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Background: This study assessed the direct, indirect and total effect of distal – political - risk indicators (affecting populations), and proximal risk indicators (affecting women) on the global prevalence of early childhood caries (ECC) in 3–5 year old children. Methods: Data on global ECC prevalence were obtained from a prior study. Data for distal risk indicators (voice and accountability; political stability/absence of terrorism; control of corruption) were obtained from the World Bank Governance indicators, 2016. Data for proximal risk indicators (women's opportunity for leadership; percentage of female legislators, top officials and managers; basic employability status of women; ability of women to afford time off work to care for newborns; gross national income (GNI) per capita for females) were derived from the Human Development Index, 2016. Associations between variables were assessed with path analysis. Results: Voice and accountability (β = − 0.60) and GNI per capita for females (β = − 0.33) were directly associated with a lower ECC prevalence. Political stability/absence of terrorism (β =0.40) and higher percentage of female legislators, senior officials and managers (β = 0.18) were directly associated with a higher ECC prevalence. Control of corruption (β = − 0.23) was indirectly associated with a lower ECC prevalence. Voice and accountability (β = 0.12) was indirectly associated with a higher ECC prevalence. Overall, voice and accountability (β = − 0.49), political stability/absence of terrorism (β = 0.34) and higher female GNI (β = − 0.33) had the greatest effects on ECC prevalence. Conclusion: Distal risk indicators may have a stronger impact on ECC prevalence than do proximal risk indicators.. Approaches to control ECC may need to include political reforms. [ABSTRACT FROM AUTHOR]

Background: Multiple factors influence a child's ability to access oral health care. The aim of this study was to identify factors that facilitated and served as barriers to children's utilization of oral health care services in Enugu, Nigeria.Methods: The study recruited 1406 primary school pupils aged 8 to 11 years. All the children received oral health education, with the aid of an oral health education curriculum appropriate for their age. After this, referral letters were given to the children. Twelve months later, the study participants were revisited in their schools to obtain information on their reasons for utilizing, or not utilizing an oral health care service in the last 12 months. The association between socio-economic status; form of parenthood; number of siblings, birth rank and reasons for utilization and non-utilization of dental services were assessed. Influence on the child's predisposition to oral health service utilization on dental visit was also assessed.Results: Only 116 (14.7 %) of the 791 children accessible during the 12 months follow-up visit had visited the dental clinic and the main reason for utilization was the desire to fulfill the dentist's request for dental visit (41.9 %) while parents' inability to make out time for a dental visit (43.3 %) was the main reason for non-utilization. The odds of utilizing oral health care services for study participants from the middle (AOR: 0.50; CI: 0.31-0.79; P = 0.003) and low (AOR: 0.24; CI: 0.13-0.45; p = <0.001) socioeconomic strata, and those living with guardians/relatives (AOR: 0.08; CI: 0.01-0.60; p = 0.01) were decreased when compared to those living with both parents, respectively. Respondents with positive perception about dental service utilization had increased odds of utilizing oral health care (AOR: 2.96; CI: 1.48-5.90; p = 0.002).Conclusion: Dentists can be strong motivators for children to utilize oral health care. Time is a significant barrier for the utilization of dental services. The programs designed to address barriers to oral health care utilization for children should be geared towards overcoming the possible threats that socio-economic status and type of parents they have may pose, to reduce inequity in dental service utilization. [ABSTRACT FROM AUTHOR]