Governance, maternal well-being and early childhood caries in 3-5-year-old children

Background: This study assessed the direct, indirect and total effect of distal-political-risk indicators (affecting populations), and proximal risk indicators (affecting women) on the global prevalence of early childhood caries (ECC) in 3-5 year old children. Methods: Data on global ECC prevalence were obtained from a prior study. Data for distal risk indicators (voice and accountability; political stability/absence of terrorism; control of corruption) were obtained from the World Bank Governance indicators, 2016. Data for proximal risk indicators (women's opportunity for leadership; percentage of female legislators, top officials and managers; basic employability status of women; ability of women to afford time off work to care for newborns; gross national income (GNI) per capita for females) were derived from the Human Development Index, 2016. Associations between variables were assessed with path analysis. Results: Voice and accountability (β =-0.60) and GNI per capita for females (β =-0.33) were directly associated with a lower ECC prevalence. Political stability/absence of terrorism (β =0.40) and higher percentage of female legislators, senior officials and managers (β = 0.18) were directly associated with a higher ECC prevalence. Control of corruption (β =-0.23) was indirectly associated with a lower ECC prevalence. Voice and accountability (β = 0.12) was indirectly associated with a higher ECC prevalence. Overall, voice and accountability (β =-0.49), political stability/absence of terrorism (β = 0.34) and higher female GNI (β =-0.33) had the greatest effects on ECC prevalence. Conclusion: Distal risk indicators may have a stronger impact on ECC prevalence than do proximal risk indicators. Approaches to control ECC may need to include political reforms.