Geospatial Patterns of Cariogenic Feeding Practices Among Children Aged 6-23 Months in Ghana: A Spatial and Multilevel Analysis of the 2022 Ghana Demographic and Health Survey
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Early childhood caries remains one of the most prevalent, and among the most neglected, chronic diseases of childhood in low- and middle-income countries, and cariogenic feeding practices introduced in infancy are a principal, modifiable driver. National, spatially explicit estimates of such practices are lacking for Ghana, constraining geographically targeted interventions.
Methods
We analysed 3,007 children aged 6-23 months from the 2022 Ghana Demographic and Health Survey, linked to 600 georeferenced clusters. A composite cariogenic feeding index was built from bottle feeding, sugar-sweetened beverage consumption, and other cariogenic foods; a child was classified as exposed if any one component was present. Complex survey design was handled by Taylor series linearisation. Determinants were examined using survey- weighted and two-level random-intercept logistic regression, and spatial clustering was assessed using global and local Moran’s I and Getis-Ord Gi* from a five-nearest-neighbour weights matrix.
Results
Weighted national prevalence was 52.97% (95% confidence interval 50.19-55.75), ranging from 27.95% in Savannah Region to 73.55% in Western Region, and patterned by residence (63.07% urban versus 43.90% rural) and wealth (32.87% poorest versus 74.45% richest quintile). Wealth and maternal education were the strongest multilevel correlates: the richest households showed roughly four times the odds of exposure relative to the poorest (adjusted odds ratio 4.00), and higher maternal education showed roughly two and a half times the odds relative to no education (adjusted odds ratio 2.51). The intraclass correlation coefficient was 0.219. Global Moran’s I was 0.231 (z = 9.73, p < 0.001), confirming significant positive spatial autocorrelation, with high-high clusters along the southern coastal belt (Western, Central, Greater Accra, Volta) and low-low clusters in the middle and northern belts (Bono, Ahafo, Upper West, Northern, North East).
Conclusions
Cariogenic feeding among Ghanaian infants is common, socioeconomically patterned, and spatially clustered rather than random. Oral health promotion through routine growth monitoring and immunisation platforms should be prioritised in the high-high clusters, while closing socioeconomic gradients would yield collateral benefit nationally.
Trial registration
Not applicable.
