Non-Cochrane · aetiology · PM41299518
Prevalence and risk factors for early childhood caries in North Africa: a systematic review and meta-analysis.
Famurewa Bamidele Adetokunbo, Aborisade Adetayo Oluwole, Dabar Anita Mofiyinfolu, et al. · BMC oral health · 2025 · PubMed · doi:10.1186/s12903-025-07419-8
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
37
current version
GRADE rated
0
No studies
0
Included studies
18
linked below
No studies 0 · 0%Ungraded 37 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children aged 0-5 years residing in North African countries (Egypt, Algeria, Tunisia, Morocco, Libya, Sudan, Mauritania) | Children 0-5 years in North Africa (n=11,319; 18 studies; Egypt 10, Tunisia 4, Sudan 3, Morocco 1) |
| Intervention | Prevalence: none (descriptive). Risk-factor objective: exposures/risk factors for ECC (sociodemographic, dietary, oral hygiene, oral microbiome) | 16 significant risk factors identified (adjusted ORs from 2 studies: Kabil 2017 Egypt, Chouchene 2022 Tunisia) |
| Comparison | Prevalence: not applicable. Risk factors: children with ECC vs without ECC | ECC present vs absent (risk-factor studies) |
| Outcomes | Prevalence of ECC; mean dmft (dmft index); risk factors (odds ratios/relative risks) | Pooled ECC prevalence 57% (95% CI 50-64; 18 studies); pooled mean dmft 2.95 (95% CI 1.86-4.67; 13 studies); 16 significant risk factors |
| Study designs | Cross-sectional, cohort, and case-control studies (observational) | 18 observational studies (mostly cross-sectional prevalence surveys; 2 cross-sectional risk-factor studies) |
| Timing | Point prevalence; studies published 2000-March 2025 | Point prevalence; primary studies conducted 2011-2022 |
Search date: March 2025. Databases: PubMed, Scopus, Web of Science, Embase, African Journals Online (AJOL)
Questions and results
Not applicable (single-group prevalence) vs Not applicable (single-group prevalence)
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC), prevalence Country: Tunisia Pooled ECC prevalence in Tunisia was 38% (95% CI 24-51), significantly lower than Egypt and Sudan. Source: Results 'Country of publication'; Fig. 3 (image not available) · same question in other reviews | Prevalence 38 [24, 51] | 4 studies | Ungraded |
Early childhood caries (ECC), prevalence Country: Sudan Pooled ECC prevalence in Sudan was 63% (95% CI 52-74). Source: Results 'Country of publication'; Fig. 3 (image not available) · same question in other reviews | Prevalence 63 [52, 74] | 3 studies | Ungraded |
Early childhood caries (ECC), prevalence Publication-bias adjusted (trim-and-fill) After trim-and-fill adjustment for publication bias, the pooled ECC prevalence was 62% (95% CI 58-81). Source: Results 'Publication bias and small study effect bias'; Figs. 7-8 (images not available) · same question in other reviews | Prevalence 62 [58, 81] | NR | Ungraded |
Early childhood caries (ECC), prevalence Sample size >500 Studies with >=500 participants reported a higher pooled ECC prevalence (65%, 95% CI 55-75). Source: Results 'Study population sizes'; Fig. 4 (image not available) · same question in other reviews | Prevalence 65 [55, 75] | 9 studies | Ungraded |
Early childhood caries (ECC), prevalence Sample size <500 Studies with <500 participants reported a lower pooled ECC prevalence (48%, 95% CI 39-58). Source: Results 'Study population sizes'; Fig. 4 (image not available) · same question in other reviews | Prevalence 48 [39, 58] | 9 studies | Ungraded |
Early childhood caries (ECC), prevalence Country: Egypt Pooled ECC prevalence in Egypt was 62% (95% CI 53-70). Source: Results 'Country of publication'; Fig. 3 (image not available) · same question in other reviews | Prevalence 62 [53, 70] | 10 studies | Ungraded |
Early childhood caries (ECC), prevalence Overall (all included studies) The pooled prevalence of ECC in North African children aged 0-5 years was 57% (95% CI 50-64), with very high heterogeneity (I2=98.6%). Source: Results 'Prevalence of early childhood caries in North Africa'; Abstract; Fig. 2 (image not available) · same question in other reviews | Prevalence 57 [50, 64] | 18 studies · 11319 participants | Ungraded |
Mean dmft (caries severity) Overall The pooled mean dmft was 2.95 (95% CI 1.86-4.67), with very high heterogeneity (I2=99.7%). Source: Results 'Mean dmft index of early childhood caries'; Supplementary File 6 · same question in other reviews | MEAN 2.95 [1.86, 4.67] | 13 studies | Ungraded |
Early childhood caries (ECC), prevalence Sampling: convenience Convenience-sampling studies gave a pooled ECC prevalence of 60% (CI not reported in main text). Source: Results 'Sampling technique'; Supplementary File 2 · same question in other reviews | Prevalence 60 | 4 studies | Ungraded |
Early childhood caries (ECC), prevalence Sampling: stratified/multistage cluster Stratified/multistage cluster sampling studies gave a pooled ECC prevalence of 50% (95% CI 40-61); sampling technique was not a significant moderator. Source: Results 'Sampling technique'; Supplementary File 2 · same question in other reviews | Prevalence 50 [40, 61] | 9 studies | Ungraded |
