Socio-behavioural associates of Early Childhood Caries among preschool children aged three to four years in Gampaha district, Sri Lanka: a cross sectional study.

BACKGROUND: Early Childhood Caries (ECC) is a highly prevalent disease among preschoolers in Sri Lanka, with stagnated prevalence over the decades. Therefore, it is important to determine the socio-behavioural associations of ECC among preschoolers to reduce the country's ECC burden. METHODS: A cross-sectional study with a multistage cluster sampling technique was used to select 3 to 4 year-old preschoolers/mothers dyads in Gampaha district in 2019. Preschoolers who completed third birthday and had not completed fifth birthday on the day of data collection were selected. The dependent variable was the presence (dmft ≥ 1) or absence (dmft = 0) of ECC. Independent variables were sex, monthly family income, mother's educational and occupational status, child's birth order, family type, frequency of consumption of sweets and sweetened drinks, time of sweet consumption during the last 24 h, toothbrushing frequency, supervision of toothbrushing, dental visit, and maternal dental caries. A pre-tested validated questionnaire was used. Multiple logistic regression analysis was used. RESULTS: Total of 1038 preschoolers were selected. There were 529 females (51.0%) and 509 males (49.0%). The prevalence of ECC was 56.3% (95% CI: 53.1-59.3). Consuming sweets between meals had a higher odds ratio than consuming sweets after main meals (OR = 1.72, 95% CI:1.25-2.35), consumption of sweets every day had a higher odds ratio than consumption of sweets several times a week or less (OR = 2.89, 95% CI: 2.02-4.13), consumption of sweetened drinks every day had a higher odds ratio than consumption of sweetened drinks several times a week or less (OR = 1.73, 95% CI: 1.07-2.79), and the presence of maternal caries had a higher odds ratio than the absence of maternal caries (OR = 1.74, 95% CI: 1.12-2.69). The use of adult fluoridated toothpaste than not using adult fluoridated toothpaste (OR = 0.64, 95% CI:0.48-0.85), tooth brushing twice per day than not brushing twice per day (OR = 0.67, 95% CI:0.51-0.89), and supervised toothbrushing than unsupervised toothbrushing (OR = 0.61, 95% CI: 0.41-0.93) was negatively associated with ECC. CONCLUSIONS: ECC is highly associated with sweet consumption and oral hygiene behaviours among preschoolers in Gampaha District. Interventions should focus on the oral health behaviours of preschoolers to reduce ECC burden.

Qualitative analysis to identify determinants of use among different occupational settings and channels of communication to address smokeless tobacco use in Sri Lanka.

Smokeless tobacco (SLT) use is a leading cause for oral and pharyngeal cancers in the Southeast Asian region which leads to considerable morbidity and mortality. This study aims to Identify the determinants of use and channels of communication to address smokeless tobacco use among specific user groups in Sri Lanka. The study uses a qualitative approach with purposive, snowballing sampling among groups. Specific high-risk demographic and occupational groups that are known to have high prevalence of SLT use were identified in five of the 25 administrative districts of Sri Lanka, were approached. Sixty-two in-depth interviews and 10 focus group discussions were carried out among different occupational groups in five districts. Thematic analysis coding each reported determinants and communication methods was carried out. Users of SLT of different groups revealed different determinants of use. Some of the determinants were common to several groups. When investigated the preferred methods to address SLT, it is found that the media use was also different among these groups. All preferred group level awareness programmes to individual level awareness programmes. Most groups watch specific television channels at specific times of the day. Most groups stated that they accepted the messages of religious leaders and cancer victim groups. Radio and newspapers were used rarely by these groups that were studied. Smart phones were used only by urban youth and others used basic mobile phones only for calling. Different risk groups were identified allowing preparation of an overall communication approach to address use of SLT. The findings here Identify determinants of use and the communication approaches that can be used to prepare an effective communication strategy to address SLT use among different and sometimes hidden groups in resource poor settings in low a middle-income country.

