Impact of COVID-19 on Oral Health Services Utilization among Peruvian Children: A Cross-Sectional Study

Abstract

Background Oral Health is the first step for general health and well-being. Unfortunately, Oral health conditions have consistently ranked as some of the most widespread Non-Communicable Diseases (NCDs) globally (WHO, 2022), affecting the financial burden and compromising the country’s health expenditure. Therefore, early diagnosis, treatment, and monitoring through visits to oral health services are essential to reduce the burden of Oral Health Diseases (Di Spirito et al., 2022; Huang & Chang, 2022; Kazeminia et al., 2020). Due to the emergence of the novel Coronavirus Disease (COVID-19) different public health measures were triggered exacerbating health inequalities affecting access to health services (Bambra et al., 2020; Gudipaneni et al., 2023). In addition, the patterns of children's dental attendance could be influenced by different factors involving parents/caregivers, household characteristics, and others that were changed by the pandemic context (Gudipaneni et al., 2023; Torres-Mantilla & Newball-Noriega, 2023). In Peru, Oral Health Services Utilization has remained relatively low in the past years while caries prevalence remained high for the past 20 years, especially in children, becoming a public health concern (MINSA, 2019) Purpose The objective of this research was to assess the impact of the COVID-19 pandemic on oral health services utilization among Peruvian children under 12 years old. Method A cross-sectional study with secondary data from the Demographic and Family Health Survey (ENDES, in Spanish) from the years 2019 (before COVID-19), 2020 (during COVID-19), and 2022 (after COVID-19) was carried out. This study involved children aged 0-11 years old. Those with complete data of all variables and who were habitual residents were considered, resulting in a total sample of 40,341 children for 2019, 19,530 for 2020, and 39,863 for 2022. The main variable was Oral Health Services Utilization in the last 6 months and the independent variables were the sociodemographic factors classified according to Andersen’s Healthcare Utilization Model into predisposing (child’s age and sex; parent/caregiver’s sex, age, marital status, relationship with the head of the household; natural region of residence; area of residence; and altitude) and enabling factors (child’s insurance, wealth index, parent/caregiver’s education level and knowledge about oral healthcare). Descriptive analysis involving absolute and relative frequencies was conducted, for the bivariate analysis Chi-square test was employed. Finally, to determine the association between predisposing and enabling factors with Oral Health Services Utilization Hierarchical Logistic Regression was performed for the multivariate analysis. Results: The prevalence of Oral Health Services Utilization (within the last 6 months of ENDES surveys) in Peruvian children under 12 years of age was 40.4% in 2019, 31% in 2020, and 41.2% in 2022. For the bivariate analysis, Oral Health Services Utilization showed a significant association (p0.001) with the following predisposing factors: child’s age, parent/caregiver’s age, natural region of residence, and area of residence before, during, and after the COVID-19 pandemic. All enabling factors (child’s insurance, wealth index, parent/caregiver’s education level, and knowledge about oral healthcare) showed significant association (p0.001) with Oral Health Services Utilization before, during, and after the COVID-19 pandemic. The parent/caregiver’s sex showed a significant association (p0.001) with Oral Health Services Utilization only before the pandemic. While. parent/caregiver’s marital status (p0.05) and their relationship with the head of the household (p0.001) were significantly associated with Oral Health Services Utilization only after the pandemic. On the other hand, the child’s sex and the altitude showed insignificantly association. Within the multivariate analysis, the child’s age, the parent/caregiver’s sex, the natural region of residence, the parent/caregiver’s level of education, the parent/caregiver’s information received about oral Healthcare, and the wealth quintile of the household were significantly associated with Oral Health Services Utilization before, during and after the COVID-19 pandemic. The parent/caregiver’s age was associated with Oral Health Services Utilization only before and after the COVID-19 pandemic. The parent/caregiver’s marital status, the area of residence, and the health insurance were associated with Oral Health Services Utilization only before and during the COVID-19 pandemic. The child’s sex was associated with Oral Health Services Utilization in children only after the COVID-19 pandemic. Finally, after analyzing samples as a whole and adding the “year” as a variable, this was significantly associated with Oral Health Service Utilization, therefore Peruvian children in 2019 (OR: 1.11, 95%CI: 1.07-1.14, p=0.000) were more likely to use Oral Health Services before the COVID-19 than after COVID-19 (2022). In addition, there was a negative association between the year 2020 (during the COVID-19) and Oral Health Services Utilization, then Peruvian children in 2020 (OR: 0.65, 95%CI: 0.63-0.68, p=0.000) were less likely to use Oral Health Services during the COVID-19 (2019) than after COVID-19 (2022). Conclusion The pre-existing low rate of Oral Health Services Utilization in Peruvian children under 12 years was exacerbated during the COVID-19 pandemic, as well as the sociodemographic factors determining Oral Health Services Utilization that were affected or even modified, changing the patterns of Oral Health Services attendance in Peruvian children. Therefore, the COVID-19 pandemic had a negative impact on Oral Health Services Utilization which is increasing again nowadays after 2 years.