In Cambodia, hygiene-related diseases are rampant among school-age children. To combat this, the German Ministry for Economic Cooperation and Development (BMZ) commissioned GIZ to implement the FIT for School program, which focuses on improving basic hygiene practices, including dental hygiene.
The FIT for School Program Assessment Study (FITPAS) done in 2014 revealed that there is a high prevalence of dental caries among primary grade pupils in Cambodia. The study is based on a random selection of 624 Grade 1 students aged six to seven years old at baseline, with 77% follow-up rate after two years. In both model and control schools, the burden of oral diseases was extremely high, with almost all children affected by dental caries in the primary teeth at baseline and follow-up.
FIT aims to prevent new caries and decrease the progression of existing caries in the permanent teeth. The FITPAS study showed evidence that daily group toothbrushing with fluoride toothpaste in schools prevented 17% of new caries lesions. Regular toothbrushing with fluoride toothpaste is a simple and realistic prevention measure that does not require involvement of health professionals and can be administered in schools. Severe dental infection can lead to eating and sleeping impacts, poor quality of life, school absenteeism, and growth retardation. Interestingly, the FITPAS study also revealed that severe untreated dental caries in children was significantly associated with underweight and stunted growth highlighting the important link between nutritional effects and WASH status.
According to a Commune Council member in-charge of community support in Angkor Chey district in Kampot province, “the community members supported this project since the beginning. Students here would sometimes rebel against their parents. When they are asked to brush their teeth, they don’t want to do it. When teachers ask them, they follow.” The program is well-reinforced in the community that even when the school ask parents to purchase supplies like toothpaste for 100 riel, they are willing to buy it.
Ms. Chum Phearum, Deputy Director DoE and Director of SHC was quoted saying, “We try to advocate the FIT program. If they cannot succeed, we do not blame [the school] but give them suggestions and provide support with their SIP (school improvement plan). [We] try to show how health and education go hand-in-hand. [We] could see how tooth decay was lessened after group toothbrushing was introduced and behaviour was changed [among the students].”
Schools can implement group toothbrushing by placing organized toothbrush holders in classrooms and by overseeing the hygiene activities. After the students understand the proper toothbrushing method, the whole activity (including handwashing) does not take longer than seven minutes. Practicing this daily will help the students even better at performing the activities by themselves and even at home.