title: Evaluation of the child oral health promotion 'MaliMali' Programme based on schools in the Kingdom of Tonga.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Biochemistry and Molecular Biology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan.|South Pacific Medical Team, Kawaguchi, Saitama, Japan.
authors.forename: Reiri
authors.initials: R
authors.lastname: Takeuchi
authors.affiliation: South Pacific Medical Team, Kawaguchi, Saitama, Japan.|Kawamura Dental Office, Kawaguchi, Saitama, Japan.
authors.forename: Kohji
authors.initials: K
authors.lastname: Kawamura
authors.affiliation: South Pacific Medical Team, Kawaguchi, Saitama, Japan.|Kawamura Dental Office, Kawaguchi, Saitama, Japan.
authors.forename: Sayuri
authors.initials: S
authors.lastname: Kawamura
authors.affiliation: South Pacific Medical Team, Kawaguchi, Saitama, Japan.|Department of Special Needs Dentistry, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan.
authors.forename: Mami
authors.initials: M
authors.lastname: Endoh
authors.affiliation: South Pacific Medical Team, Kawaguchi, Saitama, Japan.|Kawamura Dental Office, Kawaguchi, Saitama, Japan.
authors.forename: Chizuru
authors.initials: C
authors.lastname: Uchida
authors.affiliation: South Pacific Medical Team, Kawaguchi, Saitama, Japan.|Department of Preventive and Public Oral Health, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan.
authors.forename: Chieko
authors.initials: C
authors.lastname: Taguchi
authors.affiliation: Department of Special Needs Dentistry, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan.
authors.forename: Takato
authors.initials: T
authors.lastname: Nomoto
authors.affiliation: Department of Biochemistry and Molecular Biology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hiratsuka
authors.affiliation: Vaiola Hospital, Ministry of Health, Kingdom of Tonga, Nuku'alofa, Tonga.
authors.forename: Sisilia
authors.initials: S
authors.lastname: Fifita
authors.affiliation: Vaiola Hospital, Ministry of Health, Kingdom of Tonga, Nuku'alofa, Tonga.
authors.forename: Amanaki
authors.initials: A
authors.lastname: Fakakovikaetau
authors.affiliation: South Pacific Medical Team, Kawaguchi, Saitama, Japan.|Nihon University, Tokyo, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control; D006267:Health Education, Dental / Q000191:economics / Q000379:methods*; D006801:Humans; D007391:International Cooperation; D009909:Oral Health; D009910:Oral Hygiene; D015995:Prevalence; D015397:Program Evaluation; D012574:Schools; D014058:Tonga / Q000453:epidemiology; D014099:Toothbrushing
keywords: Kingdom of Tonga; Prevention of dental caries; fluoride; oral health-care system