Oral Health and Hygiene Project

Partnership objectives 

  1. To decrease the burden of oral disease in the community.
  2. To increase equitable and timely access to oral health services, both preventive and curative.
  3. To monitor oral health disease trends within the community.
  4. To develop evidence based oral health policies that can be scaled up to the regional and national level.
  5. To promote oral health and prevention of oral diseases in the community with relevant stakeholders.
  6. To place oral health on the national and international agendas.

In both Senegal and Ethiopia, all the focus groups acknowledged that oral problems in their village are widespread and severe; most thought that children were especially affected. In both Senegal and Ethiopia, all the focus groups acknowledged that oral problems in their village are widespread and severe; most thought that children were especially affected. Copyright Earth Institute, Columbia University

What are the health needs and challenges?

There are significant unmet needs in the area of oral health in sub-Saharan Africa.

With economic growth, rural communities in Africa are increasingly exposed to western diets. Although nutritious, those diets are high in refined sugars, which have been shown to increase tooth decay and periodontal disease. With increased access to food and the changing diet, often the pattern of food intake changes which can predispose to increase in caries.

Oral diseases share many modifiable risk factors with the chronic diseases that are becoming more of a public health concern in Africa and the rest of the developing world.  Developing and testing behavioural change strategies to combat oral health problems not only fits well within the current implementation framework of GSK’s existing partnership with Millenium Villages Project, but it could also have synergistic effects in slowing the growth of other health problems. 

Poor oral hygiene and changed diets lead to increase in oral diseases. With increased prevalenceof tooth decay and periodontal disease, there is increased risk of oral infections spreading through the vascular system to other parts of the body causing, for example, heart diseases. Thus, preventionof oral diseases by implementation of oral hygiene programs is a good investment in oral and in general health.

Description of partnership activities and how they address needs and challenges

The oral health and hygiene pilot in the Millennium Villages consists of three distinct phases: 

The first includes planning and assessment, the second focuses on implementation and operational research, and the third on documenting findings and communicating them on a broader policy scale. Assessment is a critical piece of the initial planning of the study design, as there is less knowledge of and academic consensus on how to address oral health and hygiene in the developing world than was the case for the PHASE (Personal Hygiene & Sanitation Education) handwashing program. Moreover, it was critically important to ensure that the oral health component of the MVP was well integrated into the overall health strategy of the MVP.

The aim of the project is to:

  • Conduct a base-line study to map the status of oral health in two Millennium Villages sites and develop a set of oral health interventions appropriate for addressing these challenges.
  • Identify appropriate way of introducing these interventions and measuring their impact on oral health outcomes in rural settings.
  • Promote oral health as an essential part of the global health agenda (akin to profile of GSK’s PHASE – Personal Hygiene & Sanitation Education handwashing program).
  • Identify, test, cost and document the use and efficacy of various oral hygiene interventions in rural settings, for example, dental sticks, tooth brushing with toothpaste, etc.
  • Explore feasibility of community management of oral health.
  • Integrate oral hygiene intothe PHASE program as a key part of the curriculum which can be adapted to other PHASE countries. 
  • Expand treatment options in underserved rural settings.
  • Document lessons learned for national scale-up. Robust data collection and rigorous evaluation are essential for making the case for global policy change and national scale up programs.

Lessons learned      

In order to implement sustainable oral health behavioural and social interventions, it is imperative to include all sectors of the community in the base-line assessments. Therefore, community leaders, health care workers, teachers, youth organizations, parents, farmers, traders, and representatives from women’s associations were invited to participate in the focus groups, surveys and workshops.

Workshops were conducted to sensitize the community to oral health interventions, as well associal mobilization events to introduce capacity building and school program interventions. These focused on increasing awareness about good oral hygiene habits and proper brushing practices.

It was important to select schools that would implement daily supervised tooth brushing/ chewing stick use with a pre-and post-evaluation of defined outcomes.

In both Senegal and Ethiopia, all the focus groups acknowledged that oral problems in their village are widespread and severe; most thought that children were especially affected.

The focus groups also revealed a variety of local materials used for cleaning purposes as well as remedies for tooth pain and alternative traditional practices in both countries. In Ethiopia, for example, toothpaste was rarely used as it was believed to be a cause of bad breath and tooth pain.

Building the evidence for the impact of investment in oral health and hygiene is critical for national and international level scale-up of oral hygiene interventions. It will also allow the project to provide evidence-based technical support to more governments in developing countries in order to sustain behavioral and social interventions especially when resources are limited. Moreover, it will support advocacy efforts for the integration of oral health into global health. 

Summary of impact and forward looking information

The school program is being currently implemented in all Koraro Millennium Research Village elementary schools (Koraro, Tala and Tonsoka).

The total number of school children who are targeted and are receiving the oral health information sessions are 1186 students attending grades 1 to 8.

The project is making a significant impact on local and government stakeholders and has pioneered the use of mobile phones for the assessment of oral health needs in developing countries.

In Ethiopia and Senegal, the project has gained recognition at the national level. In Ethiopia, it led to the establishment of the Oral Health Task Force by the Ministry of Health and oral health is included in the Visioning Document for Health Care in Ethiopia 2020-2035.

Partnership information

Company(ies) GlaxoSmithKline

Partner(s) Earth Institute at Columbia University

Type of Partner(s) Academia / Hospitals

Therapeutic Focus Other

Disease(s) General Health, Oral Health

Program Type(s) Health System Infrastructure - Outreach & Medical Services, Prevention Programs - Awareness & Outreach

Targeted Population(s) Children, Elderly, Marginalised / Indigenous People, Men, Patients in needs of treatment, Women, Youth

Region(s) Sub-Saharan Africa

Number of Countries 2

Country(ies) Ethiopia, Senegal

Start Date 2012

More information Earth Institute, Columbia University

Anticipated completion date Ongoing