Tooth Brushing Practice in Ethiopia: A Systematic Review and Meta-Analysis

Tooth Brushing Practice in Ethiopia: A Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Tooth Brushing Practice in Ethiopia: A Systematic Review and Meta-Analysis Addisu Tadesse Sahile, Mitiku Wondimu, Endeshaw Fikrie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2099035/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Apr, 2023 Read the published version in Scientific Reports → Version 1 posted 7 You are reading this latest preprint version Abstract Background: Oral hygiene refers to taking care and maintaining the cleanness of gum and teeth; a good oral hygiene practice promotes better oral health in general. Oral hygiene is the top public health concern of the population. Tooth brushing is a technique to keep oral hygiene from related complications. Therefore, this study provides the pooled prevalence of tooth brushing practice in Ethiopia. Methods: Databases searched for articles systematically across PubMed, Google Scholar, Hinari, EMBASE, and African Journals Online. Two reviewers independently conducted the selection, screening, reviewing, and data extraction using a Microsoft Excel spreadsheet and used the Joanna Briggs Institute prevalence critical appraisal tools to assess the quality of evidence. All studies conducted in Ethiopia from 2010 to 2020, reporting tooth-brushing practices extracted for and imported into the Comprehensive meta-analysis version 3.0 for further analysis. Beggs and Eggers’s tests evaluated for publication bias with Higgins’s method evaluated for heterogeneity. A random-effects meta-analysis model with a 95% confidence interval was computed to estimate the pooled effect size (prevalence). Furthermore, the authors employed subgroup analysis based on the study area and sample size. Results and Conclusion : After reviewing 36, 10 articles fulfilled the inclusion criteria, and were included in the meta-analysis. The pooled prevalence of tooth brushing practice was 12.2 % (95% CI: 7.6%-19.2%). The review reported a lower level of tooth-brushing practice in Ethiopia. We recommended that special attention should be given to the oral hygiene of the Ethiopian people. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Tooth Brushing Practice Systematic Review Meta-analysis & Ethiopia Figures Figure 1 Figure 2 Figure 3 Introduction According to the global oral health status report for 2022, oral disease affected about 3.5 billion people worldwide, where three out of four affected people live in middle-income countries. (1) Moreover, dental caries of permanent teeth affected two million people worldwide. (2) Dental caries is a progressive and irreversible degradation of the enamel/dentin following acid production as a result of bacterial metabolism(3) and causes teeth’ mineralization and destruction of the teeth’ hard tissues. (3, 4) It is one of the public health concerns of the world (5), and nearly every adult in the world has dental caries. (6) In children, it is a more prevalent condition affecting 60-90%. (7-9) With the growth of urbanization and changes in living conditions worldwide, the prevalence of main oral diseases continued to increase.(10) For this to exist, inadequate-water supply and oral hygiene products, poor access to oral health care by the communities and high sugar-containing foods availability, and affordability were among the factors that played a great role.(11) Beyond affecting the quality of life(12), poor oral health accelerates the risks of morbidity and mortality. (13) Dental caries is one of the determinant factors for poor oral health in a population, whose existence is either facilitated or determined by factors such as educational level, occupation, income (14-16), PH, social classes, oral hygiene, viscosity, and buffer capacity of the saliva, carbohydrate diet, and parental incidence of caries. (17) Oral hygiene refers to taking care and maintaining the cleanness of gum and teeth (18-20) whereas the practice of it promotes better oral health. (21-23) The American Dental Association stated oral health as “a functional, structural, aesthetic, physiologic, and psychosocial state of well-being that is essential to an individual’s general health and quality of life”. (24) Oral hygiene is the top public health concern of the world population (25) same talk; the prevalence of oral diseases in Ethiopia was observed at up to 90% of the population. (26) Corpus of evidence reported the positive effect of tooth brushing at preventing and reducing the oral health conditions. (27-33) To the best of the researcher’s knowledge, the level of tooth brushing practice in Ethiopia was not a well investigated and understood area; and hence this review examined the state of evidence on the level of tooth-brushing practice in Ethiopia. The review question is “What is the level of tooth brushing practice in Ethiopia?” Methods Reporting: The preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline (34) was used to report this meta-analysis.