Evaluation of the reliability and validity of the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire translated into Malagasy.

The Early Childhood Oral Health Impact Scale (ECOHIS) was developed to assess the impact of oral health conditions on the quality of life of preschool children and theirs families. The ECOHIS was originally developed in English language, translated and validated in several countries but no validated transcultural version of this questionnaire is currently available in Madagascar. The objectives of this cross-cultural study were to translate, validate and analyse the psychometric properties of the Malagasy version of ECOHIS. METHOD: The translation followed the forward-backward translation process. The Malagasy version obtained was pre-tested on ten mothers. Then, the questionnaire was administered by interview to 150 parents/guardians of children aged 3 to 5 years old frequenting two nursery schools in the town of Mahajanga to evaluate the reliability and validity of its psychometric characteristics. Reliability was assessed by the test-retest procedure with an interval of 15 days by using the intra-class correlation (ICC). Internal consistency was tested by Cronbach's alpha coefficient. The validity of construct, discriminant and criterion were evaluated. Construct validity was evaluated by Spearman rank correlation and tested using exploratory factor analysis and partial confirmatory factor analysis. Discriminant validity was tested between groups of children presenting consequences of untreated decayed teeth. Clinical examination was performed using the decayed, missing, filled teeth (dmft) and the pulpal involvement, ulceration, fistula, abscess (pufa) indices for assessing dental caries and consequences of untreated decayed teeth. RESULTS: The cultural adaptation showed that the respondents understood the questions. The intraclass correlation coefficient for test retest was 0.91. The internal consistency demonstrated a good reliability of the Malagasy-ECOHIS version with a Cronbach's alpha coefficient of 0.88. The convergent validity evaluated by Pearson correlation coefficients provided positive and significant correlation values between all the items ranging from 0.26 to 0.72. Significant associations between the ECOHIS scores and the global rating of oral health supported the validity of the construct. Convergent and discriminant validity were obtained by testing the association of ECOHIS scores on the child and family sections with poor parental ratings of their child's oral health, high caries experience and untreated decayed teeth consequences which were to be statistically significant. CONCLUSION: The results showed that this Malagasy version of ECOHIS questionnaire has shown good psychometric properties and could be used on Malagasy parents of preschool children to measure the impact of oral health status on the child and family quality of life.

Translation and cross-cultural validation of the French version of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire.

BACKGROUND: Sleep-disordered breathing (SDB), including obstructive sleep apnea syndrome, is often underestimated because it requires a burdensome test (ie, polysomnography) to ensure diagnosis. To improve polysomnography referral, it is of utmost importance to validate efficient alternative screening tools. This study aimed to provide a translation and a cross-cultural validation of the Pediatric Sleep Questionnaire (PSQ) into French to obtain an easy-to-use and reliable screening tool. The psychometric properties of the French version were also determined. METHODS: The process of cross-cultural adaptation was carried out following these steps: forward-backward translation, evaluation by an expert committee, and pretesting of the pre-final version. Reliability of the French-PSQ version was assessed by Cronbach's alpha coefficients and Spearman's correlation on a convenient sample of 201 children (aged between 2 and 17 years). Construct validity was determined by factor analysis of principal components. RESULTS: Internal consistency was within an adequate range for all subscales: 0.711 for snoring, 0.559 for sleepiness, 0.682 for behavioral problems, and 0.776 for the whole questionnaire. Spearman's correlation analysis comparing questionnaires administered two weeks apart showed good correlation coefficients for all subscales (snoring: 0.642, sleepiness: 0.846, behavioral problems: 0.780, and entire SRBD scale: 0.835). Factor analysis performed to assess the structure of the French-SRBD scale confirmed the same four factors described in the original questionnaire ("breathing," "behavior," "sleepiness," and "other"). CONCLUSION: The French version of the PSQ has been successfully cross-culturally adapted and showed good psychometric properties, suggesting that it is useful as a tool to screen sleep-disordered breathing in French-speaking children.

[Relation between body mass index and dental caries among adolescents]. / Relation entre l'indice de masse corporelle et la carie dentaire.

