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Mehari et al., J Community Med Health Educ 2020, 11:1
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ISSN: 2161-0711

Research Article Open Access

Assessment of Knowledge, Attitude, Practice of Oral Hygiene and

Prevalence of Dental Caries among School Children in Massawa Sub Zone,
Eritrea: Cross Sectional Study
Nazrawi Mehari1*, Berhe Tesfai2, Andebrhan Tewelde3 and Efrem Kahsu4
1
Dentist, Dental clinic head, Massawa hospital, Northern Red Sea zone, Ministry of Health, Massawa, Eritrea
2
Medical doctor, Medical director, Massawa hospital, Northern Red Sea Zone, Ministry of Health, Massawa, Eritrea
3
Epidemiologist, Health Research Division, policy and planning, Ministry of Health, Asmara, Eritrea
4
Dentist, Dekemhare hospital, Zoba Debub, Ministry of Health, Dekemhare, Eritrea

Abstract
Background: Dental caries is the most common chronic infectious disease of childhood caused by the interaction
of bacteria and sugary foods on tooth enamel. The objective of the study was to assess the Knowledge, attitude, oral
hygiene practice and the burden of the disease among school children in Massawa sub zone, Eritrea.
Methods: A prospective, cross sectional study with an interviewer administered questionnaire was used as a data
collection tool. A systematic random sampling method was used to select the schools and students from Massawa sub
zone and dental checkups were done to all the students in the primary and secondary schools of Massawa subzone.
CSPro and SPSS softwares were used for data entry and analysis purposes respectively. Results were presented in
percent, tables, graphs and P-value.
Results: of the students, 96% had poor knowledge on oral health care, 91% of them believe that brushing teeth
prevents caries and 83% practically brush their teeth. About 85% of the students reported that treatment of tooth ache
is as important as other organ of the body and 34% of the participant believes that dental problems do not affect general
health. Only 31% of the subjects brush their teeth twice a day and 52% of the students have never visited dental clinic.
Moreover; 21% of the participants do not care even if they have decayed tooth but 67 % of the students reported visit
a dentist when there is toothache. The Prevalence of dental carries on the students was found to be 32.8%.
Conclusion: The students have poor knowledge and positive attitude on oral health care and higher prevalence
of dental carries was reported in the sub zone of Massawa; Eritrea. The level of education of the students showed
significant association to their knowledge on oral health.

Keywords: Knowledge; Prevalence; Toothache; Dental carries; Oral
hygiene
Introduction
Oral health implies being free of chronic oro-facial pain, oral and
pharyngeal (throat) cancer, oral tissue lesions, birth defects such as
cleft lip and palate, and other diseases and disorders that affect the oral,
dental and craniofacial tissues, known as the craniofacial complex [1].
Oral diseases are public health problems worldwide [2]. Their impact
on individuals and communities in terms of pain and suffering,
functional impairment and reduced quality of life is considerable and
are the fourth most expensive to treat in most industrialized countries
[3]. Adolescents represent a challenging group in terms of oral health
because they have vulnerable permanent teeth erupting by the time
they are establishing their independence from parental influence [4].
Dental caries is one of the most common childhood diseases in
the world. In many developed countries, dental caries has improved
in older children in recent decade, but remains a significant problem
in younger children [5]. Dental caries occurs during childhood and
continues to be a major public health problem. The prevalence of dental
caries was associated with oral hygiene practice, sugar consumption
and implementation of the preventive oral health program [6]. Dental
caries is a significant health problem among the people of all ages
but the magnitude of the problem is greatest among young children
[7]. To overcome the global burden of oral diseases community
oriented preventive and oral health promotional programs have been
emphasized and prioritized by World Health Organization to the
general curative approach [8].
Children with inadequate oral health knowledge are twice as likely to
have caries as children with adequate knowledge and on other studies
showed that there is an association between increased knowledge and
better oral health [9]. Most relevant target group to inform about
preventive measures are parents, teachers and health care personnel as
indirectly the information reaches at the hand of the children. Greater
knowledge has been noted to be associated with better hygiene (i.e.
lower plaque score) and also with a more positive attitude towards oral
health. [10]. Although, the trend is not clear in developing countries,
the burden of dental caries has been increasing among children due
to the unlimited consumption of sugary substances, poor oral care
practices and inadequate health service utilization. Studies revealed
that the prevalence of dental caries was higher among urban children.
Similarly, a study conducted in Ethiopia was reported 36.5% prevalence
of dental caries among urban children in school [11]. Involvement
to increase awareness for oral health promotion can prevent an
irreversible damage on the teeth. In Eritrea there are very few published
literature on the Knowledge, Attitude and Practice and prevalence of
dental caries among school aged children. Dental carries were found
to be a common public health problem among school going children
*Corresponding author: Nazrawi Mehari, Dentist, Dental clinic head, Massawa
hospital, Massawa, Northern Red Sea, ministry of Health, Eritrea; Tel: +291-
7244677; E-mail: nazrawi.mehari@yahoo.com
Received December 04, 2020; Accepted December 10, 2020; Published
December 21, 2020
Citation: Mehari N, Tesfai B, Tewelde A, Kahsu E (2020) Assessment of
Knowledge, Attitude, Practice of Oral Hygiene and Prevalence of Dental Caries
among School Children in Massawa Sub Zone, Eritrea: Cross Sectional Study. J
Community Med Health Educ 11: 702.
Copyright: © 2020 Mehari N, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.

