Prevalence, Determinants, And Sociocultural Correlates Of Early Childhood Caries Among Preschool Children In Urban Kano, Nigeria

Prevalence, Determinants, And Sociocultural Correlates Of Early Childhood Caries Among Preschool Children In Urban Kano, Nigeria | 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 Research Article Prevalence, Determinants, And Sociocultural Correlates Of Early Childhood Caries Among Preschool Children In Urban Kano, Nigeria Chizoba Chineme Okolo, Taiwo G Amole This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9057715/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: Early childhood caries (ECC) represents a significant public health burden in Nigeria, yet epidemiological data from northern regions remain scarce. This study aimed to determine the prevalence, severity, and key determinants of ECC among preschool children in urban Kano, northern Nigeria. Methods: A community-based cross-sectional study was conducted among 162 children aged 3–5 years in Kano Municipal and Nasarawa Local Government Areas, selected through multistage sampling. Data were collected using structured questionnaires administered to parents/caregivers, clinical oral examinations using both WHO/dmft and International Caries Detection and Assessment System (ICDAS) criteria, and salivary microbial analysis. Bivariate and multivariate logistic regression analyses identified determinants of ECC. Results: The prevalence of ECC was 16.7% (95% CI: 11.3–23.3%) using dmft criteria, with a mean dmft of 2.4 ± 2.5 among affected children. ICDAS assessment revealed a substantially higher prevalence of 33.3%, with early-stage lesions (ICDAS 1 and 2) predominating (28.4% of total sample). Females exhibited higher caries severity (mean dmft 3.3 ± 3.1) compared to males (1.3 ± 0.5). Multivariate analysis identified frequent consumption of sugary snacks and drinks (AOR = 3.06, 95% CI: 1.06–8.83, p = 0.04) and previous dental visits (AOR = 5.90, 95% CI: 1.26–27.55, p = 0.02) as significant determinants of ECC. Bivariate analysis revealed associations with increasing age ( p = 0.05), Hausa ethnicity ( p = 0.02), and Islamic religion ( p = 0.01). Conclusion: ECC prevalence in urban Kano is substantial, with early lesions frequently undetected by traditional dmft indices. The paradoxical association between dental visits and higher caries prevalence indicates predominantly crisis-driven rather than preventive care utilisation. Culturally tailored prevention strategies focusing on dietary modification and early screening using ICDAS are urgently needed in northern Nigeria. Early childhood caries prevalence determinants sociocultural factors ICDAS Nigeria preschool children Introduction Early childhood caries (ECC) remains one of the most prevalent yet preventable chronic diseases affecting children globally, with an estimated 48% of preschool children affected worldwide [ 1 ]. In Nigeria, available data suggest ECC prevalence ranging from 4.3% to 23.5% among children under six years [ 2 – 6 ]. However, these estimates predominantly originate from studies conducted in southern Nigeria, creating a significant knowledge gap regarding the true burden in northern regions where dietary patterns, cultural practices, and healthcare access differ substantially [ 7 ]. The development of ECC results from a complex interplay of biological, behavioural, and socioeconomic factors [ 8 ]. Dietary practices, particularly frequent consumption of fermentable carbohydrates, serve as primary substrates for cariogenic bacteria [ 9 ]. Oral hygiene behaviours, fluoride exposure, and feeding practices further modulate individual caries risk [ 10 ]. Socioeconomic and cultural determinants profoundly influence ECC through multiple pathways, with low socioeconomic status consistently emerging as a strong predictor across diverse populations [ 11 ]. Northern Nigeria presents unique sociocultural characteristics that may influence ECC risk profiles [ 7 ]. The predominantly Muslim population, Hausa ethnic majority, traditional feeding practices including early introduction of sweetened weaning foods, and distinctive oral hygiene methods using miswak (traditional chewing sticks) create a context potentially different from southern Nigerian populations [ 12 , 13 ]. Furthermore, previous Nigerian ECC studies have predominantly utilised WHO diagnostic criteria that detect only cavitated lesions, potentially underestimating true disease burden [ 14 ]. This study aimed to bridge these critical knowledge gaps by determining the prevalence and severity of ECC using both traditional and enhanced diagnostic criteria, and identifying key determinants among preschool children in urban Kano, northern Nigeria. The findings provide essential baseline data for oral health surveillance and inform culturally appropriate prevention strategies in this understudied region. Methods Study Design and Setting A community-based analytical cross-sectional study was conducted between September and November 2024 in urban Kano, northwest Nigeria. Kano State, with an estimated population of 16.4 million, comprises eight urban local government areas (LGAs) characterised by mixed planned residential areas and informal settlements with variable access to healthcare and water fluoridation [ 15 ]. Study Population and Sampling The study population consisted of children aged 36–71 months residing in selected urban LGAs. A minimum sample size of 160 was determined using the formula for single population proportion, based on 10.5% ECC prevalence from a previous Nigerian study [ 2 ], 95% confidence level, 5% precision, and 10% non-response adjustment. A multistage sampling technique was employed. First, two LGAs (Kano Municipal and Nasarawa) were selected from eight urban LGAs using simple random sampling. Second, one ward was selected from each LGA (Sharada and Bompai wards, respectively). Third, ten streets were randomly selected from each ward. Finally, systematic house-to-house visits identified eligible children until the allocated sample per street was achieved. Inclusion and Exclusion Criteria Children were included if they were aged 36–71 months, had teeth present for clinical assessment, had parents/guardians who provided written informed consent, and were cooperative for oral examination. Children with debilitating conditions or acute oral infections at examination time were excluded. Data Collection Instruments and Procedures Data were collected using: (1) a structured interviewer-administered questionnaire adapted from validated instruments, covering sociodemographics, dietary practices, oral hygiene behaviours, and healthcare utilisation; (2) clinical examination forms recording dental findings using dmft and ICDAS criteria; and (3) salivary sample collection for microbial analysis. Clinical examinations were performed by trained dental surgeons using sterile mouth mirrors and WHO periodontal probes under artificial illumination. Teeth were cleaned of debris and dried with cotton rolls before examination. Caries diagnosis followed ICDAS criteria (0–6), with additional recording of dmft scores. Measurement and Operationalisation of Variables The primary outcome was ECC status, operationalised as binary (presence/absence) using dmft > 0. Secondary outcomes included caries severity using ICDAS classification and mean dmft scores. Dental caries severity was classified according to WHO DMFT thresholds (0–1.1 very low, 1.2–2.6 low, 2.7–4.4 moderate, 4.5–6.5 high, ≥ 6.6 very high) [ 16 ]. Independent variables included child characteristics (age, sex, ethnicity), family factors (parental education, family structure), dietary practices (sugary snack/drink consumption frequency), oral hygiene behaviours (brushing frequency, fluoride toothpaste use), and healthcare utilisation (dental-visit history). Data Quality Assurance Research assistants underwent