Rising from a foundation of knowledge
Written by Kristen Zapata
How oral health education is empowering Kenyan youth to lead their communities to well-being
The concept that knowledge is power is at the heart of the East Africa Oral Health Initiative, a health education program The University of Texas Health Science Center at San Antonio School of Dentistry is directing at an all-girls boarding school in Nanyuki, Kenya. Daraja Academy was established to offer high school-aged girls throughout Kenya a secondary education who otherwise would have no means to acquire one. Adolescent females in the region face greater challenges to continuing their education than their male peers. The resulting lack of employment opportunities and financial independence often leads young women into early marriage and motherhood.
Daraja students are enrolled on full scholarships to partake in a rigorous academic program, which includes a hefty portion of character and leadership development, such as a 60-hour community service requirement.
The East Africa Oral Health Initiative contributes to that development by adding oral and general health instruction to the students’ schooling and dispatching them into their local community as advocates for better oral health.
LOW PRIORITY, HIGH PREVALENCE
About 40% of Kenya’s population lives in extreme poverty, earning less than $2 a day, according to research professor Yvonne De Paiva Buischi, DDS, PhD.
“Dental treatment is a low priority for many Kenyans because any resources they have will be put toward major health concerns before dental ones. In fact, there is only one dentist for every 42,000 Kenyans,” she said.
Buischi said that Kenya’s Ministry of Health allocates only a fraction of 1% of its budget toward the management of oral diseases, and just 20% of Kenya’s dental workforce is located throughout the country’s vast rural regions — facts that emphasize the immense barriers to care in the country.
When Kenya’s Ministry of Health conducted an oral health survey, published in 2015, on the prevalence of oral diseases, it found the overall occurrence of cavities in children was 23.9%, with gingivitis at 75.7%. These issues impact daily life, leaving 31% of children surveyed with the inability to chew firm foods. The survey reported that nearly half the children had never seen a dentist.
“The quickest and most economical solution to this problem is education and prevention,” Buischi said. “Introducing oral health education, including personal oral hygiene training in schools,will positively impact children regardless of background and increases the likelihood that those good habits will follow them throughout life.”
ADVOCATES FOR HEALTH
Buischi and School of Dentistry Dean Peter M. Loomer, DDS, PhD, MBA, found the ministry’s report sobering but saw promise through a partnership with Daraja Academy. The school’s mission to graduate strong female leaders who go back to their respective tribal communities as role models generated an idea to empower the young women further as advocates for health.
“Already, through the design of the Daraja curriculum, students were paying their opportunity forward by sharing their knowledge, time and attention with others,” Loomer said. “With the academy’s help, we are able to equip them with an oral and general health education so they can share that within the community.”
Buischi and Loomer went about accomplishing this by first performing clinical examinations on each student selected for the training to determine baseline oral health. Several interactive lectures on cavities, gum diseases and oral cancer development and prevention were provided, along with information on healthy living and individualized brushing and flossing techniques.
The school’s nurse was trained how to detect dental plaque, perform a professional tooth cleaning and apply fluoride varnish. Other school staff members were also trained to reinforce good oral hygiene and healthy behaviors.
Armed with new knowledge, the students were then sent into the community to educate others.
Each student was assigned a group of 10 peers from a nearby secondary school. As a peer mentor, the Daraja girls shared the oral and general health knowledge they had learned and demonstrated proper oral hygiene practices. The disclosing tablets the members of each group are provided on a weekly basis revealed the absence or presence of dental plaque, offering accountability and reinforcing good hygiene practices between peers.
“By learning how to mentor their peers, these young women not only enhance community health, but also their interpersonal and communication skills,” Loomer said. “The personal growth developed through this activity adds to their leadership confidence as well as their self-image.”
RESULTS SPEAK FOR THEMSELVES
Buischi is the lead author of an article published in the International Journal of Dental Hygiene in April 2023 that evaluated the effectiveness of the initiative on oral health at Daraja after two and a half years. The study followed the oral health of 49 students who participated in the training and peer mentor groups.
“The oral health education program showed to be highly effective,” Buischi said. “From baseline to the 2.5-year post implementation assessment, a 98% caries reduction was observed. Plaque was down by 84% and gingival inflammation by 82%.”
The Daraja Academy is based on the belief that education is the fastest bridge out of poverty. Buischi would add that these results show it is also the fastest bridge to better health.
“Girls enrolled in our program had significant positive changes in their oral health and a widespread desire to empower others,” she said. “The leadership training developed the girls to become oral health advocates for their families and communities. The whole process brought about improvement in self-esteem. Healthy and pain-free smiles gave the girls more confidence in their appearance and a more positive outlook on life.”
REPLICATION
Dental cavities and gum disease are frequently considered the two most pressing global oral health burdens. Since the establishment of the East Africa Oral Health Initiative, over 2,000 Maasai primary school children have received oral health education through the Daraja students’ community service efforts.
Through financial support, the initiative has covered over 250 dental appointments for students with local dentists and established collaborations with local non-governmental organizations with the goal to replicate the educational model in other rural Kenyan regions. Due to the model’s success, Buischi and Loomer are evaluating the feasibility of introducing similar initiatives in Brazil and even along the U.S.- Mexico Border region of Texas and in Florida.
“I would like this program to go on because it’s so amazing, it’s so impacting,” one Daraja student said. “It has changed so many people — not only me, not only Daraja students, but members of the community.”