J Community Med Health Educ Volume 11 • Issue 1 • 1000702

Citation: Mehari N, Tesfai B, Tewelde A, Kahsu E (2020) Assessment of Knowledge, Attitude, Practice of Oral Hygiene and Prevalence of Dental
Caries among School Children in Massawa Sub Zone, Eritrea: Cross Sectional Study. J Community Med Health Educ 11: 702.
in Eritrea. More than 50% of the students had dental caries. There is
urgent need to institute national interventions to prevent the further
increase in disease burden from dental diseases [12,13]
Dental caries is consistently ranked as the first or second most
commonly reported disease with the highest morbidity in Out Patient
Departments in Eritrea. Dental caries was ranked as the highest morbid
disease in the years 2013 and 2014 and second highest reported disease
during the years 2011, 2012, 2015 and 2016 [13].
Gaps in dental health service utilization, dental health practices and
suboptimal water fluoride levels contribute to poor dental health
among school children in Eritrea [13]. Bearing in mind, this research
will help to compare the knowledge attitude and oral hygiene practice
with the prevalence of dental caries in those students.
Materials and Methods
A prospective cross sectional study was conducted during the academic
year in June 2019 among the students of all Massawa sub zone. A
stratified random sampling was used to select the required number
of schools and students for the purpose of the Knowledge, attitude
and practice study. First the schools were grouped to elementary,
middle and high school and different schools were selected randomly
from each category. Finally the students from each schools was also
stratified by their level of education (grade) and from each of these
strata respondents (students) was selected randomly by applying
proportional to size (PPS) from the schools in Massawa sub zone and
dental checkups were done to all the students in the schools. Students
who were below ten years age were not invited to participate in the study
as they were too young to understand and complete the questionnaire.
Sample size determination
Sample size was determined using Daniel’s formula. Sample size
was calculated from the source population using single population
formula. The sample size determination was based on the level of
precision required for the proportion of students who have favorable
knowledge, attitude and practice towards dental hygiene. To the best of
our knowledge, there is no documented information on proportion of
students who have favorable knowledge, attitude and practice towards
dental hygiene. Thus, we assumed the required precision level to be
50 percent. This is the “safest” choice for the population proportion
since the sample size required is largest when P = 0.5.Taking this level
of precision combined with the following assumptions, were used to
calculate the minimum sample size.
Assumptions for sample size calculation:
p= proportional=0.5 or 50%
z= standard normal distribution (1.96)
d= Margin of error (accepted error) =0.05
n= Z α/2 P (1-P)/d2= (1.96)2(0.5) (1-0.5)/ (0.05)2=382
Considering 5% non-respondents rate =383+10% = 384. A total of 384
students were selected
Data collection and analysis
Massawa sub zone had a total of 8454 students on the academic year of
2018-2019 [source: ministry of Education, Massawa sub zone. All the
students were checked up for dental caries and out of 8454 students 382
students were randomly selected with equal distribution that represent
the three level of education (elementary, junior and high school) and
the schools all over Massawa sub zone to fill the questionnaire. The
J Community Med Health Educ
Page 2 of 7
questionnaire was adopted from different similar studies and it was
modified to suit the objective o the study and the students’ capacity.
The questions in the questionnaire were designed to suit their level and
assess their basic knowledge, attitude and practices towards oral health
