Prevalence of Dental Caries and Associated Factors Among Secondary School Students in Kigali, Rwanda: A Cross-sectional study

doi:10.21203/rs.3.rs-4276956/v1

Background: Dental caries is a worldwide alarming health problem among children and adolescents in developing countries. However, few studies were conducted regarding dental caries in Rwanda. Hence, this study determined the prevalence of dental caries and its associated factors among secondary school students in Kigali, Rwanda.

Methods:

A cross-sectional study was conducted among 646 secondary school students in the City of Kigali. Data on dental caries were collected with a structured questionnaire adapted from the World Health Organization. Pre-testing of the instrument was done using Cronbach’s Alpha (0.80). Data were analyzed with SPSS version 25. Proportions and mean decayed missing and filled teeth index (DMFT) were computed. Bivariate and Poisson regression analyses were used to test the associated factors to dental caries.

Results:

The average age of study participants was 16 years. Almost half of the study participants were female (50.5%) and 50% were from an urban place of residence. The overall prevalence of dental caries was 61.1% with a mean decayed missing and filled teeth index of 3.3 (SD = 3.9). Notably, 5.1% of children had missing teeth, however, only 1.7% had filled teeth. The lower molars were the most affected teeth by tooth decay 38.7%. Being a female was 1.5 times more likely to develop dental caries (AOR=1.5, CI:1.4-1.6, P=0.001) compared to males. Children from rural places had a 1.1 times higher odds of dental caries (AOR=1.1, CI:1.0-1.3, P<0.001) when compared to their urban counterparts. Similarly, children who don’t use toothpaste were 1.2 times more likely to develop dental caries than those who use it regularly and the difference was significant (AOR=1.2, CI:1.1-1.3, P<0.001). Visiting a dentist was significantly associated with 30% lower odds of dental caries (AOR:0.7, CI:0.6-0.8, P<0.001). Moreover, being young age 12-14 years, and coming from a poor family were significantly associated with a 40% and 20% lower likelihood of dental caries compared to their counterparts.

Conclusion:

Dental caries was found a public health problem among secondary school students in Kigali, Rwanda with highly untreated dental caries. Lack of dental visits, coming from poor families, residing in rural areas, and being female were found associated factors to dental caries among secondary school students in Rwanda.

Dental caries

secondary school

prevalence

associated factors

Kigali

Rwanda

The prevalence of dental caries is a worldwide alarming health concern in developed and low-income countries [1]. It is estimated that 60–90% of the world population is affected by dental caries [1, 2]. Adolescents are losing teeth due to dental caries which cause pain and affect their quality of life. Frequent eating of sugary food and use of acidic foods or drinks were documented to be linked to dental caries [3]. On the other hand, a high prevalence of dental was associated with gender, poor oral hygiene behaviors, low socioeconomic status, and lack of access to dental care [4–6]. In some developed countries, the incidence and prevalence of dental caries were reduced due to improved oral health care systems and programs that focus on prevention such as the use of fluoride products, applications of fissure sealants, and improved oral hygiene practices [7]. However, in some Latin America, the Middle East, and South Asian countries, dental caries are quite high[2, 8, 9]. In low-income countries from sub-Saharan and African countries, the prevalence of dental caries was also increasing due to rapid growth and lifestyle change[1, 10, 11]. Yet 90% of dental caries remain untreated due to socioeconomic status, lack of dental visits, and poor oral health practices [12, 13]. In low-income countries seeking dental care was due to pain relief or extraction of teeth [14–16].

Studies done in low-income countries have shown a high untreated dental caries among adolescents and it was reported to be the main cause of pain, life-threatening dental infections, and discomfort [1]. In these countries, oral health was found to not be a priority and the availability of dental services is limited which consequently causes a high prevalence of untreated dental caries[14, 16]. On the other hand, the unavailability of preventative measures such as fluoridated water, use of toothpaste, and poor oral hygiene practices were associated with dental caries. Likewise, dental caries were attributed to low socioeconomic characteristics, poor educational execution, and inability to pay for dental care in low-income countries[17–19].

