Prevalence and Associated Risk Factors for Early Childhood Caries in Central Africa Sub-Region: A Systematic Review and Meta-analysis

Background: Children in Central Africa face compounded vulnerabilities, yet no comprehensive review has synthesized evidence on ECC prevalence or risk factors. This study aims to determine the prevalence and identify risk factors associated with early childhood caries (ECC) in the Central Africa Sub-region. Methods: This systematic review and meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the ID CRD420251019424. A comprehensive literature search was conducted across PubMed, African Journals Online, Scopus, Web of Science, CINAHL, and ProQuest as well as through Google Scholar and other grey literature sources, with no language restrictions. Eligible studies were limited to cross-sectional, cohort, case-control, and clinical trials that reported baseline data on the prevalence and risk factors of ECC in the Central Africa sub-region among children under the age of six. There was no restriction on publication date. Exclusion criteria included letters to the editor, commentaries, studies without accessible full texts, systematic reviews, reviews lacking original data, studies with overlapping data already included, and non-peer-reviewed sources such as books. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool. A random-effects meta-analysis was conducted using Review Manager 5.4.1, and heterogeneity was assessed using the I statistic. Results: Five studies met the eligibility criteria, encompassing 640 participants. Three of the studies were from Cameroon, and one from the Democratic Republic of Congo and the Central African Republic, respectively. One study that did not report the prevalence of ECC and another non-peer-reviewed publication were excluded from the meta-analysis. The prevalence of ECC in the region ranged between 29.4% and 80% with a pooled prevalence of 57% (95% CI: 22 to 92%; I = 98%). Identified risk factors for ECC were related to oral hygiene behaviours, diet and feeding practices, parental/caregiver factors, and access to dental care. Conclusions: ECC is highly prevalent in Central Africa, driven by preventable factors. Urgent region-specific policies and programs are needed to improve preventive services and address data gaps across this under-resourced subregion.