comprehensive training and calibration exercises. Inter-examiner reliability yielded Kappa scores of 0.82 for dmft and 0.95 for ICDAS assessments. Questionnaires were pretested and validated. Daily review of completed forms ensured completeness and consistency. Data Analysis Data were analysed using IBM SPSS Statistics version 26.0. Descriptive statistics summarised sociodemographic characteristics and ECC prevalence. Bivariate analysis examined associations using chi-square or Fisher's exact tests. Variables with p < 0.20 in bivariate analysis were included in multivariate binary logistic regression using backward stepwise approach. Multicollinearity was assessed using variance inflation factor. Statistical significance was set at p ≤ 0.05. Ethical Considerations Ethical approval for this study was obtained from the Kano State Health Research Ethics Committee, which is affiliated with the Kano State Ministry of Health, Kano State Government, Nigeria (Reference Number: NHREC/17/03/2018). The committee is registered with the National Health Research Ethics Committee of Nigeria (NHREC). The study was conducted in accordance with the principles of the Declaration of Helsinki and Nigerian national guidelines for health research ethics. Written informed consent was obtained from parents/guardians of all participating children prior to enrollment in the study. For children aged 4 years and above, additional verbal assent was obtained following age-appropriate explanation of the study procedures. Parents/guardians were informed of their right to withdraw from the study at any time without penalty. All participants received free oral health examinations and appropriate referrals for treatment when indicated. Results Sociodemographic Characteristics The study included 162 children with mean age 49.2 ± 8.9 months. The predominant religion was Islam, and Hausa was the major ethnic group. Most parents had tertiary education and the majority of children were fully immunised (Table 1 ). Table 1 Sociodemographic characteristics of study participants ( n = 162) Characteristics Category n (%) Sex Female 93 (57.4) Male 69 (42.6) Age (Months) 36–47 64 (39.5) 48–59 73 (45.1) 60–71 25 (15.4) Religion Islam 98 (60.5) Christianity 64 (39.5) Ethnicity Hausa 73 (45.9) Non-Hausa 89 (54.1) Mother’s education Tertiary 146 (91.3) Secondary and below 14 (8.7) Father’s education Tertiary 138 (86.2) Secondary and below 22 (13.8) Immunisation status Fully immunized 142 (89.3) Not fully immunized 17 (10.7) Prevalence and Severity of Early Childhood Caries Using dmft criteria, 27 children had ECC, yielding a prevalence of 16.7% with a mean dmft of 2.4 ± 2.5. Females had higher mean dmft compared to males, and the 60–71 months age group had the highest mean dmft (Table 2 ). Table 2 Prevalence and distribution of ECC using dmft index dmft score Total n = 162 (%) Male n = 69 (%) Female n = 93 (%) 36-47months n = 64 (%) 48–59 months n = 73 (%) 60–71 months n = 25 (%) 0 135 (83.3) 57 (82.6) 78 (83.9) 59 (92.2) 57 (78.1) 19 (76.0) ≥ 1 27 (16.7) 12 (17.4) 15 (16.1) 5 (7.8) 16 (21.9) 6 (24.0) Mean dmft ± SD* 2.4 ± 2.5 1.3 ± 0.5 3.3 ± 3.1 1.4 ± 0.5 2.1 ± 2.3 4.3 ± 3.2 WHO Scale Low Very low Moderate Low Low Moderate *Among affected children only ICDAS assessment revealed that 54 children (33.3%) have detectable lesions (ICDAS > 0). Early-stage lesions (ICDAS 1 and 2) predominated, and caries prevalence is higher among females (59.3%) and the 48–59 months age group (57.5% of affected children) (Table 3 ). Table 3 Distribution of caries severity using ICDAS by sex and age-groups ICDAS class Total N = 162 n(%) Sex n (%) Age-group (months) Male n = 69 Female n = 93 36–47 n = 64 (%) 48–59 n = 73 (%) 60–71 n = 25 (%) 0 (no caries) 108 (66.7) 47 (68.1) 61 (65.6) 48 (75.0) 42 (57.5) 18 (72.0) 1 (first visual change) 18 (11.1) 4 (5.8) 14 (15.1) 4 (6.3) 10 (13.7) 4 (16.0) 2 (distinct visual change) 28 (17.3) 15 (21.7) 13 (14.0) 9 (14.1) 8 (24.7) 1 (4.0) ≥ 3 (Moderate/advanced) 8 (4.9) 3 (4.3) 5 (5.4) 3 (4.7) 3 (4.1) 2 (8.0) Total (ICDAS ≥ 0) 54 (33.3) 22 (40.7) 32 (59.3) 16 (29.6) 31 (57.5) 7 (13.0) Determinants of Early Childhood Caries Bivariate analysis only revealed significant associations between ECC and age, Hausa ethnicity, Islamic religion, frequent sugary snack/drink consumption and dental visit history (Table 4 ). Table 4 Bivariate analysis of determinants associated with ECC Determinant Category ECC present n % ECC absent n % p -value Age-group 36–47 months 5 (7.8) 59 (92.2) 0.05 48–59 months 16 (21.9) 57 (78.1) 60–71 months 6 (24.0) 19 (76.0) Ethnicity Hausa 21 (22.8) 71 (77.2) 0.02 Non-Hausa 6 (9.0) 61 (91.0) Religion Islam 22 (22.4) 76 (77.6) 0.01 Christianity 5 (7.8) 59 (92.2) Sugary snack/drink Frequent 12 (30.0) 28 (70.0) 0.03 Infrequent 12 (10.5) 10.2 (89.5) Dental-visit history Yes 5 (55.6) 4 (44.4) 0.007 No 22 (14.5) 130 (85.5) Multivariate logistic regression identified two independent determinants: frequent consumption of sugary snacks and drinks and previous dental visits (Table 5 ). Table 5 Multivariate analysis of determinants of ECC Factor Category AOR (95% CI) p -value Age (months) 36–47 Ref 48–59 2.75 (0.80–9.41) 0.11 60–71 2.44 (0.56–10.74) 0.24 Religion Christianity Ref Islam 2.37 (0.71–7.95) 0.61 Child’s dental visit No Ref Yes 5.90 (1.26–27.55) 0.02 Sugary snack and drink Infrequent Ref Frequent 3.06 (1.06–8.83) 0.04 Discussion This study provides crucial epidemiological data on ECC in urban Kano, northern Nigeria, revealing a prevalence of 16.7% by dmft criteria, which aligns with the documented range for Nigerian paediatric urban populations[ 2 – 6 ]. However, the substantially higher prevalence detected by ICDAS (33.3%) underscores the limitation of traditional dmft indices that capture only cavitated lesions, potentially missing up to half of affected children in early disease stages[ 14 ]. This finding has significant public health implications, suggesting that ECC burden in Nigeria may be considerably underestimated in previous studies relying solely on WHO criteria. The predominance of early-stage lesions (ICDAS 1 and 2) represents both a challenge and opportunity for the children in this study. While indicating substantial disease burden, these reversible lesions are amenable to non-invasive preventive interventions such as fluoride varnish application, dietary counselling, and improved oral hygiene [ 17 ]. This highlights the urgent need for early detection systems and preventive-oriented dental services in northern Nigeria, where current healthcare-seeking patterns appear predominantly crisis-driven [ 18 , 19 ]. The gender disparity observed in the current study, with females exhibiting higher caries severity, corroborates findings from previous studies in Nigeria and globally [ 20 , 21 ]. Proposed explanations include earlier tooth eruption in girls leading to longer exposure to cariogenic challenges, potential hormonal influences on salivary composition, and sociocultural factors affecting dietary preferences and oral hygiene practices [ 20 ]. This gender dimension warrants consideration in targeted prevention strategies. The association between Hausa ethnicity and higher caries prevalence highlights the intersection of cultural practices and oral health outcomes. Traditional Hausa feeding practices, including early introduction of sweetened weaning foods like kunnu (millet-based drink) and fura da nono (millet balls with milk), often supplemented with honey or sugar for palatability, create a cariogenic dietary environment from infancy [ 12 ]. Furthermore, culturally significant foods consumed during religious festivities, such as dates ( dabino ) and sweetened hibiscus drink ( zobo ), create periods of intensified sugar exposure [ 12 ]. These findings emphasise the necessity of culturally grounded dietary interventions that respect traditional food practices while reducing cariogenic