Childhood Caries in Sub-Sahara Africa: Role for Primary Health Care

Objectives: Early childhood caries (ECC) affects the quality of life of children, and poses a significant social and economic burden for mothers and other caregivers. This study sought to inventory the prevalence of ECC in Sub-Sahara Africa (SSA) and make recommendations for preventive strategies. Methods: A systematic review of epidemiological studies on caries prevalence in children in SSA published during 1980 – 2003 as listed in Medline, was undertaken using PubMed. This was complemented by hand searches of relevant literature. For inclusion in the analysis, WHO methods had to have been used as diagnostic criteria for caries, and study must have reported caries in primary teeth (dmft) and/or caries rate in primary teeth of children between 6 months and 6 years. Results: Of the published papers, 11 fulfilled the inclusion criteria. Mean dmft ranged between 0.8 and 3.2. Most of the carious lesions were untreated. Caries prevalence ranged between 29% and 85%. Caries prevalence appears to have increased in the two countries where studies could be compared over time. Conclusions: There is paucity of data on ECC for SSA. Existing oral health care system appears not to have been able to control ECC. The following preventive strategies, based on low-cost interventions within an organised primary health care system are proposed; 1) Educating parents and non-dental personnel involved in infant health and welfare on the recognition of early signs and the prevention of the condition. 2) Linking early oral health screening with immunisation schedules within the existing growth monitoring surveillance system targeted at children, aged 0-5 years. The recording of oral health status as part of growth monitoring should then form part of a national surveillance for ECC. 3) More research on the burden of ECC in SSA and, on the evaluation of practical preventive and treatment modalities.