Ethnic and socio-economic disparities in oral health outcomes and quality of life among Sri Lankan preschoolers: a cross-sectional study

International Journal for Equity in Health

Lilani Ekanayake²  Brian Oldenburg³  André Renzaho³  Vajira Nanayakkara¹ 

[1] Ministry of Healthcare and Nutrition, Colombo, Sri Lanka;Department of Community Dental Health, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka;Global Health and Society Unit, Monash University; Burnet Institute, Level 3, Burnet Building, 89 Commercial Rd, Melbourne, Victoria 3004, Australia

关键词: Sri Lanka;    Preschoolers;    Socio-economic disparities;    Quality of life;    Bleeding gums;    Dental caries;    Oral health;   

Others  :  811103
DOI  :  10.1186/1475-9276-12-89

 received in 2013-06-06, accepted in 2013-11-06,  发布年份 2013

【 摘 要 】

Introduction

The distribution and severity of dental caries among preschool children vary according to the socio-economic and ethnic differences within and between countries. Understanding socio-economic influences on child oral health could inform early interventions to reduce the oral health burden throughout the life-cycle. The aim of this study is to examine the socio-economic and ethnic influences on oral health among preschoolers in Kegalle, Sri Lanka.

Methods

The study involved 784 children aged between 48–72 months recruited from 84 pre-schools in the Kegalle district in Sri Lanka. Cross-sectional data were collected by means of an oral examination of the children and a self-administered questionnaire to their parents/caregivers. The Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess Oral Health related Quality of Life (OHQoL). Univariate and multivariate models of Poisson regression were used to investigate the associations between the variables.

Results

Compared to children whose fathers had tertiary education, those whose fathers did not study beyond grade 5, had more caries measured in terms of decayed, missing and filled surfaces (dmfs) (IRR = 2.30; 95% CI: 1.30, 4.06; p < 0.01) and experienced poor OHQoL at child (IRR = 2.52; 95% CI: 1.20, 5.31; p < 0.05) and family (IRR = 1.59; 95% CI: 1.11, 2.27; p < 0.05) levels. However, lower educational attainment among mothers was associated with better OHQoL among children. Compared to the Sinhalese ethnic group, Tamils had more gingival bleeding (bleeding surfaces) (IRR = 3.04; 95% CI: 1.92, 4.81; p < 0.001) and poor OHQoL at child level (IRR = 2.07; 95% CI: 1.19, 3.60; p < 0.01), whereas Muslims had poor OHQoL at family level (IRR = 1.42; 95% CI: 1.10, 1.84; p < 0.01). Children of low-income families had more gum bleeding (IRR = 1.00; 95% CI: 0.99, 1.00; p < 0.05) compared to children of high-income families.

Conclusions

Socio-economic and ethnic differences in oral health outcomes exist among this population of preschoolers. Interventions targeting children of fathers with low educational levels and ethnic minority groups are required to reduce inequalities in oral health in Sri Lanka and other similar countries.