( Additional file 1 research checklist). Searching strategies: The reviewers followed the PRISMA systematic review protocol as a reporting guideline for the PRISMA checklist, eligible studies for the study were selected in terms of titles, abstracts, and then full articles based on inclusion criteria. PubMed, EMBASE, Hinari, African Journals Online, and Google scholar systematically searched for based on controlled and free-text languages. In terms of free-text searches, the keywords included the followings: (Tooth Brushing OR Dental Problems OR Dental Caries) AND Ethiopia. The controlled searches included the following Medical Subject Heading (MeSH) terms: “tooth brushing”, and “Ethiopia” as recommended for each database. The search terms were used individually and in combination using “AND” and “OR” Boolean operators. Moreover, the search was guided by PICO, population- a population that practiced tooth brushing. Inclusion and exclusion criteria: The reviewers included the following type of studies (1) study population comprised any age group, (2) study outcome is tooth brushing, (3) study design is cross-sectional, and articles published in English language. Meanwhile, the reviewers excluded the following, (1) qualitative studies, (2) report language is non-English, and (3) year of publication is older than 2010. Outcome of interest: PICO: The population of the study was any age group that brushed tooth. The main outcome was the tooth brushing practice reported in the reviewed articles both as percentage and frequency, calculated by dividing the number of individuals who brushed their tooth twice or more times a day by the total sample size then multiplied by 100. Screening and Data Extraction: Two reviewers (SAT and WMT) screened titles and abstracts against the inclusion criteria and then did an independent assessment for full text articles based on the predetermined inclusion and exclusion criteria. Arguments discussed and reached on complete consensus. The three authors (SAT, WMT, and FEM) independently did the data extraction from a random sample of 20% to check consistency and found no variation. Study Quality Assessment: While designing a data abstraction form on Microsoft Excel, the reviewers emphasized for clarity of the data, objective, study design, population, year of publication, sample size, and proportion of tooth brushing. (Table 1) An assessment for the methodological qualities was based on the Joanna Briggs Institute prevalence critical appraisal tool for the critical appraisal of the studies. (36) Data Synthesis and Statistical Analysis: The extracted data using Microsoft Excel spreadsheet imported to Comprehensive meta-analysis version 3.0 software for further analysis. The pooled effect size with a 95% confidence interval of tooth brushing practice was determined using a weighted inverse variance random-effects model. The I2 statistic used for assessing the heterogeneity across the studies, where 25, 50 and 75% represent low, moderate, and high heterogeneities consecutively. (37) A funnel plot and Beggs and Eggers tests evaluated the risks of publication bias. (38) Results Selection of the studies: A comprehensive literature search for the databases yielded 36 published articles, of which eight articles retrieved from PubMed, 13 articles from EMBASE, African journals online, and Hinari, and 15 articles from Google Scholar. Twenty-one articles excluded once assessed for duplication. Fifteen articles screened by abstracts, of which five articles excluded for no outcome report. Ten full-text articles that fulfilled the eligibility criteria with a total sample size of 3156 included in the final analysis for the systematic review and meta-analysis. ( Figure 1 ) Characteristics of the Included Studies: Pertinent information about authors, publication year, population, study area, sample size, age groups, outcome, and main findings from the selected articles were extracted and presented in table 1. All articles were cross-sectional and in Ethiopia from 2010 to 2020 and published in indexed journals. The studies were conducted in Jimma (39-41), Addis Ababa(42, 43), Adama (44), Fitche(45), Mekelle(46), Gondar(47), Fenote Selam(48), and Debre Tabor. (49) The sample size for the selected studies ranges from 115 to 422. (Table 1) Table 1 Characteristics of included studies, their sampling methods, and outcome Author , year Study place Sampling Methods, & response rate Study Design Sample size & age in years Prevalence of tooth Brushing Shedev et al., 2020(46) Mekelle Stratified sampling Response rate: NA Cross- sectional N:384 Age:15-20 5.5% Meyrema and Kedir, 2018(44) Adama Systematic Random Sampling Response rate 100% Cross-Sectional n=422 Age :> 20 46.0% Shukure and Shuke, 2017 (50) Fitche Simple random sampling Response rate: NA Cross-Sectional N:264 Age: > 16 24.3% Darout, 2014(40) Jimma Convenience sampling Response rate: NA Cross-sectional N:266 Age :> 18 30% Gualie and Tayachew, 2018(49) Debre Tabor Systematic random sampling Response rate 100% Cross-sectional N:422 Age :NA 3.3% Teshome eta al., 2016(48) Finote Selam Simple random sampling Response rate 100% Cross-sectional N:291 Age:12-20 31% Kebede et al., 2012(51) Jimma Simple random sampling Response rate: NA Cross-sectional N:240 Age:15-68 3.75% Teshome et al.,2020(47) Gonder Systematic random sampling Response rate :NA Cross-sectional N:368 Age: Any 6.5% Shenkute and Asfaw, 2019(41) Jimma Convenience sampling Response rate : NA Cross-sectional N:115 Age :NA 6% Dechasa et al.,2017(52) Addis Ababa Sampling methods: NA Response rate 100% Cross-sectional N:384 Age: > 20 19.5% Abate et al., 2020 (53) Addis Ababa Simple random sampling method Response rate: NA Cross-sectional N:320 Age :NA 22.3% Tooth brushing practice: In this systematic review and meta-analysis, the pooled estimate of tooth brushing practice was described by forest plot. The pooled prevalence of tooth brushing practice in Ethiopia from the random effects method observed was 12.2% (95%CI: 7.6%-19.2%). ( Figure 2 ) Assessment of Publication Bias: The funnel plot found to be asymmetry and Begg’s and Egger’s tests showed presence of a significant publication bias at a p-value of 0.05. (Figure 3) Investigation of Heterogeneity: For identifying the possible causes of variation across the studies, meta-regression analysis was done using sample size and study area. The result showed that there is no significant heterogeneity across the studies (P>0.05). (Table 2) Table 2 Sources of heterogeneity across the studies Source of Heterogeneity Coefficient