A Qualitative Study of Child Nutrition and Oral Health in El Salvador

Abstract

The nutrition transition from traditional diets to processed snacks and sugary beverages has contributed to a higher burden of child malnutrition, obesity, and tooth decay. While child health interventions typically promote nutritious eating, they rarely promote oral health. Mothers’ motivations for child nutrition and oral health practices need to be better understood. A convenience sample of 102 mothers in eight rural Salvadoran communities participated in focus groups addressing child nutrition and oral health. Focus groups were transcribed and coded using qualitative content analysis. Primary themes included generational changes in health environments; health knowledge, attitudes, and practices; and access and barriers to health services. Mothers noted general improvements in awareness of oral hygiene but poorer child oral health, which they attributed to widespread sales of unhealthy snacks and beverages near schools. Distance and cost limited families’ access to dental services. Knowledge gaps included the belief that oral iron supplements cause tooth decay, uncertainty regarding when to start tooth brushing, and until when parents should help children brush. Maternal-child health programs should emphasize the adverse health consequences of feeding young children processed snacks and sugary drinks, and promote dental care access and regulations to ensure health-promoting environments surrounding schools.

Healthy Food, Healthy Teeth: A Formative Study to Assess Knowledge of Foods for Oral Health in Children and Adults

“…The emerging evidence on the relationships between high consumption of ultra-processed food products and poor health outcomes should provide impetus to translate findings through more coherent nutritional guidelines that are based on foods. Food-based classifications are used increasingly in some countries to inform nutrition guidance; one such country is Brazil, where the NOVA classification scheme is used to classify foods according to levels of processing [ 69 ]. Terminology such as “minimally processed”, “processed”, and “ultra-processed” foods is used in the set of guidelines statements for the population [ 70 ].…”

Sugary Liquids in the Baby Bottle: Risk for Child Undernutrition and Severe Tooth Decay in Rural El Salvador

“…Other demographic characteristics such as mother’s education and family size were not significantly associated with undernutrition or sECC. Our finding that mothers’ oral health knowledge was not significantly associated with children’s nutrition or oral health outcomes may be indicative of structural health barriers—such as, but not limited to, the lack of affordable nutritious foods and limited access to healthcare in rural areas—to ensuring good nutrition and oral health in rural El Salvador [ 18 ].…”

“…Prior research has noted that effective implementation of school-based obesity-prevention programs suffers when there is limited integration of the children’s families and school vendors in the program’s efforts [ 47 ]. Additional policies are still needed to limit children’s access to unhealthy foods and beverages sold by vendors near the school grounds [ 18 , 45 ]. This can be supported by encouraging community access to fresh produce and by drafting additional restrictions for the marketing of fast foods and SSBs—a driver of the nutrition transition in Latin America [ 18 , 45 , 48 , 49 ].…”

“…Additional policies are still needed to limit children’s access to unhealthy foods and beverages sold by vendors near the school grounds [ 18 , 45 ]. This can be supported by encouraging community access to fresh produce and by drafting additional restrictions for the marketing of fast foods and SSBs—a driver of the nutrition transition in Latin America [ 18 , 45 , 48 , 49 ]. The feasibility of public health interventions in El Salvador is also limited by the presence of context-specific challenges, including gang violence threatening implementation of sustainable development, high vulnerability to natural disasters severely impacting infrastructure and agriculture, and limited integration of national health systems [ 50 ].…”

“…In El Salvador, over 50% of young children also experience ECC [ 17 ]. Because access to dental services is limited for much of the Salvadoran population, most cavities resulting from tooth decay remain untreated, which can cause mouth pain, difficulty eating and sleeping, poor school performance, and an overall worsened quality of life [ 8 , 18 ]. While existing studies have documented the effects of the nutrition transition on children’s nutrition status in broader Latin American contexts, its effects in rural El Salvador specifically remain unclear [ 19 ].…”