title: Barriers and facilitators of dental service utilization by children aged 8 to 11 years in Enugu State, Nigeria.
abstract: BACKGROUND
  Multiple factors influence a child's ability to access oral health care. The aim of this study was to identify factors that facilitated and served as barriers to children's utilization of oral health care services in Enugu, Nigeria.
  
  
  METHODS
  The study recruited 1406 primary school pupils aged 8 to 11 years. All the children received oral health education, with the aid of an oral health education curriculum appropriate for their age. After this, referral letters were given to the children. Twelve months later, the study participants were revisited in their schools to obtain information on their reasons for utilizing, or not utilizing an oral health care service in the last 12 months. The association between socio-economic status; form of parenthood; number of siblings, birth rank and reasons for utilization and non-utilization of dental services were assessed. Influence on the child's predisposition to oral health service utilization on dental visit was also assessed.
  
  
  RESULTS
  Only 116 (14.7 %) of the 791 children accessible during the 12 months follow-up visit had visited the dental clinic and the main reason for utilization was the desire to fulfill the dentist's request for dental visit (41.9 %) while parents' inability to make out time for a dental visit (43.3 %) was the main reason for non-utilization. The odds of utilizing oral health care services for study participants from the middle (AOR: 0.50; CI: 0.31-0.79; P = 0.003) and low (AOR: 0.24; CI: 0.13-0.45; p = <0.001) socioeconomic strata, and those living with guardians/relatives (AOR: 0.08; CI: 0.01-0.60; p = 0.01) were decreased when compared to those living with both parents, respectively. Respondents with positive perception about dental service utilization had increased odds of utilizing oral health care (AOR: 2.96; CI: 1.48-5.90; p = 0.002).
  
  
  CONCLUSIONS
  Dentists can be strong motivators for children to utilize oral health care. Time is a significant barrier for the utilization of dental services. The programs designed to address barriers to oral health care utilization for children should be geared towards overcoming the possible threats that socio-economic status and type of parents they have may pose, to reduce inequity in dental service utilization.
authors.affiliation: University of Nigeria Teaching Hospital, Enugu, Nigeria. nnekaonyejaka@yahoo.com.
authors.forename: Nneka Kate
authors.initials: NK
authors.lastname: Onyejaka
authors.affiliation: Obafemi Awolowo University, Ile-Ife, Nigeria.
authors.forename: Morenike Oluwatoyin
authors.initials: MO
authors.lastname: Folayan
authors.affiliation: University of Nigeria, Enugu, Nigeria.
authors.forename: Nkiruka
authors.initials: N
authors.lastname: Folaranmi
mesh_terms: D002648:Child; D002675:Child, Preschool; D003729:Dental Care / Q000706:statistics & numerical data*; D003815:Dentists; D005260:Female; D006267:Health Education, Dental; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009549:Nigeria; D009909:Oral Health; D010290:Parents; D012574:Schools; D012923:Social Class; D011795:Surveys and Questionnaires
keywords: Barriers; Family structure; Oral health care; Utilization