Standard error I 2 (%) p-value Sample size -0.0018 0.0061 99.0 0.7688 Study area -0.9998 -0.8781 98.4 0.557 Discussion This systematic review and meta-analysis aimed at providing comprehensive evidence on the level of tooth brushing practice in Ethiopia from 2010 to 2020. The finding from this study reported an overall level of tooth brushing practice of 12.2%. Thus, this was consistent with the findings of 14.5% in Nigeria (54) and 15.9% in Sudan. (55) The current review reported a much lower level of tooth brushing practice than studies across different parts of the world. For instance, a higher level of tooth brushing practice was reported at 77.5% in Kenya(56), 76.6% in Malawi(57), 72.4% in Tanzania(58), 56.5% in Uganda(59) and 57% in Iran(60). This variation might be due to variations in scope of the studies and sample size. Understanding all the variations in the scope and level of emphasis to the assessment of oral hygiene, there exists differences in the level of tooth brushing practice. As an evidence for this is; reports from China and Italy reported a tooth brushing practice of 44.4% (61) and 33.6% (62) respectively. Where such variation might be due to differences in population characteristics across the studies. There exists a variation in the distribution of level of oral hygiene (tooth brushing) across the global population. This uneven distribution to happen to the people might take on difference factors that includes service access differences, awareness level, perception, and healthcare infrastructure. A report from India revealed a level of tooth brushing practice of 99.5%, (63) which is by far higher than the current review report. With a relative understanding, studies from Eritrea and Sudan reported a tooth brushing practice of 19.1% (64) and 20% (30) respectively which is almost comparable with the current review report. Moreover, an assessment from Saudi Arabia reported the tooth brushing practice of 41.5% (65). A study from Jorpati, Kathmandu, Nepal also reported the tooth brushing practice of 36.9% (66). Comparing these findings with the current review report, it is clear that a higher level of oral hygiene practice. A finding from Nigeria also reported a higher level tooth brushing practice which was 28.46% (67). This variation might be due to differences in scope across the studies. Furthermore, studies from Malaysia and Tanzania revealed a much higher practice than the current finding. It was 59.4% in Tanzania (68) and 75.3% in Malaysia (69). Scope across the studies, sample sizes and population characteristics might have attributed for the observed variations. Limitation of the systematic reviw and Meta-Aanalysis: In the current study, tooth brushing was measured two or more times of tooth brushing per day. However, the authors didn’t get a comprehensive expression within the reviewed articles. The authors acknowledge shoratge of related lietertaure while discussing the finding. Conclusion The review reported a lower level of tooth brushing practice in Ethioia. Strengthening tooth brushing practice in Ethiopia is a key to the promotion of oral hygiene and therefore; concerned bodies Should work on the identified oral health concern of the Ethiopian population. Abbreviations CI: Confidence Interval MeSH: Medical Subject Heading PRISMA: Preferred Reporting Items for Systematic Reviewsand Meta-Analyses Declarations Supporting Information S1 Appendix. PRISMA 2009 checklist Data availablity The data that supported the finding of this study are available within the manuscript and supplementary file. Conflicts of interest The authors declare that they have no competing interests. Author contribution SAT, WMT and FEM were involved in development of the protocol, design, selection of the study, data extraction, statistical analysis, and developing developing the initial draft of the manuscript. All authors prepared and edited the final draft of the mansucript. All authors read and approaved the final draft of the manuscript. 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Tanzania Dental Journal. 2007;14(1):1-7. Kaur S, Maykanathan D, Lyn NK. Factors associated with dental caries among selected urban school children in Kuala Lumpur, Malaysia. Archives of Orofacial Science. 2015;10(1). Additional Declarations No competing interests reported. Supplementary Files SIPRISMAchecklist.docx Cite Share Download PDF Status: Published Journal Publication published 19 Apr, 2023 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Accepted 14 Apr, 2023 Reviewers agreed at journal 06 Mar, 2023 Reviews received at journal 21 Feb, 2023 Reviewers agreed at journal 21 Feb, 2023 Reviewers invited by journal 21 Feb, 2023 Submission checks completed at journal 10 Feb, 2023 First submitted to journal 06 Feb, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2099035","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":174962346,"identity":"090f9fe9-e811-4fb6-bb63-242b19ac521a","order_by":0,"name":"Addisu Tadesse Sahile","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYFACHgaJBAYbHn4QO6GAeC1pMpINIC0GxGphYDhsY3AAxCFGi3z72YM3Hvw5zGN8fnXihwcGDPL8YgfwazE4k5dskdiWzmN24+1mCaDDDGfOTiCghSHHTCKxwRqo5ewGkJYEg9sEtMj3vzGTSPjDzGM84+zmH0RpYbgBtCWBzZnHgL93G3G2GNx4Ywz0SxqPxA3ebRYJBhKE/SLfn2N488cfG3v+/rObb/6osJHnlybkMDiQAKuUIFY5CPAfIEX1KBgFo2AUjCQAAO75QuzvF4CnAAAAAElFTkSuQmCC","orcid":"","institution":"Unity University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Addisu","middleName":"Tadesse","lastName":"Sahile","suffix":""},{"id":174962348,"identity":"fd92752b-65c6-4b0c-8de7-062767bb1d10","order_by":1,"name":"Mitiku Wondimu","email":"","orcid":"","institution":"Menelik II Referral Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mitiku","middleName":"","lastName":"Wondimu","suffix":""},{"id":174962350,"identity":"381d2c5b-e533-401e-8ca6-6c2d42805422","order_by":2,"name":"Endeshaw