and oral hygiene maintenance. There were 27 questions consisting
of 9 questions to assess their knowledge, 8 to assess attitude and 10
to assess their oral hygiene practice. Subjects were divided into high
and low knowledge groups. Students who scored six and above were
categorized as having high knowledge and those with a score of below
five were considered to be in poor knowledge group. Regarding the
attitude and perception of oral health and the dental care providers,
if a student answer indicated a positive impact on oral health, the
subject was considered to be having a positive attitude. Positive attitude
responses were given a score of 1 and negative responses were given a
score of 2 and ‘I don’t know response’ were given score 3. Those who
responded five or more score were considered to be having a positive
attitude and those scoring less than 5 score were considered having a
negative attitude towards oral health. Data management and statistical
analysis were performed using the statistical software SPSS version 17.0.
Data was examined to explore the pattern and distribution of the
characteristics of the students. Categorical variables were presented
with frequency and percentages and continuous variables were
presented as mean, standard deviation and range. Chi-squared test was
employed to test association between categorical variables and t-test
was applied to test continuous variables.
Ethical consideration
The study was approved by the Health research and ethical clearance
committee of Ministry of health of Eritrea and the directorate of
education in Massawa sub zone. A letter was sent to the selected schools
directors explaining the purpose of the study and the procedures that
would be followed during its conduct. The principal of each school
was asked to inform the students. Verbal consent to participate in
the research was obtained from each student before enrolment in
the study. The Verbal informed consent procedure for the students
was approved by the Health Research Proposal Review and Ethical
Clearance committee of the Ministry of Health.
Results
A total of 369 students have participated in the study with different
age groups and genders demonstrated no significant differences in
their responses, so the frequency tables present the subjects as a whole.
13 students were excluded from the study due to incomplete response
in the questionnaire with a response rate of 96.6%. The number of
male and female participants was almost equal, 50.4% female and
49.6% male. And 68.8% of the participants were in age group of 10-14
years. Regarding the educational level, most of the participants were
elementary and junior with High school participants consists only 19%
[Table 1].
Knowledge category of students by background characteristics
Most of the students have poor knowledge in both age categories with
only 3.1% and 5.2% in the age range of 10 to 14 and 15 to 19 years have
good knowledge about dental carries respectively. Almost all (96.2%)
of the students with similar gender distribution have poor knowledge
on dental carries and as their level of education increases, the level of
knowledge increases with only 0.6% of elementary students and 12.9%
of secondary students have good knowledge. The students knowledge
was also associated with level of education of their family that those
with illiterate family has very poor knowledge compared to these who
reach secondary and tertiary level family [Table 2].
Volume 11 • Issue 1 • 1000702
Citation: Mehari N, Tesfai B, Tewelde A, Kahsu E (2020) Assessment of Knowledge, Attitude, Practice of Oral Hygiene and Prevalence of Dental
Caries among School Children in Massawa Sub Zone, Eritrea: Cross Sectional Study. J Community Med Health Educ 11: 702.

Page 3 of 7

Attitude of students towards mouth and teeth cleanness by and 86% thought that treatment of tooth ache is as important as any
background characteristics other organ of the body [Table 3].

