Early Childhood Caries in Preschool-Aged Children in Sana’a, Yemen: Prevalence and Associated Factors

Basem H Al-Huthaifi,1– 3 Khalid Aldhorae,1,4 Baker M Abdullah,2 Arwa M Alhaj,5 Taghreed A Al-Kibsi,2 Thiyezen Abdullah Aldhelai,6 Randa MF Ibrahim,6 Emad M Shaamala,7 Shadha Daghshar,1 Yassmin Daghshar,1 Nadia E Al-Qadasy,1 Mohammed M Al Moaleem81Faculty of Dentistry, Ibn Al-Nafis University for Medical Sciences, Sana’a, Yemen; 2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sana’a University, Sana’a, Yemen; 3Orthodontic Department, Faculty of Dentistry, University of Sciences and Technology, Sana’a, Yemen; 4Department of Orthodontics, Faculty of Dentistry, Thamar University, Thamar, Yemen; 5Department of Preventive and Biomedical Sciences, College of Dentistry, University of Sciences and Technology, Sana’a, Yemen; 6Department of Orthodontic and Pediatric Dentistry, College of Dentistry, Qassim University, Buraydah, 52571, Saudi Arabia; 7Health Informatics Program, Department of Computer Science, Metropolitan College, Boston University, Boston, MA, USA; 8Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi ArabiaCorrespondence: Basem H Al-Huthaifi, Faculty of Dentistry, Ibn Al-Nafis University for Medical Sciences, Sana’a, Yemen, Email [email protected]: Early childhood caries (ECC) remains a significant public health concern, particularly in resource-limited settings. This study aimed to determine the prevalence of ECC and examine its associations with sociodemographic, feeding, and dietary factors among preschool children in Sana’a, Yemen.Methods: A preschool-based cross-sectional study was conducted among 360 children aged 36– 71 months recruited through stratified random sampling from preschools in Sana’a City. ECC was diagnosed using WHO 2013 criteria (dmft ≥ 1), with ICDAS used to identify non-cavitated lesions. Caregivers completed a structured questionnaire on sociodemographic characteristics, feeding practices, and dietary behaviors. Chi-square tests assessed unadjusted associations (p ≤ 0.05), and prevalence ratios (PR) with 95% confidence intervals (CI) were calculated for key exposures.Results: ECC prevalence was 17.5% (95% CI: 13.8– 21.8%), with the highest rate among 4-year-olds (25.0%). The sample was skewed toward 5-year-olds (n = 270, 75.0%), weighting prevalence estimates toward this group. Mean dmft was 0.42 (SD: 1.12); by age: 3 years, 0.13 (0.43); 4 years, 0.62 (1.25); 5 years, 0.43 (1.15); by sex: males, 0.40 (1.08); females, 0.44 (1.16). No significant associations were found with birth weight (p = 0.416) or maternal education (p = 0.991). Significant unadjusted associations included: bottle-feeding (30.3% vs 10.0% breastfeeding, p < 0.001); nighttime bottle-feeding (35.1% vs 9.6%, p < 0.001; PR = 3.64, 95% CI: 2.30– 5.75); and pacifier sweetening (43.5% vs 11.8%, p < 0.001; PR = 3.70, 95% CI: 1.65– 8.30). Consumption of grains and sugars showed the highest prevalence (40.9%, p < 0.001; PR = 4.34, 95% CI: 2.43– 7.75). Snacking frequency was also significantly associated with ECC (χ2 = 11.45, df = 4, p = 0.022).Conclusion: ECC prevalence in this Yemeni preschool population is within the lower range of regional estimates. Statistically significant unadjusted associations with modifiable feeding practices and dietary behaviors generate hypotheses for caregiver education interventions. Longitudinal and multivariable studies are needed to confirm these findings.Keywords: early childhood caries, cross-sectional study, prevalence, feeding practices, dietary habits, preschool children, Yemen