potential through practical modifications. Frequent consumption of sugary snacks and drinks emerged as the most significant modifiable determinant of ECC, consistent with established caries aetiology models [ 9 ]. This finding gains particular relevance in the context of Nigeria's ongoing nutrition transition, where urbanisation has increased accessibility of processed foods and sugar-sweetened beverages while traditional high-sugar foods remain culturally embedded [ 12 ]. Effective interventions must balance cultural preservation with health promotion, focusing on reducing frequency of sugar consumption rather than unrealistic prohibitions, and exploring culturally acceptable alternatives. The paradoxical association between dental visits and higher caries prevalence reveals critical insights into healthcare-seeking behaviours in this population. Rather than indicating preventive care utilisation, dental visits appear predominantly symptom-driven, with children presenting only when experiencing pain, swelling, or functional impairment [ 18 , 19 ]. This reactive approach means interventions occur at advanced disease stages, missing opportunities for early prevention. The finding underscores the need to transform dental care utilisation patterns through community education, integration of oral health into primary healthcare, and addressing cultural beliefs that may delay professional consultation. The relatively high parental education in our sample (over 85% tertiary education) is atypical for northern Nigeria, where nationally representative surveys show a predominance of no formal schooling and very low tertiary attainment, particularly in rural areas [ 22 ]. This likely reflects selection bias towards more accessible, better-educated urban households and which may have underestimated true ECC prevalence, as lower socioeconomic status consistently associates with higher caries risk globally [ 11 ]. Future studies should include more socioeconomically diverse samples to better represent population heterogeneity. Strengths and Limitations This study's strengths include use of enhanced diagnostic criteria (ICDAS), community-based sampling, comprehensive assessment of determinants, and focus on an understudied region. Limitations include cross-sectional design precluding causal inferences, potential recall bias in parental reporting, urban sample limiting rural generalisability, and possible social desirability bias in self-reported behaviours. The unexpected finding of high parental education suggests possible selection bias towards more accessible households. Conclusion This study reveals substantial ECC burden among preschool children in urban Kano, with early lesions frequently undetected by traditional indices. Frequent sugary consumption and crisis-driven dental visits emerge as key modifiable determinants. The findings underscore the need for: (1) enhanced surveillance using ICDAS or similar sensitive criteria; (2) culturally tailored prevention strategies addressing dietary practices; (3) transformation of healthcare-seeking patterns towards preventive care; and (4) integration of oral health into maternal and child health programmes. These evidence-based recommendations can inform policy and programming to reduce ECC burden in northern Nigeria and similar regions. Recommendations Health System Strengthening: Integrate ICDAS-based screening into routine paediatric assessments at primary healthcare centres. Incorporate fluoride varnish application into immunisation schedules as a feasible preventive strategy. Community-Based Interventions: Develop culturally appropriate educational materials addressing traditional feeding practices and promoting early preventive dental visits. Engage religious and community leaders as oral health advocates. Policy Development: Advocate for inclusion of preventive paediatric dental care in health insurance schemes. Consider regulatory measures on sugar content in commercial weaning foods. Further Research: Conduct longitudinal studies to establish causal relationships. Explore rural-urban disparities and cost-effectiveness of various prevention strategies in northern Nigerian context. Declarations Ethics Approval and Consent to Participate Ethical approval for this study was obtained from the Kano State Health Research Ethics Committee (Reference Number: NHREC/17/03/2018). The study was conducted in accordance with the principles of the Declaration of Helsinki and Nigerian national guidelines for health research ethics. Written informed consent was obtained from parents/guardians of all participating children prior to enrollment in the study. For children aged 4 years and above, additional verbal assent was obtained following age-appropriate explanation of the study procedures. Parents/guardians were informed of their right to withdraw from the study at any time without penalty. All participants received free oral health examinations and appropriate referrals for treatment when indicated. Consent for Publication Not applicable. This manuscript does not contain any individual person's data in any form (including individual details, images, or videos). All data are presented in aggregate form only. Availability of Data and Materials The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Access to individual-level data will be subject to approval and completion of a data sharing agreement in accordance with institutional data protection policies and ethical guidelines. Summary data supporting the findings of this study are included in this published article. Competing Interests The authors declare that they have no competing interests. No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. Funding This research was funded by a small research grant from the Africa Centre of Excellence in Population Health and Policy (ACEPHAP), Bayero University, Kano, Nigeria. The grant supported laboratory consumables for salivary microbial analysis. ACEPHAP is supported by the World Bank through the Africa Centers of Excellence for Impact Project (ACE Impact). The funding body played no role in the design of the study, data collection, analysis, interpretation of data, or in writing the manuscript. The views expressed in this publication are those of the authors and do not necessarily reflect the views of ACEPHAP or the World Bank. Authors' Contributions CCO (Chizoba C. Okolo): Conceptualization, Methodology, Investigation, Formal Analysis, Writing – Original Draft, Writing – Review & Editing, Project Administration, Funding Acquisition. TGA (Taiwo G. Amole): Supervision, Writing – Review & Editing. All authors read and approved the final manuscript. Acknowledgements The authors thank the parents and children who participated in this study for their cooperation and willingness to contribute to advancing oral health knowledge. We acknowledge the research assistants for their dedication during data collection and the community leaders in Kano Municipal and Nasarawa Local Government Areas for facilitating access to the communities. We are grateful to the Africa Centre of Excellence in Population Health and Policy (ACEPHAP), Bayero University Kano, for financial and technical support. We also thank the Kano State Health Research Ethics Committee for ethical oversight of this study. References Chen J, Duangthip D, Gao SS, et al. Oral health policies to tackle the burden of early childhood caries: a review of 14 countries/regions. Front Oral Health. 2021;2:670154. Olatosi OO, Inem V, Sofola OO, et al. The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution. Niger J Clin Pract. 2015;18(4):493–501. Iyun OI. Prevalence and pattern of early childhood caries in Ibadan, Nigeria. Afr J Med Med Sci. 2014;43(3):239–44. Folayan MO, Oginni AB, El Tantawi M, et al. Epidemiological profile of early childhood caries in a sub-urban population in Nigeria. BMC Oral Health. 