Fikrie","email":"","orcid":"","institution":"Addis Ababa City Health Bureau","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Endeshaw","middleName":"","lastName":"Fikrie","suffix":""}],"badges":[],"createdAt":"2022-09-24 11:29:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2099035/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2099035/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-023-33541-0","type":"published","date":"2023-04-19T20:32:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":36027005,"identity":"41d82c63-6f95-4639-adf2-8550d4dbbcdf","added_by":"auto","created_at":"2023-04-19 20:51:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56508,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram for showing screening and selection process of duties\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2099035/v1/26a575a5280f7d955fb4eab9.png"},{"id":36027006,"identity":"50a49dbc-fe7f-48ce-9999-78cdcea5a988","added_by":"auto","created_at":"2023-04-19 20:51:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":282403,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of pooled prevalence/level/ of tooth brushing practice\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-2099035/v1/d1ded76a487ba8f0a0fb933f.png"},{"id":36027007,"identity":"142d5adb-2c65-4e3f-a116-64c8de4de3ea","added_by":"auto","created_at":"2023-04-19 20:51:55","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":13706,"visible":true,"origin":"","legend":"\u003cp\u003eFunnel plot for the selected studies\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-2099035/v1/5c31737838f348d2d9f228d5.png"},{"id":44725896,"identity":"8b4fb66b-8415-4c36-b3c5-ef3a5080e51d","added_by":"auto","created_at":"2023-10-16 20:43:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":633207,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2099035/v1/41f1eadb-c06c-4f33-886f-5b9e8c80cb3c.pdf"},{"id":36027008,"identity":"0600c919-1b24-45c9-9f9e-dcf0a60261fd","added_by":"auto","created_at":"2023-04-19 20:51:55","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19716,"visible":true,"origin":"","legend":"","description":"","filename":"SIPRISMAchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-2099035/v1/5a8db48f3821f74f175b2504.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Tooth Brushing Practice in Ethiopia: A Systematic Review and Meta-Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the global oral health status report for 2022, oral disease affected about 3.5 billion people worldwide, where three out of four affected people live in middle-income countries. (1) Moreover, dental caries of permanent teeth affected two million people worldwide. (2)\u003c/p\u003e\n\u003cp\u003eDental caries is a progressive and irreversible degradation of the enamel/dentin following acid production as a result of bacterial metabolism(3) and causes teeth\u0026rsquo; mineralization and destruction of the teeth\u0026rsquo; hard tissues. (3, 4) It is one of the public health concerns of the world (5), \u0026nbsp;and nearly every adult in the world has dental caries. (6) In children, it is a more prevalent condition affecting 60-90%. (7-9)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWith the growth of urbanization and changes in living conditions worldwide, the prevalence of main oral diseases continued to increase.(10) For this to exist, inadequate-water supply and oral hygiene products, \u0026nbsp;poor access to oral health care by the communities and high sugar-containing foods availability, and affordability were among the factors that played a great role.(11)\u003c/p\u003e\n\u003cp\u003eBeyond affecting the quality of life(12), poor oral health accelerates the risks of morbidity and mortality. (13) Dental caries is one of the determinant factors for poor oral health in a population, whose existence is either facilitated or determined by factors such as educational level, occupation, income (14-16), PH, \u0026nbsp;social classes, oral hygiene, viscosity, and buffer capacity of the saliva, carbohydrate diet, and parental incidence of caries. (17)\u003c/p\u003e\n\u003cp\u003eOral hygiene refers to taking care and maintaining the cleanness of gum and teeth (18-20) whereas the practice of it promotes better oral health. (21-23) The American Dental Association stated oral health as \u0026ldquo;a functional, structural, aesthetic, physiologic, and psychosocial state of well-being that is essential to an individual\u0026rsquo;s general health and quality of life\u0026rdquo;. (24) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOral hygiene is the top public health concern of the world population (25) same talk; the prevalence of oral diseases in Ethiopia was observed at up to 90% of the population. (26) \u0026nbsp;Corpus of evidence reported the positive effect of tooth brushing at preventing and reducing the oral health conditions. (27-33) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo the best of the researcher\u0026rsquo;s knowledge, the level of tooth brushing practice in Ethiopia was not a well investigated and understood area; and hence this review examined the state of evidence on the level of tooth-brushing practice in Ethiopia. The review question is \u0026ldquo;What is the level of tooth brushing practice in Ethiopia?\u0026rdquo;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eReporting: The preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline (34) was used to report this meta-analysis.( Additional file 1 research checklist).