WORKING PAPER
HUMBLE SEEDS A CHILD ORAL HEALTH PROMOTION PROJECT Nicaragua Pilot November, 2016
III.
I.
INFORMATION ON HUMBLE SMILE FOUNDATION
1.
Primary Contact: Dr Darren (Doron) Weiss Qualification: B.D.Sc.(Melb.) Designation: President, Humble Smile Foundation Tel.: +972-522675410 Fax.: +972-772062600 Email: darren@humblesmile.org
2.
Goals and Vision: The prevention of suffering caused by oral disease by promoting effective oral health initiatives where needs are great.
3.
Main Working Areas: Schools in developing countries.
4.
Organizational Structure: Board of Directors –scientific and policy governance; fund management Community Executive Committees – mission management
5.
Institutional Infrastructure and Capacity: President is an oral health promotion consultant for companies and organizations, with 22 years experience as a clinician in private dentistry. A member of The Alliance for Oral Health Across Borders. Board with its executive and advisory committees, comprises professionals and academics in community, clinical and preventive dentistry, international health and child welfare. International leaders and organizations on global health research and humanitarian assistance are partners . Academic partners include dental schools, professional (dental and dental hygiene) and student associations. NGOs locally provide the on-site platforms and access to schools. Corporations provide materials and funding as part of their commitment to Corporate Social Responsibility.
II.
INFORMATION ON SEEDS FOR PROGRESS FOUNDATION 1.
Primary Contact: Ms Alejandra Rodriguez Designation: Project Co-ordinator. Marketing and Fundraising Manager, Seeds for Progress Foundation. Tel.: 505 89348855 Email: arodriguez@seedsforprogress.org
2.
Goals and Vision: Increase the quality of education and health services to children in rural communities in coffee regions.
3.
Main Working Areas: Schools in Nicaraguan coffee growing communities
4.
Organizational Structure: 18 staff members, including 9 on site school facilitators.
5.
Institutional Infrastructure and Capacity: 501c3 Nonprofit organization. Offices in Managua and Matagalpa, Nicaragua.
INFORMATION ON INTERNATIONAL ASSOCIATION OF DENTAL STUDENTS
1. Primary Contact: Rawan Saeed Designation: Volunteer Programs Coordinator
Tel.: +249-91-482-2700 email: Rowan-faisal@hotmail.com 2.
Goals and Vision: The international association of dental students was founded in Denmark 1951 and currently represents more than 200,000 dental students and graduates in more than 60 countries worldwide. IADS mission is to serve and fulfill the need of implanting the educational development necessities to their various communities in order to develop a passionate dental student and leader. IADS wishes to involve students with the people in need starting from having students feel the necessity to taste extracurricular activity such as voluntary participation to raise prophylaxis awareness in Nicaragua.
III. CONTEXT AND BACKGROUND Oral health is fundamental to general health and well-being. Poor oral health affects quality of life as a result of pain or discomfort, tooth loss, impaired oral functioning, disfigurement, missing school time, loss of work hours and death in the case of oral cancer and noma. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. This, together with insufficient emphasis on primary prevention of oral diseases, poses a considerable challenge for several countries, particularly developing countries and countries with economies and health systems in transition. Nicaragua is among the poorest countries in the Americas. According to the United Nations Development Programme, 48% of the population of Nicaragua live below the poverty line, 79.9% of the population live with less than $2 per day. Nicaragua's minimum wage is among the lowest in the Americas and in the world. Rural workers are dependent on agricultural wage labor, especially in coffee and cotton. Only a small fraction hold permanent jobs, while most are migrants who follow crops during the harvest period and find other work during the off-season. Of the 1,150 dentists in Nicaragua, a minority are in the state health sector, and most of those are not in the rural areas where most of the population lives. 73% of children have dental caries. A recent study found a mean dmft of 3.54 in 6-9 year old Nicaraguan children, and reported that less than half the kids brushed their teeth once a day (Herrera M. et al, Med Sci Monit, 2013; 19). The average DMFT among adults is 10.25, and more prevalent in the rural areas where a toothbrush may cost more than a person's daily income. The annual sugar consumption per person is reported at 38kg – twice as high as the world average and WHO recommendation. A recent study amongst rural children found increasingly high consumption of sugar-sweetened beverages and highly processed snack foods (Contreras M. et al, Matern Child Nutr. 2016;12) . Nicaragua has no water fluoridation program, but there is a fluoridated salt program. The most common dental problems, such as dental caries which is pandemic, can be prevented by simple and inexpensive methods. Dental health is based on oral hygiene, nutrition, fluoride intake and dental service utilization; whereas bad dental health in adults is usually the result of the absence of these influences during childhood. Dental health promotion aims to create an environment favorable to the adoption of these healthy behaviors. The use of school structure is particularly beneficial as activities can be integrated into the curricula, and it provides quality personnel to ensure proper implementation. The implementation of dental health promotion generally doesn't result from a national initiative in developing countries, largely due to the lack of integration of dental health in activities of education and health promotion in general. There is a great window of opportunity for promoting dental health among the disadvantaged youth of vulnerable communities such as in northern central Nicaragua, through self-care and community participation oriented programs.
IV. PROJECT CONCEPT A. Overall Objective: o To improve oral health integration in BHC and education systems in Nicaragua, 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 for the pilot
o
o
Work with school directors and teachers on appropriate food intake (where necessary) Prepare a training module and schedule for the school kids Advocate to MoH and MoE for policies and protocols implementation Meet local leaders to sensitize and explain oral health Plaque control measures increased among children in schools Introduce oral health habits in school routine Sensitize local leaders and parents 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 school professionals on the subject Create brushing stations 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 school professionals Apply Silver Diamine Fluoride to cavities
E.
Implementation strategy: A capacity development model whereby the IADS field team educates local school staff to promote specific behaviorbased 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.
F.
Project target groups/beneficiaries: o Primary: Children under 12 – the Nicaragua pilot aims to reach up to 879 kids Government o Secondary: Schools General population
G. Indicators and Success (Monitoring and Evaluation): th WHO Oral Health Surveys, Basic methods, 5 edition, Annex 8.
H. Location of the project site:
San Juan de Rio Coco, Madriz 1.
Modesto Armijo Elementary School - 721 children - 28 teachers - Grades 1-6 - All parents work in agriculture – 30% in coffee
2.
Anexo Modesto Armijo Elementary School - 158 children - Grades 1-6
Total potential reach: 879
I.
Project time frame. th th 3 weeks, between November 9 to 29
J.
Operational Roles and Responsibilities Humble Smile will be responsible for - Training the field team - Providing oral care products - Providing educational resources - Advocating the integration of oral health in upstream policies - Monitoring, evaluation and reporting
Seeds for Progress will be responsible for funding and logistics of - Gaining access to schools - Authorization from local government / oral health / education depts. - 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 in non-visa exempt countries - Organizing weekend excursions (not including payment) IADS st - announcing and publishing the program by September 1 th - enrolling 5 or 6 student volunteers incl. copy of passports (with 6 month validity) by September 27 . Volunteers - Health insurance - Vaccinations. Consult with travel clinic. None are recommended. - Visa. Not necessary if from a visa exempt country. - Flights - Extras incl. excursion costs, shopping, leisure activities etc
Excursions
th
1. __________________ (Nov. 19-20 ) Cost $ per person
th
2. __________________ (Nov. 26-27 ) Cost $ 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.
L.
Sponsors: