Category: News

The DeRouen Center manuscript publishing class for junior researchers in Kenya is steadily moving forward, making strides in the publication process. This project, which was made possible by the University of Washington’s (UW) Global Innovation Fund (GIF), with collaborative efforts between the UW Dentistry, Global Health, and Libraries, the University of Nairobi (UoN), and Moi University (MU), is assisting Kenyan oral health professionals in transforming their masters’ theses into manuscripts for publication.

One of our students, Dr. Kerre Nduguyu, is hoping to publish his project entitled “Comparison of measured and predicted mesiodistal tooth-widths in 13-17-year-old Kenyans.” To determine orthodontic treatment plans adolescents and teens, mixed dentition analysis is carried out to estimate the mesiodistal tooth-widths of unerupted permanent teeth. Currently, this analysis includes radiographic analysis, regression/prediction equations, or a combination of the two. The most utilized analysis method is the Tanaka and Johnston formula. However, this analysis was based on Caucasian populations. While it continues to be used worldwide, racial and ethnic differences have shown challenges when the Tanaka and Johnston analysis is applied to other populations besides Caucasians. The aim of Dr. Nduguyu’s study was to develop an analysis tool pilot that better predicts space for the Kenyan population.

The project was a cross-sectional study carried out in sixty-eight 13–17-year-old Kenyans of African descent. Dr. Nduguyu’s research team obtained dentition casts from the children to measure for mesiodistal tooth-widths. Results indicate that there are significant differences between predicted values from the Tanaka Johnston analysis, compared to actual tooth measurements from the casts. Findings from this exciting pilot study will be used in a larger project aimed at validating a proposed space analysis equation to be used by Kenyan oral health providers.

The government of Kenya has established a company named Kenya Biovax Institute Ltd, in order to manufacture vaccines and other biologics within the country. Currently, Kenya imports 70% of required biologics and medications, but with the establishment of Kenya Biovax Institute, the hope is to manufacture the bulk of required vaccines and other biologics at home.

The shortage of COVID-19 vaccines in Kenya and through the African continent throughout the pandemic was the impetus for the new company. Supply chain issues created difficulties in vaccinating the Kenya population. Local manufacturing of COVID-19 vaccines is set to begin in April.

The creation of Kenya Biovax Institute will be a significant step towards self-sustenance in supply and availability of medical commodities. The hope is that local production of vaccines will support public healthcare programs, economic growth, national security, and the ability to more adequately control future disease outbreaks.

The current US administration aims to resettle 125,000 refugees in fiscal year 2022, up from 62,500 in fiscal year 2021, doubling the number of refugees allowed to resettle in the United States. The 2022 refugee amount is a 733% increase in the number of allowed refugees up from a historic low of 15,000 during the prior administration. In 2021, the United States welcomed refugees from 50 countries, with the majority arriving from the Democratic Republic of the Congo, Syria, Afghanistan, Ukraine, and Myanmar.

The administration memorandum outlines the current administration’s fiscal year 2022 plans to distribute 40,000 refugee spots for Africa, 35,000 for Near East and South Asia, 15,000 for East Asia, 15,000 for Latin America and the Caribbean, 10,000 for Europe and Central Asia, and 10,000 unallocated. A recently passed Congressional spending bill allotted $7 billion to the care and resettlement of Afghan refugees, after the 20-year end of the US-led ware in Afghanistan forced Afghans to flee.

The overall amount of newly arriving refugees in the country impacts the number of refugees arriving in Washington state. Given the current situation, this can be a call for action for initiatives to increase health and well-being within the local refugee community, particularly among the Washington Afghan community.

Washington state ranks third in the United States in the number of refugees it accepts. As a leader in the resettlement of refugees, identifying and addressing severe oral health disease is vital to early treatment and preventing further deterioration. With the generous support of Arcora Foundation, the Refugee Oral Health Project seeks to understand the processes of the initial refugee medical healthcare screening.

As of early December 2021, the team from the Timothy A. DeRouen Center for Global Oral Health at University of Washington has conducted initial virtual interviews with all seven clinics that are authorized to conduct initial medical screenings for newly arrived refugees in Washington state. All sites have been welcoming and open to collaborate on ways that refugees can have stable dental homes early in their resettlement journey in Washington state.

As part of our next phase, the team is currently conducting site visits to learn more about the refugee medical screening process at each clinic that will help in the implementation of strategies to aid the refugee community. Of relevance is that all seven clinics address oral health at some level, which is essential to identify severe oral health disease. The goal is to facilitate oral health integration into the resettlement process across Washington state, and establish dental homes.

Oral diseases are among the most prevalent non-communicable diseases worldwide, disproportionally affecting vulnerable populations. Oral diseases manifest as pain, impairment, and loss of function, and can affect individuals throughout their lifetime. Our study published in Annals of Global Health entitled “An Assessment of Pediatric Dental Caries and Family Quality of Life in an Informal Amazonian Community” examines the associations between child dental health status (DHS) and child and family quality of life in the community of Claverito, on the outskirts of Iquitos, Peru.