BACKGROUND: Obesity and dental caries are both multifactorial diseases. Their prevalence is increasing among infants and adolescents. Research results on the association between dental caries and obesity are contradictory and the nature of factors involved remains unclear. The aims were to review and summarize the type of the relation between dental caries and obesity among infants and adolescents aged 8 to 18 years old and to identify factors contributing to the clarification of the relationship. METHOD: Research of literature was undertaken on electronically databases Scholar Google, Medline, completed by manual searches from reference lists of studies. Review was based on cross sectional studies published between 2010 and 2015. RESULTS: The results showed that dental caries were associated with high and low body mass index. In addition to the socio-economic, environmental, behavioural, lifestyle factors, the review identified that the choice of instruments used to diagnose the dental caries and the obesity had impact on the results. CONCLUSION: The present review has identified the impact of the indicators used for measuring obesity and dental caries other than the standard BMI or DMFT respectively. Future research should test if their use will change the conclusions on the association between obesity and dental caries.

Parental-Caregivers Perceptions Questionnaire (P-CPQ): translation and evaluation of psychometric properties of the French version of the questionnaire.

BACKGROUND: The Parental-Caregivers Perceptions Questionnaire (P-CPQ) is a measure of parental/caregivers' perceptions of the impact of children's oral health on quality of life. The aim of the study was evaluate the psychometric properties of the French version of the P-CPQ. METHOD: The original P-CPQ was developed in English language and has 31 items divided into four sub-scales. This cross-sectional study used the translation-back translation method. The translated questionnaire was pretested on 14 parents-caregivers to obtain the final French version. The psychometric properties were tested on 142 parents/caregivers of three clinical groups of children from 8 to 10 years old without dental/facial anomalies (presumed healthy), with oral-facial clefts and with oral-dental anomalies linked to a rare disease other than cleft, approached in the waiting room of the Centre of the Hospital Rothschild in Paris, France, where the children attended treatment. Internal consistency was assessed by Cronbach's alpha and test-retest reliability by Intra-class Correlation Coefficient (ICC). Construct validity was measured by correlations between the total scores and the global ratings of oral health and overall wellbeing, and tested using exploratory factor analysis (EFA) and the factorial structure was evaluated by the partial confirmatory factor analysis (PCFA). Discriminant validity was determined using Kruskall-Wallis test. RESULTS: The mean (standard deviation) P-CPQ score was 18.73(18.79). Internal consistency was confirmed by a Cronbach alpha of 0.85. The test-retest reliability revealed that the responses to items were satisfactorily stable (ICC = 0.88). Construct validity was demonstrated by significant correlation coefficients between the total scale and the global ratings (r = 0.54 and 0.46; p < 0.001). Factor analysis with Principal Component Analysis extracted seven factors explaining 65.23% cumulative variance. Goodness-of-fit indices for partial confirmatory factor analysis were satisfactory for the 7-factors model of the French-PCPQ version. There were statistically significant differences between clinical groups regarding the total scale, thus demonstrating discriminant validity (p < 0.001). CONCLUSION: This French P-CPQ version showed reliability and validity comparable to the previous versions. However, the cross-cultural structure of the subscales should be further evaluated.

Translation and validation of the French version of the Child Perceptions Questionnaire for children aged from 8 to 10 years old (CPQ 8-10).

BACKGROUND: The Child Perceptions Questionnaire (CPQ) belongs to a set of questionnaires measuring Child Oral Health Quality of Life (COHQOL). The CPQ is used to collect the perceptions of children on the impact of oral diseases on their quality of life. This cross-sectional study was aimed to translate the CPQ8-10 into French language and evaluate its psychometric properties. METHODS: The translation process complied with international recommendations. The final French version was tested on children aged 8-10 years old attending consultations in a Parisian public hospital and divided into three groups: children with oral-facial clefts, children with dental anomalies linked to a rare disease other than clefts and children presumed to be healthy and without anomalies. The internal consistency relating to the reliability of CPQ8-10 was evaluated by Cronbach's alpha. The intra-class correlation was used to measure reproducibility at the test-retest level. Construct validity was evaluated by Spearman's correlation and tested using factor analysis. The discriminant validity was assessed using Kruskall Wallis test. Criterion validity was calculated using Spearman's correlation. RESULTS: One hundred seventy-six children participated in this study. During the translation process, minor changes were made. The French version showed good reliability with a Cronbach's alpha of 0.81 for the total scale. The ICC of the test-retest was excellent (=0.90) demonstrating good reproducibility. The construct validity was acceptable with a statistically significant correlation between the scores of the French-CPQ8-10 and the evaluation of oral health (r = 0. 381 and p < 0.001) and its impact on oral health quality of life (r = 0.363 and p < 0.001). The loading weights obtained in the Exploratory Factor Analysis showed that this model revealed seven factors with eigenvalue greater than 1, explaining the 63,89% of the cumulative variance. The differences observed between the scores of the study groups revealed good discriminant validity. Criterion validity was supported by significant association between CPQ scores and pain. CONCLUSION: The French-CPQ8-10 is reliable and valid for use with the children of this age group.