In Rwanda, much effort has been made to address the magnitude of dental caries through the first national oral health surveys conducted in 2016. The survey found about two-thirds (64.9%) of the population of Rwanda had experienced dental caries and 54.3% had untreated caries [20]. Half of the people who have dental caries were from the city of Kigali[17]. Other available studies done in Rwanda, have only been restricted to primary school children [15, 21] and there was limited information regarding dental caries among secondary school students. Therefore, this study aimed to determine the prevalence of dental caries and associated factors among secondary schools in Kigali, Rwanda

Study Design

A quantitative analytical cross-sectional study was conducted from September 2023 up to January in Kigali capital city of Rwanda. It was carried out in 42 secondary schools in both private and public schools. The observation of past caries experience and distributions of associated factors to dental caries in secondary school students were collected.

Study Population

The present study focused on secondary school students aged 12 to 25 years old from both daytime private and public schools. Being a student in one of the selected schools of Kigali city was the criteria for inclusion in the study. On the other hand, having any mental problem was an exclusion criterion [22]. According to 2019 Rwanda Education statistics, a population of 62 408 students were enrolled in secondary schools in Kigali as a basis to calculate the sample size. This age range was desired for WHO classification and comparison for dental caries surveillance [23].

Sample size determination

The study sample used a proportions formula for calculating sample size[24]. Rwanda's oral health survey reported 55% of adolescents [21]. Where n was the sample size, N was the total population (62408 students), p was the proportion of those who had dental caries (55.7%), q was the proportion of those who don’t have dental caries (44.3%), e stands for marginal error (4%) and Stands for critical value which is 1.96 for 95% confidence level

A total of 646 students participated after adding a 10% non-response rate which was 59 students.

Sampling strategies

The sample size was allocated proportionately to three districts of the city of Kigali. The schools were selected randomly from both urban and rural areas of each district. A proportional random sampling method was used to get the twenty-one rural secondary schools and twenty-one urban schools from the list of all schools located in Kigali city. With school rosters as the sampling frame, systematic sampling was used to select study participants with a sampling interval of 39 based on the formula of calculating sampling interval for systematic sampling.

Data collection procedure and research instruments

Face-to-face interviews and oral examinations were used to collect data. The researcher executed oral examinations on portable dental chairs at all schools. Before data collection one-week training session was conducted for validating the research tool. Data collection was done by one research assistant who was a dentist and one recording assistant calibrated during the pilot study. An acceptable inter-observer agreement Cronbach’s Alpha coefficient (0.80) was found. The assistant was sitting close enough to the examiner so that instructions and codes were recorded. The examiner also verified the data that was being recorded correctly. Dental caries were assessed based on clinical criteria by the WHO for performing an oral health survey [23].

The questionnaire was adapted from previous studies [23] and it was translated into Kinyarwanda. Back-translation was used as a quality assurance method. Information regarding social demographics, risk behaviors, and oral hygiene practices were collected. Variables such as age, gender, socioeconomic status, school location, parent’s education level, oral hygiene measures, visits to the dentist dietary habits, and resident area were collected. Dental caries experience as an outcome variable was recorded through oral examination. An oral examination was conducted in class with disposable dental instruments such as explorer, dental mirrors, facemasks, gloves, and headlamps were used during oral examination [23]. Dental caries was assessed as WHO recommended for performing an oral health survey [23]. Decayed (D), missing (M), and filled (F) teeth (T) index (DMFT) was recorded from each study participant.

Data analysis

Data were entered into an Excel sheet which was exported into Statistical Package for Social Sciences (SPSS) version 25 for statistical querying. Descriptive statistics such as frequency and mean of variables were computed to describe data. The DMFT index was classified for the identification of the caries severity index following WHO [25]. DMFT of 0.0-1.1 = Very low, 1.2–2.6, low severity, 2.7–4.4 = Moderate,4.5–6.5 = High. Social demographic characteristic such as social category was transformed into two categories (poor or rich) and education was categorized into 3 categories (no formal, secondary or less, and University level). Qualitative variables such as socioeconomic status and oral health behavior were presented as frequency distributions. Cross-tabulation tables with two independent t-tests and ANOVA tests were used for bivariate analysis to test the relationship between independent and dependent variables. Poisson regression analysis was used to assess the associated factors to DMFT. This model was suitable for evaluating count data, with the result variable representing the number of times an event occurs in a given unit of observation. The significance was set at P-value < 0.05 with their odd ratios and 95% confidence intervals.

