SMP Oral Health Forum stimulates joint working between MUBAS, Strathclyde University and the MalDent Project

In a previous blog post, I described the Oral Health Forum that was organised by the Scotland Malawi Partnership whilst Esther Khomba and Chifundo Banda, two dental students from Kamuzu University of Health Sciences, were visiting Scotland. If you would like to watch the forum, a time-stamped video is available here.

Tracy Morse, Professor of Environmental Health and Head of the Centre for Sustainable Development at Strathclyde University, Maria Soko, a Behaviour Change Specialist from Water Aid Malawi, and I delivered a short presentation during the forum which examined the possibilities for collaboration between colleagues working on projects addressing the WASH agenda in schools, particularly hand hygiene, and our plans for developing oral health interventions aimed at improving oral health in children.

One of the very positive outcomes of the meeting was that Tracy subsequently arranged a Zoom call that allowed Lorna and I to meet her friend and colleague Dr Kondwani Chidziwisano who is an academic at Malawi University of Business and Applied Sciences. Kondwani did both his Masters degree and PhD at Strathclyde University and has been working with Tracy for many years.

During that on-line conversation we learned about a project of Kondwani’s that was about to begin, which would examine aspects of sanitation and hygiene in Early Childhood Development Centres (ECDCs) – facilities that provide care for children under the age of six years who are not yet attending a formal school or equivalent. Lorna is keen that we include such centres, as well as primary schools, in our plans to develop oral health improvement interventions. Kondwani explained that his team was developing a data collection tool to gather relevant information from ECDCs and invited us to submit a small number of oral health questions that could be included. Lorna sent the appropriate material and it was agreed that I would meet in person with Kondwani during my current visit to Malawi.

On arrival in Malawi I contacted Kondwani who explained that he and his teams would be going out into the field on Friday 27th September to pre-test the data collection tool, which included the small number of oral health related questions submitted by Lorna. He invited me to join them, which provided an excellent opportunity for me to visit an ECDC and to meet the members of the team.

Kondwani collected me from The Leslie at 9am and we set off for the selected ECDC. We were soon driving along very rutted, unmetalled roads through busy villages:

Eventually we arrived at a junction and Kondwani called a colleague for directions – we were to take the left fork.

Finally we arrived at a very steep incline which put the 4×4 Ford Explorer pickup through its paces …

… before arriving at our destination, Kachumbe Community Based Childcare Centre (CBCC):

CBCCs are buildings that are used as pre-school facilities and as feeding stations for children between 3 and 5 years old. This particular building that we were visiting is also used in the afternoons to deliver classes to older children.

As soon as we arrived, and out of courtesy, Kondwani introduced me to the headteacher. Whilst I was there, he enquired about delivery of oral health education messages to the children, but we were told that none are provided.

Whilst the team worked hard with pre-testing of the data collection tool, I was allowed to wander and observe activities. This was a wonderful opportunity for me to gain a feel for what may be possible in terms of oral health interventions in such environments. Around the site, Kondwani’s team members were busy collecting information from those who work at the CBCC …

… and making observations on the facilities available relevant to sanitation and hygiene:

Each element of data collection was repeated independently by two team members to check for inter-observer consistency of responses and observations, which would be assessed in the afternoon when the team reviewed the data.

I was standing in the shade of the verandah when suddenly there was an outpouring of childrens’ voices – meal time was close and the children were running out through the back door to a handwashing station.

I ran around to the rear of the classroom and saw the children clustered together under supervision of two of the staff members – this was the handwashing station:

As the children finished their handwashing, they skipped and ran back into the classroom to wait for their porridge;

Once the last two children had completed the handwashing …

… the children all sat on the floor of the classroom and tucked into the food they were served:

The feeding component of the work of CBCCs is a critically important part of their activities. There is significant hunger in many parts of Malawi and receiving at least one good meal per day makes a tremendous difference to both the children and their parents.

The food is prepared in a small kitchen behind the classroom:

There was a team of ladies who prepared and served the food and who cleaned all the utensils and dishes after the food had been served.

There was no soap available for either the handwashing or the cleaning of the cooking utensils, dishes and spoons. Kondwani explained that the village community was dependent on NGO supplies and that when soap was available it was often prioritised for washing clothes.

As our visit came towards a close, I went inside the classroom …

… specifically to check whether there would be a secure space in which we could store toothbrushes and toothpaste if we were to consider the feasibility of a supervised toothbrushing programme in facilities like this CBCC. I was very pleased to be shown two lockable cupboards:

This visit left a very deep impression on me. The outward happiness of the children at play and receiving food in very basic surroundings was heartwarming. The dedication of the teachers and staff involved was also inspiring.

I left with the feeling that there was definitely a potential opportunity to include an oral hygiene element into the daily routine, which would complement the handwashing and nutrition programmes already in place. With the support of colleagues like Kondwani, Tracy and Maria we look forward to the next steps in our mission to integrate oral health interventions with the WASH and nutrition sectors as part of the proposed National Child Oral Health Improvement Programme for Malawi.