Non-utilization of oral health services in ecuadorian children and its associated factors: a cross-sectional study
Abstract
Background: Oral health care plays a critical role in childhood. Factors influencing the non-utilization of oral health services must be identified to improve oral health in children. Objective: To estimate the frequency of non-utilization of oral health services in Ecuadorian children and identify its associated factors.
Material and Methods: A cross-sectional study was conducted in a probabilistic sample of 8,461 Ecuadorian children aged 5-9. The data were obtained from the 2012 National Survey of Health and Nutrition. The information on oral health care and sociodemographic variables was collected through a questionnaire applied to mothers or caregivers of the children. Bivariate and multivariate analyses, using logistic regression, were employed to identify factors associated with the non-utilization of oral health services.
Results: 30.6% (95% CI:29.6-31.6) did not visit the dentist in the last year before the survey. 47.5% of parents or guardians mentioned that it was unnecessary, 13.8% did not attend due to a lack of time, and 9.8% did not have the necessary funds. Non-utilization of oral health services was associated with living in urban areas (OR: 1.26; 95% CI 1.13-1.41), in the Coast region (OR: 1.55; 95% CI 1.37-1.74), self-identify as indigenous (OR: 1.72; 95% CI 1.48-2.01), that the child lives only with the mother (OR: 1.13; 95% CI 1.01-1.28), only with the father (OR: 1.48; 95% CI 1.01-2.17), or in the absence of both (OR: 1.54; 95% CI 1.22-1.94). For each year of increasing age, the probability of not visiting the dentist decreased by 6% (OR: 0.94; 95% CI 0.90-0.97) and for each increase in the socioeconomic quintile by 11% (OR: 0.89; 95% CI 0.86-0.93).
Conclusions: Demographic and socioeconomic factors associated with the non-utilization of oral health services in Ecuador act as barriers to dental care.
References
World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. Regional summary of the Region of the Americas. World Health Organization. Geneva; 2023.
Mitchell C. Pan American Health Organization/World Health Organization. La salud bucodental es esencial para la salud general. 2021.
Ferreira RG, Bastianini ME, Marsicano JA, Prado RL do. Influence of socioeconomic conditions on access to oral health services: a scoping review. Research, Society and Development. 2022;11(7):e26911729890–e26911729890.
Jackson SL, Vann WF, 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.
Sischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. 2011;90(11):1264–70. http://doi.org/101177/0022034511399918.
Malele-Kolisa Y, Yengopal V, Igumbor J, Nqcobo CB, Ralephenya TRD. Systematic review of factors influencing oral health-related quality of life in children in Africa. Afr J Prim Health Care Fam Med. 2019;11(1):1943.
Geetha Priya PR, Asokan S, Janani RG, Kandaswamy D. Effectiveness of school dental health education on the oral health status and knowledge of children: A systematic review. Indian J Dent Res. 2019;30(3):437–49.
de la Cruz SP, Cebrino J. Oral Health Problems and Utilization of Dental Services among Spanish and Immigrant Children and Adolescents. Int J Environ Res Public Health. 2020;17(3).
Goswami S, Tseveenjav B, Kaila M. Non-utilization of oral health services and associated factors among children and adolescents: an integrative review. Acta Odontol Scand. 2023;81(2):105–18.
da Costa VPP, Goettems ML, de Oliveira LJC, Tarquinio SBC, Torriani DD, Correa MB, et al. Nonuse of dental service by schoolchildren in Southern Brazil: impact of socioeconomics, behavioral and clinical factors. Int J Public Health. 2015;60(4):411–6.
López R, Baelum V. Factors associated with dental attendance among adolescents in Santiago, Chile. BMC Oral Health. 2007;7(1):4.
Seminario AL, DeRouen T, Cholera M, Liu J, Phantumvanit P, Kemoli A, Castillo J, Pitiphat W. Mitigating Global Oral Health Inequalities: Research Training Programs in Low- and Middle-Income Countries. Ann Glob Health. 2020; 86(1):141. http://doi.org/10.5334/aogh.3134. PM ID: 33200072; PMCID: PMC7646278.
Baldani MH, Mendes YBE, De Campos Lawder JA, De Lara API, Da Silva Rodrigues MMA, Antunes JLF. Inequalities in dental services utilization among Brazilian low-income children: The role of individual determinants. J Public Health Dent. 2011;71(1):46–53.
Ministerio de Salud Pública del Ecuador. Ma-nual del Modelo de Atención Integral del Sis-tema Nacional de Salud Familiar Comunitario e Intercultural (MAIS-FCI). Subsecretaría nacio-nal de gobernanza de la salud pública. Quito -Ecuador: MSP; 2012.
Parise-Vasco JM, Zambrano-Achig P, Viteri-García A, Armas-Vega A. Estado de la salud bucal en el Ecuador. Odontología Sanmarquina. 2020;23(3):327–31.
Herrera-Franco G, Montalván-Burbano N, Mora-Frank C, Bravo-Montero, Lady. Scientific Research in Ecuador: A Bibliometric Analysis. Publications. 2021;9(4):55.
Freire W, Romero N, Ramirez M, Belmont P, Piñeiros P MR. Tomo II. Encuesta Nacional de Salud y Nutrición del Ecuador. ENSANUT-ECU 2011-2013 Ministerio de Salud Pública/Instituto Nacional de Estadísticas y Censos. Quito, Ecuador. Primera Ed. 2014.
Instituto Nacional de Estadística y Censos del Ecuador. 2018.
Instituto Nacional de estadísticas y Censos INEC. Ecuador en cifras. 2023.