Out of 646 secondary school students recruited to take part in the study have fulfilled the eligibility criteria. The response rate was 100 % fact that a face-to-face interview was used to collect data. Table 1 shows the demographic and socioeconomic characteristics of the study participants. Female participants had 50.5% of the study sample whereas 15-19 years old comprised 442 (68.4%). Half of the participants were from rural areas 324(50.2%). Regarding parental education, 357(55.3%) of the adolescents’ fathers and 366(56.7%) of their mothers had attained secondary education. Most of the adolescents came from moderate socio-economic status 260(40.2%).

Table 1: Social demographic characteristics of the study participants (n=646)

Variables		Frequency (n)	Percent (%)
Age	12-14 years	149	23.1
	15-19 years	442	68.4
	20-25 years	55	8.5
Gender	Female	326	50.5
Gender	Male	320	49.5
Social category	Category 1	108	16.7
	Category 2	196	30.3
	Category 3	260	40.2
	Category 4	82	12.7
Type of School	Private	322	49.8
Type of School	Public	324	50.2
Father's education level	No formal school	116	18
	Primary-Secondary	357	55.3
	University	173	26.8
Mother education level	No formal school	106	16.4
	Primary-Secondary	366	56.7
	University	174	26.9
Residence	Rural	324	50.2
Residence	Urban	322	49.8

Category 1: Poor, Category 2: Moderately poor, Category 3: Moderately rich, Category 4: Rich

Table 2 Component of DMFT score of study participants (n = 646)

Variables	Component of DMFT score
	Mean (SD Percentile (%)
Decayed	3.17(3.7) 395(61.1)
Missed	0.09(0.37) 33(5.1)
Filled	0.08(0.5) 11(1.7)
DMFT	3.3(3.9)

SD: Standard deviation

Table 2 examined the prevalence of dental caries in the study population, finding that 61.1% (395 out of 646 children) had DMFT>1. Dental caries severity was found to be moderate. The average DMFT score was 3.3 (SD = 3.9), with the decayed component accounting for 61.1% of the total population. The untreated dental caries component had a mean of 3.17 and an SD of 3.7. Notably, 33(5.1%) of students were missing teeth as a result of dental caries, whereas 11(1.7%) had teeth filled.

Table 3: Dental caries severity status by age, gender, social category, and residence among study participants (n=646)

Dental caries severity index score (DMFT)

Variables		Very low (0.0-1.1)	Low	Moderate	High	K-test	P-value
Variables		Very low (0.0-1.1)	(1.2-2.6 )	(2.7-4.4)	(4.5 – 6.5 )	K-test	P-value
Age(years)	12-14	80(27.4%)	14(19.2%)	18(22.2%)	37(18.5%)	6.7	0.034**
	15-19	190(65.1%)	57(78.1%)	55(67.9%)	140(70.0%)
	20-25	22(7.5%)	2(2.7%)	8(9.9%)	23(11.5%)
Gender	Female	127(43.5%)	30(41.1%)	37(45.7%)	132(66.0%)	21.04	<0.001**
Gender	Male	165(56.5%)	43(58.9%)	44(54.3%)	68(34.0%)
Residence	Rural	139(47.6%)	32(43.8%)	41(50.6%)	112(56.0%)	3.14	0.076
Residence	Urban	153(52.4%)	41(56.2%)	40(49.4%)	88(44.0%)
Social category	poor	146(50.0%)	29(39.7%)	39(48.1%)	90(45.0%)	1.17	0.027
Social category	rich	146(50.0%)	44(60.3%)	42(51.9%)	110(55.0%)

K-test: Kruskal-wallis H test **: Significance

Table 3 shows the caries severity index, with the Kruskal-Wallis test used to test any differences in dental severity index by age, gender, residence, and social category. The test revealed significant differences in dental caries severity by age (P=0.034) and by gender (P<0.001). Participants who were aged 15 to 19 years had a high dental caries severity index of 140(70.0%)when compared to other age categories. Female participants had higher severe carious conditions 132(66.0%) when compared to their male counterparts.