A Sociological Analysis and Exploration of Factors Associated with Commercial Preparations of Smokeless Tobacco Use in Sri Lanka.

BACKGROUND: Use and addiction to commercial preparation of Smokeless Tobacco (CPSLT) is creating new socio-cultural issues and health challenges in Sri Lanka.  The objective of this sociological study is to investigate and analyse the socio-cultural factors that influence CPSLT use Sri Lanka to enable development of effective interventions.  Methods: This is a qualitative study for which data was collected through in-depth interviews in selected groups that use CPSLT. Thirty-five interviews were carried out in seven of the 24 districts in the country representing urban, rural, plantation communities and different livelihood and ethnic, gender and age groups in the year 2016. Purposive and snowball sampling techniques were used for selecting interviewees. The data was analysed by using qualitative data analysis techniques and sociological perspectives. RESULTS: This study reveals that the CPSLT use has integrated with the culture of several sociological and livelihood groups. Products such Thool (tobacco powder) and Maawa (dried areca-nut with flaked tobacco and some flavoured chemicals) were identified as the most popular forms of CPSLT.  Use of CPSLT has developed as a silent sub-culture specific to several social and livelihood groups. The informal CPSLT industry operating in the urban and sub-urban areas is influencing the school children and youth engaged in sports. Different groups of users express different reasons and justifications for its use. CONCLUSION: Use of CPSLT is closely integrated with the day to-day lifestyle and values of people of specific groups. and is an unseen part of life. Therefore, interventions will be urgently required to control the use of CPSLT to prevent its significant health impacts, considering the different contexts, symbolisms and justifications of its among the different groups. 
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Soft drink consumption in Sri Lankan adolescents.

OBJECTIVE: To determine the factors associated with sugar-sweetened soft drink consumption in adolescents from Sri Lanka. DESIGN: A cross-sectional study where the data were collected by means of a self-administered questionnaire. SETTING: Government, private and international schools in the Colombo district of Sri Lanka. SUBJECTS: Adolescents aged 17 years attending sixty-five schools. RESULTS: Overall 82 % consumed sugar-sweetened soft drinks once weekly or more often, while 77 % and 48 % consumed sugar-sweetened carbonated drinks and sugar-sweetened fruit drinks once weekly or more often. Being a boy (OR = 1·44; 95 % CI 1·02, 2·03), attending a private/international school (OR = 4·12; 95 % CI 1·94, 8·75), mother's level of education (OR = 1·53; 95 % CI 1·03, 2·28) and father's occupation (middle level: OR = 2·39; 95 % CI 1·63, 3·52; upper level: OR = 2·48; 95 % CI 1·35, 4·56) were independently associated with the consumption of sugar-sweetened soft drinks. CONCLUSIONS: The majority of adolescents in this sample consumed sugar-sweetened beverages once weekly or more often. It was evident that some sociodemographic factors were associated with the consumption of these drinks.

Prevalence and distribution of tooth wear among Sri Lankan adolescents.

PURPOSE: The aim of the present study was to assess the prevalence, distribution and sociodemographic factors associated with tooth wear among Sri Lankan adolescents. MATERIALS AND METHODS: A total of 1200 17-year-olds were selected from government, private and international schools in the Colombo district of Sri Lanka using a two-stage cluster sampling technique. The data were collected using a pretested, validated self-administered questionnaire and by conducting a clinical examination. Tooth wear was recorded using a modified version of Smith and Knight's tooth wear index. RESULTS: The prevalence of tooth wear among Sri Lankan adolescents was found to be 22.4%. In nearly 13.7%, tooth wear was confined to the enamel, whereas 8.7% had wear lesions extending up to the dentine. Occlusal surface was the most frequently affected surface, while the first molar was the most frequently affected tooth. Tooth wear was significantly associated with the type of school attended, father's occupational status and mother's level of education. CONCLUSIONS: The present study found that nearly one-fourth of the adolescents were affected by tooth wear. These findings are in agreement with those from developed countries where tooth wear has been shown to be an emerging oral health problem.