Residency as a determinant of oral health disparities in primary dentition among HIV-infected, HIV-exposed, and unexposed children in Kenya – findings from a cohort study

Residency is a critical factor related to the social determinants of health. This study aimed to evaluate the role of residency in oral health disparities among Kenyan children during the primary dentition period. We recruited participants from three cohorts of children, all aged 3 years, including those living with HIV infection (HIV), exposed to HIV but uninfected (HEU), and their healthy peers (HUU; uninfected and unexposed). We recruited 120 children in each cohort. Logistic regression was used to estimate the associations between oral diseases, HIV status, and residence, adjusting for sex and school type. Most children (47%) were enrolled in private schools, and 49% lived in rural areas. Children in HIV cohort had a significantly higher prevalence (81%) of abnormal oral findings compared with those in HEU (60%) and HUU (54%) cohorts (p < 0.0001). Children living in rural areas (OR = 3.3, 95% CI:1.7-6.3) and urban areas (OR = 2.0, 95% CI:1.1-3.9) were more likely to have abnormal findings than those in peri-urban areas. However, peri-urban residents had the highest prevalence of dental caries (63%), while rural residents had the highest combined prevalence of all dental conditions (83%). Residential area contributed to differences in the burden of oral diseases among HIV and HEU cohorts. Targeted prevention and treatment strategies should be considered by residential location.