Most of the students have good attitude towards oral health care,
interestingly 91% believes that brushing teeth prevents decaying,
though 36%of the students are afraid of visiting dental clinic and
73% thought that regular visit to dentist is necessary. Majority of the
students (66%) believed that dental problem can affect general health
Practice of students on brushing their teeth, timing and
frequency of brushing
Most of the students (93%) brush their teeth and the frequency of tooth
brushing was low. About one third of the students had brushed their

Age group Number(N) Percent (%)

10 – 14 254 68.8
15 – 19 115 31.2
Sex
Female 186 50.4
Male 183 49.6
Education level
Elementary 162 43.9
Junior 137 37.1
Secondary 70 19
Father's education
No education 164 44.4
Elementary 37 10
Junior 42 11.4
Secondary 115 31.2
Tertiary 11 3
Mother's education
No education 159 43.1
Elementary 54 14.6
Junior 62 16.8
Secondary 93 25.2
Tertiary 1 0.3
Total 369 100

Table 1: Distribution of students by age, sex, education level, father’s and mother’s education.

Knowledge Category
Poor knowledge Good Knowledge
Age group Number of respondents
Number Percent Number Percent
10 – 14 246 96.9 8 3.1 254
15 – 19 109 94.8 6 5.2 115
Sex
Male 176 96.2 7 3.8 183
Female 179 96.2 7 3.8 186
Education level
Elementary 161 99.4 1 0.6 162
Junior 133 97.1 4 2.9 137
Secondary 61 87.1 9 12.9 70
Father's education
No education 163 99.4 1 0.6 164
Elementary 35 94.6 2 5.4 37
Junior 40 95.2 2 4.8 42
Secondary 108 93.9 7 6.1 115
Tertiary 9 81.8 2 18.2 11
Mother's education
No education 155 97.5 4 2.5 159
Elementary 53 98.1 1 1.9 54
Junior 61 98.4 1 1.6 62
Secondary 85 91.4 8 8.6 93
Tertiary 1 100 0 0 1
Total 355 96.2 14 3.8 369

Table 2: Percentage of distribution of knowledge category of students by background characteristics.

J Community Med Health Educ Volume 11 • Issue 1 • 1000702

Citation: Mehari N, Tesfai B, Tewelde A, Kahsu E (2020) Assessment of Knowledge, Attitude, Practice of Oral Hygiene and Prevalence of Dental
Caries among School Children in Massawa Sub Zone, Eritrea: Cross Sectional Study. J Community Med Health Educ 11: 702.

Page 4 of 7

teeth once per day and a few percent brushes their teeth two times per third of them brush their teeth from one to more than two minutes
week. Majority of the students (76%) brush their teeth in the morning [Table 4]. Although most of the respondents (93%) brush their teeth
while a very few brushes their teeth after lunch. About one tenth of but only 29% of these brush twice a day while 27% brushes when they
the students brush their teeth for less than one minute but about one remembered it [Figure 1].

Dental problem Regular visit to Think that Afraid of Treatment of tooth ache is Dentist care only Sweets affect Brushing teeth
can affect the dentist is smoking is a going to the as important as any other about treatment and the teeth prevents dental
general health necessary bad habit dentist organ of the body not prevention adversely decay
Age group
10-14 59.8 74 75.6 39.4 83.5 45.3 90.2 90.6
15-19 78.3 71.3 87.8 29.6 90.4 29.6 93 90.4
Sex
Male 69.9 70.5 78.1 34.4 81.4 41.5 88 90.7
Female 61.3 75.8 80.6 38.2 89.8 39.2 94.1 90.3
Education
Elementary 58 75.3 75.9 47.5 82.7 46.9 89.5 93.2
Junior 69.3 70.8 78.1 28.5 83.9 43.8 89.8 88.3
Secondary 75.7 72.9 90 25.7 95.7 18.6 97.1 88.6
Father's education
No
71.3 70.7 73.8 36.6 81.1 45.7 86.6 87.2
education
Elementary 73 70.3 81.1 21.6 94.6 27 91.9 100
Junior 76.2 78.6 83.3 38.1 85.7 35.7 90.5 95.2
Secondary 51.3 76.5 83.5 40.9 87.8 39.1 96.5 90.4
Tertiary 63.6 63.6 100 27.3 100 36.4 100 90.9
Mother's education
No
69.8 69.8 76.1 39.6 81.8 43.4 88.1 89.3
education
Elementary 75.9 72.2 81.5 25.9 88.9 44.4 92.6 94.4
Junior 66.1 83.9 79 46.8 87.1 40.3 91.9 93.5
Secondary 51.6 72 83.9 30.1 89.2 33.3 94.6 88.2
Tertiary 100 100 100 0 100 0 100 100
Total 65.6 73.2 79.4 36.3 85.6 40.4 91.1 90.5