\u003c/p\u003e\n\u003cp\u003eSearching strategies: The reviewers followed the PRISMA systematic review protocol as a reporting guideline for the PRISMA checklist, eligible studies for the study were selected in terms of titles, abstracts, and then full articles based on inclusion criteria. PubMed, EMBASE, Hinari, African Journals Online, and Google scholar systematically searched for based on controlled and free-text languages. In terms of free-text searches, the keywords included the followings: (Tooth Brushing OR Dental Problems OR Dental Caries) AND Ethiopia. The controlled searches included the following Medical Subject Heading (MeSH) terms: \u0026ldquo;tooth brushing\u0026rdquo;, and \u0026ldquo;Ethiopia\u0026rdquo; as recommended for each database. The search terms were used individually and in combination using \u0026ldquo;AND\u0026rdquo; and \u0026ldquo;OR\u0026rdquo; Boolean operators. \u0026nbsp;Moreover, the search was guided by PICO, population- a population that practiced tooth brushing.\u003c/p\u003e\n\u003cp\u003eInclusion and exclusion criteria: The reviewers included the following type of studies (1) study population comprised any age group, (2) study outcome is tooth brushing, (3) study design is cross-sectional, and articles published in English language. Meanwhile, the reviewers excluded the following, (1) qualitative studies, (2) report language is non-English, and (3) year of publication is older than 2010.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOutcome of interest: PICO: The population of the study was any age group that brushed tooth. The main outcome was the tooth brushing practice reported in the reviewed articles both as percentage and frequency, calculated by dividing the number of individuals who brushed their tooth twice or more times a day by the total sample size then multiplied by 100.\u003c/p\u003e\n\u003cp\u003eScreening and Data Extraction: Two reviewers (SAT and WMT) screened titles and abstracts against the inclusion criteria and then did an independent assessment for full text articles based on the predetermined inclusion and exclusion criteria. Arguments discussed and reached on complete consensus. The three authors (SAT, WMT, and FEM) independently did the data extraction from a random sample of 20% to check consistency and found no variation.\u003c/p\u003e\n\u003cp\u003eStudy Quality Assessment: While designing a data abstraction form on Microsoft Excel, the reviewers emphasized for clarity of the data, objective, study design, population, year of publication, sample size, and proportion of tooth brushing. (Table 1) \u0026nbsp;An assessment for the methodological qualities was based on the Joanna Briggs Institute prevalence critical appraisal tool for the critical appraisal of the studies. (36)\u003c/p\u003e\n\u003cp\u003eData Synthesis and Statistical Analysis: The extracted data using Microsoft Excel spreadsheet imported to Comprehensive meta-analysis version 3.0 software for further analysis. \u0026nbsp;The pooled effect size with a 95% confidence interval of tooth brushing practice was determined using a weighted inverse variance random-effects model. The I2 statistic used for assessing the heterogeneity across the studies, where 25, 50 and 75% represent low, moderate, and high heterogeneities consecutively. (37) \u0026nbsp;A funnel plot and Beggs and Eggers tests evaluated the risks of publication bias. (38)\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSelection of the studies: A comprehensive literature search for the databases yielded 36 published articles, of which eight articles retrieved from PubMed, 13 articles from EMBASE, African journals online, and Hinari, and 15 articles from Google Scholar. Twenty-one articles excluded once assessed for duplication. Fifteen articles screened by abstracts, of which five articles excluded for no outcome report. \u0026nbsp;Ten full-text articles that fulfilled the eligibility criteria with a total sample size of 3156 included in the final analysis for the systematic review and meta-analysis. (\u003cstrong\u003eFigure 1\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003eCharacteristics of the Included Studies: Pertinent information about authors, publication year, population, study area, sample size, age groups, outcome, and main findings from the selected articles were extracted and presented in table 1. All articles were cross-sectional and in Ethiopia from 2010 to 2020 and published in indexed journals. The studies were conducted in Jimma (39-41), Addis Ababa(42, 43), Adama (44), Fitche(45), Mekelle(46), Gondar(47), Fenote Selam(48), and Debre Tabor. (49) The sample size for the selected studies ranges from 115 to 422. (Table 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 1 Characteristics of included studies, their sampling methods, and\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eoutcome\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor , year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy place\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSampling Methods, \u0026amp; response rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy \u0026nbsp;Design\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample size \u0026nbsp;\u0026amp; age in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence of tooth Brushing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eShedev et al., 2020(46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003e\u0026nbsp;Mekelle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eStratified sampling\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResponse rate: NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross- sectional\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:384\u003c/p\u003e\n \u003cp\u003eAge:15-20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e5.