Basic Packages of Oral Care for Rwandan children (BPOC) Steps towards healthier children -Raising Smiles Together It is clear that without proper education, health suffers. And without proper health, good education is not possible. Gro Harlem Brundtland, Director General, World Health Organization (2000)
Description of the Project Overall Goals To create an environment in schools that will be helpful to meet the MDGs. They are: Achieve universal primary education Reduce neglected childhood diseases and thereby the risk of other major diseases Develop global partnerships for development. Objectives: Oral health among the school children has improved by 50%. School attendance is increased by 30% and the academic performance is improved by 25 %. All teachers in the project are able to use and follow the BPOC teacher s manual to educate the children. Strategy: Implement the Basic Packages of Oral Care BPOC for children in Rwanda. Which is a framework developed by WHO/UNICEF for Health Promoting Schools. The program will be implemented in selected public elementary schools in Kigali, Gicumbi and Nyamagabe. Background of the program Oral health is an important international public health issue, because oral diseases have a significant impact on individuals, communities, health systems, economies and society at large. Oral health is an essential and integral component of overall health, because oral diseases impact on general health and systemic diseases show symptoms in the oral cavity. Tooth decay (dental caries) and gum diseases (periodontal diseases) affect virtually every human being during their lifetime, although both diseases are almost entirely preventable. It is a global trend that the non-existence or inefficiency of community oriented caries preventive programs result in high caries levels, while lack of access to oral health care services results in virtually all caries being untreated, and when treatment happens, it is limited to extraction of teeth. Dental caries is a global public health problem especially in children since it remains mostly untreated. Research suggests that untreated caries can have an effect on children s growth and their general health. Toothache is known to affect quality of life of the children, because the nagging pain interrupts the sleep, abstains the child from socializing with other children and disturbs concentration in school and while doing homework, which inevitably leads to poorer tests results in school. Oral health in Rwanda A FDI supported study showed in 2005 that the most common dental problems are: Pain (58%), bleeding gums (40%) and various infections (12%), in Rwanda there are no data available from national surveys on dental health neither on children nor adults. Our pilot study in Nyamagabe, showed that children attending public schools are highly affected. Each of them has on average more than one tooth and 20 % of them have two teeth each that need treatment. Apparently tooth brushing performed with a regular toothbrush and fluoride toothpaste twice a day is not an everyday habit among the general population at the moment. This common lack of tooth brushing in the population combined with an increase in sugar consumption will soon result in a dramatic increase in the prevalence of dental decay.
The diseases affecting the children are not life-threatening but they are neglected childhood diseases and have a tremendous impact on children s physical and mental development, on their school attendance and academic performance as well as quality of life and the ability to resist other potentially serious and life threatening diseases. As mentioned above, children who suffer from toothache cannot eat, sleep or concentrate at school and their growth and development is affected. This means that malnourished children become even more malnourished. All these findings are strongly associated with poverty. Crowded living conditions, overcrowded classrooms, lack of clean water, lack of sanitation facilities at home as well as in schools, lack of healthy and sufficient food are the root causes of many diseases. The social and the physical environment lead to diseases, which will keep the children in a cycle of poverty. More importantly, all these diseases can be controlled through relatively simple cost-effective interventions, like the BPOC program. Prevention is the basis for improvement in children`s health The public health resources in Rwandan cannot cope with the large unmet dental treatment need in children if comprehensive treatment methods are used. Clinical treatment is expensive and beyond the resources of the health system in Rwanda at this time. Therefore strategies based on prevention and health promotion have been introduced in TUGs pilot project schools in Gikongoro to address the problem in an affordable and sustainable way. This approach is based on a vision that schools can be environments where healthy lifestyles are not only taught, but also practiced, where dental education and bi-annually dental treatment (ART and OUT) are available, where basic personal hygiene like hand washing and tooth brushing with fluoride toothpaste is possible and done. Thereby hygiene practices will become routine for Rwandan children. It is expected that through knowledge and active participation of non-health professionals such as teachers, parents and community members, sustainable improvements concerning general health and oral health of the public school children as well as their families will be achieved. Parents, mostly mothers, will be empowered and encouraged to participate fully in the implementation, training and evaluation of this program. Program In the framework of WHO/UNICEF Health Promoting School strategies a Basic Packages of Oral Care is ready for implementation. Training modules, including implementation guidelines and monitoring tools have been developed and pre-tested. In order to address the issue of equity and accessibility; Every Rwanda child attending primary schools should have a free toothbrush in school. Fluoride toothpaste will not be provided to the child individually but is available in the classroom from a toothpaste dispenser for supervised daily use. Soap for daily hand washing and a nail-cutter to keep students fingernails short will be available in the class room. Educational focus on dental education and bi-annually dental treatment. In order to facilitate the implementation and the sustainability of these activities, access to water plays a key role and needs to be prioritized.
The BPOC elements: Daily tooth brushing with fluoride toothpaste Daily hand washing with soap Oral and general health education
Oral Urgent Treatment (OUT) and restorative treatment (ART) Raising awareness and collecting data Building sustainable capacity (Training of schoolchildren, teachers, health- and dental professionals)
Advocating oral health promotion