"The mind of child once expanded never returns to it's original size."

This program is based on a successful Canadian initiative developed in partnership with a remote first nation’s community to address poor oral health in aboriginal children through a school-based health promotion program. Begun in 2000 the program provided health education through additions to the in-class curriculum, daily health practices with tooth brushing after lunch, and supervision and intervention (education and topical fluoride application) by a team of medical trainees and faculty from the University of British Columbia (UBC). Formal evaluation established that a major reduction in caries (dental cavities), better oral health, and improved health knowledge occurred over 3 years. In addition, the success with oral health led to the community going on to address issues related to low immunization rates, poor nutrition and the community’s predisposition to diabetes. ^1,2

The program has also expanded to other Canadian communities. The children, parents and elders at Hartley Bay now contribute regularly to Brighter Smiles Africa by hosting an orientation for the teams each year before they go to Uganda. The school also has pen pals who correspond and exchange photographs with Ugandan school children in the program.

Students and faculty at Uganda’s Makerere University (MUK) heard about the program and in 2006, in partnership with a team from UBC, translated it successfully to 4 rural Ugandan schools. In addition to improving the oral health of the participating children the program provides unique opportunities for MUK/UBC teams for collaboration, mutual learning and exchange through conduct of the school-based health education, structured interventions, health surveillance, and research components of the program. MUK students incorporate culturally pertinent issues and language into the educational program, and reference to Ugandan family systems and community dynamics. They maintain a presence throughout the year at the schools as they have become university community-based learning sites, and joint MUK/UBC teams visit annually. Five years on success in improving oral health has led to each school expanding the health promotion topics to include other issues identified as relevant by the community. MUK/UBC students and faculty are responsible for developing the relevant education and health practices related to each issue identified, they then assist the school in delivery of the new initiatives, and provide on-going evaluation of their impact on individuals and the community.

Interactive education delivered by Brighter Smiles teams now reinforces the importance of personal hygiene and hand-washing in the prevention of diarrheal diseases, teaches the function of major organs and essentials of nutrition, and the contribution of clean water and adequate hydration to good health. Preventive measure against malaria and other disease are also taught, and when asked for the topic of sexual health is addressed. There are always memorable moments during these sessions: like children eagerly raising their hands and shouting thoughtful answers when asked how they can keep their hearts healthy; their obvious enjoyment when contributing to an interactive moment; and the laughter that accompanies our demonstrations of unhealthy practices. Pupils always stay behind after the sessions to ask us questions about their own health. Many teachers provide positive feedback, and all of the school principals are pleased to see the students interact with the team, and delighted to see that their students feel comfortable and confident enough to ask health-related questions.

In south western Uganda the town of Kalisizo is an example of a rural community that has shown sustained benefits from the initiatives of our international Brighter Smiles partnership. Kalisizo was the epicentre of the HIV epidemic in East Africa, and has welcomed school-based health promotion as a means of informing and empowering the next generation on a broad range of health and social issues. WHO believes health promotion has important benefits for the individuals involved on determinants of health and in the broader community. At St James’ school health promotion is now clearly part of daily learning, and education in prior years on the negative effects of poor nutrition on a child’s ability to learn has resulted in parents volunteering to establish a garden where maize and beans are now grown that provide a meal at school for those unable to bring one from home. At the local hospital MUK and UBC faculty are now encouraged to conduct rounds and contribute to education and care with their students. Links with Canada have translated into practical aid with the donation of beds, X-ray and ultrasound machines and other equipment

Collaborative research conducted as part of the program includes:

• A pioneering project for sub-Saharan Africa currently in its fifth year, which is evaluating the impact of health education and daily tooth brushing on the oral health of school children, and the potential benefit in a cohort of 600 of topical fluoride application
• A study to  record the height, weight, and head circumference of rural primary school students to see if they align with the 2009 World Health Organization Child Growth Standards.
• An evaluation of children’s Knowledge, Attitudes, and Practices (KAP) relating to malaria and diarrhea diseases. By understanding their current awareness and cultural practices, this survey will guide future education on these topics.

In 2009 the African Hearts children were added as a Brighter Smiles program community, following an association between health care professionals at UBC and AH that began in 2006. In addition to health promotion in both the Kampala and Ssenge homes, on-going care is provided for many of the children by the teams, and MUK students also provide state of the art dental care at their University clinic at Mulago. Activities with this organization have expanded to include educational sponsorship of individual children, acquisition of musical instruments for their band, medical and organizational support, fundraising, and membership of Rose Charities to achieve further development and the sustainability of African Hearts’ programs. The program also conducts outreach clinics to care for street youth in the Kiseyni slum.

1. Harrison R, et al. ‘Brighter Smiles’. Health promotion and service-learning in a remote First nation’s community. Can J Pub Health. 2006 97(3) 237-40
2. Macnab AJ, et al. 3-year results of a collaborative school-based oral health program in a remote First Nation’s community. Rural and Remote Health. (On line), 2008 8(2) 882.
3. Macnab AJ, Kasangaki A, Mbabali M, Zavuga R, Radziminski N, Budden H, Gagnon F. Brighter Smiles Africa. Translation of a Canadian community-based health-promoting school program to Uganda. Education for Health; 2010, 23(2), 1-8. EPub. 10 (online), 2010: 241 http://www.educationforhealth.net
4. Macnab AJ, Kasangaki A, Gagnon F. Health promoting schools provide community-based learning opportunities conducive to careers in rural practice. Int J Fam Prac. 2011; vol. 2011, article ID 892518, 5 pages, doi: 10.1155/2011/892518