Dental Caries Prevalence and Associated Factors Among Primary School Children in Kigali, Rwanda: A Cross-Sectional Study
DOI:
https://doi.org/10.22270/ijmspr.v12i3.202Keywords:
dental caries, child oral health, epidemiology, risk factors, fluoride, parental involvement, Rwanda, East AfricaAbstract
Background: Dental caries represents a significant public health challenge in low- and middle-income countries, yet epidemiological data from sub-Saharan Africa remain scarce.
Objective: To determine the prevalence of dental caries and identify associated risk factors among 5–11-year-old children attending public primary schools in Kimironko Sector, Kigali, Rwanda.
Methods: This cross-sectional study employed stratified random sampling to recruit 325 children from three public primary schools (G.S. Kimironko I & II, E.P. Kibagabaga) between November 2024 and June 2025. Data collection comprised clinical oral examinations by calibrated dental examiners using WHO diagnostic criteria and parent-completed structured questionnaires assessing sociodemographic characteristics, dietary habits, oral hygiene practices, and parental knowledge. Chi-square tests examined bivariate associations, with statistical significance set at α=0.05.
Results: Dental caries prevalence was 51.1% (95% CI: 45.7–56.5%), with significant inter-school variation. Significant associations emerged for residence (OR=1.75, 95% CI: 1.11–2.76, p=0.015), dental visit frequency (p=0.045), parental reminders to brush (OR=2.55, 95% CI: 1.35–4.81, p=0.003), parental tooth-checking behavior (p=0.002), and composite parental knowledge score (p=0.031). Fluoride treatment showed an inverse association that did not reach statistical significance (OR=0.42, 95% CI: 0.17–1.07, p=0.077). No significant associations were detected for age, gender, or dietary habits.
Conclusions: Dental caries prevalence among Kimironko primary school children exceeds both national and regional estimates and was significantly associated with modifiable environmental and behavioral factors rather than demographic characteristics in bivariate analyses. Our findings underscore the urgent need for school-based preventive interventions to reduce this substantial disease burden.
Keywords: dental caries; child oral health; epidemiology; risk factors; fluoride; parental involvement; Rwanda; East Africa
References
Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJL, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J Dent Res. 2015;94(5):650-8. https://doi.org/10.1177/0022034515573272 PMid:25740856 PMCid:PMC11811587
Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent. 2019;29(3):238-48. https://doi.org/10.1111/ipd.12484 PMid:31099128
Alsumait A, ElSalhy M, Raine K, Cor K, Gokiert R, Al-Mutawa S, et al. Impact of dental health on children's oral health-related quality of life: a cross-sectional study. Health Qual Life Outcomes. 2015;13:98. https://doi.org/10.1186/s12955-015-0283-8 PMid:26149439 PMCid:PMC4491877
World Health Organization. Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030. Geneva: World Health Organization; 2022. Available from: https://www.who.int/publications/i/item/9789240061484 .
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005;83(9):661-9.
Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019;394(10194):249-60. https://doi.org/10.1016/S0140-6736(19)31146-8 PMid:31327369 PMCid:PMC9174604
Watt RG, Serban S, Arora M, Bomfim RA, Feldens CA, Foxley S, et al. Ending the neglect of global oral health: time for radical action. Lancet. 2019;394(10194):261-72. https://doi.org/10.1016/S0140-6736(19)31133-X PMid:31327370
Bowden GHW. The microbial ecology of dental caries. Microb Ecol Health Dis. 2000;12(3):138-48. https://doi.org/10.1080/089106000750051800
Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007;369(9555):51-9. https://doi.org/10.1016/S0140-6736(07)60031-2 PMid:17208642
Sheiham A. Dental caries affects body weight, growth and quality of life in pre-school children. Br Dent J. 2006;201(10):625-6. https://doi.org/10.1038/sj.bdj.4814259 PMid:17128231
Jackson SL, Vann WF Jr, Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children's school attendance and performance. Am J Public Health. 2011;101(10):1900-6. https://doi.org/10.2105/AJPH.2010.200915 PMid:21330579 PMCid:PMC3222359
Haag DG, Peres KG, Balasubramanian M, Brennan DS. Oral conditions and health-related quality of life: a systematic review. J Dent Res. 2017;96(8):864-74. https://doi.org/10.1177/0022034517709737 PMid:28581891
Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and tooth loss in adults in the United States, 2011-2012. NCHS Data Brief. 2015;(197):1-8.
