Introduction

TLUG had started a supervised toothbrushing project in a close vicinity of Old Mutare. A total number of 151 children were recruited from Toronto Beaulieu elementary school, with the aim of:

  • Improving oral health in children at school
  • Decrease the rate of caries
  • Increase the knowledge of teachers, parents and children on oral health

The project started in February 2017, and the children were clinically examined by two qualified dentists. Plaque index, Gingival Bleeding Index and Caries was registered. Information about oral health, oral hygiene and nutrition was given for the children and their teachers in their classroom and an optimal training on tooth brushing technique was given to the children in small groups thereafter.

It was agreed that the children will brush their teeth, supervised by their teachers every morning before they starts their class. Toothbrush and toothpaste will be provided by TLUG on a 3 month basis.

The project is monitored by oral health staff from Mutare on a monthly basis and qualified dentists from TULG and Mutare are expected to evaluate the project after 3, 6 months and one year.

A follow-up report from oral health staff monitoring the project for the last 3 months was positive and there is a need to expand the project to a nearby school in the same area.

3 months evaluation report:

A team composed of two dentist, Biniyam Wondimu and Conny Abrahamsson from TULG visited the project site, between 170714-170719, and hade discussion with the oral health staff monitoring the project. Discussion with the teachers and the students were performed at the school.

  • Dr. Advance Chingwena, & Dr. Noel Simangolwa as well as Mr. Tatenda Tsuro were generally satisfied with the progress of the project and have not encountered any major problem in the deliverance of the materials used. Their impression of the project is positive and have expressed a wish to expand the project to a nearby school in the same area.
  • The teachers and the schoolmaster at the Toronto Beaulieu elementary school were enthusiastic and were satisfied with project. The implementation process and the logistic (supply of the materiel needed) during the past 3 months was satisfactory according to the teachers. The have however raised up the issue of dropouts from the school as a problem. Most of the children’s parents in the school are farmworkers and move out of the area due to the socio-economic situation that prevails in the area. They have however equal number of new children enrolling in the middle of the term and the total number of the children in the project haven’t changed significantly.
  • The children’s toothbrush are marked and are kept in a cup together with a toothpaste in a special cupboard in the classrooms properly.
  • We have observed that the children were brushing their teeth once a day, only in the morning.
  • Clinical examination was performed by two dentist Biniyam Wondimu and Noel Simangolwa. A total of randomly selected 62 children (39 girls & 23 boys), were examined.
  • The journals were kept properly at the dental office in Mutare and the same journal was used for the 3 month examination.
  • The children were asked about their oral health habit after they were thought and instructed how and when to brush their teeth
  • The children were clinically examined at the beginning of the project by two dentists without inter & intra calibration. Under and over diagnosed individuals were found during the second examination suggesting some bias. Although the data can’t be used for scientific purpose, it could be used to analyze a trend in the population.
  • Result from the clinical examination suggest a significant improvement in the indices of GBI (bleeding of gum) and PI (accumulation of plaque) indicating improved gingival health (se Figure below).

  • 3 children who were in immediate need of treatment were identified and were referred to the dental clinic in Mutare.

Project Expansion:          

There was a need to expand the project to a nearby school from both TULG and the project leaders. A school, Imbeza Primary School, situated in a close vicinity of Old Mutare, was identified and selected by Mr. Tatenda Tsuro. Biniyam Wondimu visited the school and had a discussion with the schoolmaster and the teachers. The staff were well informed about the ongoing project in the other school and were ready to start as soon as possible.

  • The school have 9 classes with 250 children
  • Some children come from Mozambique, the border is very close to the school.

Recommendations:

In general the project at Toronto Beaulieu Elementary School is managed properly and is progressing well. It should, therefore, be continued with one major improvement.

  • The teachers should be reinstructed to supervise toothbrushing twice a day. Once in the morning and once after the last class, before the children leave the school.

I recommend TULG to start a new supervised toothbrushing project at Imbeza Primary School preferably when the next group of LULG volunteers are in Old Mutare.

  • The same procedure (ethical approval, consent from parents, naming and preserving toothbrushes) as the first project should be used while implementing the project. A new Memorandum of Understanding is recommended.
  • The children should be asked about their oral health habit before they were thought about sugary diets and before they are instructed how and when to brush their teeth.
  • Clinical examination should be performed after inter & intra calibration
  • Teachers should be instructed to supervise toothbrushing twice a day

I would like to thank Dr. Advance Chingwena, Dr. Noel Simangolwa, and Mr. Tatenda Tsuro who have made my stay in Zimbabwe unforgettable.

Biniyam Wondimu

170808/Stockholm

Biniyam Wondimu | Associate Professor

Department of Pediatric Dentistry | Karolinska Institutet

Box 4064 | 141 04 Huddinge

Alfred Nobels Allé 8, Huddinge

______________________________________

Karolinska Institutet – a medical university

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