A Scoping Review of Early Childhood Caries Prevalence, Determinants, and Interventions Among Indigenous Populations in Africa Using a Decolonizing Framework.

BACKGROUND: Indigenous populations experience a disproportionate burden of early childhood caries (ECC). However, the true scale of the problem among Indigenous populations in Africa is unknown, obscuring and hindering the development of equitable interventions. This scoping review aimed to map the existing literature on the prevalence, determinants, and interventions for ECC among Indigenous children's populations in Africa using a decolonizing framework. METHODS: The scoping review was registered with the Open Science Foundation (DOI: 10.17605/OSF.IO/A8YHN) and followed PRISMA-ScR guidelines. Guided by the Population, Concept, Context framework, the study examined evidence on the prevalence, social determinants (including water access, food sovereignty, and colonial legacy), and interventions for ECC among Indigenous children (aged 0-5 years) in Africa. A search in PubMed, Scopus, Google Scholar, and grey literature (WHO, UNICEF, IWGIA, African Commission) was conducted up to December 2025, with hand-searching of references of manuscripts and expert consultation. Two reviewers extracted data on study characteristics, ECC prevalence, determinants (categorized as individual/family, community, or systems/policy level), and intervention approaches (decolonizing vs. conventional). Descriptive and inductive thematic analyses were performed. RESULTS: Two studies (one from South Africa and Cameroon, respectively), both cross-sectional, met the inclusion criteria. ECC prevalence was high but variable (27.5%-63%). The studies identified multi-level social determinants, including individual/family factors (diet, oral hygiene), community factors (cultural norms), and systemic factors (healthcare access inequalities, colonial legacy). The data collection process was characterized by externally driven, consultative approaches with minimal community involvement, failing to reflect decolonizing or participatory principles. CONCLUSION: There is a gap in knowledge regarding ECC in African Indigenous children's populations. The near-total absence of evidence, coupled with research models that perpetuate colonial power dynamics, highlights an urgent need for a paradigm shift. Future research must be grounded in decolonizing frameworks that prioritize community-led, participatory approaches, Indigenous sovereignty, and self-determination to address this oral health crisis effectively.