Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis
Abstract Background Risk factors for oral disease can potentially be ameliorated by school-based interventions. This review evaluates the effectiveness of primary school-based interventions in improving oral health among children in low-and middle-income countries (LMICs). Methods Our systematic rev...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | BMC Oral Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12903-022-02291-2 |
| _version_ | 1818117203316178944 |
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| author | Peter Akera Sean E. Kennedy Raghu Lingam Mark J. Obwolo Aletta E. Schutte Robyn Richmond |
| author_facet | Peter Akera Sean E. Kennedy Raghu Lingam Mark J. Obwolo Aletta E. Schutte Robyn Richmond |
| author_sort | Peter Akera |
| collection | DOAJ |
| description | Abstract Background Risk factors for oral disease can potentially be ameliorated by school-based interventions. This review evaluates the effectiveness of primary school-based interventions in improving oral health among children in low-and middle-income countries (LMICs). Methods Our systematic review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Medline, Embase, Global Health, CINAHL, Emcare, Scopus, Web of Science, WHO website, Google Advanced and Google Scholar were searched for experimental and observational studies published between 1995 and 2021 in English. Quality assessment and data extraction of the articles were performed by two independent reviewers. The primary outcome was decayed, missing, and filled teeth/surfaces [dmft(s)/DMFT(S)] scores. Seven meta-analyses were conducted. Results The search yielded 1178 publications and after removing duplicates, 753 remained. A further 648 publications were excluded after screening titles and abstracts. 105 publications were reviewed in full and 34 were included. Narrative synthesis showed school-based interventions had a positive effect on oral health outcomes. Meta-analysis showed a significant positive effect on dental caries measured by DMFT scores (standardised mean difference (SMD) = − 0.33; 95% CI − 0.56 to − 0.10; P = 0.005), net increment in DMFS scores (SMD = − 1.09; 95% CI − 1.91 to − 0.27; P = 0.009), dmft and DMFT/S score > 1 (Risk Ratio = 0.70; 95% CI 0.53 to 0.94; P = 0.02) and plaque scores (SMD = − 0.32; 95% CI − 0.46 to − 0.18; P < 0.00001). Non-significant positive effect was observed for dental caries measured by net increment in DMFT scores (SMD = − 0.34; 95% CI − 0.69 to 0.02; P = 0.06) and DMFS scores (SMD = − 0.26; 95% CI − 0.70 to 0.18; P = 0.24), and gingival health (SMD = 0.12; 95% CI − 0.32 to 0.55; P = 0.60). Certainty of evidence was assessed as very low for all oral health outcomes. Conclusion School-based interventions can be effective in reducing the burden of oral disease among primary school children in LMICs, with skills-based education, teacher training, provision of access to oral health services and parental engagement emerging as particularly promising. Further research is required to provide evidence of effectiveness of primary school-based interventions to improve oral health. Systematic review registration The title of this review was registered with PROSPERO (registration number: CRD42020202599). |
| first_indexed | 2024-12-11T04:34:41Z |
| format | Article |
| id | doaj.art-911c3a9699f2418ba1e74aea1b0f01c1 |
| institution | Directory Open Access Journal |
| issn | 1472-6831 |
| language | English |
| last_indexed | 2024-12-11T04:34:41Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
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| series | BMC Oral Health |
| spelling | doaj.art-911c3a9699f2418ba1e74aea1b0f01c12022-12-22T01:20:47ZengBMCBMC Oral Health1472-68312022-06-0122112010.1186/s12903-022-02291-2Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysisPeter Akera0Sean E. Kennedy1Raghu Lingam2Mark J. Obwolo3Aletta E. Schutte4Robyn Richmond5School of Population Health, Faculty of Medicine and Health, University of New South WalesSchool of Women’s and Children’s Health, Faculty of Medicine and Health, University of New South WalesSchool of Women’s and Children’s Health, Faculty of Medicine and Health, University of New South WalesDepartment of Public Health, Faculty of Medicine, Gulu UniversitySchool of Population Health, Faculty of Medicine and Health, University of New South WalesSchool of Population Health, Faculty of Medicine and Health, University of New South WalesAbstract Background Risk factors for oral disease can potentially be ameliorated by school-based interventions. This review evaluates the effectiveness of primary school-based interventions in improving oral health among children in low-and middle-income countries (LMICs). Methods Our systematic review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Medline, Embase, Global Health, CINAHL, Emcare, Scopus, Web of Science, WHO website, Google Advanced and Google Scholar were searched for experimental and observational studies published between 1995 and 2021 in English. Quality assessment and data extraction of the articles were performed by two independent reviewers. The primary outcome was decayed, missing, and filled teeth/surfaces [dmft(s)/DMFT(S)] scores. Seven meta-analyses were conducted. Results The search yielded 1178 publications and after removing duplicates, 753 remained. A further 648 publications were excluded after screening titles and abstracts. 105 publications were reviewed in full and 34 were included. Narrative synthesis showed school-based interventions had a positive effect on oral health outcomes. Meta-analysis showed a significant positive effect on dental caries measured by DMFT scores (standardised mean difference (SMD) = − 0.33; 95% CI − 0.56 to − 0.10; P = 0.005), net increment in DMFS scores (SMD = − 1.09; 95% CI − 1.91 to − 0.27; P = 0.009), dmft and DMFT/S score > 1 (Risk Ratio = 0.70; 95% CI 0.53 to 0.94; P = 0.02) and plaque scores (SMD = − 0.32; 95% CI − 0.46 to − 0.18; P < 0.00001). Non-significant positive effect was observed for dental caries measured by net increment in DMFT scores (SMD = − 0.34; 95% CI − 0.69 to 0.02; P = 0.06) and DMFS scores (SMD = − 0.26; 95% CI − 0.70 to 0.18; P = 0.24), and gingival health (SMD = 0.12; 95% CI − 0.32 to 0.55; P = 0.60). Certainty of evidence was assessed as very low for all oral health outcomes. Conclusion School-based interventions can be effective in reducing the burden of oral disease among primary school children in LMICs, with skills-based education, teacher training, provision of access to oral health services and parental engagement emerging as particularly promising. Further research is required to provide evidence of effectiveness of primary school-based interventions to improve oral health. Systematic review registration The title of this review was registered with PROSPERO (registration number: CRD42020202599).https://doi.org/10.1186/s12903-022-02291-2Oral healthPrimary schoolChildrenDental cariesMeta-analysis |
| spellingShingle | Peter Akera Sean E. Kennedy Raghu Lingam Mark J. Obwolo Aletta E. Schutte Robyn Richmond Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis BMC Oral Health Oral health Primary school Children Dental caries Meta-analysis |
| title | Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis |
| title_full | Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis |
| title_fullStr | Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis |
| title_full_unstemmed | Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis |
| title_short | Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis |
| title_sort | effectiveness of primary school based interventions in improving oral health of children in low and middle income countries a systematic review and meta analysis |
| topic | Oral health Primary school Children Dental caries Meta-analysis |
| url | https://doi.org/10.1186/s12903-022-02291-2 |
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