2021;21(1):1–10. Onyejaka NK, Amobi EO. 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Individual, family, and socioeconomic contributors to dental caries in children from low-and middle-income countries. Int J Environ Res Public Health. 2022;19(12):7114. Petrikova I, Bhattacharjee R, Fraser PD. The ‘Nigerian diet’and its evolution: review of the existing literature and household survey data. Foods. 2023;12(3):443. Bos G. The miswak, an aspect of dental care in Islam. Med Hist. 1993;37(1):68–79. Frencken JE, Giacaman RA, Leal SC. An assessment of three contemporary dental caries epidemiological instruments: a critical review. Br Dent J. 2020;228(1):25–31. Kano State. Subdivision. www.citypopulation.de. [cited 2025 Aug 18]. World Health Organization. Oral health surveys: basic methods. World Health Organization; 2013. World Health Organization. Global strategy and action plan on oral health 2023–2030. Geneva: WHO; 2024. Aborisade A, Okolo C, Aminu R, Moghalu H, Aminu N, Bamgbose B. Pattern of dental services utilization among adolescents and adults in Kano, Northern Nigeria. Pyramid J Med. 2024;7(1). Okolo CC, Adeyemo YI, Oguchi CO, et al. An analysis of the practice of accompanying paediatric patients for dental treatment in Kano, Nigeria. Niger J Med. 2022;31:581–4. Lukacs JR, Largaespada LL. Explaining sex differences in dental caries prevalence: Saliva, hormones, and life-history etiologies. Am J Hum Biol. 2006;18(4):540–55. Okolo CC, Aborisade AO, Oguchi CO, et al. A systematic review and meta-analysis on the epidemiology of early childhood caries in Nigeria. Discov Public Health. 2024;21:1–7. Okoli CI, Hajizadeh M, Rahman MM, Khanam R. Geographic and socioeconomic inequalities in the survival of children under-five in Nigeria. Sci Rep. 2022;12(1):8389. Additional Declarations No competing interests reported. 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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-9057715","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633644091,"identity":"853854b0-28d3-4a64-976c-0db1f4677577","order_by":0,"name":"Chizoba Chineme Okolo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYHACZgaGAhCdw/iYgSGBAYIJajEAa2E2JlkLmzRRWvjbDx82+GBgA2TkHqsubEtj4GfPMWAu+IVbi8SZtOTEGQZpQMa7tNsz23IYJHveGDDP7MOtxUCCx/gwj8FhICPH7DZvWwWDwQ2gLbw9RGopBmmxJ0ZLMkwLMy/QYUCGATPPD/x+MQT6hUfizBtj6RnnQIxnBYd5G3BrAYWYxIcKGzn+9hzDzwVlyUBG8sbHPH9wa4EBHhTGAcY2wlrQARG2jIJRMApGwYgBAOd/ReqPqQ5hAAAAAElFTkSuQmCC","orcid":"","institution":"Bayero University","correspondingAuthor":true,"prefix":"","firstName":"Chizoba","middleName":"Chineme","lastName":"Okolo","suffix":""},{"id":633644092,"identity":"dc4c2cd1-4d8a-4d9b-a17d-d6524c9e462a","order_by":1,"name":"Taiwo G Amole","email":"","orcid":"","institution":"Bayero University","correspondingAuthor":false,"prefix":"","firstName":"Taiwo","middleName":"G","lastName":"Amole","suffix":""}],"badges":[],"createdAt":"2026-03-07 10:39:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9057715/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9057715/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108804146,"identity":"6a97d162-b2eb-4d9a-b9c2-ed6548d3a461","added_by":"auto","created_at":"2026-05-08 15:16:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":330665,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9057715/v1/8e434578-3790-4ed1-bdba-0711489dd471.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence, Determinants, And Sociocultural Correlates Of Early Childhood Caries Among Preschool Children In Urban Kano, Nigeria","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEarly childhood caries (ECC) remains one of the most prevalent yet preventable chronic diseases affecting children globally, with an estimated 48% of preschool children affected worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Nigeria, available data suggest ECC prevalence ranging from 4.3% to 23.5% among children under six years [\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, these estimates predominantly originate from studies conducted in southern Nigeria, creating a significant knowledge gap regarding the true burden in northern regions where dietary patterns, cultural practices, and healthcare access differ substantially [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe development of ECC results from a complex interplay of biological, behavioural, and socioeconomic factors [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Dietary practices, particularly frequent consumption of fermentable carbohydrates, serve as primary substrates for cariogenic bacteria [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Oral hygiene behaviours, fluoride exposure, and feeding practices further modulate individual caries risk [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Socioeconomic and cultural determinants profoundly influence ECC through multiple pathways, with low socioeconomic status consistently emerging as a strong predictor across diverse populations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNorthern Nigeria presents unique sociocultural characteristics that may influence ECC risk profiles [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The predominantly Muslim population, Hausa ethnic majority, traditional feeding practices including early introduction of sweetened weaning foods, and distinctive oral hygiene methods using miswak (traditional chewing sticks) create a context potentially different from southern Nigerian populations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, previous Nigerian ECC studies have predominantly utilised WHO diagnostic criteria that detect only cavitated lesions, potentially underestimating true disease burden [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aimed to bridge these critical knowledge gaps by determining the prevalence and severity of ECC using both traditional and enhanced diagnostic criteria, and identifying key determinants among preschool children in urban Kano, northern Nigeria. The findings provide essential baseline data for oral health surveillance and inform culturally appropriate prevention strategies in this understudied region.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eA community-based analytical cross-sectional study was conducted between September and November 2024 in urban Kano, northwest Nigeria. Kano State, with an estimated population of 16.4\u0026nbsp;million, comprises eight urban local government areas (LGAs) characterised by mixed planned residential areas and informal settlements with variable access to healthcare and water fluoridation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population and Sampling\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of children aged 36\u0026ndash;71 months residing in selected urban LGAs. A minimum sample size of 160 was determined using the formula for single population proportion, based on 10.5% ECC prevalence from a previous Nigerian study [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], 95% confidence level, 5% precision, and 10% non-response adjustment.\u003c/p\u003e \u003cp\u003eA multistage sampling technique was employed. First, two LGAs (Kano Municipal and Nasarawa) were selected from eight urban LGAs using simple random sampling. Second, one ward was selected from each LGA (Sharada and Bompai wards, respectively). Third, ten streets were randomly selected from each ward. Finally, systematic house-to-house visits identified eligible children until the allocated sample per street was achieved.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eChildren were included if they were aged 36\u0026ndash;71 months, had teeth present for clinical assessment, had parents/guardians who provided written informed consent, and were cooperative for oral examination. Children with debilitating conditions or acute oral infections at examination time were excluded.