Survey findings on changes in community attitudes to Infant Oral Mutilation following Bridge2Aid’s training programme in Mara, Tanzania – August 2022


Infant Oral Mutilation happens to around 2.5 million children each year in East Africa. It is a dangerous and sometimes fatal practice where developing teeth are gouged out of the gums of small children using unsterilised, sharpened bicycle spokes. This practice is dangerous and sometimes deadly.

There is very little knowledge around oral health in rural east Africa. If infants suffer from sickness or diarrhoea when they are developing their first set of teeth, traditional healers often diagnose the growing teeth as the cause of the illness. They call this condition ‘plastic teeth’. The ‘treatment’ is to remove the growing canine teeth without the use of anaesthetic – and usually with unsterilised, improvised implements. This is extremely painful, dangerous and can be fatal.

Bridge2Aid (B2A) is currently implementing an Infant Oral Mutilation (IOM) awareness training programme in regions of Tanzania where Infant Oral Mutilation is practiced. It is crucial that we raise awareness of this through community engagement programmes to ensure IOM ceases to be a form of supposed treatment for common childhood symptoms of other diseases (malaria, food poisoning, infections etc).

A pilot study began with training workshops delivered in Tarime District (Mara Region) in February 2022 , the training workshops were implemented by our local dental partner, the Sibaba Dental Clinic, led by Dr Nila Jackson.

The training was delivered with the help of Dr Omary Gamuya (Regional Dental Officer), Dr Hadson Nyanswi (District Dental Officer), Dr Amon Kaleb (District Dental Officer), and Dr Alex Kanoni. The training was developed by Bridge2Aid and Nila Jackson, and the project was initiated with the help of Raman Bedi and the Global Child Dental Fund.

A total of 512 people were trained and there was representation from different community leaders who had been identified as having a key role to play in raising awareness of IOM within their communities.

Prior to our training, 442 women who attended local maternal healthcare clinics were surveyed to assess the level of awareness of the myth of ‘plastic teeth’ and their perception of the dangers or benefits of IOM as a treatment.

Six months after th training was carried out, we returned to health centres in the same areas and carried our identical surveys on a larger number of women (508 in total). This post-training survey will help us gauge the effects that the training had in changing attitudes. The comparative results are outlined in this report.

The total expenditure for this pilot study was TZS 44,670,900.00 (£15,650). This equates to just under £31 per trainee.

Key Findings:

The 6-month survey results show an initial shift in community attitudes in understanding the dangers of the myth of ‘plastic teeth’ and IOM. During the post-training survey, Dr Nila Jackson interviewed some of those who attended February’s training to ask them if they had noticed a change in attitudes. Boniface Biazara, a Community Health Worker from Mara, said that “[the training] helped me educate the community to get rid of the misconception of plastic teeth”. Local nurse, Sister Kahotaro, agrees that there has been a shift in attitudes, noting that she and her colleagues “have received many mothers who come to their clinic asking to check what treatment is available for their ill child whereas before they would seek help from a traditional healer. We are able to direct them to the doctor for appropriate treatment”.

84% of those surveyed in February said that they believed that ‘plastic teeth’ caused illness and required treatment. Our post-training survey in August, with a larger sample size, found that this number had dropped to 66% (see Figure 1) with frequent information sessions taking at clinics using the collateral that the project supplied. Following the training, the project team had provided the trainees with 900 posters, 10 banners to help disseminate awareness to the community. Seven local radio sessions against the practice of IOM were also funded for maximum exposure. The post-survey showed that these materials were being used on a regular basis.

The link between childhood illness and the myth of ‘plastic teeth’ is also being broken with all perceived associated symptoms seeing a drop of 14% or more (see Figure 2).
However, there is still a belief that ‘plastic teeth’ exists and can cause death and illness. Yet Figure 4 shows that those who believe that death is a realistic outcome has fallen considerably and that a significant number (20%) say that it does not exist.
However, there is still a belief that ‘plastic teeth’ exists and can cause death and illness. Yet Figure 4 shows that those who believe that death is a realistic outcome has fallen considerably and that a significant number (20%) say that it does not exist.

Another encouraging sign is how the post-training survey shows an increase of awareness on IOM from 79% to 91% (see Figure 5). Figure 6 also shows that after six months of programme implementation, those who believe IOM is a bad treatment has increased from 51% to 65%, while those who see it as a good treatment has seen a similar shift, decreasing from 35% to 19%.

Conclusions & Lessons Learned:

To the best of our knowledge there has been no other intervention or education carried out either locally or nationally around the issue of Infant Oral Mutilation during the time period that our training and surveys were carried out. This programme in the Mara Region of Tanzania is a pilot study and early findings have clearly shown that these cascade training workshops have had the desired impact of shifting attitudes within local communities away from the myth of ‘plastic teeth’ while highlighting the dangers of IOM.

We have already identified the key improvement is that we can increase penetration of the messaging into schools by including District Education Officers going forward to support the training of teachers and ensure consistent messaging is provided to pupils. This is already forming an integral part of our upcoming programmes in Tanzania.

The pilot also shows the potential if this work were to be scaled up in this region and similar areas of Tanzania, as well as other countries. We at Bridge2Aid have therefore developed our own performance matrix which we will use to analyse data and compare these between other programmes to monitor changes and further inform future programmes.

We would like to acknowledge and thank our funders:
The Laing Trust
The Mageni Trust
James Gaskell
Bow Lane Dental Group
The Casey Trust

And the clinical expertise and advise of:
Raman Bedi
Diane Bell
Nila Jackson
Adam Jones
Andrew Paterson
Kiaran Weil
Kathy Wilson
Baraka Nzobo

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