mothers a | Ecuador N = 290 Children/ Mothers a | Nepal N = 469 Children/ Mothers a | Vietnam N = 593 Children/ Mothers a | One Child N = 496 Children/ Mothers a | Multiple Children N = 851 Children/ Mothers a | Difference between One Child and Multiple Children (p-Value) b |
---|---|---|---|---|---|---|---|
Site Type | Urban: 51.7% Rural: 48.3% | Rural: 100% | Urban: 69.7% Rural: 30.3% | Urban: 100% | Urban: 83.1% Rural: 16.9% | Urban: 57.9% Rural: 43.0% | <0.001 |
Children | |||||||
Age (years) | 3.7 ± 1.5 | 3.8 ± 1.8 | 3.7 ± 1.7 | 3.6 ± 1.0 | 3.2 ± 1.4 | 4.0 ± 1.4 | <0.001 |
Sex (Male/Female) | 52.7%/47.3% | 54.8%/45.2% | 53.2%/46.8% | 51.2%/48.8% | 55.9%/44.1% | 50.2%/49.8% | 0.076 |
Mothers and Households | |||||||
Age (years) | 30.9 ± 6.4 | 30.4 ± 8.4 | 28.6 ± 5.4 | 33.0 ± 5.1 | 28.7 ± 5.7 | 32.2 ± 6.4 | <0.001 |
Education (years) | 8.7 ± 5.5 | 7.1 ± 4.8 | 5.1 ± 4.4 | 12.8 ± 3.7 | 10.9 ± 4.8 | 7.4 ± 5.5 | <0.001 |
Number of Children | 2.2 ± 1.6 | 3.7 ± 2.4 | 2.2 ± 1.1 | 1.6 ± 0.7 | 1.0 ± 0.0 | 2.9 ± 1.6 | <0.001 |
Range of Number of Children | 1–12 | 1–12 | 1–7 | 1–5 | 1 | 2–12 | |
Number in Household | 5.3 ± 2.3 | 7.0 ± 2.9 | 5.1 ± 2.0 | 4.5 ± 1.7 | 4.6 ± 2.2 | 5.7 ± 2.3 | <0.001 |
Potable Water at Home | 79.3% | 32.1% | 85.5% | 98.6% | 89.1% | 73.6% | <0.001 |
Electricity | 98.0% | 87.6% | 98.5% | 99.5% | 98.6% | 95.4% | <0.001 |
Cooking Fuel Other Than Wood (Gas or Electric) | 84.1% | 86.9% | 63.7% | 98.8% | 92.5% | 79.0% | 0.019 |
Time to walk from home to a store that sells junk food: | |||||||
Less than 5 min | 84.7% | 64.4% | 78.9% | 82.3% | 85.1% | 73.3% | <0.001 |
6–20 min | 16.4% | 23.4% | 13.9% | 15.5% | 12.8% | 23.5% | <0.001 |
Over 20 min | 5.9% | 12.1% | 8.1% | 2.2% | 2.1% | 3.2% | 0.221 |
Characteristics | Total N = 1352 Children/ Mothers a | Ecuador N = 290 Children/ Mothers a | Nepal N = 469 Children/ Mothers a | Vietnam N = 593 Children/ Mothers a | One Child N = 496 Children/ Mothers a | Multiple Children N = 851 Children/ Mothers a | Difference between One Child and Multiple Children (p-Value) b |
---|---|---|---|---|---|---|---|
Mother’s knowledge of the causes of childhood caries c | |||||||
Don’t know | 15.1% | 14.8% | 10.9% | 20.0% | 14.7% | 15.4% | <0.001 |
Eating sweets | 73.6% | 66.2% | 85.3% | 66.8% | 73.8% | 73.5% | 0.891 |
Not brushing teeth | 26.4% | 44.8% | 27.7% | 16.4% | 24.4% | 27.6% | 0.196 |
Drinking soda/juice | 3.8% | 6.6% | 5.3% | 1.2% | 3.6% | 3.9% | 0.768 |
Using the baby bottle | 0.9% | 3.8% | 0.2% | 0.0% | 0.2% | 1.3% | 0.040 |
Mother’s knowledge of the complications of childhood caries c | |||||||
Don’t know | 5.5% | 11.4% | 7.2% | 0.2% | 3.8% | 6.5% | 0.046 |
Pain | 56.0% | 62.8% | 76.8% | 31.1% | 49.3% | 59.9% | <0.001 |
Difficulty eating | 40.9% | 27.9% | 45.0% | 44.9% | 41.9% | 40.4% | 0.591 |
Difficulty sleeping | 14.6% | 19.3% | 17.5% | 8.9% | 15.2% | 16.1% | 0.056 |