Table 4 Distribution of oral health behaviors among study participants (n=646)

Variables		Frequency (n)	Percent (%)
Fluoridated toothpaste	No	316	48.9
Fluoridated toothpaste	Yes	330	51.1
Visiting a dentist in 12 months	No	497	76.9
Visiting a dentist in 12 months	Yes	149	23.1
Regular teeth cleaning	No	285	44.1
Regular teeth cleaning	Yes	361	55.9
Frequent consumption of sugary foods or drinks	No	233	36.1
Frequent consumption of sugary foods or drinks	Yes	413	63.9
Use of tobacco	No	645	99.8
Use of tobacco	Yes	1	0.2

Table 4 shows the distributions of oral health behavior related to dental caries among study participants. The proportion of students who reported using fluoridated toothpaste was 330(51.1%). Only one-third of study participants 149(23.1%) have visited a dentist in the past 12 months. Frequent sugary food consumption and regular teeth cleaning were 413(63.9%) and 361(55.9%) respectively.

Table 5: Associations between dental caries and associated factors among study participants (n=646)

Variables		Mean DMFT±SD	P-value	AOR	95% CI	P-value
Gender	Female	4.0(4.2)	<0.001**	1.5	1.4-1.6	<0.001**
Gender	Male	2.6(3.3)		Reference
Age^¶	12-14 years	2.6(3.6)	0.035**	0.6	0.5-0.7	<0.001**
	15-19 years	3.5(3.9)		0.8	0.7-0.9	0.056
	20-25 years	4.0 (3.7)		Reference
Residence	Rural	3.6(3.8)	0.124	1.1	1.0-1.3	0.001**
	Urban	3.1(3.9)		Reference
Social category	Poor	3.2(3.8)	0.408	0.8	0.7-0.9	<0.001**
	Rich	3.4(3.9)		Reference
Use of toothpaste	No	3.5(3.9)	0.19	1.2	1.1-1.3	<0.001**
	Yes	3.1(3.8)		Reference
Father education^¶	No formal school	3.4(0.3)	0.007**	0.9	0.8-1.0	0.336
	Primary-Secondary	3.9(0.2)		1.1	0.9-1.2	0.131
	University	3.9(0.3)		Reference
Mother education^¶	No formal school	2.7 (3.2)	<0.001**	0.9	0.7-1.1	0.099
	Primary-Secondary	3.6 (4.1)		1.1	0.9-1.2	0.264
	University	3.1 (3.6)		Reference
Sugary foods	No	3.1(3.8)	0.253	0.9	0.8-0.9	0.039**
	Yes	3.4(3.9)		Reference
Visit a dentist	No	3.1(3.7)	<0.001**	0.7	0.6-0.8	<0.001**
	Yes	4.3( 4.1)		Reference
Teeth cleaning	No	3.3(3.6)	0.961	1	0.9-1.1	0.521
	Yes	3.3(4.0)		Reference

SD: Standard deviation, AOR: Adjusted Odd Ratio, CI: Confidence Interval, **: Significance, ^¶: Analysis was done using ANOVA

Table 5 summarizes the bivariate analysis results and Poisson regression analysis used to investigate the associated factors to dental caries (DMFT). Through bivariate analysis, gender, age, education level of parents and visiting a dentist predicted dental caries. With Poisson regression analysis, females had a 1.5 likelihood of getting dental caries compared to (AOR=1.5, P=0.001). Being younger (12-14 years) was 40% less likely to have dental caries (AOR=0.6, P<0.001), showing that DMFT increased in older participants. With multiple comparisons test, there was no significant differences in age group. Residence and social category were also significant factors in dental caries. Belonging to low-income families was a 20% likelihood reduction for having dental caries when compared to participants from rich families (AOR=0.8, P<0.001). On the other hand, participants who did not use sugary foods or drinks frequently had a 10% decreased likelihood of dental caries (AOR=0.9, p<0.001). However, DMFT was 1.2 times among participants who did not use fluoridated toothpaste (AOR=1.2, P<0.001), and 1.1 times more likely to get dental caries among those from rural areas (AOR=1.1, P<0.001) when compared to their counterparts.

This study was to determine the prevalence of dental caries and associated factors to dental caries among students of secondary schools in Kigali, Rwanda. The prevalence of dental caries was found as a dental public health problem (61.1%). The current study findings were almost similar to another study in (64%) of Rwanda [26] and in Vietnam 68.9% [27]. However, these findings were higher than the prevalence done in Indore district, India (47.2%) [28]. On the other hand, this prevalence was lower when compared with other studies done in (85%) of Qatar, (74%) of Kazakhstan [8], Moldova (77.5%), Russia (77.5%) [29]; Tanzania (91.5%)[30], and in Tamil Nadu, India (89.3%) [31]. These differences might have been attributed to social economic differences, study setting, and oral health behavior among study participants.