【 授权许可】

   
2013 Nanayakkara et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C: The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005, 83:661-669.
• [2]Pahel B, Rozier RG, Slade G: Parental perceptions of children’s oral health: The Early Childhood Oral Health Impact Scale (ECOHIS). Health Qual Life Outcomes 2007, 5(Suppl1):6.
• [3]Rayner J, Holt R, Blinkhorn F, Duncan K: A policy document on oral health care in preschool children. Int J Paediatr Dent 2003, 13:279-285.
• [4]Kowash MB, Pinfield A, Smith J, Curzon MEJ: Effectiveness on oral health of a long-term health education programme for mothers with young children. Br Dent J 2000, 188:201-205.
• [5]Rayner JA: A dental health education programme, including home visits, for nursery school children. Br Dent J 1992, 172:57-62.
• [6]Levin KA, Davies CA, Topping GVA, Assaf AV, Pitts AB: Inequalities in dental caries of 5-year- old children in Scotland, 1993–2003. Eur J Publ Health 2009, 19(Suppl 3):337-342.
• [7]Pattussi MP, Marcenes W, Croucher R, Sheiham A: Social deprivation, income inequality, social cohesion and dental caries in Brazilian school children. Soc Sci Med 2001, 53(Suppl 7):915-925.
• [8]Shiboski CH, Gransky SA, Ramos-Gomez F, Ngo L, Isman R, Pollick HF: The Association of Early Childhood Caries and Race/Ethnicity among California preschool children. J Public Health Dent 2003, 63(Suppl 1):38-46.
• [9]Christensen LBT, Twetman S, Sundby A: Oral Health in children and adolescents with different socio-cultural and socio-econimic backgrounds. Acta Odontol Scand 2010, 68:34-42.
• [10]Hallett KB, O’Rourke PK: Social and behavioural determinents of early childhood caries. Aust Dent J 2003, 48(Suppl 1):27-33.
• [11]Waxman A: Prevention of chronic diseases: global strategy on diet, physical activity and health. Food Nutr Bull 2003, 24(Suppl 3):281-284.
• [12]Ministry of Health Sri Lanka: National Oral Health Survey 2003/2004. Colombo: Ministry of Health; 2007.
• [13]Watt RG: From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol 2007, 35(Suppl 1):1-11.
• [14]Ministry of Health Sri Lanka: National Oral Health Survey 1993/1994. Colombo: Ministry of Health; 1998.
• [15]Carino KMG, Shinada K, Kawaguchi Y: Early childhood caries in Nothern Phillippines. Community Dent Oral Epidemiol 2003, 31:81-89.
• [16]Jin B, Ma D, Moon H, Paik D, Hahn S, Horowitz AM: Early childhood caries: prevalence and risk factors in Seoul Korea. J Public Health Dent 2003, 63(Suppl 3):183-188.
• [17]Kiwanuka SN, Astron AN, Trovik TA: Dental caries experience and its relationship to social and behavioural factors among 3–5 year old children in Uganda. Int J Paediatr Dent 2004, 14(Suppl 5):336-346.
• [18]Kopycka-Kedzierawski DT, Billings RJ: Prevalence of dental caries and dental care utilization in preschool urban children enrolled in a comparative-effectiveness study. Eur Arch Paediatr Dent 2011, 12(suppl 3):133-138.
• [19]Hallet KB, O’Rourke PK: Dental caries experience of preschool children from the North Brisbane region. Aust Dent J 2002, 47(suppl 4):331-338.
• [20]Fisher-Owens SA, Gansky SA, Platt LJ, Weintraub JA, Soobader MJ, Bramlett MD, Newacheck PW: Influences on children’s oral health: a conceptual model. Pediatriacs 2007, 120(Suppl 3):510-520.
• [21]Low W, Tans S, Schwartz S: The effect of severe caries on the quality life in young children. Pediatr Dent 1999, 21(Suppl 6):325-326.
• [22]Global burden of disease. http://www.fdiworldental.org webcite
• [23]Mignogna MD, Fedel S: The neglected global burden of chronic oral diseases. J Dent Res 2006, 85(Suppl 5):390-391.
• [24]Amaratunge A, Heidmann J, Jayatilake K: Oral health in a group of pre-school children attending dental nurse clinics in the Kandy area, Sri Lanka. Community Dent Health 1986, 3(Suppl 2):169-174.
• [25]Ekanayake L, Ando Y, Miyazaki H: Patterns and factors affecting Dental utilization among adolescents in Sri Lanka. Int Dent J 2001, 51(5):353-358.
• [26]Perera I, Ekanayake L: Factors influencing perception of oral health among adolescents in Sri Lanka. Int Dent J 2008, 58(6):349-355.
• [27]Wellappuli N, Amarasena N: Influnce of family structure on dental caries experience of preschool children in Sri Lanka. Caries Res 2012, 46:208-212.
• [28]Department of Census and Statistics Sri Lanka: District report - Kegalle district. Colombo: Department of Census and Statistics; 2001.
• [29]Abrahamson JH, Abrahamson ZH: Survey Methods in Community Medicine: Epidemiological Research, Programme Evaluation, Clinical trials. Edinburgh: Churchill Livingstone; 1999.
• [30]Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH: Diagnosing and reporting early childhood caries for research purposes. J Public Health Dent 1999, 59(3):192-197.
• [31]Ramfjord SP: Indices for prevalence and incidence of periodontal disease. J Periodontol 1959, 30:51-59.
• [32]Department of Census and Statistics Sri Lanka: Demographic and Health Survey 2006–07. Colombo: Department of Census and Statistics; 2009.
• [33]Cameron AC, Trivedi PK: Microeconometrics using stata. The Stata News 2008, 23(Number 4):688.
• [34]Hashim R, Thomson WM, Ayers KMS, Lewsey JD, Awad M: Dental caries experience and use of dental services among preschool children in Ajman, UAE. Int J Paediatr Dent 2006, 16(4):257-262.
• [35]Sarwar AFM, Kabir MH, Rahman AFMM, Haque M, Kasem MA, Ahmad SA, Debnath PK, Mallic PC, Hque M, Hossain KA, Khan S, Ahmed AHHU, Parveen S: Oral hygiene practice among the primary school children in selected rural areas of Bangladesh. Journal of Dhaka National Medical College & Hospital 2011, 18(Issue 1):43-48.
• [36]Edelstein BL: Disparities in oral health and access to care: findings of national surveys. Ambul Pediatr 2002, 2(2):141-147.
• [37]Oliveira LB, Sheiham A, Bonecker M: Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children. Eur J Oral Sci 2008, 116(1):37-43.
• [38]Schroth RJ, Moor P, Brothwell DJ: Prevalence of early childhood caries in 4 Manitoba communities. Journal of Canadian Dental Association 2005, 71(No 8):567.
• [39]Finlayson TL, Siefert K, Ismail AI, Sohn W: Psychosocial factors and early childhood caries among low income African-American children in Detroit. Community Dent Oral Epidemiol 2007, 35(6):439-448.
• [40]Piovesan C, Mendes FM, Ferreira FV, Guedes RS, Ardenghi TM: Socio-economic inequalities in the distribution of dental caries in Brazilian preschool children. J Public Health Dent 2010, 70(4):319-326.
• [41]Tinanoff N, Reisine S: Update on early childhood caries since the surgeon general’s report. Acad Pediatr 2009, 9(6):396-403.
• [42]Piovesan C, Antunes JLF, Guedes RS, Ardenghi TM: Impact of socio-economic and clinical factors on child oral health-related quality of life (COHRQoL). Qual Life Res 2010, 19:1359-1366.
• [43]Hawkins SS, Cole TJ, Law C: Examining the relationship between maternal employment and health behaviours in 5-year-old British children. J Epidemiol Community Health 2009, 63(Issue 12):999-1004.