Our review was guided by the following research questions: (i) what is the proportion of good oral hygiene.

and (ii) what is mean value oral hygiene index among children with cerebral palsy in Africa and Asia?

Searching strategies

A systematic review and meta-analysis were conducted, adhering to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, in order to explore the level of good oral hygiene and the average value of the Oral Hygiene Index (OHI-index) in children with cerebral palsy residing in Asia and Africa. The PROSPERO was registered under CRD42024540182.

The study utilized various databases, including PubMed, Scopus, Embase, Hinari, citation searching, and gray literature. The review utilized various search terms, such as Oral Hygiene, Oral Health, Oral Health Index, Dental Health Survey, Cerebral Palsy, Children, and Child to search across Asian and African countries. Boolean operators like “AND” and “OR” were used appropriately to combine these terms. The search was conducted from April 10 to May 01, 2023, covering all papers published up until May 01, 20,239 (Additional file 1).

Eligibility criteria

This review included full articles conducted among children with cerebral palsy in Africa and Asia, assessing the proportion of oral hygiene and/or the mean oral hygiene index. However, studies conducted outside these regions, lacking adequate data for assessing oral hygiene and/or the oral hygiene index, or unable to differentiate children with cerebral palsy from those with other special needs, were not included in the review. Furthermore, case reports, case series, and content from predatory journals were not taken into account. The strategies utilized to identify predatory journals includes confirming the journal’s indexing in reputable databases such as PubMed, Scopus, and Web of Science, use of predatory journal lists, seeking advice from peers and experts, and analyzing journal websites. The observational research designs (cross-sectional, cohort, and case-control) reporting on the proportion of oral hygiene and/or the mean OHI-index value among children diagnosed with cerebral palsy in Asia and/or Africa were considered.

Outcome of interests

The oral hygiene proportion and/or mean OHI-index value among children with cerebral palsy within Asia and Africa.

Outcome measurement among children with cerebral palsy

This systematic review emphasizes two main outcome variables. The primary variable involves the proportion of good oral hygiene, computed by dividing the number of children with cerebral palsy showcasing good oral hygiene by the total number of children with cerebral palsy displaying poor, fair, and good oral hygiene, and then multiplied by 100. The second outcome variable is focused on calculating the mean value of the OHI index. We utilized the Oral Hygiene Index (OHI), a well-established and validated tool employed to evaluate oral hygiene status, to maintain a standardized and comparable measure across the studies.

Study selection

After conducting a literature search, the retrieved articles were imported into Zotero Library, and duplicates were removed. Four reviewers (NM, DTA, ZAA, and MAZ) initially screened the titles and abstracts, and then assessed the full texts of selected papers based on predetermined eligibility criteria. The eligibility of potentially included studies was thoroughly evaluated by six authors (ESC, AK, NAT, NAG, and MAM), with any discrepancies resolved through discussions involving a third reviewer (MAS, MMG, and ECA).

Data extraction

The titles and abstracts of all studies were thoroughly screened using a standardized JBI data extraction format by six authors (ESC, YSK, AMD, BB, TAD, and KSC) to extract relevant data. The data extraction format included information such as primary author, continent/country, year of publication, study area, study design, sample size, prevalence, and OHI-index with 95% confidence interval or standard deviation score for each study. Any discrepancies or differences of opinion were resolved through discussion and agreement during the data extraction process. The retrieved studies were organized using the citation manager Zotero, and duplicate articles were removed. Any disagreements were resolved through a consensus meeting with other reviewers (ESC, MAZ, HSH, NAG, and SSC) to finalize the selection of studies for inclusion in the systematic review and meta-analysis.

Quality assessment

The Joanna Briggs Institute Critical Appraisal tool for use in JBI Systematic Reviews (JBI-MAStARI) was used to assess the trustworthiness, relevance, and results of published papers [20]. The tool compromises eight main standards for evaluating each primary study critically. As a result, primary studies that had a score of 50% or higher were included in the systematic review and meta-analysis study.

Statistical analysis

The data extracted from the reviewed articles were editing, cleaning, and verification for completeness in an Excel sheet. Subsequently, the data was exported to STATA 17 software for further analysis. A meta-analysis was conducted using a random effects model to estimate the overall pooled prevalence of good oral hygiene and the mean value of the OHI-index. The heterogeneity of reported prevalence and mean value was assessed using Cochrane Q-statistics and p-values from the I2 test. Publication bias was assessed using a funnel plot, and sensitivity analysis was performed to evaluate the impact of individual studies on the overall estimation. Additionally, subgroup analysis was conducted based on factors such as the continent of the study, study design, sample size, and year of publication.