Prevalence and risk factors for early childhood caries in North Africa: a systematic review and meta-analysis

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BACKGROUND: Early childhood caries (ECC) is a significant public health concern, with its prevalence steadily increasing across Africa. However, the extent of North Africa's contribution to the global burden of ECC remains poorly understood. This study aimed to estimate the prevalence and identify its risk factors in North Africa. METHODS: This systematic review and meta-analysis was registered with PROSPERO on March 7th, 2025and examined studies published between 2000 and March 2025 on the prevalence and risk factors of ECC in North African countries. Five databases were searched. Eligible studies included cross-sectional, cohort, and case-control designs involving children aged 0-5 years. Two independent reviewers extracted data on study and population characteristics, ECC prevalence, mean dmft scores, and associated risk factors. Pooled prevalence estimates were calculated using the DerSimonian-Laird random effects model, with heterogeneity assessed via Tau², I², and Cochran's Q test. RESULTS: Of the 1690 studies screened, 18 met the eligibility criteria. The pooled prevalence of ECC was 57% (95% CI: 50-64, p < 0.001), and the dmft was 2.95 (95% CI: 1.86-4.67). Marked heterogeneity was observed in the meta-analysis. The 16 risk factors associated with ECC were grouped into sociodemographic factors, dietary factors and habits, oral hygiene/health-related factors, and factors related to the oral microbiome (spoon sharing with household). CONCLUSIONS: There is a high burden of ECC among children residing in North Africa. Local, national, and region-specific preventive policies targeting identified risk factors should be deployed to stem the tide of ECC in North Africa. PROSPERO REGISTRATION ID: CRD420251006590. CLINICAL TRIAL NUMBER: Not Applicable.

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