Table 3: Percentage distribution of students on attitude towards mouth and teeth cleanness by background characteristics.

When do they brush their teeth Length of brushing

Variables
Morning Noon (after lunch) Before going to bed Other times One minute Less than one minute Two minutes More than two minutes
Age group
10 – 14 76.7 13.6 32.6 9.3 28.4 9.7 26.7 35.2
15 – 19 75.9 6.5 42.6 8.3 30.6 15.7 20.4 33.3
Sex
Male 75.6 9.3 33.7 11.6 32 10.5 23.3 34.3
Female 77.3 13.4 37.8 6.4 26.2 12.8 26.2 34.9
Education level
Elementary 78.2 10.9 31.3 11.6 29.9 11.6 29.3 29.3
Junior 75 15.2 31.8 6.8 27.3 12.1 21.2 39.4
Secondary 75.4 4.6 53.8 7.7 30.8 10.8 21.5 36.9
Father's education
No education 73.3 16 37.3 8.7 31.3 14.7 25.3 28.7
Elementary 78.4 0 54.1 5.4 27 2.7 29.7 40.5
Junior 80 17.5 25 2.5 30 12.5 30 27.5
Secondary 80.2 6.6 26.4 14.2 28.3 9.4 18.9 43.4
Tertiary 63.6 9.1 81.8 0 9.1 18.2 36.4 36.4
Mother's education
No education 74.3 12.5 36.8 7.6 29.9 14.6 22.9 32.6
Elementary 80.8 13.5 30.8 9.6 32.7 11.5 25 30.8
Junior 85.2 9.8 34.4 6.6 26.2 11.5 29.5 32.8
Secondary 70.9 9.3 37.2 12.8 27.9 7 24.4 40.7
Tertiary 100 0 100 0 0 0 0 100
Total 76.5 11.3 35.8 9 29.1 11.6 24.7 34.6

Table 4: Percentage of students who report on when do they brush their teeth and length of brushing by background characteristics.

J Community Med Health Educ Volume 11 • Issue 1 • 1000702

Citation: Mehari N, Tesfai B, Tewelde A, Kahsu E (2020) Assessment of Knowledge, Attitude, Practice of Oral Hygiene and Prevalence of Dental
Caries among School Children in Massawa Sub Zone, Eritrea: Cross Sectional Study. J Community Med Health Educ 11: 702.

Page 5 of 7

Students care made towards their teeth and mouth cleanness
About half (52.4%) of the students aged 10 to 14 years were watched by
their parents while brushing their teeth that; Elementary students
were more watched (54.9%) by their parents compared to secondary
students (31.4%). Only about one third of the students were advised
by their parents to brush their teeth and most of the students brush
their teeth after eating food. Above 50% of the students visit a dentist
when they have a decayed teeth and around 10% was treated at
home while a few students reported that they took medicine by their
own when they have a decayed teeth. The majority of the students
were treated at home when they have a tooth pain and only below
10% of students had regular visit to a dentist on 6 to 12 months
[Figure 2].
Association knowledge and background characteristics
Of the students, 96.9% of them aged 10 to 14 years have poor knowledge
score with similar gender distribution and 99.4% of the elementary
students have poor knowledge compared to the secondary students
(87.1%). Of the students, 99.4% with illiterate father had poor knowledge
compared to tertiary level father’s education (81.8%) [Table 5].
Prevalence of dental carries among students by sex and age
The overall prevalence of dental carries among the students were found
to be 32.8%, which was much higher on males when compared to
females, 59.4% and 40.6% respectively. The prevalence was also higher
on the younger students and as the age of the students’ increases the
prevalence of dental carries was decreased [Table 6].