Early childhood caries (ECC), prevalence Sampling: simple random Simple-random-sampling studies gave a pooled ECC prevalence of 67% (CI not reported in main text). Source: Results 'Sampling technique'; Supplementary File 2 · same question in other reviews | Prevalence 67 | 5 studies | Ungraded |
Older child age (months) vs Younger age (reference)
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) 48-59 months Age 48-59 months was associated with higher odds of ECC (OR 2.602). Source: Table 3 (Risk factors); Chouchene 28 · same question in other reviews | OR 2.602 [1.122, 2.302] | 1 study | Ungraded |
Early childhood caries (ECC) 60-71 months Older age (60-71 months) was associated with higher odds of ECC (OR 2.845). Source: Table 3 (Risk factors); Chouchene 28 · same question in other reviews | OR 2.845 [1.128, 2.072] | 1 study | Ungraded |
Male sex vs Female sex
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Male children had higher odds of ECC (OR 2.911). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 2.911 [1.42, 5.99] | 1 study | Ungraded |
Having siblings vs No siblings
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) 1 sibling Having one sibling was associated with higher odds of ECC (OR 3.32). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 3.32 [1.15, 9.54] | 1 study | Ungraded |
Higher parental education (tertiary) vs Lower parental education (reference)
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Paternal tertiary education [Kabil] Paternal tertiary education was associated with lower odds of ECC (OR 0.381). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 0.381 [0.16, 0.91] | 1 study | Ungraded |
Early childhood caries (ECC) Maternal tertiary education [Kabil] Maternal tertiary education was strongly associated with lower odds of ECC (OR 0.083). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 0.083 [0.03, 0.21] | 1 study | Ungraded |
Early childhood caries (ECC) Parents' education level [Chouchene] Higher parental education level was associated with lower odds of ECC (OR 0.797; source CI garbled). Source: Table 3 (Risk factors); Chouchene 28 · same question in other reviews | OR 0.797 [0.171, 0.650] | 1 study | Ungraded |
Frequent sugary food intake at night vs No nighttime sugary intake
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) At night only Nighttime sugary food intake was associated with higher odds of ECC (OR 1.104; source CI garbled). Source: Table 3 (Risk factors); Chouchene 28 · same question in other reviews | OR 1.104 [1.167, 2.826] | 1 study | Ungraded |
Nocturnal (night) feeding vs No nocturnal feeding
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Nocturnal feeding was associated with higher odds of ECC (OR 2.417). Source: Table 3 (Risk factors); Chouchene 28 · same question in other reviews | OR 2.417 [1.340, 4.358] | 1 study | Ungraded |
Feeding on demand vs Scheduled feeding
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Feeding on demand was associated with markedly higher odds of ECC (OR 9.66). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 9.66 [4.26, 21.93] | 1 study | Ungraded |
Cessation of breastfeeding/bottle after 18 months vs Cessation at or before 18 months
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) >18 months Weaning after 18 months was associated with higher odds of ECC (OR 2.417). Source: Table 3 (Risk factors); Chouchene 28 · same question in other reviews | OR 2.417 [1.340, 4.358] | 1 study | Ungraded |
Daily tooth brushing vs Reference (no/less brushing)
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Twice daily Brushing twice daily was associated with lower odds of ECC (OR 0.033). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 0.033 [0.004, 0.276] | 1 study | Ungraded |
Early childhood caries (ECC) Once daily Brushing once daily was associated with lower odds of ECC (OR 0.033). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 0.033 [0.004, 0.263] | 1 study | Ungraded |
Brushing at recommended time vs Reference brushing time
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Brushing at the recommended time was associated with lower odds of ECC (OR 0.028). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 0.028 [0.004, 0.223] | 1 study | Ungraded |
Unsupervised tooth brushing vs Supervised brushing
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Unsupervised brushing showed a non-significant association with ECC (OR 1.385, p=0.061). Source: Table 3 (Risk factors); Chouchene 28 · same question in other reviews | OR 1.385 [0.809, 1.369] | 1 study | Ungraded |
Tooth brushing method (per source) vs Reference brushing method
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Tooth brushing method was associated with higher odds of ECC (OR 1.435). Source: Table 3 (Risk factors); Chouchene 28 · same question in other reviews | OR 1.435 [1.207, 2.915] | 1 study | Ungraded |
Prior history of dental visit vs No prior dental visit
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) A history of dental visits was associated with higher odds of ECC (OR 2.444). Source: Table 3 (Risk factors); Chouchene 28 · same question in other reviews | OR 2.444 [1.108, 2.072] | 1 study | Ungraded |