Harm their health | 22.3% | 13.1% | 8.7% | 41.3% | 26.7% | 19.7% | 0.004 |
Child Nutrition Practices | |||||||
Child breastfed | 97.3% | 97.5% | 98.7% | 96.0% | 96.1% | 98.1% | 0.020 |
Mean duration of breastfeeding (months) | 18.3 ± 12.2 | 17.7 ± 8.2 | 22.5 ± 16.0 | 14.9 ± 8.4 | 19.0 ± 12.1 | 22.5 ± 13.5 | <0.001 |
Child bottle fed (mixed breast- and bottle feeding) | 52.8% | 40.1% | 19.0% | 86.1% | 64.2% | 46.0% | <0.001 |
Mean duration of bottle feeding (months) | 27.5 ± 15.2 | 21.2 ± 15.2 | 20.3 ± 14.4 | 30.1 ± 14.5 | 29.4 ± 15.1 | 27.6 ± 15.0 | 0.014 |
Unhealthy bottle feeding practices | 44.6% | 35.6% | 13.2% | 74.3% | 54.6% | 38.6% | <0.001 |
Bottle fed with sugary liquid | 29.4% | 31.7% | 1.9% | 62.3% | 35.8% | 25.8% | <0.001 |
Bottle fed while sleeping | 14.6% | 12.0% | 7.1% | 22.1% | 16.2% | 13.5% | 0.184 |
Bottle fed past 24 months of age | 34.3% | 18.7% | 8.3% | 62.8% | 43.6% | 28.7% | <0.001 |
Daily consumption of milk | 67.2% | 20.8% | 69.9% | 91.0% | 79.7% | 60.1% | <0.001 |
Daily consumption of soda | 6.1% | 7.8% | 5.0% | 5.9% | 6.3% | 6.0% | 0.847 |
Daily consumption of candy/sweets | 29.9% | 21.8% | 53.4% | 12.9% | 26.0% | 32.2% | 0.024 |
Daily consumption of chips/biscuits | 17.6% | 15.9% | 25.6% | 11.6% | 17.6% | 17.7% | 0.954 |
Daily consumption of any junk food or sugary drink | 34.6% | 28.9% | 56.0% | 18.2% | 36.5% | 40.4% | 0.048 |
Mother calms fussy child with sweets | 13.8% | 9.7% | 27.5% | 1.8% | 11.3% | 15.2% | 0.058 |
Mother restricts candy | 6.9% | 7.9% | 13.6% | 1.0% | 6.0% | 7.4% | 0.333 |
Child Oral Health Practices | |||||||
Child has own toothbrush | 88.2% | 90.8% | 75.7% | 97.0% | 88.4% | 88.0% | 0.810 |
Child has toothpaste | 90.4% | 84.4% | 89.6% | 94.1% | 91.9% | 89.6% | 0.169 |
Mother helps with brushing frequently/almost always | 54.6% | 54.0% | 24.5% | 80.0% | 64.2% | 48.9% | <0.001 |
Mother never/occasionally helps with brushing | 45.4% | 46.0% | 75.5% | 20.0% | 35.8% | 51.1% | <0.001 |
Mother does nothing to care for child’s teeth | 6.4% | 7.6% | 12.6% | 0.2% | 5.3% | 7.1% | 0.223 |
Child has visited the dentist | 38.1% | 74.0% | 9.7% | 44.5% | 30.9% | 42.0% | <0.001 |
Characteristics | Total N = 1352 Children/ Mothers a | Ecuador N = 290 Children/ Mothers a | Nepal N = 469 Children/ Mothers a | Vietnam N = 593 Children/ Mothers a | One Child N = 496 Children/ Mothers a | Multiple Children N = 851 Children/ Mothers a | Difference between One Child and Multiple Children (p-Value) b |
---|---|---|---|---|---|---|---|
Child Tooth Decay | |||||||
Child has any decayed, missing or filled teeth (dmft) | 72.3% | 86.9% | 59.9% | 75.0% | 64.1% | 77.2% | <0.001 |
Range in number of dmft | 0–24 | 0–24 | 0–17 | 0–23 | 0–20 | 0–24 | |
Mean dmft | 5.4 ± 5.3 | 8.3 ± 5.4 | 3.1 ± 3.8 | 5.9 ± 5.4 | 4.4 ± 4.9 | 6.0 ± 5.4 | <0.001 |
Mean # dmft for children with caries | 7.5 ± 4.8 | 9.6 ± 4.6 | 5.2 ± 3.6 | 7.8 ± 4.9 | 6.9 ± 4.5 | 7.8 ± 4.9 | 0.003 |