The mean DMFT was 3.3 (SD = 3.9) which is very high when compared to similar studies done in China (2.38) [32], Tanzania (0.59) [30], and Sudan(3.06) [33]. In the current study, the decay component accounted for 61.1% of the DMFT and contributed 3.17 to the total DMFT. This figure was high when compared to the DMFT set by WHO suggesting a DMFT greater than 3 indicates high caries severity and this showed a low utilization of dental services [23]. These findings showed a significant difference in DMFT among female and male participants. Female participants had a greater mean DMFT of 4.1 (SD = 4.2) than male students 2.6(4.5). The age-related rise in DMFT was also in current results presumably due to the period of exposure of permanent teeth compared to older students. The current study highlights participants who were coming from low socioeconomic status and participants who were not using sugary foods or drinks frequently, had a reduced risk of dental caries. This might be because participants from rural areas do not frequently snack when compared to their urban counterparts. However, the higher DMFT was 1.2 times among participants who did not use fluoridated toothpaste and 1.1 times more among participants from rural areas when compared to their counterparts.

When compared to other countries that improved the prevention of dental caries, the prevalence of dental caries has decreased significantly in developed countries due to the availability of healthcare systems, such as the United States and several European countries, owing to widespread access to preventive measures such as fluoridated water, regular dental check-ups, and health education programs. The application of these measures has made a substantial contribution to the overall improvement in oral health outcomes among developed-country populations [2, 34]. However, the current results showed few filled teeth and low proportions who had fissure sealant placed on high-risk teeth. Another study done in Korea estimating the prevalence, severity, and dental caries distribution among secondary school children reported a decrease in DMFT indices in 2000 and 2012, with mean DMFT of 3.3, and 2.2 respectively due to improving healthcare systems and provision of fissure sealants on posterior teeth [4].

The current study also reported that 76.9% did not visit a dentist in the past 12 months and this is not the contrary in many low- to middle-income nations. The prevalence of dental caries was higher in these areas because of limited access to dental care services, insufficient infrastructure, a lack of preventative measures with excessive sugar intake, and a lack of oral hygiene practices [10, 35]. Poverty and a lack of knowledge, for example, have a substantial role in impeding effective oral health promotion in these countries [2, 36, 37].

One limitation of the study was the method used to detect dental caries, which relied entirely on visual and tactile screening rather than radiographic pictures. This method most likely resulted in an underestimate of the true prevalence of dental caries. Furthermore, the study utilized a cross-sectional methodology, while appropriate for analyzing variable correlations, only focused on characteristics thought to be predisposed to dental caries. The testing did not detect the presence or absence of caries at any given period. As a result, a cohort study within the examined age range is required to gain a more thorough knowledge of the relationship between dental caries and the underlying causes of tooth decay. This would allow for a longitudinal investigation of the dynamic nature of dental caries development and its link.

The prevalence of dental caries among secondary school students aged 12 to 25 years old in Kigali, Rwanda was a public health problem. Factors found to be associated with dental caries were gender, age, low socioeconomic status, dental service utilization, frequent use of sugary foods or drinks, use of fluoridated toothpaste, and residence. This recommended the necessity of resolving inequities in access to oral healthcare and establishing community-based initiatives to improve oral health equality in secondary students in Kigali. This shows that early treatments and preventative strategies are needed for dental caries among Kigali secondary schools. These findings might be used for oral health surveillance and monitoring among secondary students in Kigali, Rwanda.

DMFT

Decayed, Missing, Filled Teeth

AOR

Adjusted Odd Ratio

OR

Odd ratio

SD

Standard Deviation

CI

Confidence Interval

ANOVA

Analysis of Variance, WHO:World Health Organization

SPSS

Statistical Package for the Social Sciences

Acknowledgment

The authors want to acknowledge the role of the administration of the city of Kigali and the head teachers who have facilitated data collection. We want to thank the research participants especially those who were under 18 years old for their assent.

Authors contribution

S.J. T.M; P.U; J.M. and A.K.A. contributed to developing and conducting research. S.J. T.M; P.U; J.M. and A.K.A Contributed to the statistical analysis and interpretation of the results. S.J.T.M and A.K.A lead in writing the manuscript.

