Evaluation of the child oral health promotion 'MaliMali' Programme based on schools in the Kingdom of Tonga.
INTRODUCTION
The South Pacific Medical Team (SPMT) has supported oral health care for Tongan juveniles since 1998. This voluntary activity, named the MaliMali ('smile' in Tongan) Programme, is evaluated in detail in this paper.


METHODS
This evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The objectives were to explore: (i) whether the programme was accessible to Tongan schoolchildren (Reach); (ii) the impact of the programme on decayed, missing and filled teeth (DMFT) scores and toothbrushing habits (Effectiveness); (iii) factors that affected the adoption of the programme (Adoption); (iv) whether implementation was consistent with the programme model (Implementation); and (v) the long-term sustainability of the programme (Maintenance).


RESULTS
The MaliMali Programme has grown into an international project, has spread countrywide as a uniform health promotion and is reaching children in need. Following implementation of this programme, the oral health of Tongan juveniles has improved, with a decrease in the mean DMFT index and an increase in toothbrushing. To provide training that will allow Tongans to assume responsibility for the MaliMali Programme in the future, dental health education literature was prepared and workshops on oral hygiene and the MaliMali Programme were held frequently. At present, the programme is predominantly managed by Tongan staff, rather than by Japanese staff.


CONCLUSIONS
This evaluation found the MaliMali Programme to be feasible and acceptable to children and schools in the Kingdom of Tonga. The programme promotes oral health and provides accessible and improved oral health care in the school setting, consistent with the oral health-promoting school framework.
['Takeuchi|Reiri|R|', 'Kawamura|Kohji|K|', 'Kawamura|Sayuri|S|', 'Endoh|Mami|M|', 'Uchida|Chizuru|C|', 'Taguchi|Chieko|C|', 'Nomoto|Takato|T|', 'Hiratsuka|Koichi|K|', 'Fifita|Sisilia|S|', 'Fakakovikaetau|Amanaki|A|', 'Kobayashi|Seigo|S|']
D002648:Child D003362:Cost-Benefit Analysis D004245:DMF Index D003731:Dental Caries D006267:Health Education, Dental D006801:Humans D007391:International Cooperation D009909:Oral Health D009910:Oral Hygiene D015995:Prevalence D015397:Program Evaluation D012574:Schools D014058:Tonga D014099:Toothbrushing
Kingdom of Tonga Prevention of dental caries fluoride oral health-care system