Early childhood caries; prevalance & associated factors in a low income, urban community of Karachi

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Early childhood caries (ECC) is a chronic infectious disease of the primary teeth in children less than 6 years of age. The global burden of ECC is high, particularly in developing countries and is considered as an international public health problem. ECC is known to affect the child's quality of life, and is associated with a number of adverse health outcomes in children which include physical and cognitive development. Emerging evidence has also shown an association between ECC and anemia. In local context, limited evidence is available on the prevalence of ECC and its associated factors, particularly in low income, urban communities. Objective: The primary objective of the study was to determine the prevalence of ECC in 2-6 year old children form a low income, urban community of Karachi, and to determine the associated factors, particularly anemia. Our secondary objective was to describe the oral health and hygiene in the study population. Methods: A house to house survey was conducted in Sultanabad, Karachi between 3rd march and 16th April, 2014. Eligible households were identified and included in the survey. A preformed, structured questionnaire was administered to the mother to collect information on child related and parental/household characteristics. Physical examinations were done for each child which included measurement of height and weight, assessment for anemia using a point of care testing method and a detailed dental examination using sterile, disposable dental examination kits. Results: A total of 409 households from six blocks were surveyed from the community. The overall prevalence of ECC was 52.5% (95% CI: 47.7%-57.3%), which included 29.3% (25.0%-33.6%) mild/moderate ECC and 23.2% (19.2%-27.2%) severe ECC. Prevalence was higher in older age groups and in male children. Using a zero-inflated negative binomial regression, a total of 6 factors were found to be associated with ECC in the study population, which included the child's anemic status, age, sex, derbis index score, consumption of sweetened yoghurt and household size. In the adjusted model, we found a significant association between mean DMFT scores and the presence of severe anemia in children. (DMFT ratio: 2.23, 95%CI: 1.42-3.51). Conclusion: Our study suggests a high burden of ECC in the community, most of which comprises decayed, untreated teeth. The findings add to the current evidence showing association between ECC and anemia in 2-6 year old children. Further studies are required to replicate our findings and establish the factors associated with ECC in other settings.

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