Prevalence of early childhood caries in Southern Africa: systematic review and meta-analysis

There is currently no comprehensive pooled analysis or regional synthesis previously been conducted on the prevalence of early childhood caries (ECC) in the Southern Africa region. This study determined the prevalence of ECC and its associated risk factors in the Southern African region. The systematic review and meta-analysis were registered with PROSPERO (CRD420251004718). PubMed, Scopus, Web of Science, and AJOL databases were searched up to April 2025. Studies were included if they were cross-sectional, cohort, or case-control. had to be published between 1st January 2000 and 31st March 2025 and had to report the prevalence of ECC and associated risk factors in Southern Africa. There were no language restrictions. Studies among children with special needs were excluded. Heterogeneity was evaluated using the I² statistic, while a random-effects model was applied to estimate the overall prevalence of dental caries. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. It utilised the Joanna Briggs Institute Critical Appraisal Checklist to assess the methodological quality of the studies. A total of 113 publications were identified through databases, and 15 publications (including 25,935 children) met the eligibility criteria for the systematic review and nine for the meta-analysis. The pooled prevalence of ECC in Southern Africa was 52% (95% CI: 44 to 59%; p < 0.00001). Studies with sample sizes greater than 500 reported an ECC prevalence of 53% (95% CI: 41–65%), while those with fewer than 500 participants reported a prevalence of 50% (95% CI: 46–54%). Hospital-based and school-based studies each reported a prevalence of ECC of 49% while studies conducted in mixed settings reported a higher prevalence of 72%. The prevalence of ECC was higher among males at 51% (95% CI: 42–61%) compared to females at 46% (95% CI: 38–54%). The risk factors associated with ECC include sociodemographic and environmental risk factors, oral hygiene practices, feeding practices, dietary habits and sugar consumption, and access to dental care and fluoride exposure. The prevalence of ECC in Southern Africa is high, driven by behavioural, environmental, and sociodemographic factors. The results highlight the critical need for tailored preventive measures, such as better oral hygiene, appropriate feeding and dietary habits, and increased access to fluoride-based care to support effective policy and planning to reduce the prevalence of ECC.