Dental hygiene therapy oral health education intensity and caregiver-reported child toothbrushing in Rwandan early-childhood centres: a cluster-randomised implementation evaluation

Caregiver-reported toothbrushing among children attending early-childhood centres in Rwanda remains poorly characterised, and the intensity of oral health education delivered by dental hygiene therapists has not been evaluated against a comparable counterfactual. The analysis draws on the DHS Program indicator 'Children attending an early childhood education program' (id ED_EEDP_C_ECE) for 17 African countries surveyed between 2019 and 2025, with a mean of 23.465 and a standard deviation of 22.159 across the 17 country-survey observations. The evaluation framework specifies the estimand, the randomisation schedule, the therapist-delivered education dose and the caregiver-report instrument, and it fixes the primary analysis at the centre level with a pre-specified intracluster correlation. The contribution is a defensible implementation template for dental hygiene therapy trials in East African early-childhood settings, together with a calibrated statement of what the available DHS evidence can and cannot support. Education intensity should be treated as a manipulable implementation parameter rather than a fixed programme attribute, and that caregiver report requires explicit validation before it can carry a trial's primary endpoint.