Oral Health Policy and Research Capacity: Perspectives From Dental Schools in Africa.

INTRODUCTION AND AIMS: The prioritisation of oral health in all health policies in the WHO African region is gaining momentum. Dental schools in this region are key stakeholders in informing the development and subsequent downstream implementation and monitoring of these policies. The objectives of our study are to determine how dental schools contribute to oral health policies (OHPs) in this region, to identify the barriers to and facilitators for engaging with other local stakeholders, and to understand their capacity to respond to population and public health needs. METHODS: We developed a needs assessment survey, including quantitative and qualitative questions. The survey was developed electronically in Qualtrics and distributed by email in February 2023 to the deans or other designees at dental schools in the WHO African region. Data were analysed in SAS version 9.4 and ATLAS.ti. RESULTS: The capacity for dental schools to respond to population and public health needs varied. Most schools have postgraduate programs to train the next generation of researchers. However, these programs have limitations that may hinder the students from achieving the necessary skills and training. A majority (75%) of respondents were aware of the existence of national OHPs and encountered a myriad of challenges when engaging with them, including a lack of coordination with other stakeholders, resources, and oral health professionals, and the low priority given to oral health. Their strengths as technical experts and researchers was a common facilitator for engaging with OHPs. CONCLUSION: Dental schools in the region face common challenges and facilitators in engaging in the OHP process. There were several school-specific research and training capacities that enabled them to respond to population and public health needs. Overall, shared challenges and facilitators can inform stakeholder dialogues at a national and subnational level and help develop tailored solutions for enhancing the oral health policy pipeline.

Prevalence of dental caries and associated risk factors in children living with disabilities in Rwanda: a cross-sectional study.

INTRODUCTION: several studies have been done on children with disabilities, and the results have shown that these particular individuals are more prone to developing various abnormal oral conditions. However, little is known about the oral health conditions among children with disabilities in Rwanda. This study aims to determine the prevalence of dental caries and associated risk factors among children with disabilities. METHODS: a cross-sectional study conducted among 226 randomly selected children living with physical disabilities; learning, intellectual and developmental disabilities; deafness, blindness and hearing impairment disabilities aged between 7 and 20 years old, who live and/or are under the care of NYANZA Home de la Vierge des Pauvres (HVP) GATAGARA. Bivariate and logistic regression analyses were done using SPPS version 20 at 95% confidence interval. The significance level was set at p<0.05. RESULTS: the prevalence of dental caries found in children with disabilities is 42.4%. In bivariate analysis age (p=0.003), frequency of sugary food consumption (p=0.001) and oral hygiene status (p=0.000) are respectively significantly associated with dental caries. In logistic regression model, children who take once or more times per day sugary food like biscuits, cake, chocolates and sweets are almost 6 times higher at risk of developing dental caries [OR: 5.945, CI: 1.187; 29.774, P=0.03) while a good oral hygiene status was protective against dental caries [OR: 0.296, CI: 0.159; 0.550, P=0.000]. CONCLUSION: dental caries is a reality among children living with disabilities. Appropriate measures should be taken to protect these children and these measures should mainly focus on identified factors.

Building oral health research infrastructure: the first national oral health survey of Rwanda.

BACKGROUND: Oral health affects quality of life and is linked to overall health. Enhanced oral health research is needed in low- and middle-income countries to develop strategies that reduce the burden of oral disease, improve oral health and inform oral health workforce and infrastructure development decisions. OBJECTIVE: To implement the first National Oral Health Survey of Rwanda to assess the oral disease burden and inform oral health promotion strategies. METHODS: In this cross-sectional study, sample size and site selection were based on the World Health Organization (WHO) Oral Health Surveys Pathfinder stratified cluster methodologies. Randomly selected 15 sites included 2 in the capital city, 2 other urban centers and 11 rural locations representing all provinces and rural/urban population distribution. A minimum of 125 individuals from each of 5 age groups were included at each site. A Computer Assisted Personal Instrument (CAPI) was developed to administer the study instrument. RESULTS: Nearly two-thirds (64.9%) of the 2097 participants had caries experience and 54.3% had untreated caries. Among adults 20 years of age and older, 32.4% had substantial oral debris and 60.0% had calculus. A majority (70.6%) had never visited an oral health provider. Quality-of-life challenges due to oral diseases/conditions including pain, difficulty chewing, self-consciousness, and difficulty participating in usual activities was reported at 63.9%, 42.2% 36.2%, 35.4% respectively. CONCLUSION: The first National Oral Health Survey of Rwanda was a collaboration of the Ministry of Health of Rwanda, the University of Rwanda Schools of Dentistry and Public Health, the Rwanda Dental Surgeons and Dental (Therapists) Associations, and Tufts University and Harvard University Schools of Dental Medicine. The international effort contributed to building oral health research capacity and resulted in a national oral health database of oral disease burden. This information is essential for developing oral disease prevention and management strategies as well as oral health workforce and infrastructure.

A Case Study Optimizing Human Resources in Rwanda's First Dental School: Three Innovative Management Tools.

Harvard School of Dental Medicine, University of Maryland School of Dentistry, and the University of Rwanda (UR) are collaborating to create Rwanda's first School of Dentistry as part of the Human Resources for Health (HRH) Rwanda initiative that aims to strengthen the health care system of Rwanda. The HRH oral health team developed three management tools to measure progress in systems-strengthening efforts: 1) the road map is an operations plan for the entire dental school and facilitates delivery of the curriculum and management of human and material resources; 2) each HRH U.S. faculty member develops a work plan with targeted deliverables for his or her rotation, which is facilitated with biweekly flash reports that measure progress and keep the faculty member focused on his or her specific deliverables; and 3) the redesigned HRH twinning model, changed from twinning of an HRH faculty member with a single Rwandan faculty member to twinning with multiple Rwandan faculty members based on shared academic interests and goals, has improved efficiency, heightened engagement of the UR dental faculty, and increased the impact of HRH U.S. faculty members. These new tools enable the team to measure its progress toward the collaborative's goals and understand the successes and challenges in moving toward the planned targets. The tools have been valuable instruments in fostering discussion around priorities and deployment of resources as well as in developing strong relationships, enabling two-way exchange of knowledge, and promoting sustainability.

Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda.

BACKGROUND: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. METHODS: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. RESULTS: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. CONCLUSION: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.

Effects of vitamin D status on oral health.

Normal humans of all ages have the innate ability to produce vitamin D following sunlight exposure. Inadequate vitamin D status has shown to be associated with a wide variety of diseases, including oral health disorders. Insufficient sunlight exposure may accelerate some of these diseases, possibly due to impaired vitamin D synthesis. The beneficial effects of vitamin D on oral health are not only limited to the direct effects on the tooth mineralization, but are also exerted through the anti-inflammatory functions and the ability to stimulate the production of anti-microbial peptides. In this article, we will briefly discuss the genesis of various oral diseases due to inadequate vitamin D level in the body and elucidate the potential benefits of safe sunlight exposure for the maintenance of oral and general health.