Untreated dental caries in permanent teeth is the most prevalent disease, and dental caries of the primary teeth affect more than 530 million children. Oral diseases manifest as pain, impairment, and loss of function, and can affect individuals throughout their lifetime. At the most extreme end of the socioeconomic spectrum, growing populations of marginalized individuals worldwide reside in slums. Claverito, is a community in the Peruvian Amazonian rainforest, and due to lack of housing has resulted in floating structures built on the Amazon River. Unfortunately, due to such precarious housing and poor environmental conditions, residents experience chronic illnesses, vector borne and infectious diseases, exposure to severe storms and flooding, and lack of water, sanitary infrastructure, and access to food.

In 2017, a collaborative group from the University of Washington (UW) schools and departments of Dentistry, Civil and Environmental Engineering, Environmental and Occupational Health, Global Health, Landscape Architecture, Neurology, and Nursing teamed up with the Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales (CITBM), the Universidad Nacional de la Amazonía Peruana (UNAP) and the Instituto Nacional de Salud (INS) in Peru and developed a transdisciplinary action research program, InterACTION Labs, to design and implement research projects aimed at advancing the health, community strength, and future development of residents of one of these informal river communities – the Community of Claverito.  As a contributor to InterACTION Labs, dental faculty collected information about the community’s oral health status and the impact of oral health on the residents’ quality of life. The purpose of this study was twofold: 1) to describe the prevalence and distribution of dental caries among the pediatric and caregiver populations of a slum community located on the Amazon River in Claverito, Peru; and 2) to evaluate the relationships between the children’s dental health status and their oral health related quality of life (OHRQoL) of the children and the impact of the child’s condition on the family.

Children and their caregivers living in the Community of Claverito exhibited high levels of dental caries. Children’s untreated dental caries were associated with both family’s quality of life and caregivers’ untreated dental caries. Further research is needed on how improving availability and access to oral health services have the potential to benefit the health of residents of informal communities like the one of Claverito.

Dr. María Elena Inocente Díaz from Universidad Peruana Cayetano Heredia (UPCH) in Lima, Peru has ranked second in the Bicentennial Generation awards. A graduate of UPCH’s Stomotology program, her excellence in oral health has led to a scholarship to the attend the Johns Hopkins University Master of Public Health program in Baltimore, Maryland, USA.

Oral health and dentistry have been a family tradition for Dr. Inocente Diaz, as both her mother and aunt have both dedicated their careers to public health dentistry. She hopes to do the same, after being introduced to the area of study in the UPCH Stomotology program’s “Social Dentistry” class which explored the dental realities in the urban-marginal areas of Lima. She went on the do her residency in the small rural town of San Miguel in Cajamarca, where she took part in the radio program “Odontologists on the Air” where she gave practical oral health advice and dispelled common dental myths.

Dr. Inocente Diaz hopes to work at improving the health system in Peru and strengthening access to quality oral healthcare upon completing her MPH program at Johns Hopkins University. She also hopes to be able to be a university professor, to collaborate in the training of public health professionals within Peru.

It is evident that breastfeeding and human breast milk provide numerous health advantages for both children and mothers. Many health organizations recommend continuing breastfeeding for as long as mother and child desire. However, there is concern that breastfeeding more than 12 months may increase caries risk in children, but existing evidence on this relationship are still inconsistent and limited, especially from longitudinal studies. Researchers at Khon Kaen University in Thailand and University of Washington, led by Sirima Sritangsirikul, PhD Program in Oral Sciences, Faculty of Dentistry, Khon Kaen University, (NIH D43 trainee, #1D43TW009071) conducted a prospective cohort study that followed 1-year-old children for 2 years to investigate the association between breastfeeding duration and dental caries titled “Impact of Prolonged and On Demand Breastfeeding on Early Childhood Caries in Khon Kaen”.

The researcher team recruited 568 one-year-old children from 18 public health facilities in Khon Kaen, Thailand and interviewed their main caregivers using a structured questionnaire every 6 months to update breastfeeding information prospectively and collect information on possible confounding factors. Disregarding other foods and liquids, “full breastfeeding” refers to feeding breast milk without formula milk, whereas “any breastfeeding” refers to feeding breast milk with or without formula milk. Based on breastfeeding duration, children were categorized into four groups: less than 6 months, 6-11 months, 12-17 months, and equal to or greater than 18 months, for full breastfeeding and any breastfeeding separately. When the children were 36 months old, a dental caries examination was performed by a trained and calibrated dentist using World Health Organization criteria. At the end of the study, we had 486 children who completed the two-year study follow-up.

