Africa has 54 acknowledged sovereign states and countries with many ethnic
groupings. The African region has the heaviest burden of disease in spite of impor-
tant national and regional efforts (World Bank 1994). The World Bank states that
32 African countries are among the world’s 48 least developed nations, and 80%
of the people in the region are in the low socioeconomic category (World Bank
1994). Poverty is the most important determinant of ill health in Africa (World
Health Organization 2002). Sub-Saharan Africa is the poorest region in the world,
and it is marked by political and economic instability and great variations in natu-
ral resources with most of the poorest countries in the world residing in this region
(Popkin 2002). The region faces an intense scourge of HIV/AIDS in addition to
the rising prevalence of non-communicable diseases (NCDs) like hypertension,
diabetes mellitus, and other medical conditions related to obesity (Popkin 2002).
Nigeria has a high burden of infectious diseases with related morbidity and
mortality, while women and children bear the greatest impact of diseases in this
region (Lambo 2015). About 70% of the population live in rural areas (World
Bank 1987), and even though Nigeria has one of the highest numbers of health
workers in Africa, there are disparities in their distribution between the rural and
urban areas, geopolitical zones, states, and local government areas (Lambo 2015).
These poorly motivated staff work in poor work environments with inadequate
infrastructure, limited opportunity for continuing education, inadequate supervi-
sion, and low logistic support (Lambo 2015). This ultimately leads to poor reten-
tion and migration of health workers, further worsening the health indices of
Nigeria. The presence of widespread poverty and underdevelopment in Nigeria,
like other African countries, means that these communities are also exposed to the
major environmental determinants of oral disease (Thorpe 2006).
The prevalence of dental diseases closely mimics the levels of social depriva-
tion. Oral diseases are among the most common NCDs that affect people through-
out their lifetime, causing pain, disfigurement, and even death. In the World
Health Organization (WHO) African Region where above 80% of the population
are of low socioeconomic status, these diseases affect the health and wellbeing
of millions of people. Oral health disparities continue to widen, more so among disadvantaged and vulnerable groups where the vast majority experience the
highest burden of oral diseases (Petersen et al. 2005, Watt 2005, Jin et al. 2011).
Importantly, children in developing countries are known to suffer disproportion-
ately from the burden of dental diseases. Children with poor oral health experi-
ence pain and tooth loss which affect their feeding and negatively impact their
nutrition, self-esteem, speech, socialisation, quality of life, and school attendance
(Edelstein et al. 2006). Worldwide, it is estimated that over 51 million school
hours are lost annually from dental-related illness (Peterson et al. 2005, Pau et al.
2008, Rowan-Legg 2013). The majority of these children in Africa have no access
to dental care (Petersen et al. 2005).
Barry Popkin’s revised demographic, epidemiologic, and nutrition transition
model (Popkin 2002) serves as the framework for this work, and it addresses how
nutrition-related NCDs are now the main causes of disability and death globally.
Dental caries is a unique diet-dependent disease which has a communicable com-
ponent through the horizontal or vertical transmission of cariogenic bacteria such
as streptococcus mutans (SM), especially from the mother. It can manifest due to
a complex interplay between dietary and infectious processes in addition to other
social and cultural influences. Mothers are key decision makers on children’s
oral healthcare, and maternal knowledge and attitudes to oral health have been
reported to be an important predictor of children’s oral health in Nigeria (Adeniyi
et al. 2009). Since the critical focus of this model was on prevention and because
many oral diseases have modifiable risk factors, it is desirable to determine mater-
nal perception about early childhood caries in Nigeria and to explore preventive
strategies that can be adopted.