Funding

None

Availability of data and materials

The data set used in this study is available upon reasonable request from the corresponding author

Ethical Consideration:

The ethical clearance was sought from the Institution Review Board of the University of Rwanda-College of Medicine Health Sciences (IRB-UR/CMHS) with approval notice: No 247/CMHS IRB/2023 and permission was obtained from District authorities and head teachers before data collection. Participation in this study was voluntary. Codes were assigned to each participant to ensure data confidentiality. The study participants signed consent forms. For those under 18 years, the information sheet and consent form were sent to the parents or guardians to help with students. A signed consent form from the parents was returned by the students after signing their assent. Students whose parents did not consent to participate in the study were excluded.

Consent for publication

Not applicable

Competing interests

None

World Health Organization. (2022) Global oral health status report.
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;83:661–9.
Gupta S, Mahajan M, Khanna I, Yousuf A, Gupta A, Pabla GS, Jakhar D. Dent Caries Abstract. 2020;19:1–8.
Alyafei NA. (2021) Dental Hygiene for Children : Conducting a Scoping Review for Assessing the Prevalence of Dental Caries in Primary Schools. 11:1–9.
García-Barata AR, Ventura I, Ribas-Pérez D, Flores-Fraile J, Castaño-Séiquer A. Oral Health Status in a Group of Roma Children in Seville. Spain Healthc. 2023;11:1–12.
Schwendicke F, Dörfer CE, Schlattmann P, Page LF, Thomson WM, Paris S. Socioeconomic inequality and caries: A systematic review and meta-analysis. J Dent Res. 2015;94:10–8.
Slade GD, Grider WB, Maas WR, Sanders AE. Water Fluoridation and Dental Caries in U.S. Children and Adolescents. J Dent Res. 2018;97:1122–8.
Zhumadilova A, Supiyev T, Abralina S, Yeslyamgaliyeva A, Kulmirzayeva A, Supiyev A. Determinants of Dental Caries Experience Among Adolescents in Kazakhstan: A Cross-Sectional Study. Curr Top Nutraceutical Res. 2021;19:388–97.
Bagramian RA, Garcia-Godoy F, Volpe AR. The global increase in dental caries. A pending public health crisis. Am J Dent. 2009;22:3–8.
Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. J Dent Res. 2015;94:1355–61.
Kimmie-Dhansay F, Bhayat A. Prevalence of dental caries in the permanent dentition amongst 12-year-olds in Africa: a systematic review and meta-analysis. BMC Oral Health. 2022. https://doi.org/10.1186/s12903-022-02489-4.
Tafere Y, Chanie S, Dessie T, Gedamu H. Assessment of prevalence of dental caries and the associated factors among patients attending dental clinic in Debre Tabor general hospital: A hospital-based cross-sectional study. BMC Oral Health. 2018;18:1–8.
Mukanga B, Sakala K, Nyirenda TH, Daka V, Mulenga D. Oral Health Knowledge, Attitude and Practices among Adolescents in Choma District of Zambia. Med J Zambia. 2022;49:118–27.
Sahab L, Sabbah W. Is the inability to afford dental care associated with untreated dental caries in adults? Community Dent Health. 2022;39:113–7.
Uwayezu D, Uwambaye P, Uwitonze AM, et al. Prevalence of Dental Caries, its Associated Risk Factors and Treatment Needs among School Aged Children at Kimironko II Primary School, Kigali, Rwanda. Rwanda J Med Heal Sci. 2021;4:341–6.
Mukashyaka C, Uzabakiriho B, Amoroso CL, Mpunga T, Odhiambo J, Mukashema P, Seymour BA, Sindayigaya JDD. Dental caries management at a rural district hospital in northern Rwanda: a neglected disease. Public Heal action. 2015;I:158–61.
Kanmodi KK, Uwambaye P, Amzat J, Salami AA. Dental caries in Rwanda: A scoping review. Heal Sci Rep. 2023;6:1–9.
Benzian H, Hobdell M, Holmgren C, Yee R, Monse B, Barnard JT, Van Palenstein Helderman W. Political priority of global oral health: An analysis of reasons for international neglect. Int Dent J. 2011;61:124–30.