Timing of first dental visit vs Reference visit timing
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Early visit An early first dental visit was associated with much lower odds of ECC (OR 0.042). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 0.042 [0.013, 0.136] | 1 study | Ungraded |
Early childhood caries (ECC) Delayed/late visit A delayed first dental visit was associated with lower odds of ECC (OR 0.248; reported p=0.27). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 0.248 [0.072, 0.852] | 1 study | Ungraded |
Caries in mother's mouth vs No maternal caries
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Caries in the mother's mouth was associated with markedly higher odds of ECC (OR 20.44). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 20.44 [8.37, 49.92] | 1 study | Ungraded |
Spoon sharing with household members vs No spoon sharing
Population: Children aged 0-5 years in North Africa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC) Spoon sharing with household members was associated with higher odds of ECC (OR 8.79). Source: Table 3 (Risk factors); Kabil 25 · same question in other reviews | OR 8.79 [2.92, 26.51] | 1 study | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (ECC), prevalence Study design: hospital-based | Prevalence 64 [40, 89] | 2 studies | Ungraded |
Early childhood caries (ECC), prevalence Study design: school-based | Prevalence 55 [44, 67] | 9 studies | Ungraded |
Early childhood caries (ECC), prevalence Study design: population-based | Prevalence 57 [44, 70] | 7 studies | Ungraded |
Early childhood caries (ECC), prevalence Study site: urban and rural (both) | Prevalence 51 [35, 67] | 7 studies | Ungraded |
Early childhood caries (ECC), prevalence Study site: urban | Prevalence 59 [52, 67] | 9 studies | Ungraded |
Included primary studies 18
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Abbass et al. 2017 The prevalence of dental caries among Egyptian children and adolescences and its association with age, socioeconomic status, dietary… PMID:30854195 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Abd Allah 2022 Caries Assessment in Preschool Children in Relation to Some Socioeconomic Factors DOI:10.21608/adjc.2022.101295.1116 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Abdel Fattah et al. 2022 Epidemiology of dental caries in permanent dentition: evidence from a population-based survey in Egypt. PMID:36575430 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Abdul-Jalil & Abuaffan 2017 Early Childhood Caries Prevalence in Sudanese Preschool Children DOI:10.21088/ijde.0974.6099.10217.1 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Abou El Fadl et al. 2019 Assessing the prevalence of early childhood caries and the associated determinants in a group of preschool children: results from a… DOI:10.21608/edj.2015.71243 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Abou El-Yazeed et al. 2011 matched by author and year (probable) | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Abu Hamila 2013 matched by author and year (probable) | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Awooda et al. 2013 matched by author and year (probable) | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Chamli et al. 2020 matched by author and year (probable) | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Chouchene et al. 2022 Early Childhood Caries Prevalence and Associated Risk Factors in Monastir, Tunisia: A Cross-Sectional Study. PMID:35284400 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Elelmi et al. 2021 Black stain and dental caries in primary teeth of Tunisian preschool children. PMID:32643037 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Elidrissi & Naidoo 2016 Prevalence of dental caries and toothbrushing habits among preschool children in Khartoum State, Sudan. PMID:27061284 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Kabil et al. 2017 Prioritizing the Risk Factors of Severe Early Childhood Caries. PMID:29563410 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Maatouk et al. 2017 Oral Health and Occlusion in Tunisian Preschool Children DOI:10.4172/2573-444x.1000137 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Mahmoud Abdallah et al. 2022 Prevalence of early childhood caries and associated factors among a group of preschool children in El-Gharbia Governorate DOI:10.4103/tdj.tdj_12_22 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Mtalsi et al. 2020 Assesment of the Impact of Severe Early Childhood Caries on the Quality of Life of Preschool Children and their Parents DOI:10.14744/jpd.2020.15_20 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Omar et al. 2019 Oral Health Status and Dental Treatment Needs of Preschool Children in 6th October City, Egypt DOI:10.21608/edj.2015.71245 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |
| Shalan & Abobakr 2018 Oral Health Status among Egyptian Preschool Children DOI:10.21608/edj.2018.76915 | this review only | Early childhood caries (ECC), prevalence | not extracted yet | not extracted yet |