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Association between early childhood caries and poverty in low and middle income countries.

ABSTRACT: BACKGROUND:The aim of this study was to assess the relationship between early childhood caries (ECC) in 3-5-year-old children, seven indicators of poverty and the indicator of monetary poverty in low- and middle-income countries (LICs, MICs). METHODS:This ecologic study utilized 2007 to 2017 country-level data for LICs and MICs. Explanatory variables were seven indicators of poverty namely food, water, sanitation, health, shelter, access to information, education; and monetary poverty. The outcome variable was the percentage of 3-5-year-old children with ECC. A series of univariate general linear regression models were used to assess the relationship between the percentage of 3-5?year-old children with ECC and each of the seven indicators of poverty, and monetary poverty. This was followed by multivariable regression models to determined the combined effect of the seven indicators of poverty, as well as the combined effect of the seven indicators of poverty and monetary poverty. Adjusted R2 measured models' ability to explain the variation among LICs and MICs in the percentage of 3-5-year-old children with ECC. RESULTS:Significantly more people had food, sanitation, shelter, access to information, education and monetary poverty in LICs than in MICs. There was no difference in the prevalence of ECC in 3-5-year-old children between LICs and MICs. The combination of the seven indicators of poverty explained 15% of the variation in the percentage of 3-5-year-old children with ECC compared to 1% explained by monetary poverty. When the seven indicators of poverty and the indicator for monetary poverty were combined, the amount of variation explained by them was 10%. Only two of the poverty indicators had a direct relationship with the percentage of children with ECC; there was a higher percentage of ECC in countries with higher percentage of population living in slums (B?=?0.35) and in those countries with higher percentage of the population living below poverty lines (B?=?0.19). The other indicators had an inverse relationship. CONCLUSION:The use of multiple indicators to measures of poverty explained greater amount of variation in the percentage of 3-5-year-olds with ECC in LICs and MICs than using only the indicator for monetary poverty.

SUBMITTER: Folayan MO

PROVIDER: S-EPMC6945445 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:INTRODUCTIONDisability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability and economic poverty, with a focus on the situation in low and middle income countries (LMICs).METHODSTen electronic databases were searched to retrieve studies of any epidemiological design, published between 1990-March 2016 with data comparing the level of poverty between people with and without disabilities in LMICs (World Bank classifications). Poverty was defined using economic measures (e.g. assets, income), while disability included both broad assessments (e.g. self-reported functional or activity limitations) and specific impairments/disorders. Data extracted included: measures of association between disability and poverty, population characteristics and study characteristics. Proportions of studies finding positive, negative, null or mixed associations between poverty and disability were then disaggregated by population and study characteristics.RESULTSFrom the 15,500 records retrieved and screened, 150 studies were included in the final sample. Almost half of included studies were conducted in China, India or Brazil (n = 70, 47%). Most studies were cross-sectional in design (n = 124, 83%), focussed on specific impairment types (n = 115, 77%) and used income as the measure for economic poverty (n = 82, 55%). 122 studies (81%) found evidence of a positive association between disability and a poverty marker. This relationship persisted when results were disaggregated by gender, measure of poverty used and impairment types. By country income group at the time of data collection, the proportion of country-level analyses with a positive association increased with the rising income level, with 59% of low-income, 67% of lower-middle and 72% of upper-middle income countries finding a positive relationship. By age group, the proportion of studies reporting a positive association between disability and poverty was lowest for older adults and highest for working-age adults (69% vs. 86%).CONCLUSIONSThere is strong evidence for a link between disability and poverty in LMICs and an urgent need for further research and programmatic/policy action to break the cycle.

Project description:AimThis ecological study examined the associations between the prevalence of early childhood caries (ECC), overweight, country's per capita sugar consumption and duration of exclusive breastfeeding.MethodsPer capita consumption of sugar in kilograms, percentage of children exclusively breastfed until 6 months of age, percentage of 0-5-year-old children with overweight status, and percentage of 3-5-year-old children with ECC were compared among low-income countries (LICs), middle-income countries (MICs) and high-income countries (HICs). The association between the prevalence of ECC and the study variables, and the effect modification by income region were assessed using multivariable linear regression models. Regression coefficients, confidence intervals, partial eta squared and P-values for effect modification were calculated.ResultsThe per capita sugar consumption in LICs was significantly lower than in MICs (P = 0.001) and HICs (P < 0.001). The percentage of infants who exclusively breastfed up to 6 months was significantly lower in HICs than in LICs (P < 0.001) and MICs (P = 0.003). The prevalence of overweight was significantly lower in LICs than in MICs (P < 0.001) and HICs (P = 0.021). The prevalence of ECC was significantly lower in HICs than in MICs (P < 0.001). Income was a significant modifier of the associations between the prevalence of ECC, per capita sugar consumption (P = 0.005), and exclusive breastfeeding up to 6 months (P = 0.03). The associations between the prevalence of ECC and per capita sugar consumption at the global level and for MICs were stronger (partial eta squared = 0.05 and 0.13 respectively) than for LICs and HICs (partial eta squared <0.0001 and 0.003 respectively). Only in MICs was there a significant association between the prevalence of ECC and per capita sugar consumption (P = 0.002), and between the prevalence of ECC and the percentage of children exclusively breastfed up to 6 months (P = 0.02).ConclusionThough the quantity of sugar consumption and exclusive breastfeeding may be a significant risk indicator for ECC in MICs, sugar consumption may be more of a risk indicator for ECC in HICs than in LICs, and vice versa for exclusive breastfeeding. Although ECC and overweight are both sugar-related diseases, we found no significant relationship between them.

Project description:BackgroundGrowth and early development (ECD) are vital outcomes for children. This study aimed to examine the association between child growth and overall development in children aged 3 to 5?years in low- and middle-income countries.MethodsA secondary analysis of nationally representative data collected in UNICEF's Multiple Indicator Cluster Surveys (MICS) and national Demographic and Health Surveys (DHS). The early development of children aged 3 to 5?years from the randomly selected households was ascertained using a 10-item scale which assessed four developmental domains: language-cognitive, physical, socio-emotional, and approaches to learning with a total development score ranging from 0 (the least optimal) to 10 (the most optimal). Children's growth, the height-for-age Z score (HAZ), was calculated using the WHO Child Growth Standards. Unadjusted (Pearson's correlation coefficient, r) and adjusted estimations (standardised mean difference (SMD) adjusted for child sex, child age, and household wealth index) of the magnitude of the association between HAZ and ECD scores were calculated for each country.ResultsData contributed by 178,393 children aged 36 to 59?months from 55 countries were included in the analyses. The pooled r between HAZ and standardised ECD scores was 0.12 and the pooled adjusted SMD was 0.06. The r ranged from ~?0 in Barbados, Lebanon, and Moldova to 0.32 in Pakistan and 0.36 in Nigeria. Overall, 47/55 countries had correlation coefficients less than the cut-off for a small association. The adjusted SMDs were ~?0 in 20 countries. All SMDs were lower than the cut-off for a small effect size. The magnitudes of the association were highest in South Asia and lowest in Middle East and North Africa, and lowest in the highest HDI group.ConclusionsThe association between growth and development in early childhood appears to be primarily a co-occurrence because the magnitude of the association varies among settings from no association in higher-income countries to a moderate level in low-income countries. In low-income countries, interventions targeting child growth and ECD should be integrated given their common risks frequency in these settings. Overall, growth is not a sensitive and therefore suitable indicator of child development.

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Association between early childhood caries and poverty in low and middle income countries.

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