This project was commissioned as the borough had the highest proportion of its five-year-olds experiencing decay in the whole of England back in 2018/19. 51% of five-year-olds had at least one decayed missing or filled tooth and South Asian children were significantly more likely to have had tooth decay than White children. It also had the second highest rate for hospital admissions for tooth decay for nought to five-year olds in the North-West in 2021/22. The borough had the same proportion of five-year-olds experiencing decay as 2014/15 (Office for Health Improvement and Disparities, 2023).

Tackling children’s oral health is complex and bound up with issues of culture, lifestyle and deprivation and requires sustained effort, resource and commitment from all partners and residents to tackle this long-standing public health issue. Given the disparity in oral health identified between South Asian and White children in Blackburn, Health Living undertook a pilot project working with a local Madrassah (a Muslim school usually associated with a Mosque) to try to understand oral health knowledge and behaviours of South Asian children and their families, as well as the potential of delivering educational workshops. This pilot project did provide some valuable insights, but only involved one Madrassah, and raised more questions.

The project was again commissioned by Blackburn with Darwen Public Health after the success of the pilot. The project this time needed to be scaled up and the data and statistics collected needed to be more robust as we wished to publish a paper therefore needed academic support for this project. We approached the University of Central Lancashire’s (UCLan) Dentistry Department for support, who accepted and provided an ‘in-kind’ contribution.

This larger study aimed to build on the pilot and identify the key factors that influence the oral health of children who attend Madrassah in Blackburn with Darwen, as well as what information exists and how any potential interventions should be delivered.

Objectives of the larger project:

1. Identify the dietary behaviours and oral health behaviours of children attending Madrassah in Blackburn
2. Gain insight into the reasons why these behaviours may occur
3. Identify the potential for oral health interventions that address the issues identified in objectives 1 and 2 and how these should be delivered
4. Synthesise the findings and produce recommendations for implementation

The research question was:

What are the contributors towards children’s oral health and information needs of children and parents of children who attend Madrassah in Blackburn with Darwen?

A three-pronged approach was taken for the research; Interviews, focus groups and surveys with parents and children of each madrassah.

Ethical approval from UCLan was required for this research which delayed the starting date by few months which left us unable to start working with the Madrassahs until January 2024.

We recruited 10 Madrassahs from across the borough and as the study was explorative, the aim was to collect data from as many participants as possible, the size of the various Madrassah varied, so we did not have a prescribed sample size but aimed for 1,000 children for parent surveys.

To understand the oral health behaviours and eating patterns of children, it was necessary to ask the children themselves: parents may be unaware of what the child eats outside of the home. By asking children and parents, we are hoping to be able to triangulate the findings of the two groups and see if there is any suggestion of this. Due to not collecting individual information it will not be possible to link the responses of any individuals in the two groups – only aggregated data will be compared.

There were a few barriers to accessing the Madrassahs such as school holidays, Ramadhan, Eid and prayer times, which delayed the project further. We also did an opt in option to the surveys, which left us with no control with the number of surveys being completed and returned by parents. But the overall percentage for parent survey returned were 23% which in research terms is very satisfactory.

Total number of madrassahs recruited	10
Total number of madrassahs agreed to 1-1 interviews with children	9
Total number of parent surveys sent out	1598
Total number of forms returned	320
Total number of children interviewed	86

The qualitative and quantitative data analysis is being processed by the university, findings and the paper will follow.