Early childhood caries in Africa: prevalence, determinants, and implications for oral health promotion-an umbrella review.

Background: Early childhood caries (ECC) remains one of the most prevalent chronic diseases affecting children worldwide and represents a major public health challenge in many African settings. Understanding its determinants is essential for developing oral health promotion strategies and preventive policies aimed at improving child oral health and reducing inequalities. Methods: This umbrella review followed PRISMA guidelines and was registered in PROSPERO (CRD420261379153). Systematic reviews and meta-analyses published between January 2000 and May 2026 were identified through searches of MEDLINE, Scopus, Web of Science, and Embase. Methodological quality was assessed using AMSTAR 2, risk of bias using ROBIS, overlap using a citation matrix and corrected covered area (CCA), and certainty of evidence using a narrative GRADE approach. Findings were synthesized narratively. Results: Seven systematic reviews and meta-analyses were included. Methodological quality ranged from high to critically low, while ROBIS identified predominantly low overall risk of bias, although two reviews were judged to be at high risk of bias. The corrected covered area (CCA) was 4.7%, indicating a low degree of overlap among reviews. ECC prevalence ranged from 17% to 57%, with higher estimates reported in North and Southern Africa. The most consistently reported determinants were dietary, oral hygiene-related, sociodemographic, and breastfeeding and bottle-feeding-related factors, whereas maternal/caregiver-related, biological, health-related, and contextual determinants were supported by a smaller body of evidence. Certainty of evidence was moderate for ECC prevalence and the most consistently reported determinants, but low for maternal/caregiver-related, health-related, biological, and contextual determinants. These findings support evidence-informed oral health promotion and prevention strategies across African settings. Conclusion: ECC remains a substantial oral health burden in Africa and is influenced by interacting behavioral, sociodemographic, caregiver-related, biological, health-related, and healthcare access determinants. Comprehensive oral health promotion strategies should strengthen caregiver education, support healthy dietary and oral hygiene behaviors, improve access to preventive services, and integrate oral health into maternal and child health programs. Such approaches may help reduce ECC burden and oral health inequalities among vulnerable populations. Systematic Review Registration: PROSPERO, identifier CRD420261379153, http://www.crd.york.ac.uk/PROSPERO/view/CRD420261379153.