Fleming E, Afful J. Prevalence of total and untreated dental caries among youth: United States, 2015-2016. NCHS Data Brief. 2018;(307):1-8.
Frencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T. Global epidemiology of dental caries and severe periodontitis - a comprehensive review. J Clin Periodontol. 2017;44 Suppl 18:S94-S105. https://doi.org/10.1111/jcpe.12677
Hooley M, Skouteris H, Boganin C, Satur J, Kilpatrick N. Body mass index and dental caries in children and adolescents: a systematic review of literature published 2004 to 2011. Syst Rev. 2012;1:57. https://doi.org/10.1186/2046-4053-1-57 PMid:23171603 PMCid:PMC3621095
Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers. 2017;3:17030. https://doi.org/10.1038/nrdp.2017.30 PMid:28540937 PMCid:PMC11811587
Bernabé E, Vos T, Arora M, Bartold M, Bhutta Z, Bhandari B, et al. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the Global Burden of Disease 2017 Study. J Dent Res. 2020;99(4):362-73. https://doi.org/10.1177/0022034520908533 PMid:32122215 PMCid:PMC7088322
Teshome A, Muche A, Girma B. Prevalence of dental caries and associated factors in East Africa, 2000-2020: systematic review and meta-analysis. Front Public Health. 2021;9:645091. https://doi.org/10.3389/fpubh.2021.645091 PMid:33996722 PMCid:PMC8116500
Mwakatobe AJ, Mumghamba EG. Dental caries experience and dietary intake among pre-school children in Morogoro, Tanzania. East Afr J Public Health. 2007;4(2):11-6.
Kiwanuka SN, Astrom AN, Trovik TA. Dental caries experience and its relationship to social and behavioural factors among 3-5-year-old children in Uganda. Int J Paediatr Dent. 2004;14(5):336-46. https://doi.org/10.1111/j.1365-263X.2004.00570.x PMid:15330999
Tafere Y, Chanie S, Dessie T, Gedamu H. Assessment of prevalence of dental caries and the associated factors among patients attending dental clinic in Debre Tabor general hospital: a hospital-based cross-sectional study. BMC Oral Health. 2018;18(1):119. https://doi.org/10.1186/s12903-018-0581-8 PMid:29973262 PMCid:PMC6030759
Rwanda Ministry of Health. National Oral Health Strategic Plan 2019-2024. Kigali: Ministry of Health; 2019.
Uwayezu D, Uwambaye P, Uwitonze AM, Murererehe J, Nzabonimana E, Ineza MC, et al. Prevalence of dental caries, its associated risk factors and treatment needs among school aged children at Kimironko II Primary School, Kigali, Rwanda. Rwanda J Med Health Sci. 2021;4(3):341-6. https://doi.org/10.4314/rjmhs.v4i3.3 PMid:40667405 PMCid:PMC12257230
World Health Organization. Oral Health Surveys: Basic Methods. 5th ed. Geneva: World Health Organization; 2013.
Kasangaki A, Sewankambo NK, Nkoyooyo JN, Okullo I. Prevalence of dental caries and associated risk factors in primary school children in Uganda: a school-based cross-sectional study. BMC Oral Health. 2022;22(1):186. doi:10.1186/s12903-022-02218-z
Al-Darwish M, El Ansari W, Bener A. Prevalence of dental caries among 12-14 year old children in Qatar. Saudi Dent J. 2014;26(3):115-25. https://doi.org/10.1016/j.sdentj.2014.03.001 PMid:25057231 PMCid:PMC4095052
Xu M, Yuan C, Sun X, Cheng M, Xie Y, Si Y. Caries experience in deciduous teeth and its association with risk factors in 3- to 5-year-old children in Shenyang, China. Clin Oral Investig. 2020;24(5):1869-77. doi:10.1007/s00784-019-03044-5
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-22. https://doi.org/10.1016/S0140-6736(20)30925-9 PMid:33069326 PMCid:PMC7567026
Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res. 2014;93(1):8-18. https://doi.org/10.1177/0022034513508954 PMid:24323509 PMCid:PMC3872848
Sheiham A, James WP. Diet and dental caries: the pivotal role of free sugars reemphasized. J Dent Res. 2015;94(10):1341-7. https://doi.org/10.1177/0022034515590377 PMid:26261186 PMCid:PMC11811587
World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva: World Health Organization; 2015.
Nanyingi NM, Gatheche LW, Ramadhani AM, Muturi PN, Githaiga JN. Fluoride levels in bottled water, tap water and fresh fruit juices in Nairobi, Kenya. J Water Health. 2017;15(3):428-35.
