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.