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eMeyrema and Kedir, 2018(44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003eAdama\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eSystematic Random Sampling\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResponse rate 100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-Sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003en=422\u003c/p\u003e\n \u003cp\u003eAge\u003cu\u003e:\u0026gt;\u003c/u\u003e20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e46.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eShukure and Shuke, 2017 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003eFitche\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eSimple random sampling\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResponse rate: NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-Sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:264\u003c/p\u003e\n \u003cp\u003eAge:\u003cu\u003e\u0026gt;\u003c/u\u003e16\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e24.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eDarout, 2014(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003e\u0026nbsp;Jimma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eConvenience sampling\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResponse rate: NA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:266\u003c/p\u003e\n \u003cp\u003eAge\u003cu\u003e:\u0026gt;\u003c/u\u003e18\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eGualie and Tayachew, 2018(49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003eDebre Tabor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eSystematic random sampling\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResponse rate 100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:422\u003c/p\u003e\n \u003cp\u003eAge :NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e3.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eTeshome eta al., 2016(48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003eFinote Selam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eSimple random sampling\u003c/p\u003e\n \u003cp\u003eResponse rate 100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:291\u003c/p\u003e\n \u003cp\u003eAge:12-20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eKebede et al., 2012(51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003e\u0026nbsp;Jimma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eSimple random sampling\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResponse rate: NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:240\u003c/p\u003e\n \u003cp\u003eAge:15-68\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e3.75%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eTeshome et al.,2020(47)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003e\u0026nbsp;Gonder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eSystematic random sampling\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResponse rate :NA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:368\u003c/p\u003e\n \u003cp\u003eAge: Any\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e6.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eShenkute and Asfaw, 2019(41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003eJimma\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eConvenience sampling\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResponse rate : NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:115\u003c/p\u003e\n \u003cp\u003eAge :NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eDechasa et al.,2017(52)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003eAddis Ababa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eSampling \u0026nbsp; \u0026nbsp; methods: NA\u003c/p\u003e\n \u003cp\u003eResponse rate 100%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:384\u003c/p\u003e\n \u003cp\u003eAge: \u003cu\u003e\u0026gt;\u003c/u\u003e20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e19.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.17591125198098%\"\u003e\n \u003cp\u003eAbate et al., 2020 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.361331220285262%\"\u003e\n \u003cp\u003eAddis Ababa\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.673534072900157%\"\u003e\n \u003cp\u003eSimple random sampling method\u003c/p\u003e\n \u003cp\u003eResponse rate: NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.164817749603802%\"\u003e\n \u003cp\u003eCross-sectional\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.213946117274167%\"\u003e\n \u003cp\u003eN:320\u003c/p\u003e\n \u003cp\u003eAge :NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.410459587955627%\"\u003e\n \u003cp\u003e22.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTooth brushing practice: In this systematic review and meta-analysis, the pooled estimate of tooth brushing practice was described by forest plot. The pooled prevalence of tooth brushing practice in Ethiopia from the random effects method observed was 12.2% (95%CI: 7.6%-19.2%). \u0026nbsp;(\u003cstrong\u003eFigure 2\u003c/strong\u003e)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAssessment of Publication Bias: The funnel plot found to be asymmetry and Begg\u0026rsquo;s and Egger\u0026rsquo;s tests showed presence of a significant publication bias at a p-value of 0.05. (Figure 3)\u003c/p\u003e\n\u003cp\u003eInvestigation of Heterogeneity:\u0026nbsp;For identifying the possible causes of variation across the studies, meta-regression analysis was done using sample size and study area. The result showed that there is no significant heterogeneity across the studies (P\u0026gt;0.05). (Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Sources of heterogeneity across the studies\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.73076923076923%\"\u003e\n \u003cp\u003eSource of Heterogeneity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.423076923076923%\"\u003e\n \u003cp\u003eCoefficient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.237179487179485%\"\u003e\n \u003cp\u003eStandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.455128205128204%\"\u003e\n \u003cp\u003eI\u003csup\u003e2\u003c/sup\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.153846153846153%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.73076923076923%\"\u003e\n \u003cp\u003eSample size\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.423076923076923%\"\u003e\n \u003cp\u003e-0.0018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.237179487179485%\"\u003e\n \u003cp\u003e0.0061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.455128205128204%\"\u003e\n \u003cp\u003e99.