Validation of maternal report of early childhood caries status in Ile-Ife, Nigeria.

BACKGROUND: To determine the validity of maternal reports of the presence of early childhood caries (ECC), and to identify maternal variables that increase the accuracy of the reports. METHODS: This secondary data analysis included 1155 mother-child dyads, recruited through a multi-stage sampling household approach in Ile-Ife Nigeria. Survey data included maternal characteristics (age, monthly income, decision-making ability) and maternal perception about whether or not her child (age 6 months to 5 years old) had ECC. Presence of ECC was clinically determined using the dmft index. Maternally reported and clinically determined ECC presence were compared using a chi-squared test. McNemar's test was used to assess the similarity of maternal and clinical reports of ECC. Sensitivity, specificity, positive and negative predictive values, absolute bias, relative bias and inflation factor were calculated. Statistical significance was determined at p < 0.05. RESULTS: The clinically-determined ECC prevalence was 4.6% (95% Confidence interval [CI]: 3.5-5.0) while the maternal-reported ECC prevalence was 3.4% (CI 2.4-4.6). Maternal reports underestimated the prevalence of ECC by 26.1% in comparison to the clinical evaluation. The results indicate low sensitivity (9.43%; CI 3.13-20.70) but high specificity (96.9%; CI 95.7-97.9). The positive predictive value was 12.8% (CI 4.3-27.4) while the negative predictive value was 95.7% (CI 94.3-96.8). The inflation factor for maternally reported ECC was 1.4. Sensitivity (50.0%; CI 6.8-93.2) and positive predictive value were highest (33.3%; CI 4.3-77.7) when the child had a history of visiting the dental clinic. CONCLUSIONS: Mothers under-reported the presence of ECC in their children in this study population. The low sensitivity and positive predictive values of maternal report of ECC indicates that maternal reporting of presence of ECC may not be used as a valid tool to measure ECC in public health surveys. The high specificity and negative predictive values indicate that their report is a good measure of the absence of ECC in the study population. Child's history of dental service utilization may be a proxy measure of presence of ECC.

Challenges with study procedure fidelity when conducting household survey: reports from the field.

OBJECTIVES: The aim of the study was to identify reasons for protocol deviations during conduct of large epidemiological surveys despite training of field workers, validating clinicians, and providing field supervisory support. Enquiries focused on breaches of recruitment procedures, privacy, confidentiality, and informed consent. The case study was a household survey conducted in Ile-Ife, Nigeria. RESULTS: The study reveals that despite training of field workers, providing supervisory support, and conducting validation exercises, protocol deviation still occurred. Measures to improve internal research validity during the conduct of surveys can minimise but not eliminate protocol deviations. Individual and environmental factors increase the risk for protocol deviation. Individual factors include personal bias against adherence to elements of the protocols, and pressure to meet personal recruitment targets to maximise remuneration. These pressures increase the risk of breaching study participants' recruitment process. Environmental pressures resulted from low research literacy that made it possible for field workers not to consent participants and for participants not to prioritise privacy. The use of electronic data collection enhanced data security. A key recommendation from the study was that improved field supervision will reduce the risk for protocol violation.