Assessing the validity and reliability of the Malagasy version of Oral Impacts on Daily Performance (OIDP): a cross-sectional study.

BACKGROUND: Evaluating health needs includes measures of the impact of state of health on the quality of life. This entails evaluating the psychosocial aspects of health. To achieve this, several tools for measuring the quality of life related to oral health have been developed. However, it is vital to evaluate the psychometric properties of these tools so they can be used in a new context and on a new population. The purpose of this study was to evaluate the reliability and validity of the Malagasy version of a questionnaire for studying the impacts of oral-dental health on daily activities (Oral Impacts on Daily Performance), and analyse the interrelations between the scores obtained and the oral health indicators. METHOD: A cross-sectional study was performed for the transcultural adaptation of the Oral Impacts on Daily Performance questionnaire forward translated and back-translated from English to Malagasy and from Malagasy to English, respectively. The psychometric characteristics of the Malagasy version of the Oral Impacts on Daily Performance were then evaluated in terms of internal reliability, test-retest, and construct, criteria and discriminant validity. Four hundred and six adults responded in face-to-face interviews to the Malagasy version of the Oral Impacts on Daily Performance questionnaire. RESULTS: Nearly 74% of the participants indicated impacts of their oral health on their performance in their daily lives during the 6 months prior to the survey. The activities most affected were: "smiling", "eating" and "sleeping and relaxing". Cronbach's alpha was 0.87. The construct validity was demonstrated by a significant association between the Oral Impacts on Daily Performance scores and the subjective evaluation of oral health (p <0.001). Discriminant validity was demonstrated by the fact that the Oral Impacts on Daily Performance scores were significantly higher in subjects with more than ten missing teeth, compared to those with fewer than ten missing teeth (p < 0.001). CONCLUSION: The Malagasy version of the Oral Impacts on Daily Performance index is a valid and reliable measure for use in Malagasy adults over 55 years old.

The assessment of status of tobacco smoking among urban primary schoolchildren in Madagascar.

The prevalence of tobacco smoking among adolescents aged 13-15 years old in Madagascar was previously reported to be higher than the average in other African regions. A preventive approach is urgently needed to avoid the initiation of early tobacco smoking. Therefore, the aims of this study were to evaluate the status of tobacco smoking among primary schoolchildren in Madagascar and explore the factors associated with initiation of tobacco smoking in the young. This study was conducted in the Mahajanga region of Madagascar. Three primary schools in this region and children of both genders between the ages of nine to 12 years old were randomly selected and approached to participate in this study. A self-administered questionnaire modified from the Global Youth Tobacco Survey Core Questionnaire 2007 was used to assess the status of tobacco smoking among primary schoolchildren. A total of 150 schoolchildren (14.0%) declared that they had smoked tobacco, with 30% starting to smoke tobacco at the age of seven or younger. The prevalence of tobacco smoking was lower among schoolchildren with non-smoking parents (p < 0.001) or non-smoking close friends (p < 0.001). Furthermore, schoolchildren's antismoking intention (p < 0.001) and their knowledge about the harmfulness of tobacco (p = 0.009) had significant effects on the prevalence of tobacco smoking. The results of this study indicate that tobacco smoking among schoolchildren in Madagascar may be influenced by peers, or parents, as well as smoking intention and knowledge about the harmfulness of tobacco use.

Use of plants in oral health care by the population of Mahajanga, Madagascar.