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.153846153846153%\"\u003e\n \u003cp\u003e0.7688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.73076923076923%\"\u003e\n \u003cp\u003eStudy area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.423076923076923%\"\u003e\n \u003cp\u003e-0.9998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.237179487179485%\"\u003e\n \u003cp\u003e-0.8781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.455128205128204%\"\u003e\n \u003cp\u003e98.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.153846153846153%\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis systematic review and meta-analysis aimed at providing comprehensive evidence on the level of tooth brushing practice in Ethiopia from 2010 to 2020. The finding from this study reported an overall level of tooth brushing practice of 12.2%. Thus, this was consistent with the findings of 14.5% in Nigeria (54) \u0026nbsp;and 15.9% in Sudan. (55)\u003c/p\u003e\n\u003cp\u003eThe current review reported a much lower level of tooth brushing practice than studies across different parts of the world. For instance, a higher level of tooth brushing practice was reported at 77.5% in Kenya(56), 76.6% in Malawi(57), \u0026nbsp;72.4% in Tanzania(58), 56.5% in Uganda(59) and \u0026nbsp;57% in Iran(60). This variation might be due to variations in scope of the studies and sample size.\u003c/p\u003e\n\u003cp\u003eUnderstanding all the variations in the scope and level of emphasis to the assessment of oral hygiene, there exists differences in the level of tooth brushing practice. As an evidence for this is; reports from China and Italy reported a tooth brushing practice of 44.4% \u0026nbsp;(61) and 33.6% (62) respectively. Where such variation might be due to differences in population characteristics across the studies.\u003c/p\u003e\n\u003cp\u003eThere exists a variation in the distribution of level of oral hygiene (tooth brushing) across the global population. This uneven distribution to happen to the people might take on difference factors that includes service access differences, awareness level, perception, and healthcare infrastructure. A report from India revealed a level of tooth brushing practice of 99.5%, (63) which is by far higher than the current review report.\u003c/p\u003e\n\u003cp\u003eWith a relative understanding, studies from Eritrea and Sudan reported a tooth brushing practice \u0026nbsp;of 19.1% (64) \u0026nbsp;and 20% (30) respectively \u0026nbsp; which is almost comparable with the current review report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, an assessment from Saudi Arabia reported the tooth brushing practice of \u0026nbsp;41.5% (65). A study from \u0026nbsp;Jorpati, Kathmandu, Nepal also reported the tooth brushing practice of \u0026nbsp;36.9% (66). Comparing these findings with the current review report, it is clear that a higher level of oral hygiene practice. A finding from Nigeria also reported a higher level tooth brushing practice which was 28.46% (67). This variation might be due to differences in scope across the studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, studies from Malaysia and Tanzania revealed a much higher practice than the current finding. It was 59.4% \u0026nbsp;in Tanzania (68) and \u0026nbsp;75.3% in Malaysia (69). \u0026nbsp;Scope across the studies, sample sizes and population characteristics might have attributed for the observed variations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLimitation of the systematic reviw and Meta-Aanalysis:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the current study, tooth brushing was measured two or more times of tooth brushing per day. However, the authors didn\u0026rsquo;t get a comprehensive expression within the reviewed articles. \u0026nbsp;The authors acknowledge shoratge of related lietertaure while discussing the finding.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe review reported a lower level of tooth brushing practice in Ethioia. Strengthening tooth brushing practice in Ethiopia is a key to the promotion of oral hygiene and therefore; concerned bodies Should work on the identified oral health concern of the Ethiopian population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCI: Confidence Interval\u003c/p\u003e\n\u003cp\u003eMeSH: Medical Subject Heading\u003c/p\u003e\n\u003cp\u003ePRISMA: Preferred Reporting Items for Systematic Reviewsand Meta-Analyses\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSupporting Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS1 Appendix. PRISMA 2009 checklist\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availablity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The data that supported the finding of this study are available within the manuscript and supplementary file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSAT, WMT and FEM were involved in \u0026nbsp;development of the protocol, design, selection of the study, data extraction, statistical analysis, and developing developing the initial draft of the manuscript. All authors \u0026nbsp;prepared and edited the final draft of the mansucript. \u0026nbsp;All authors read and approaved the final draft of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding : \u003c/strong\u003eThe study was funded by the authors\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBenzian H, Watt R, Makino Y, Stauf N, Varenne B. WHO calls to end the global crisis of oral health. The Lancet. 