Prevalence and Distribution of Oral Submucous Fibrosis Occurrence Among Schoolchildren in Karachi, Pakistan

Abstract

Oral submucous fibrosis (OSF) is a chronic, progressive disease characterized by fibrosis of the oral mucosa, leading to restricted mouth opening and potentially malignant transformation. While traditionally more prevalent among adults in South Asian countries, recent studies have shown an alarming increase in OSF cases among children, particularly in urban areas like Karachi, Pakistan. This study was approved by the ethical committee board of Dow University of Health Sciences, Karachi. The aim was to assess the geographical distribution of OSF cases among school-going children in Karachi, Pakistan, and identify potential risk factors associated with the disease. A cross-sectional study was conducted among school-going children aged 5-16 years in Karachi. A stratified random sampling technique was used to select schools from different geographical regions of the city. After verbal and written consent from students and school authorities, children were examined for clinical signs of OSF, including reduced mouth opening, palpable fibrous bands, and mucosal stiffness. Demographic data, dietary habits, oral hygiene practices, and exposure to risk factors such as areca nut and tobacco use were recorded through a structured questionnaire. An alarming prevalence of 0.7% of OSF was found among small children which is unexpected for a disease that is potentially malignant and previously found only in adults. The most affected areas in Karachi were Saddar and Liaqatabad town. Government school children were mostly affected. This study concluded that the prevalence of OSF was high in the group of schoolchildren and the sale of commercial preparation of areca nut may play a part in this increase. The town-wise pathology split shows the area of Gadap and Liaqatabad town should be targeted for intervention strategies followed by other towns in Karachi. This is crucial for effective public health interventions aimed at reducing the burden of this potentially debilitating disease among school-going children in Karachi.