BACKGROUND: The use of medicinal plants to address oral health problems is not well documented in Madagascar, yet the country is full of endemic flora. The aim of this study was to collect information on the use of plants in the region of Mahajanga, Madagascar, for the treatments of oral diseases mainly tooth decay. METHODS: The ethnobotanical survey with respect to the use of plants for curing dental problems was carried out in 2012. A cluster sampling at three levels was applied when choosing the study sites. The target population was made up of heads of household. The following data were collected from a semi-structured questionnaire: name of plants, part used, mode of preparation, and administration. The Informant Consensus Factor and Fidelity Level indexes were calculated for each condition treated and used plants. The Results revealed that 93 per cent of the targeted population has used plants to calm dental pain, whereas 44.2% have reported using plants due to financial problems. About 65 species of plants are commonly used for oral health care and 63 of them treated caries. Cajanus cajan (L.) Millsp. was the most plant used. It was mostly used in crushed form of 5 to 9 leaves which were prepared and placed directly on the affected oral part or in the tooth cavity. In general, the treatment lasted about 5 days or minus. The ICF were 0.83 for caries and 0.81 for periodontal diseases. CONCLUSION: This ethnobotanical survey will serve as database for further phytochemical and pharmacological study of plants in order to identify their active components and advise the population on the most effective administration.

[Prevalence of tobacco use and associated factors among teenage students in Madagascar]. / Tabagisme et facteurs associés chez les adolescents scolarisés à Madagascar.

The available data on the prevalence of tobacco use among teenagers in Madagascar are very limited. The aim of this study was to analyze tobacco-use behaviors among teenage pupils aged 12 to 18 living in urban and suburban areas of Madagascar and to identify the associated risk factors. A cross-sectional descriptive study was conducted as part of this research. Probabilistic multistage sampling was used to obtain a representative sample. Data were collected using an anonymous self-reported questionnaire and computer analyzed using SPSS 16. Correlation and logistic regression were used to analyze the risk factors. The results show that approximately one third of the 711 pupils (36.3%) included in the sample reported that they had tried tobacco. Among them, 25.2% were regular users. Nearly 10% had started smoking before the age of 14. Male adolescents were found to smoke twice as much as their female counterparts. The study found that the key factors associated with tobacco use include: male gender (Exp(B)=3,769(95%IC 2,579-5,509), urbanization (Exp(B) = 3,679, 95% IC 2,138-6,332), age, peer influence, a sense of insecurity at school, and the impact of the mass media (films, television). The study found that the family environment did not have a significant impact on tobacco use. To conclude, the prevalence of smoking among teenage pupils in Madagascar is a significant issue. This paper argues that it is important to understand the associated risk factors in order to develop a prevention program aimed at reversing the tobacco epidemic in schools.

Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups.

UNLABELLED: OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries. CLINICAL SETTING: Nurseries, health centres and dental clinics in 17 countries. PARTICIPANTS: 2822 children aged 3 to 4 years and their parents. MAIN OUTCOME MEASURES: Dental examination of children and questionnaire to parents. RESULTS: Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group. CONCLUSIONS: This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

Barriers to the treatment of childhood caries perceived by dentists working in different countries.

OBJECTIVE: To explore whether dentists' beliefs and attitudes to providing preventive and restorative dental care for young children can form a barrier to the provision of care. BASIC RESEARCH DESIGN: The Barriers to Childhood Caries Treatment (BaCCT) Questionnaire, a standardised international measure was developed and applied. PARTICIPANTS: Through a research consortium, each site was asked to recruit 100 dentists. The sample participating was not intended to be nationally representative. Dentists were mainly randomly selected and contacted by mail with one or more mailings depending on site. RESULTS: 2,333 dentists in 14 countries and 17 sites participated. Factor analysis identified four factors as potential barriers. Two factors were found to be barriers in many sites. First, in most countries, dentists agreed that young children's coping skills limit their ability to accept dental care. Secondly, dentists with negative personal feelings, for example, that providing care can be stressful and troublesome and that they feel time constrained. Differences in dentists' beliefs can be partly explained by their work profile, with those treating children often, and those working under systems where they feel they can provide quality care being least likely to identify barriers to providing care for children. CONCLUSIONS: The BaCCT Questionnaire was determined to be a valid psychometric measure. Separately, it was found that health systems do impact on dentists' ability to deliver preventive and restorative care for children but that these effects vary across countries and further work is needed to determine how best these should be examined.