\u003c/p\u003e\n\u003ch3\u003eData Collection Instruments and Procedures\u003c/h3\u003e\n\u003cp\u003eData were collected using: (1) a structured interviewer-administered questionnaire adapted from validated instruments, covering sociodemographics, dietary practices, oral hygiene behaviours, and healthcare utilisation; (2) clinical examination forms recording dental findings using dmft and ICDAS criteria; and (3) salivary sample collection for microbial analysis.\u003c/p\u003e \u003cp\u003eClinical examinations were performed by trained dental surgeons using sterile mouth mirrors and WHO periodontal probes under artificial illumination. Teeth were cleaned of debris and dried with cotton rolls before examination. Caries diagnosis followed ICDAS criteria (0\u0026ndash;6), with additional recording of dmft scores.\u003c/p\u003e\n\u003ch3\u003eMeasurement and Operationalisation of Variables\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was ECC status, operationalised as binary (presence/absence) using dmft\u0026thinsp;\u0026gt;\u0026thinsp;0. Secondary outcomes included caries severity using ICDAS classification and mean dmft scores. Dental caries severity was classified according to WHO DMFT thresholds (0\u0026ndash;1.1 very low, 1.2\u0026ndash;2.6 low, 2.7\u0026ndash;4.4 moderate, 4.5\u0026ndash;6.5 high, \u0026ge;\u0026thinsp;6.6 very high) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIndependent variables included child characteristics (age, sex, ethnicity), family factors (parental education, family structure), dietary practices (sugary snack/drink consumption frequency), oral hygiene behaviours (brushing frequency, fluoride toothpaste use), and healthcare utilisation (dental-visit history).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Quality Assurance\u003c/h2\u003e \u003cp\u003eResearch assistants underwent comprehensive training and calibration exercises. Inter-examiner reliability yielded Kappa scores of 0.82 for dmft and 0.95 for ICDAS assessments. Questionnaires were pretested and validated. Daily review of completed forms ensured completeness and consistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analysed using IBM SPSS Statistics version 26.0. Descriptive statistics summarised sociodemographic characteristics and ECC prevalence. Bivariate analysis examined associations using chi-square or Fisher's exact tests. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.20 in bivariate analysis were included in multivariate binary logistic regression using backward stepwise approach. Multicollinearity was assessed using variance inflation factor. Statistical significance was set at p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for this study was obtained from the Kano State Health Research Ethics Committee, which is affiliated with the Kano State Ministry of Health, Kano State Government, Nigeria (Reference Number: NHREC/17/03/2018). The committee is registered with the National Health Research Ethics Committee of Nigeria (NHREC). The study was conducted in accordance with the principles of the Declaration of Helsinki and Nigerian national guidelines for health research ethics.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e Written informed consent was obtained from parents/guardians of all participating children prior to enrollment in the study. For children aged 4 years and above, additional verbal assent was obtained following age-appropriate explanation of the study procedures. Parents/guardians were informed of their right to withdraw from the study at any time without penalty. All participants received free oral health examinations and appropriate referrals for treatment when indicated.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic Characteristics\u003c/h2\u003e \u003cp\u003eThe study included 162 children with mean age 49.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9 months. The predominant religion was Islam, and Hausa was the major ethnic group. Most parents had tertiary education and the majority of children were fully immunised (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of study participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;162)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (57.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69 (42.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (Months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (39.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (45.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (15.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98 (60.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (39.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHausa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (45.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Hausa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (54.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother\u0026rsquo;s education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e146 (91.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (8.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather\u0026rsquo;s education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138 (86.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (13.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmunisation status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFully immunized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142 (89.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot fully immunized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence and Severity of Early Childhood Caries\u003c/h2\u003e \u003cp\u003eUsing dmft criteria, 27 children had ECC, yielding a prevalence of 16.7% with a mean dmft of 2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5. Females had higher mean dmft compared to males, and the 60\u0026ndash;71 months age group had the highest mean dmft (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence and distribution of ECC using dmft index\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003edmft score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;162 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;69 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;93 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36-47months \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;64 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48\u0026ndash;59 months \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;73 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60\u0026ndash;71 months \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25 (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (83.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59 (92.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57 (78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19 (76.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026ge;\u003c/b\u003e\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (24.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean dmft \u0026plusmn; SD*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.4 \u0026plusmn; 2.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.3 \u0026plusmn; 0.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3.3 \u0026plusmn; 3.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.4 \u0026plusmn; 0.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.1 \u0026plusmn; 2.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e4.3 \u0026plusmn; 3.