Caregiving and workload burden among female-headed households as a barrier to pediatric dental care access in Peru

Quispe Zuta R.H.; Orrego-Ferreyros L.A. · Revista de la Asociacion Odontologica Argentina (2026) · DOI: 10.52979/raoa.1140812.1360

Resumen

Aim: To analyze the evolution of access to dental care in children under 12 years of age in maternal-headed households in Peru, 2019-2023, considering workload as a potential barrier. Materials and methods: A secondary analysis of panel data from the National Household Survey (ENAHO) 2019-2023. Fixed-effects econometric models were employed, allowing for the control of unobserved heterogeneity and the examination of intra-and inter-individual temporal variation. Results: A total of 4,238 child-year observations from 1,653 minors were analyzed. Aggregate access was 88.7%, although 28.7% never accessed care during the period. In the parsimonious multivariate model, female head of household was the strongest determinant (RR = 72.9; 95% CI: 16.6320.6; p < 0.001). Income showed the steepest gradient: the third quartile multiplied access by 6.6 (RR = 6.58; 95% CI: 3.06-14.14) and the fourth by 23 (RR = 23.01; 95% CI: 8.5561.94) compared to the lowest quartile (p < 0.001). The SIS (Comprehensive Health Insurance) increased access (RR = 3.43; 95% CI: 1.45-8.11; p = 0.005); EsSalud, private insurance, and EPS showed positive effects (RR 2.6-7.9) without statistical significance. In the bivariate models, 35-40 hour workweeks acted as a barrier (RR = 0.54; p = 0.013), an effect that lost significance upon adjustment; workweeks >60h/week were associated with greater access in the final model (RR = 3.26; 95% CI: 1.31-8.06; p = 0.011). Conclusion: Inequalities in children’s dental care access persist, determined by the head of household, income, insurance status, and, in a more complex manner, maternal workload, despite the increase in coverage.

Instituciones: Universidad César Vallejo