Garcia R, Dietrich T. (2012) Introduction to periodontal epidemiology. Periodontol 2000 58:7–9.
Hackley DM, Jain S, Pagni SE, Finkelman M, Ntaganira J, Morgan JP. (2021) Oral health conditions and correlates: a National Oral Health Survey of Rwanda. Glob Health Action. https://doi.org/10.1080/16549716.2021.1904628.
Nsabimana U, Isyagi M, Rutayisire R, Nyirazinyoye L. Dental Caries Risk Assessment in Primary School Children Aged 11 to 12 years: Case of Nyarugenge District, Rwanda. Rwanda J Med Heal Sci. 2023;6:113–22.
Rios D, Magasi S, Novak C, Harniss M. Conducting accessible research: Including people with disabilities in public health, epidemiological, and outcomes studies. Am J Public Health. 2016;106:2137–44.
Who. Oral Health Surveys - Basic Methofd. World Heal Organ. 2013;1:137.
Adam AM. (2020) Sample Size Determination in Survey Research. J Sci Res Rep 90–7.
WHO. (2013) Oral health surveys: basic methods.
Morgan JP, Isyagi M, Ntaganira J, et al. Building oral health research infrastructure : the first national oral health survey of Rwanda Building oral health research infrastructure : the first national oral health. Glob Health Action. 2018. https://doi.org/10.1080/16549716.2018.1477249.
Van Chuyen N, Van Du V, Van Ba N, Long DD, Son HA. The prevalence of dental caries and associated factors among secondary school children in rural highland Vietnam. BMC Oral Health. 2021;21:1–8.
Kumar S, Kumar A, Badiyani B, Kumar A, Basak D, Ismail MB. Oral health impact, dental caries experience, and associated factors in 12-15-year-old school children in India. Int J Adolesc Med Health. 2015. https://doi.org/10.1515/ijamh-2015-0041.
Gorbatova M, Gorbatova LN, Pastbin M, Grjibovski AM. (2012) Urban-rural differences in dental caries experience among 6-year-old children in the Russian north. https://doi.org/10.22605/RRH1999.
Mbawalla HS, Nyamuryekung’e KK, Mtaya-Mlangwa M, Masalu JR. Dental Caries Pattern Amongst Tanzanian Children: National Oral Health Survey. Int Dent J. 2023;73:731–7.
John JB, Asokan S, Aswanth K, Priya PRG, Shanmugaavel AK. (2015) Dental Caries and the Associated Factors Influencing it in Tribal, Suburban and Urban School Children of Tamil Nadu, India: A Cross Sectional Study. J Public health Res 4:jphr.2015.361.
Li J, Zhang K, Lu Z. Prevalence and factors contributing to dental caries in 12-15-year-old school adolescents in northeast China. BMJ Open. 2021. https://doi.org/10.1136/bmjopen-2020-044758.
Omara H, Elamin A. Oral health status and related risk factors among adolescents attending high schools in Khartoum, Sudan: A cross-sectional study. Clin Epidemiol Glob Heal. 2022. https://doi.org/10.1016/j.cegh.2022.101080.
Bernabe E, Marcenes W, Hernandez CR, et al. Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study. J Dent Res. 2020;99:362–73.
Bundy DAP, de Silva N, Horton S, Jamison DT, Patton GC. (2017) Disease Control Priorities, Third Edition (Volume 8): Child and Adolescent Health and Development. Dis Control Priorities, Third Ed (Volume 8) Child Adolesc Heal Dev. https://doi.org/10.1596/978-1-4648-0423-6.
Watt RG, Daly B, Allison P, et al. The Lancet Oral Health Series: Implications for Oral and Dental Research. J Dent Res. 2020;99:8–10.
Chidzonga MM, Carneiro LC, Kalyanyama BM, Kwamin F, Oginni FO. Determinants of Oral Diseases in the African and Middle East Region. Adv Dent Res. 2015;27:26–31.

No competing interests reported.

Prevalence of Dental Caries and Associated Factors Among Secondary School Students in Kigali, Rwanda: A Cross-sectional study

Status:

Version 1

Abstract

BACKGROUND

METHODS

Study Design

Study Population

Sample size determination

Sampling strategies

Data collection procedure and research instruments

Data analysis

RESULTS

DISCUSSION

CONCLUSION

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1