2022;400(10367):1909-10.\u003c/li\u003e\n \u003cli\u003eJepsen S, Blanco J, Buchalla W, Carvalho JC, Dietrich T, D\u0026ouml;rfer C, et al. Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 of joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. Journal of clinical periodontology. 2017;44:S85-S93.\u003c/li\u003e\n \u003cli\u003eSilk H. Diseases of the mouth. 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PloS one. 2012;7(6):e39142.\u003c/li\u003e\n \u003cli\u003eDarout IA. Knowledge and behavior related to oral health among Jimma University Health Sciences students, Jimma, Ethiopia. European Journal of General Dentistry. 2014;3(03):185-9.\u003c/li\u003e\n \u003cli\u003eShenkute D, Asfaw T. Streptococcus mutans Dental Carries among Patients Attending Jimma University Specialized Hospital, Ethiopia.\u003c/li\u003e\n \u003cli\u003eDechssa M, Cherie A, Luelseged B. Tooth Brushing Practice and its Determinants among Adults Attending Dental Health Institutions in Addis Ababa, Ethiopia. Age.30(39):105.\u003c/li\u003e\n \u003cli\u003eAbate B, Ephrem M, Gebremariam M, Ayalew Y, Shimels T. Knowledge, Attitude and Practices towards Oral Hygiene among Students of Medhanealem High School, Addis Ababa, Ethiopia. 2020.\u003c/li\u003e\n \u003cli\u003eMeyrema A, Kedir T. Prevalence of oral health care and problems among Rift Valley university health sciences students in Adama, South East, Ethiopia. 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Factors associated with dental caries among selected urban school children in Kuala Lumpur, Malaysia. Archives of Orofacial Science. 2015;10(1).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tooth Brushing, Practice, Systematic Review, Meta-analysis \u0026 Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-2099035/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2099035/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Oral hygiene refers to taking care and maintaining the cleanness of gum and teeth; a good oral hygiene practice promotes better oral health in general. Oral hygiene is the top public health concern of the population. Tooth brushing is a technique to keep oral hygiene from related complications. Therefore, this study provides the pooled prevalence of tooth brushing practice in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Databases searched for articles systematically across PubMed, Google Scholar, Hinari, EMBASE, and African Journals Online. Two reviewers independently conducted the selection, screening, reviewing, and data extraction using a Microsoft Excel spreadsheet and used the Joanna Briggs Institute prevalence critical appraisal tools to assess the quality of evidence. All studies conducted in Ethiopia from 2010 to 2020, reporting tooth-brushing practices extracted for and imported into the Comprehensive meta-analysis version 3.0 for further analysis. Beggs and Eggers’s tests evaluated for publication bias with Higgins’s method evaluated for heterogeneity. A random-effects meta-analysis model with a 95% confidence interval was computed to estimate the pooled effect size (prevalence). Furthermore, the authors employed subgroup analysis based on the study area and sample size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults and Conclusion\u003c/strong\u003e: After reviewing 36, 10 articles fulfilled the inclusion criteria, and were included in the meta-analysis. The pooled prevalence of tooth brushing practice was 12.2 % (95% CI: 7.6%-19.2%). The review reported a lower level of tooth-brushing practice in Ethiopia. We recommended that special attention should be given to the oral hygiene of the Ethiopian people.\u003c/p\u003e","manuscriptTitle":"Tooth Brushing Practice in Ethiopia: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-19 20:51:50","doi":"10.21203/rs.3.rs-2099035/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2023-04-14T05:56:16+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"14c19395-5f30-4e32-8582-333116c9f007","date":"2023-03-06T07:55:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-02-22T01:02:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"551a959e-35c0-43a5-9c4f-a17e1652e4f2","date":"2023-02-22T00:47:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-02-22T00:20:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-02-10T05:52:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2023-02-06T08:37:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dfe657e3-b625-4595-ba9d-8533d44de07c","owner":[],"postedDate":"April 19th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":19106179,"name":"Health sciences/Diseases"},{"id":19106180,"name":"Health sciences/Health care"},{"id":19106181,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2023-10-16T20:37:43+00:00","versionOfRecord":{"articleIdentity":"rs-2099035","link":"https://doi.org/10.1038/s41598-023-33541-0","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2023-04-19 20:32:57","publishedOnDateReadable":"April 19th, 2023"},"versionCreatedAt":"2023-04-19 20:51:50","video":"","vorDoi":"10.1038/s41598-023-33541-0","vorDoiUrl":"https://doi.org/10.1038/s41598-023-33541-0","workflowStages":[]},"version":"v1","identity":"rs-2099035","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2099035","identity":"rs-2099035","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}