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWHO Scale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eVery low\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Among affected children only\u003c/p\u003e \u003cp\u003eICDAS assessment revealed that 54 children (33.3%) have detectable lesions (ICDAS\u0026thinsp;\u0026gt;\u0026thinsp;0). Early-stage lesions (ICDAS 1 and 2) predominated, and caries prevalence is higher among females (59.3%) and the 48\u0026ndash;59 months age group (57.5% of affected children) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of caries severity using ICDAS by sex and age-groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eICDAS class\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal N\u0026thinsp;=\u0026thinsp;162 n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSex \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAge-group (months)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;69\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;93\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u0026ndash;47 n\u0026thinsp;=\u0026thinsp;64 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48\u0026ndash;59 n\u0026thinsp;=\u0026thinsp;73 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60\u0026ndash;71 n\u0026thinsp;=\u0026thinsp;25 (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 (no caries)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (68.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e42 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e18 (72.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 (first visual change)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 (distinct visual change)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1 (4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 (Moderate/advanced)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal (ICDAS\u0026thinsp;\u0026ge;\u0026thinsp;0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e54 (33.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e22 (40.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e32 (59.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e16 (29.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e31 (57.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e7 (13.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of Early Childhood Caries\u003c/h2\u003e \u003cp\u003eBivariate analysis only revealed significant associations between ECC and age, Hausa ethnicity, Islamic religion, frequent sugary snack/drink consumption and dental visit history (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis of determinants associated with ECC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeterminant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eECC present \u003cem\u003en\u003c/em\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eECC absent \u003cem\u003en\u003c/em\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge-group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;47 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59 (92.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u0026ndash;59 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57 (78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;71 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19 (76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHausa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71 (77.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Hausa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61 (91.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76 (77.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59 (92.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSugary snack/drink\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfrequent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.2 (89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDental-visit history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e130 (85.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMultivariate logistic regression identified two independent determinants: frequent consumption of sugary snacks and drinks and previous dental visits (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis of determinants of ECC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.75 (0.80\u0026ndash;9.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.44 (0.56\u0026ndash;10.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.37 (0.71\u0026ndash;7.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild\u0026rsquo;s dental visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.90 (1.26\u0026ndash;27.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSugary snack and drink\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfrequent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.06 (1.06\u0026ndash;8.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides crucial epidemiological data on ECC in urban Kano, northern Nigeria, revealing a prevalence of 16.7% by dmft criteria, which aligns with the documented range for Nigerian paediatric urban populations[\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, the substantially higher prevalence detected by ICDAS (33.3%) underscores the limitation of traditional dmft indices that capture only cavitated lesions, potentially missing up to half of affected children in early disease stages[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This finding has significant public health implications, suggesting that ECC burden in Nigeria may be considerably underestimated in previous studies relying solely on WHO criteria.\u003c/p\u003e \u003cp\u003eThe predominance of early-stage lesions (ICDAS 1 and 2) represents both a challenge and opportunity for the children in this study. While indicating substantial disease burden, these reversible lesions are amenable to non-invasive preventive interventions such as fluoride varnish application, dietary counselling, and improved oral hygiene [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This highlights the urgent need for early detection systems and preventive-oriented dental services in northern Nigeria, where current healthcare-seeking patterns appear predominantly crisis-driven [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe gender disparity observed in the current study, with females exhibiting higher caries severity, corroborates findings from previous studies in Nigeria and globally [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Proposed explanations include earlier tooth eruption in girls leading to longer exposure to cariogenic challenges, potential hormonal influences on salivary composition, and sociocultural factors affecting dietary preferences and oral hygiene practices [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This gender dimension warrants consideration in targeted prevention strategies.\u003c/p\u003e \u003cp\u003eThe association between Hausa ethnicity and higher caries prevalence highlights the intersection of cultural practices and oral health outcomes. Traditional Hausa feeding practices, including early introduction of sweetened weaning foods like \u003cem\u003ekunnu\u003c/em\u003e (millet-based drink) and \u003cem\u003efura da nono\u003c/em\u003e (millet balls with milk), often supplemented with honey or sugar for palatability, create a cariogenic dietary environment from infancy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, culturally significant foods consumed during religious festivities, such as dates (\u003cem\u003edabino\u003c/em\u003e) and sweetened hibiscus drink (\u003cem\u003ezobo\u003c/em\u003e), create periods of intensified sugar exposure [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These findings emphasise the necessity of culturally grounded dietary interventions that respect traditional food practices while reducing cariogenic potential through practical modifications.