International Association of Dental Students
SUNSHINE APPROACH FOUNDATION
SUNSHINE & SMILES A CHILD ORAL HEALTH PROMOTION
5th to 26th September
2016
International Association of Dental Students
HUMBLE SMILE FOUNDATION
SUNSHINE APPROACH FOUNDATION
Mozambique 2016 | 3
CONTEXT AND BACKGROUND Oral health is fundamental to general health and
population to dentist ratio of 135,000:1. In 1997, 50%
well-being. Poor oral health affects quality of life as a
of children had dental caries.
result of pain or discomfort, tooth loss, impaired oral functioning, disfigurement, missing school time, loss
The most common dental problems, such as dental
of work hours and death in the case of oral cancer and
caries which is pandemic, can be prevented by simple
noma. Significant barriers exist to ensuring the world’s
and inexpensive methods. Dental health is based on
people receive basic healthcare, including oral health-
oral hygiene, nutrition, fluoride intake and dental
care. Amongst these are poverty, ignorance, inadequate
service utilization; whereas bad dental health in adults
financial resources and lack of adequate numbers of
is usually the result of the absence of these influences
educated and trained (oral) healthcare workers. This,
during childhood. Dental health promotion aims to
together with insufficient emphasis on primary preven-
create an environment favorable to the adoption of
tion of oral diseases, poses a considerable challenge
these healthy behaviors. The use of school structure
for several countries, particularly developing countries
is particularly beneficial as activities can be integrated
and countries with economies and health systems in
into the curricula, and it provides quality personnel to
transition.
ensure proper implementation. The implementation of dental health promotion generally doesn’t result from a
Mozambique is one of the world’s poorest and most
national initiative in developing countries, largely due
underdeveloped countries. Despite rising GDP, chronic
to the lack of integration of dental health in activities
child malnutrition is rising. Access to clean water is
of education and health promotion in general. There
low (51% in 2011) as is access to adequate sanitation
is a great window of opportunity for promoting dental
(25%). HIV prevalence in 15-49 year age group was
health among the disadvantaged youth of vulnerable
11.5% in 2011, and in Maputo and Gaza provinces the
communities such as in southern Mozambique, through
prevalence is more than double.
self-care and community participation oriented programs.
In 2007 there were 159 dentists in Mozambique – a
4 | International Voluntary Project
PROJECT CONCEPT A.
Overall Objective:
o
To improve oral health integration in BHC and education systems in Mozambique,
following WHO recommendations. B.
Project Purpose:
o
To reduce morbidity due to caries among vulnerable population in target region.
C. Outputs: o
Sugar and acid intake habits are improved among children
o
Plaque control measures are increased
o
The ratio of favourable:unfavourable host factors is increased
D.
Output-wise major activities:
o
Sugar and acid intake habits are improved among children
Obtain authorisation to work in schools and orphanages and child centres for the
pilot
Work with school directors and teachers on appropriate food intake (where neces-
sary)
Prepare a training module and schedule for the school kids
Train BHC nurses and professionals (Community Health Workers)
Advocate to MoH and MoE for policies and protocols implementation
Meet local leaders to sensitize and explain oral health
o
Plaque control measures increased among children in schools
Introduce oral health habits in school routine
Sensitize local leaders and parents
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Toothbrushes or other culturally accepted accessories distribution (1 year supply)
to the school students,
Discuss with government opportunities to reduce taxes on those accessories
Find potential donors for the accessories
Train the BHC and school professionals on the subject
Create brushing stations
o
The ratio of favourable:unfavourable host factors is increased
Introduce fluoride based toothpaste into the school routine
Sensitize the community regarding fluoride intake benefits
Sensitize the community regarding sugarless chewing gums benefits
1 year supply distribution for the school kids
Advocate to MoH, WHO and UNICEF regarding fluoridation
Train BHC and school professionals
E.
Implementation strategy:
A capacity development model whereby the IADS field team educates local school staff to promote specific behavior-based preventive oral health initiatives, and advocates the integration of oral health in upstream policies. The principle recommended dental health measures are: 1/ topical fluoridation; 2/ modification of the amount of sugar in the diet, and; 3/ implementation of monitored dental hygiene activities in schools. Supporting school health in this way aims at broad exposure to the host population, while maximizing long-term benefit to the host population, and minimizing cost and any potential dangers to the local infrastructure. This proposal envisages a model based on the PLANNING-IMPLEMENTATION-EVALUATION cycle for oral health programs in developing countries - one cycle per region.
6 | International Voluntary Project
F.