Prevalence of deep decay, in or near pulp | 28.5% | 39.7% | 20.7% | 31.2% | 16.9% | 28.0% | <0.001 |
Child Mouth Pain | |||||||
Any mouth pain (occasionally/frequently/always) | 51.2% | 47.2% | 27.5% | 71.8% | 52.4% | 50.4% | 0.023 |
Mouth pain (frequently/always) | 22.9% | 18.1% | 5.5% | 39.0% | 26.9% | 20.4% | 0.617 |
Mother’s Overall Assessment of Child’s Health | |||||||
Mother’s assessment of child’s oral health as “bad” | 17.4% | 13.8% | 21.9% | 15.5% | 15.1% | 18.8% | 0.089 |
Mother’s assessment of child’s overall health as “bad” | 2.9% | 3.9% | 3.2% | 2.1% | 2.3% | 3.1% | 0.365 |
Logistic Regression Analysis | ||||
---|---|---|---|---|
Oral Health Practices | Unadjusted Odds Ratio (OR) (95% Confidence Interval) | Adjusted Odds Ratio (aOR) a (95% Confidence Interval) | Significance of aOR p-Value | |
Nutrition practices | ||||
Unhealthy baby bottle feeding | 0.75 (0.69–0.82) | 0.85 (0.77–0.93) | 0.0009 | |
Daily consumption of junk food | 0.97 (0.90–1.04) | 1.00 (0.92–1.09) | 0.96 | |
Calms child with sweets | 1.04 (0.94–1.13) | 0.99 (0.88–1.11) | 0.93 | |
Mother restricts candy | 1.08 (0.96–1.21) | 1.03 (0.89–1.18) | 0.65 | |
Oral Hygiene Practices | ||||
Child has own toothbrush | 0.90 (0.82–0.99) | 0.89 (0.80–0.99) | 0.031 | |
Child has toothpaste | 0.80 (0.74–0.88) | 0.83 (0.75–0.93) | 0.0007 | |
Mother helps child brush | 0.78 (0.72–0.85) | 0.86 (0.79–0.94) | 0.001 | |
Child has been to the dentist | 1.33 (1.23–1.45) | 1.19 (1.09–1.30) | 0.0001 | |
Child Caries Experience | ||||
Child has any decayed, missing or filled teeth (dmft) | 1.36 (1.22–1.52) | 1.18 (1.06–1.32) | 0.005 | |
Zero-Inflated Poisson (ZIP) Regression Analysis | ||||
Oral Health Outcome | Count Model Estimate b,d (95% CI) | Count Model p-value | Inflation Model Estimate c,d (95% CI) | Inflation Model p-value |
Number of decayed, missing and filled teeth (dmft) | 1.04 (1.01–1.06) | <0.0001 | 0.85 (0.76–0.94) | 0.005 |
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Park, A.H.; Kulchar, R.J.; Susarla, S.M.; Turton, B.; Sokal-Gutierrez, K. Fewer Children in Families Associated with Lower Odds of Early Childhood Caries: A Sample from Three Countries. Int. J. Environ. Res. Public Health 2023, 20, 2195. https://doi.org/10.3390/ijerph20032195
Park AH, Kulchar RJ, Susarla SM, Turton B, Sokal-Gutierrez K. Fewer Children in Families Associated with Lower Odds of Early Childhood Caries: A Sample from Three Countries. International Journal of Environmental Research and Public Health. 2023; 20(3):2195. https://doi.org/10.3390/ijerph20032195
Chicago/Turabian StylePark, Amy H., Rachel J. Kulchar, Sita Manasa Susarla, Bathsheba Turton, and Karen Sokal-Gutierrez. 2023. "Fewer Children in Families Associated with Lower Odds of Early Childhood Caries: A Sample from Three Countries" International Journal of Environmental Research and Public Health 20, no. 3: 2195. https://doi.org/10.3390/ijerph20032195