\u003c/p\u003e \u003cp\u003eFrequent consumption of sugary snacks and drinks emerged as the most significant modifiable determinant of ECC, consistent with established caries aetiology models [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This finding gains particular relevance in the context of Nigeria's ongoing nutrition transition, where urbanisation has increased accessibility of processed foods and sugar-sweetened beverages while traditional high-sugar foods remain culturally embedded [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Effective interventions must balance cultural preservation with health promotion, focusing on reducing frequency of sugar consumption rather than unrealistic prohibitions, and exploring culturally acceptable alternatives.\u003c/p\u003e \u003cp\u003eThe paradoxical association between dental visits and higher caries prevalence reveals critical insights into healthcare-seeking behaviours in this population. Rather than indicating preventive care utilisation, dental visits appear predominantly symptom-driven, with children presenting only when experiencing pain, swelling, or functional impairment [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This reactive approach means interventions occur at advanced disease stages, missing opportunities for early prevention. The finding underscores the need to transform dental care utilisation patterns through community education, integration of oral health into primary healthcare, and addressing cultural beliefs that may delay professional consultation.\u003c/p\u003e \u003cp\u003eThe relatively high parental education in our sample (over 85% tertiary education) is atypical for northern Nigeria, where nationally representative surveys show a predominance of no formal schooling and very low tertiary attainment, particularly in rural areas [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This likely reflects selection bias towards more accessible, better-educated urban households and which may have underestimated true ECC prevalence, as lower socioeconomic status consistently associates with higher caries risk globally [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Future studies should include more socioeconomically diverse samples to better represent population heterogeneity.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study's strengths include use of enhanced diagnostic criteria (ICDAS), community-based sampling, comprehensive assessment of determinants, and focus on an understudied region. Limitations include cross-sectional design precluding causal inferences, potential recall bias in parental reporting, urban sample limiting rural generalisability, and possible social desirability bias in self-reported behaviours. The unexpected finding of high parental education suggests possible selection bias towards more accessible households.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reveals substantial ECC burden among preschool children in urban Kano, with early lesions frequently undetected by traditional indices. Frequent sugary consumption and crisis-driven dental visits emerge as key modifiable determinants. The findings underscore the need for: (1) enhanced surveillance using ICDAS or similar sensitive criteria; (2) culturally tailored prevention strategies addressing dietary practices; (3) transformation of healthcare-seeking patterns towards preventive care; and (4) integration of oral health into maternal and child health programmes. These evidence-based recommendations can inform policy and programming to reduce ECC burden in northern Nigeria and similar regions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealth System Strengthening: Integrate ICDAS-based screening into routine paediatric assessments at primary healthcare centres. Incorporate fluoride varnish application into immunisation schedules as a feasible preventive strategy.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCommunity-Based Interventions: Develop culturally appropriate educational materials addressing traditional feeding practices and promoting early preventive dental visits. Engage religious and community leaders as oral health advocates.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePolicy Development: Advocate for inclusion of preventive paediatric dental care in health insurance schemes. Consider regulatory measures on sugar content in commercial weaning foods.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFurther Research: Conduct longitudinal studies to establish causal relationships. Explore rural-urban disparities and cost-effectiveness of various prevention strategies in northern Nigerian context.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Kano State Health Research Ethics Committee (Reference Number: NHREC/17/03/2018). The study was conducted in accordance with the principles of the Declaration of Helsinki and Nigerian national guidelines for health research ethics.\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from parents/guardians of all participating children prior to enrollment in the study. For children aged 4 years and above, additional verbal assent was obtained following age-appropriate explanation of the study procedures. Parents/guardians were informed of their right to withdraw from the study at any time without penalty. All participants received free oral health examinations and appropriate referrals for treatment when indicated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person's data in any form (including individual details, images, or videos). All data are presented in aggregate form only.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Access to individual-level data will be subject to approval and completion of a data sharing agreement in accordance with institutional data protection policies and ethical guidelines. Summary data supporting the findings of this study are included in this published article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests. No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by a small research grant from the Africa Centre of Excellence in Population Health and Policy (ACEPHAP), Bayero University, Kano, Nigeria. The grant supported laboratory consumables for salivary microbial analysis. ACEPHAP is supported by the World Bank through the Africa Centers of Excellence for Impact Project (ACE Impact).\u003c/p\u003e\n\u003cp\u003eThe funding body played no role in the design of the study, data collection, analysis, interpretation of data, or in writing the manuscript. The views expressed in this publication are those of the authors and do not necessarily reflect the views of ACEPHAP or the World Bank.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCCO\u003c/strong\u003e (Chizoba C. Okolo): Conceptualization, Methodology, Investigation, Formal Analysis, Writing – Original Draft, Writing – Review \u0026amp; Editing, Project Administration, Funding Acquisition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTGA\u003c/strong\u003e (Taiwo G. Amole): Supervision, Writing – Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the parents and children who participated in this study for their cooperation and willingness to contribute to advancing oral health knowledge. We acknowledge the research assistants for their dedication during data collection and the community leaders in Kano Municipal and Nasarawa Local Government Areas for facilitating access to the communities. We are grateful to the Africa Centre of Excellence in Population Health and Policy (ACEPHAP), Bayero University Kano, for financial and technical support. We also thank the Kano State Health Research Ethics Committee for ethical oversight of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen J, Duangthip D, Gao SS, et al. Oral health policies to tackle the burden of early childhood caries: a review of 14 countries/regions. Front Oral Health. 2021;2:670154.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlatosi OO, Inem V, Sofola OO, et al. The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution. Niger J Clin Pract. 