Project target groups/beneficiaries:
o Primary:
Children under 12 – the Mozambique pilot aims to reach 660 kids and 40 adults
Government
o Secondary:
Schools and BHC professionals
General population
G.
Indicators and Success (Monitoring and Evaluation):
WHO Oral Health Surveys, Basic methods, 5th edition, Annex 8. H.
Location of the project sites (and rationale for selecting these locations):
o Secondary:
Schools and BHC professionals
General population
G.
Indicators and Success (Monitoring and Evaluation):
WHO Oral Health Surveys, Basic methods, 5th edition, Annex 8.
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Location of the project sites: Matola Duration: - one week Base: Larson Home - within 40 mins drive from all sites - 30 mins from Matola International Airport
Child Centers: 1. 2. 3.
Iris Matola Rio - 45 children Iris Matola Rio Preschool - 60 children Iris Zimpeto - 250 children
4.
Project Purpose - 20 children
5.
Promise Center - 30 children
8 | International Voluntary Project
6.
Berta’s Project - 40 children
Schools: 7. Iris Zimpeto School – 1600 students: 800 in the morning Grades 1 to 8 (16 classes), and; 800 Grade 9 to 11 in the afternoon (16 classes) 8. Berta’s Preschool - 40 children
Total potential reach: 2085
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Manjacaze Duration: - one week Base: Kapulana Hotel, Nwadjahane (birthplace of Eduardo Mondlane - liberator of Mozambique who lost his life attempting to gain independence from Portugal) – within 30 mins drive from all sites.
10 | International Voluntary Project
I.
Project time frame.
3 weeks, between September 5th to 26th 2 weeks on sites, one week for acclimatization, training and excursions (Xai Xai beach, Kruger Park, artisan’s market‌) J.
Operational Roles and Responsibilities
Humble Smile will be responsible for - Training the field team - Providing oral care products - Advocating the integration of oral health in upstream policies - Monitoring, evaluation and reporting Sunshine Approach will be responsible for the daily logisitics of - Gaining access to schools - Providing local support personnel incl. guides, translators, drivers, cooks - Food - Accommodation - Transport - Managing the products and supplies including regulatory and shipping issues - Letter of invite for volunteers
IADS - enrolling 5 student volunteers incl. copy of passports - providing the volunteers with information Volunteers - Health insurance - Vaccinations. Consult with travel clinic. Recommended: Hepatitis A and B, Tdap- Tetanus, Diptheria, and Pertusis, Typhoid. Malarone tabs for Malria. - Visa. Visitor not tourist. Try for a multiple entry- required for safari to South Africa. You will need to apply for a visa at the Mozambican embassy in your home country. If you do not have a Mozambican embassy in your home country, you can get a visa at the airport. BUT BE SURE YOU DO NOT HAVE A
Mozambique 2016 | 11
MOZAMBICAN EMBASSY IN YOUR HOME COUNTRY BEFORE YOU DO THIS!!! If you arrive and you do have a Mozambican embassy in your home country, they will not give you a visa and WILL send you home. - Flights - Extras incl. excursion costs, shopping, leisure activities etc Excursions
1. Kruger Park Safari
We go to South Africa in the afternoon and enjoy a South African braai (cook out). Stay at Elephant Walk Retreat, www.elephantwalk.co.za which is right outside the gate to Kruger Park. A very experienced Kruger guide picks us up in an open air safari vehicle at 5am and we enter the park at daybreak. She will take us through the park and make a stop for lunch. She will take us back to our vehicle at the end of the day, we will cross back into Mozambique and home again. Cost $120 per person incl. guided tour in safari vehicle, meals, accommodation.
2. Xai Xai Beach
We leave Manjacaze after breakfast and go to the beach for the day, stay overnight at Zona Braza http:// www.zonabraza.com/ and then head back to home after breakfast and a nice relaxing morning on the beach. Cost incl. accommodation and meals $60 per person. K. Sustainability: In addition to training the local non-dental personnel, interventions must aim to promote and facilitate long-term sustainable improvements, such as tackling upstream factors, and the environment that cause poor oral health and create inequities. It is clear that actions from the health departments alone have limited impact on the wider determinants of health inequities. Healthy public policies and legislation are important upstream measures to promote oral health, such as legislation to support the implementation of uoridation programs (water, milk, salt and toothpaste), and healthy diet policy to create a supportive environment that is conducive to oral health. In particular, water uoridation is one of the most cost-effective public health measures to improve dental health and reduce inequalities. Also, removal of taxes for oral health products is fundamental to avoid health inequities.