Figure 1: Percentage of students who report on the frequency of brushing their teeth.

Figure 2: Frequency of students who report on the frequency of visiting a dentist.

J Community Med Health Educ Volume 11 • Issue 1 • 1000702

Citation: Mehari N, Tesfai B, Tewelde A, Kahsu E (2020) Assessment of Knowledge, Attitude, Practice of Oral Hygiene and Prevalence of Dental
Caries among School Children in Massawa Sub Zone, Eritrea: Cross Sectional Study. J Community Med Health Educ 11: 702.

Page 6 of 7

Knowledge Category
P - value
Poor knowledge (%) Good Knowledge (%)
14-Oct 96.9 3.1
Age group 0.336
15 - 19 94.8 5.2
Male 96.2 3.8
Sex 0.975
Female 96.2 3.8
Elementary 99.4 0.6
Education level Junior 97.1 2.9 < 0.001
Secondary 87.1 12.9
No education 99.4 0.6
Elementary 94.6 5.4
Father's education Junior 95.2 4.8 0.012
Secondary 93.9 6.1
Tertiary 81.8 18.2
No education 97.5 2.5
Elementary 98.1 1.9
Mother's education Junior 98.4 1.6 0.091
Secondary 91.4 8.6
Tertiary 100 0

Table 5: Percent of association of knowledge and background characteristics.

Overall prevalence 32.80%

Number (N) Percent (%)
Sex
Male 1644 59.4
Female 1125 40.6
Age group
6–9 1232 44.5
10 – 14 1100 39.7
15 – 19 416 15
Missing 21 0.8
Total 2769 100

Table 6: Prevalence of dental carries among students by sex and age.

Discussion to improve their knowledge and practice in dental health. Some of

The majority of the study participants were between the ages of 10 to
14 years with elementary level of education. Amazingly (96.9%) of the
students aged 10 to 14 years have poor knowledge score and 99.4% of
the students with illiterate father had poor knowledge compared to
tertiary level of father’s education (81.8%). This could be a reason for
the very poor knowledge of the students. Students with illiterate family
had also very poor knowledge compared to these who reach secondary
and tertiary level family, which also shows the significance of parental
education on health awareness of the children. This result shows a
direct relationship with the increase in dental caries rate among the
participants with poor knowledge which is similar with the statement
given by Du [14, 15], that Children with inadequate oral health
knowledge are twice as likely to have caries as children with adequate
knowledge and on other studies showed that there is an association
between increased knowledge and better oral health.
As the age and level of education of the students increases, the
knowledge of the students also increases, which shows the significance
of the schools in general oral health awareness. Majority of the students
(66%), most of them with secondary educational level thought that
dental problem can affect general health, which is comparable to the
study done in 2016 by Kumar et al. in which 64% agreed that oral
health is important for overall health of the body. Above three –fourth
of the students thought that regular visit to the dentist is necessary and
smoking is a bad habit, which is an essential attitude of the students
the students still are afraid of going to the dentist and thought that
Dentist care only about treatment and not prevention, which shows the
importance of dental school health on preventive measures.
Only a few students have regular visit to a dentist (6.5%) and about
half of the students have never visited a dentist which could be a
reason for their poor knowledge and high prevalence of dental carries
on the students, this is similar to other study conducted in Eritrea by
Andegiorgish [13] that More than half of the respondents had never
visited a dentist and visits for regular checkups were cited by only 6.6% of
the respondents. But this was lower when compared with Humagain M
that 20% of regular attendees and visited dentist only when they got dental
pain. Similarly shows 24.4% and Kumar reported 58% of students visit
dentist only when there is a problem. similar study by Madhan showed the
importance of visiting dentist once in every six months was known by 74%
of subjects however 59% of them never been to dentist.
This study showed that the frequency of tooth brushing was low with
only 30% students brush their teeth two times per day and most of
the students (76%) brush their teeth in the morning. This was almost
similar to Andegiorgish [13], that 28.1% of the study participants
cleaned their teeth once a day and 19.1% twice daily, and Humagain
that Only 35.1% of the students brushes their teeth at least twice daily
while 64.9% reported regular brushing once daily. But it was lower to
Kumar that 66% of students brush their teeth only once daily showed
that 60% of the respondents practice brushing tooth twice daily.