2015;18(4):493\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIyun OI. Prevalence and pattern of early childhood caries in Ibadan, Nigeria. Afr J Med Med Sci. 2014;43(3):239\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFolayan MO, Oginni AB, El Tantawi M, et al. Epidemiological profile of early childhood caries in a sub-urban population in Nigeria. BMC Oral Health. 2021;21(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnyejaka NK, Amobi EO. Risk factors of early childhood caries among children in Enugu, Nigeria. Pesqui Bras Odontopediatria Cl\u0026iacute;n Integr. 2016;16(1):381\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAborisade AO, Okolo CC, Oguchi CO, Alalade O. Protocol for a Systematic Review and Meta-analysis of the Epidemiology of Early Childhood Caries in Nigeria. J Prim Care Dentistry Oral Health. 2024;5(2):49\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOziegbe EO, Schepartz LA. Is parity a cause of tooth loss? Perceptions of northern Nigerian Hausa women. PLoS ONE. 2019;14(12):e0226158.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBegzati A, Berisha M, Mrasori S et al. Early childhood caries (ECC)\u0026mdash;etiology, clinical consequences and prevention. Emerg Trends Oral Health Sci Dent. 2015;31\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBradshaw DJ, Lynch RJ. Diet and the microbial aetiology of dental caries: new paradigms. Int Dent J. 2013;63:64\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer F, Enax J. Early childhood caries: epidemiology, aetiology, and prevention. Int J Dent. 2018;2018:1415873.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYousaf M, Aslam T, Saeed S, et al. Individual, family, and socioeconomic contributors to dental caries in children from low-and middle-income countries. Int J Environ Res Public Health. 2022;19(12):7114.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetrikova I, Bhattacharjee R, Fraser PD. The \u0026lsquo;Nigerian diet\u0026rsquo;and its evolution: review of the existing literature and household survey data. Foods. 2023;12(3):443.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBos G. The miswak, an aspect of dental care in Islam. Med Hist. 1993;37(1):68\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrencken JE, Giacaman RA, Leal SC. An assessment of three contemporary dental caries epidemiological instruments: a critical review. Br Dent J. 2020;228(1):25\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKano State. Subdivision. www.citypopulation.de. [cited 2025 Aug 18].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Oral health surveys: basic methods. World Health Organization; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Global strategy and action plan on oral health 2023\u0026ndash;2030. Geneva: WHO; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAborisade A, Okolo C, Aminu R, Moghalu H, Aminu N, Bamgbose B. Pattern of dental services utilization among adolescents and adults in Kano, Northern Nigeria. Pyramid J Med. 2024;7(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkolo CC, Adeyemo YI, Oguchi CO, et al. An analysis of the practice of accompanying paediatric patients for dental treatment in Kano, Nigeria. Niger J Med. 2022;31:581\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLukacs JR, Largaespada LL. Explaining sex differences in dental caries prevalence: Saliva, hormones, and life-history etiologies. Am J Hum Biol. 2006;18(4):540\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkolo CC, Aborisade AO, Oguchi CO, et al. A systematic review and meta-analysis on the epidemiology of early childhood caries in Nigeria. Discov Public Health. 2024;21:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkoli CI, Hajizadeh M, Rahman MM, Khanam R. Geographic and socioeconomic inequalities in the survival of children under-five in Nigeria. Sci Rep. 2022;12(1):8389.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Early childhood caries, prevalence, determinants, sociocultural factors, ICDAS, Nigeria, preschool children","lastPublishedDoi":"10.21203/rs.3.rs-9057715/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9057715/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eEarly childhood caries (ECC) represents a significant public health burden in Nigeria, yet epidemiological data from northern regions remain scarce. This study aimed to determine the prevalence, severity, and key determinants of ECC among preschool children in urban Kano, northern Nigeria.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA community-based cross-sectional study was conducted among 162 children aged 3\u0026ndash;5 years in Kano Municipal and Nasarawa Local Government Areas, selected through multistage sampling. Data were collected using structured questionnaires administered to parents/caregivers, clinical oral examinations using both WHO/dmft and International Caries Detection and Assessment System (ICDAS) criteria, and salivary microbial analysis. Bivariate and multivariate logistic regression analyses identified determinants of ECC.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe prevalence of ECC was 16.7% (95% CI: 11.3\u0026ndash;23.3%) using dmft criteria, with a mean dmft of 2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 among affected children. ICDAS assessment revealed a substantially higher prevalence of 33.3%, with early-stage lesions (ICDAS 1 and 2) predominating (28.4% of total sample). Females exhibited higher caries severity (mean dmft 3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1) compared to males (1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5). Multivariate analysis identified frequent consumption of sugary snacks and drinks (AOR\u0026thinsp;=\u0026thinsp;3.06, 95% CI: 1.06\u0026ndash;8.83, p\u0026thinsp;=\u0026thinsp;0.04) and previous dental visits (AOR\u0026thinsp;=\u0026thinsp;5.90, 95% CI: 1.26\u0026ndash;27.55, p\u0026thinsp;=\u0026thinsp;0.02) as significant determinants of ECC. Bivariate analysis revealed associations with increasing age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05), Hausa ethnicity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02), and Islamic religion (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eECC prevalence in urban Kano is substantial, with early lesions frequently undetected by traditional dmft indices. The paradoxical association between dental visits and higher caries prevalence indicates predominantly crisis-driven rather than preventive care utilisation. Culturally tailored prevention strategies focusing on dietary modification and early screening using ICDAS are urgently needed in northern Nigeria.\u003c/p\u003e","manuscriptTitle":"Prevalence, Determinants, And Sociocultural Correlates Of Early Childhood Caries Among Preschool Children In Urban Kano, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 09:03:32","doi":"10.21203/rs.3.rs-9057715/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"247952397729693635924722517150094350914","date":"2026-05-08T16:28:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-23T10:34:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-14T11:02:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-18T11:53:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-17T21:11:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-03-17T14:44:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ab558ef-9c9f-46d9-929f-2c0cecaca099","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"247952397729693635924722517150094350914","date":"2026-05-08T16:28:10+00:00","index":59,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T09:03:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 09:03:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9057715","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9057715","identity":"rs-9057715","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}