Association of Higher Caries Levels With Reduced Oral Health-Related Quality of Life Among Somali School Children in Hargeisa

Abstract

Background Evidence on how Somali children are affected by their oral health status is limited. This study aimed to assess oral health-related quality of life (OHRQoL) among 12-year-old schoolchildren in Hargeisa, Somaliland, and to examine the potential association of dental caries status (DMFT index) with OHRQoL. Methods A cross-sectional study was conducted in Hargeisa in December 2022, in which 405 children were randomly selected from 16 primary public and nonpublic schools using 2-stage probability cluster sampling. Data collection involved clinical examinations, and OHRQoL was assessed using six items from the WHO Child Oral Health Questionnaire (2013), capturing pain, functional, and psychosocial impacts. Associations were analysed using Poisson regression with robust variance estimation, accounting for clustering at the school level and adjusted for sociodemographic and behavioural factors. Results Approximately 71% reported at least one OHRQoL impact, predominantly toothache (54.7%) and eating difficulty (50.1%). Only 24% had a score > 2 impacts (on a 0-6 scale). Compared to public school peers, students from nonpublic schools reported significantly higher levels of dissatisfaction with the appearance of their teeth, thus avoiding smiling and laughing. In multivariable analysis, higher caries levels (DMFT ≥2) were associated with an increased prevalence of OHRQoL impacts (prevalence ratio [PR] = 1.15; 95% CI: 1.01-1.29). Urban residence (PR = 1.15; 95% CI: 1.03-1.28), dental visits in the past 12 months (PR = 1.34; 95% CI: 1.18-1.53), and poor self-rated oral health (PR = 1.40; 95% CI: 1.24-1.58) were also associated with higher prevalence of impacts. Conclusion Despite relatively low mean caries levels among 12-year-old school children in Hargeisa, higher caries levels (DMFT ≥2) were associated with an increased prevalence of OHRQoL impacts. The promotion of oral health education alongside preventive dental health programs specifically designed for Somali school children is recommended.