Abstract
Introduction: Serbia has universal health coverage (UHC) for pediatric dental care and similar country distribution for dentists and physicians per 1,000 inhabitants. However, a high prevalence of early childhood caries (ECC) with wide variation across the country was observed in previous studies. This paper aimed to analyze the association between economic and healthcare country macro-level factors with ECC prevalence and treatment.Method: The outcome variables were ECC prevalence and frequency of untreated ECC in 36- to 71-month-olds. Cross-sectional pathfinder survey on a nationally representative sample of children was conducted in order to obtain data. Independent variables included the following: gross domestic product (GDP), social and health care budget beneficiaries' expenditures, local self-government budget, unemployment rate, population density and density of physicians and dentists. Guided by the WHO's Basic Methods for Oral Health Surveys stratified cluster sample, 17 sites were randomly chosen to obtain adequate distribution of data regarding urban, peri-urban and rural areas in each analyzed statistical territorial unit. The variables were analyzed using the independent t-test or Mann–Whitney U test. A probability value of <0.05 was considered significant.Results: The final sample included 864 children aged 36 to 71 months. Observed prevalence of ECC was 41.1%. Although no statistically significant difference was found, children with ECC compared to healthy children were living in parts of the country with averages of ≈122€ lower GDP per capita, ≈4€ lower social and health care expenditures per capita, 9 inhabitants per km2 lower population density, almost 7€ per capita lower local self-government budget and a 0.6% higher unemployment rate. Furthermore, although without a statistically significant difference, untreated ECC was associated with ≈302€ lower GDP per capita, ≈12€ lower social and health care expenditures per capita, 34 inhabitants per km2 lower population density, almost 20€ per capita lower local self-government budget and a 1.7% higher unemployment rate.Conclusions: This study, performed in a nationally representative sample of preschool children, revealed the association of economic macro-level factors with ECC prevalence and its (non-) treatment. Further research on a larger sample is necessary to confirm the results. These findings suggest that most of the public-health efforts regarding prevention and early treatment of ECC should be directed at regions with lower economic performance.
Highlights
Serbia has universal health coverage (UHC) for pediatric dental care and similar country distribution for dentists and physicians per 1,000 inhabitants
In order to reduce disease burden, public health experts recognized the necessity of introducing a feasible prevention program that would be in accordance with population needs—understanding the etiological concept of oral disease as non-communicable diseases (NCDs) might represent the crucial part of this process
No statistically significant associations were observed between oral health outcome variables and healthcare professionals’ density, the results showed that children with untreated early childhood caries (ECC) compared to children with treated caries lived in the parts of the country with almost 14 inhabitants more per physician and almost 29 inhabitants more per dentist (Tables 2, 3)
Summary
Serbia has universal health coverage (UHC) for pediatric dental care and similar country distribution for dentists and physicians per 1,000 inhabitants. In the era of worldwide epidemic of non-communicable diseases (NCDs) [1], and considering oral disease as being part of this group and sharing the same etiology [2], poor oral health in preschool children has arisen as a public health issue that needs attention [3]. In order to reduce disease burden, public health experts recognized the necessity of introducing a feasible prevention program that would be in accordance with population needs—understanding the etiological concept of oral disease as NCD might represent the crucial part of this process. If considering oral disease as NCD, the process of prevention planning needs to involve introduction and understanding of other factors that strongly correlate with health inequalities and originate from macro- or country-level factors such as social, economic, environmental and political determinants [5]. Development and implementation of appropriate preventive strategies and adequate policies requires thorough oral health knowledge from a social and economic point of view [8]
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