J Community Med Health Educ Volume 11 • Issue 1 • 1000702

Citation: Mehari N, Tesfai B, Tewelde A, Kahsu E (2020) Assessment of Knowledge, Attitude, Practice of Oral Hygiene and Prevalence of Dental
Caries among School Children in Massawa Sub Zone, Eritrea: Cross Sectional Study. J Community Med Health Educ 11: 702.
About half of the students aged 10 to 14 years were watched by their
parents while brushing their teeth and a few percent of students
were not taking care by their parents on brushing their teeth. But
Andegiorgish showed that, the majority of the students (85%) claimed
that they cleaned their teeth unassisted while 9% reported they received
assistance from their mother. The majority of the students brush their
teeth after eating food and above half of the students visit a dentist
when there is a decayed teeth with some of them didn’t care and treated
at home and a few took medicine by their own.
The prevalence of dental caries among the study population is found
to be 32.8% which is lower than studies carried out in other parts of
Ethiopia (36.3-48.1%), Nigeria (35.5%), Nepal (52%) 59.4%, and India
(77%). However, it was higher than a study conducted in Tanzania
(17.6%). The difference in dental caries rate in these different studies
could be due to difference in knowledge, attitude and practices on oral
hygiene of the study population. This study showed that the prevalence
of dental caries was higher on the young students (44.5%) with male
predominance (59.4%) and was higher in these their family had no
formal education. This high prevalence could be attributed by their
poor knowledge and practice on oral hygiene. This result was much
lower when compared to previous studies conducted in Eritrea; the
prevalence of dental caries was 78%, without significant difference
between males (78%) and females (79%) [13]. Females had higher
dental caries and was highly prevalent among children their aged ≤ 10
years (64.7%) [12].
Conclusion
The study shows dental caries was a common public health problem in
school children in the sub zone associated with poor knowledge on oral
hygiene, low teeth brushing practice and dental visit habits. Therefore
oral health-oriented education programs should be included in their
curriculum that helps to improve their knowledge and behavior. The
communities’ knowledge and their awareness should be increased on
the preventive methods of dental caries. Students should be advised by
their family and teachers to have regular brushing and dietary habits
advice with follow up to a dentist.
The main limitation of the study was on diagnosis of the dental caries
which leads as to define dental caries as presence of any cavitated
or darkly stained tooth in permanent or primary dentition. Lack of
standard and adequate basic examination instrument was also another
burden to the study.
Acknowledgment
The authors acknowledge the Ministry of Health, Northern Red Sea Zone and
the Ministry of Education Massawa subzone branch for their continued technical
support. We also thank the data collectors and students who took part in this study.
Author’s contribution
Nazrawi Mehari, Berhe Tesfai, Andebrhan Tewelde and Efrem Kahsu have
designed the proposal. All the authors have participated on drafting the final form of
the proposal. Nazrawi Mehari and Berhe Tesfai have participated on data collection
and supervision of the data collectors. Andebrhan Tewelde designed the data
J Community Med Health Educ
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Page 7 of 7
entry tool and analyzed the results using SPSS software. Nazrawi Mehari, Berhe
Tesfai and Andebrhan Tewelde have participated on writing the first manuscript,
and then all authors had contributed on writing the final manuscript. The final
form of the research article was edited and finalized by Nazrawi Mehari, Berhe
Tesfai, Andebrhan Tewelde and Efrem Kahsu. All the authors have reviewed and
approved the final form of the manuscript.
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