The results were interesting. They found that full breastfeeding and any breastfeeding had different patterns of caries risk. The longer the “full breastfeeding” duration, the lower the risk of caries. In contrast, once formula milk is added in “any breastfeeding”, the longer any breastfeeding duration, the higher the risk of caries. Importantly, this study is different from most previous studies as they investigated full breastfeeding and any breastfeeding separately and categorized the duration into intervals rather than just using one cutoff point. This allowed the research team to see the differing breastfeeding and caries pattern which will be recommended for future studies.

This study just won “The 1^st Prize Winner of the Asian Academy of Preventive Dentistry (AAPD) LION AWARD” in the 14^th International Conference of Asian Academy of Preventive Dentistry (AAPD) from October 1-2, 2021, in Daegu, South Korea.

ComMed, or Integrated Health Science Field Work at Khon Kaen University (KKU) Thailand, is an Inter-Professional Education program for undergraduate students from 6 schools: Dentistry, Medicine, Nursing, Physiotherapy, Pharmaceutical Science, and Veterinary Medicine at KKU and the College of Asian Scholars.  In 2020, this was the 38^th annual event in which 694 third- and fourth-year students, and over 70 academic staffs from various schools, joined forces as a health team to conduct community surveys and health promotion activities in a rural area.

Normally, students would have to spend 7-10 days in rural villages, overnight staying at the villagers’ homes to understand the community’s folkways and complicated context of people’s illnesses. But due to COVID-19 last year, the ‘new normal’ practice has been implemented, while we must fulfill the original course’s objectives and learning outcomes.

In 2020, a group of mixed 56-58 students from different schools was arranged in 12 clusters within 12 villages under the supervision of 5-6 academic staff members. The program orientation and meetings were provided online via the website, ZOOM meetings, and Google Classroom Platform which was offered manually for students, video clips, documents, and various information manuals.  All academic activities in university and villages were designed to guard against the spread of COVID-19: social distancing, facial mask wearing, hand washing, early detection of signs and symptoms, telemedicine communication, and staying away from the villages. This new normal practice could encourage students to achieve learning community health amid the spread of the coronavirus pandemic all over the world.

 

Despite efforts to improve oral health, low- and middle-income countries such as Kenya often lack the resources necessary to build research and health system capacity. University of Washington and University of Nairobi were awarded an NIH D71 planning grant entitled “TABASAMU: A multidisciplinary collaboration on building up research capacity in oral health and HIV/AIDS”, in June 2021. This innovative D71 award will provide the basis for developing a training program with the goal of creating sustainable institutional capacity in research and training for oral health and HIV/AIDS.

As part of this two-year planning, we will interview stakeholders and key investigators in Kenya, identifying oral health champions and potential researchers who will play a pivotal role in defining an organizational structure to support a future HIV research training program in oral health. We have partnered with experts in qualitative analysis, Dr. Matthew Saxton and Dr. David Hendry, at the University of Washington’s Information School, and are finalizing the instruments and will conduct our interviews September 2021 to February 2022. Drs. Saxton and Seminario both serve on the University of Washington’s Advisory Committee for the Office of Global Affairs and look forward to continued collaboration in global health research in Kenya and other DeRouen Center sites around the world.

From these interviews, we will identify key stakeholders and discuss current oral health research capacity and needs, identify potential mentors and trainees and gather data on access and barriers to research, and finalize our NIH D43 grant application which will pave the way to implementing a comprehensive oral health research training program across Kenya. This project will conduct the stakeholder analysis in several areas, including Nairobi, and in Western (Kisumu) and Eastern (Mombasa) cities where the prevalence of HIV is highest.

The University of Washington’s DeRouen Center for Global Oral Health has submitted another NIH grant entitled, “Tabamasu-EHR: Integrating dental records within an existing HIV electronic health system.” This proposal aims to strengthen the scientific capacity for interdisciplinary research in Kenya involving the University of Washington (Seattle, USA), the Maseno University Jaramogi Oginga Odinga Teaching and Referral Hospital (Kisumu, Kenya), and the University of Nairobi (Nairobi, Kenya). The Tabasamu-EHR application complements our existing D71 Tabasamu grant. Our overarching goal is to develop a robust infrastructure that provides support and training for conducting oral HIV research in Kenya utilizing existing resources based on the JOOTRH HIV electronic health records (EHR) system.

Our aims for this project are to: 1) Ensure adequate computer hardware infrastructure for integration of the dental and HIV clinic EHR systems, 2) Integrate dental electronic records within existing HIV EHR software, and 3) Generate a cadre of oral HIV researchers with expertise in the retrieval of electronic health records, health statistics, management of large databases, and epidemiologic research, while making JOOTRH a model for oral health integration into the national HIV HER for other large institutions in Kenya.

On this project we are excited to partner on UW’s International Training and Education Center for Health (iTECH) who has vast experience in EHR. This project will provide training opportunities in research areas that will be needed to conduct research utilizing EHRs. If funded, Tabamasu-EHR will provide the foundational basis for a future medium- or long-term program aimed at mastering clinical and health service research, strengthen inter-professional collaborations, decrease Kenyan geographical research inequalities, and increase capacities in oral HIV research.