Psoter WJ, Reid BC, Katz RV. Malnutrition and dental caries: a review of the literature. Caries Res. 2005;39(6):441-7. https://doi.org/10.1159/000088178 PMid:16251787 PMCid:PMC1362953
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. https://doi.org/10.1002/ajhb.20530 PMid:16788889
Schwendicke F, Dörfer CE, Schlattmann P, Foster Page L, Thomson WM, Paris S. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res. 2015;94(1):10-18. https://doi.org/10.1177/0022034514557546 PMid:25394849 PMCid:PMC11811587
Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(1):CD002278. https://doi.org/10.1002/14651858.CD002278 PMid:12535435 PMCid:PMC8439270
Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013;(7):CD002279. https://doi.org/10.1002/14651858.CD002279.pub2 PMid:23846772 PMCid:PMC10758998
Weintraub JA, Ramos-Gomez F, Jue B, Shain S, Hoover CI, Featherstone JD, et al. Fluoride varnish efficacy in preventing early childhood caries. J Dent Res. 2006;85(2):172-6. https://doi.org/10.1177/154405910608500211 PMid:16434737 PMCid:PMC2257982
Ekwunife OI, Okafor CE, Ezenduka CC, Udeogaranya OP. Cost-utility analysis of community-based preventive interventions to reduce caries burden in children. Int J Technol Assess Health Care. 2013;29(4):423-31. https://doi.org/10.1017/S0266462313000469 PMid:24290336
Sköld UM, Petersson LG, Lith A, Birkhed D. Effect of school-based fluoride varnish programmes on approximal caries in adolescents from different caries risk areas. Caries Res. 2005;39(4):273-9. https://doi.org/10.1159/000084800 PMid:15914983
Adair PM, Pine CM, Burnside G, Nicoll AD, Gillett A, Anwar S, et al. Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economically diverse groups. Community Dent Health. 2004;21(1 Suppl):102-11.
Finlayson TL, Siefert K, Ismail AI, Sohn W. Maternal self-efficacy and 1-5-year-old children's brushing habits. Community Dent Oral Epidemiol. 2007;35(4):272-81. https://doi.org/10.1111/j.1600-0528.2007.00313.x PMid:17615014
Pine CM, Adair PM, Nicoll AD, Burnside G, Petersen PE, Beighton D, et al. International comparisons of health inequalities in childhood dental caries. Community Dent Health. 2004;21(1 Suppl):121-30.
Fishbein M, Ajzen I. Predicting and Changing Behavior: The Reasoned Action Approach. New York: Psychology Press; 2010. https://doi.org/10.4324/9780203838020
Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143-64. https://doi.org/10.1177/1090198104263660 PMid:15090118 PMCid:PMC8127012
Gao X, Lo ECM, Kot SCCY, Chan KCW. Motivational interviewing and oral health promotion in schoolchildren: a randomized controlled trial. J Dent Res. 2014;93(6):589-95. doi:10.1177/0022034514534915
Hooley M, Skouteris H, Boganin C, Satur J, Kilpatrick N. Parental influence and the development of dental caries in children aged 0-6 years: a systematic review of the literature. J Dent. 2012;40(11):873-85. https://doi.org/10.1016/j.jdent.2012.07.013 PMid:22842202
Frazão P, Peres MA, Cury JA. Toothbrushing frequency in Brazilian children by age and socio-economic background. Community Dent Health. 2008;25(4):241-5.
Ssebagala J, Astrøm AN, Tumwine JK, Kasangaki A. Toothbrushing behaviour and associated factors among primary school children in Uganda: a cross-sectional study. BMC Oral Health. 2020;20(1):215. https://doi.org/10.1186/s12903-020-01195-3 PMid:32819333 PMCid:PMC7439720
Republic of Rwanda. Rwanda National Child Nutrition Policy. Kigali: Ministry of Health; 2020. Available from: https://www.moh.gov.rw/fileadmin/templates/policies/Rwanda_National_Child_Nutrition_Policy.pdf [Accessed 10 June 2026].
Bhatt DL, Bhattacharya J, Brewer L, et al. Global oral health: time for action. Lancet. 2022;400(10361):1373-74. doi:10.1016/S0140-6736(22)02034-2
Published
How to Cite
Issue
Section
Copyright (c) 2026 Collins Nimbiye Agholor, Danilo Milanes Zambrano, Jean Marc Ubuntubwayesu , Alex Nshuti
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
.