Survey findings on changes in community attitudes to Infant Oral Mutilation following Bridge2Aid’s 2nd training programme in Tanzania – November 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).

The training was developed by Bridge2Aid and Dr Nila Jackson. The training workshops are being implemented by our local dental partner, the Sibaba Dental Clinic, led by Dr Jackson and a pilot study began in February with training delivered to 512 community participants in the Tarime District (Mara Region) in February 2022. With the support of the Chief Dental Officer, Dr Baraka Nzobo, we continued with a second, larger workshop in the Kyerwa District (Kagera Region) in May 2022, training a total of 834 people from across the local community.

Prior to our training, we survey women who attended local maternal healthcare clinics 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. Then six months after the training is carried out, we return to health centres in the same areas and carry out identical surveys to gauge the effects that the training had in changing attitudes.

The results from the first survey in Tarime (taken in August 2022) were very positive, showing that there had been a shift in attitudes among the local population away from the myth of ‘plastic teeth’ and the use of IOM as a treatment. The post-training survey in Kyerwa took place between 15th & 23rd November and the comparative results with the pre-survey undertaken in May 2022 are summarised in this report.

Key Findings

In May 2022, prior to the training in Kyerwa, the team surveyed 1,083 women attending maternal clinics to assess the level of awareness of IOM and ‘plastic teeth’. This was carried out by using pre-structured self-administered questionnaires. The 6-month post-survey in November surveyed 1,012 women in Kyerwa and the results show a shift in community attitudes in understanding the dangers of the myth of ‘plastic teeth’ and IOM, that are consistent with what we saw in the Tarime results of the pilot programme. During the post-training survey, Dr Nila Jackson interviewed some of the Community Health Workers who attended May’s training to ask them if they had noticed a change in attitudes.

88% of those surveyed in May said that they believed that ‘plastic teeth’ caused illness and required treatment. Our post-training survey in November, with a similar sample size, found that this number had shown a gradual fall to 75%, similar to that of the pilot survey (see Figure 1).

The link between childhood illness and the myth of ‘plastic teeth’ showed a massive decline with all perceived associated symptoms seeing a drop of 18% to 36% (see Figure 2).
A clear sign of changing attitudes can be seen in Figure 3 below, where mothers seeing IOM as a treatment option for their child is down to 23% from 64%, whereas the numbers of those seeking hospital treatment instead has increased seven-fold!
However, there is still a belief that ‘plastic teeth’ exist and can cause death and illness. Yet Figure 4 shows that those who believe that death is a realistic outcome has fallen considerably from 84% to 65%.
Another encouraging sign is how the post-training survey shows an increase of awareness on IOM from 84% to 96% (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 40% to 67%, while those who see it as a good treatment has seen a similar shift, decreasing from 49% to 23%.

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 second programme in the Kagera Region of Tanzania has confirmed what we had found in the Tarime pilot study, which is that these cascade training workshops have clearly had the desired impact of shifting attitudes within local communities away from the myth of ‘plastic teeth’ while highlighting the dangers of IOM.

One of our key lessons from the pilot was increasing penetration of our messaging into schools by including District Education Officers in our programmes. As part of our 3-month supervision visit to the District in September 2022, the delivery team checked that schoolchildren were being educated on the dangers of IOM. The team visited 21 schools (4 secondary and 17 primary) and found that children had been taught by the Bridge2Aid trained teachers that IOM was child abuse and led to complications such as bleeding, infections, missing teeth and death. The pupils were questioned and they proved that they were now aware that whenever a child is sick with symptoms such as increased body temperature, vomiting and diarrhea that are mistakenly linked to plastic teeth, they should be taken to hospital for treatment instead of to traditional healers for IOM or ‘rubbing’ with traditional herbs.

These programmes show the potential if this work were to be scaled up in similar areas of Tanzania, as well as other countries. We at Bridge2Aid have therefore developed plans to increase the number of training sessions across northern Tanzania in 2023. We have also developed our own performance matrix which will help us analyse data and compare these between other programmes to monitor changes and further inform future programme.

We would like to acknowledge and thank our funders:
Bridge2Aid Australia
Henry Schein

And the clinical expertise and advice of:
Baraka Nzobo
Andrew Paterson

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