Banco Mundial. Datos sobre las cuentas nacionales del Banco Mundial y archivos de datos sobre cuentas nacionales de la OCDE. 2021. PIB per cápita (US$ a precios actuales) - Ecuador.
Lucio R, Villacrés N, Henríquez R. Sistema de salud de Ecuador. Salud Publica Mex. 2011; 53(suppl. 2):177–87.
Machry RV, Tuchtenhagen S, Agostini BA, da Silva Teixeira CR, Piovesan C, Mendes FM, Ardenghi TM. Socioeconomic and psychosocial predictors of dental healthcare use among Brazilian preschool children. BMC Oral Health. 2013;13:60. https://doi.org/10.1186/1472-6831-13-60. PMID: 24171711; PMCID: PMC3816203.
Medina-Solís CE. Desigualdades socioeconó-micas en la utilización de servicios de alud bucal: estudio en escolares mexicanos de 6 a 12 años de edad. Cad Saúde Pública, Rio de Janeiro. 2009.
Sen B, Blackburn J, Morrisey MA, Kilgore ML, Becker DJ, Caldwell C, Menachemi N. Ef-fectiveness of preventive dental visits in reducing nonpreventive dental visits and expenditures. Pediatrics. 2013;131(6):1107-13. https://doi.org/10.1542/peds.2012-2586. Epub 2013 May 27. PMID: 23713098.
Souza JGS, Sampaio AA, Costa Oliveira BE, Jones KM, Martins AMEDBL. Socioeconomic inequalities in the use of dental care services during early childhood: an epidemiological survey. Int J Paediatr Dent. 2018;28(4):400–9.
López R, Baelum V. Factors associated with dental attendance among adolescents in Santiago, Chile. BMC Oral Health. 2007;7(1):4.
Lebrun-Harris LA, Canto MT, Vodicka P. Preven-tive oral health care use and oral health status among US children: 2016 National Survey of Children’s Health. J Am Dent Assoc. 2019;150(4):246–58.
NHS Dental Statistics for England, 2021-22, Annual Report - NHS Digital.
Darmawikarta D, Chen Y, Carsley S, Birken CS, Parkin PC, Schroth RJ, Maguire JL; TARGet Kids! Collaboration. Factors associated with dental care utilization in early childhood. Pediatrics. 2014;133(6):e1594-600. https://doi.org/10.1542/peds.2013-3725. Epub 2014 May 5. PMID: 2479 9544.
Badri P, Saltaji H, Flores-Mir C, Amin M. Factors affecting children's adherence to regular dental attendance: a systematic review. J Am Dent Assoc. 2014;145(8):817-28. https://doi.org/10.14219/jada.2014.49. PMID: 25082930.
Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine. 2012;9.
Alhareky M, Nazir MA. Dental Visits and Pre-dictors of Regular Attendance Among Female Schoolchildren in Dammam, Saudi Arabia. Clin Cosmet Investig Dent. 2021; 13:97–104.
Nourijelyani K, Yekaninejad MS, Eshraghian MR, Mohammad K, Rahimi Foroushani A, Pakpour A. The influence of mothers’ lifestyle and health behavior on their children: an exploration for oral health. Iran Red Crescent Med J. 2014;16(2): e16051.
Folayan MO, Coelho EMRB, Ayouni I, Nguweneza A, Al-Batayneh OB, Daryanavard H, Duangthip D, Sun IG, Arheiam A, Virtanen JI, Gaffar B, El Tantawi M, Schroth RJ, Feldens CA. Association between early childhood caries and parental education and the link to the sustainable development goal 4: a scoping review. BMC Oral Health. 2024;24(1):517. https://doi.org/10.1186/s12903-024-04291-w. PMID: 38698356; PMCID: PMC11064360.
Moimaz SAS, Fadel CB, Lolli LF, Garbin CAS, Garbin AJÍ, Saliba NA. Social aspects of dental caries in the context of mother-child pairs. Journal of Applied Oral Science. 2014;22(1):73–8.
Mao M, Zang L, Zhang H. The Effects of Parental Absence on Children Development: Evidence from Left-Behind Children in China. Int J Environ Res Public Health. 2020;17(18):1–17.
Badri P, Saltaji H, Flores-Mir C, Amin M. Factors affecting children’s adherence to regular dental attendance: a systematic review. J Am Dent Assoc. 2014;145(8):817–28.
Onyejaka NK, Folayan MO, Folaranmi N. Barriers and facilitators of dental service utilization by children aged 8 to 11 years in Enugu State, Nigeria. 2016;1–9.
Verma A, Priyank H, P R, Kumari M, Sayed Abdul N, Shivakumar S. A Systematic Review and Meta-Analysis on Oral Health Disparities Among the Indigenous Paediatric Population. Cureus. 2023;1–13.
Soares GH, Pereira NF, Biazevic MGH, Braga MM, Michel-Crosato E. Dental caries in south american indigenous peoples: a systematic review. Community Dent Oral Epidemiol. 2019;47(2):142–52./
Isidro-Olán, Beatriz L, Estrella-Castillo F, Vega-Lizama EM, Rueda-Ventura MA, Rubio-Zapata A. Influencia de los determinantes sociales en la salud oral en poblaciones indígenas de las Américas. Revisión de literatura. Odontología Sanmarquina. 2022.
Ha DH, Crocombe LA, C Mejia G. Clinical oral health of Australia’s rural children in a sample attending school dental services. Australian Journal of Rural Health. 2014;22(6):316–22.
Onyejaka NK, Folayan MO, Folaranmi N. Barriers and facilitators of dental service utilization by children aged 8 to 11 years in Enugu State , Nigeria. 2016;1–9.
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. © 2024.
