School-based oral health“Malimali” program and additional
health promotion activities
in the Kingdom of Tonga
Ministry of Health
Kingdom of Tonga

Salote Tu’ihalamaka Tu’iniua

“Malimali” Program“Malimali” in Tongan
means“Smile” in English

Let’s smile and be relax together before I start to talk.

8000 km

The Kingdom of Tonga is located inthe middle of the South Pacific andcomprises of 177 islands of which 52
islands are inhabited.

Kingdom of Tonga
General information•

Part of Polynesia and neighbors with Fiji,Samoa and New Zealand.

••••••

Population : 105,323 (2013)Capital: Nuku’alofa
Official language ：Tongan, English
Religion: Christianity
Currency: Pa’anga (TOP)Foods ：Yam, Taro, Tapioka, Fish, Tropicalfruits
Life expectancy: 76 yrs••Tonga became known as the Friendly Islands
because of the congenial reception accorded
to Captain James Cook on his first visit in1773
Coat of arms

Niua Group
Population: 1932

Dental staff in Tonga• There are 11 Dentists with aDentist to population ratio ofabout 1:14,000• 19 Dental Therapists to thepopulation to working dental
personnel is about 1:4,000• 3 Dental Technicians forProsthetic• 2 Dental engineering ( for dentalequipment)• 2 sterilizing officer and 3
receptionists

Vava’u Group
Population: 15,679

Ha’apai Group
Population: 8,000

Tongatapu Group
Population: 75416‘Eua Group
Population: 5,000

With large families being the norm and young adults
often emigrating to benefit from high salaries abroad,one third of Tonga population is under 12 years old.

Schooling hierarchy
age 0 １ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Preschool

Primary School

Secondary SchoolUniversity(oversea)
Career●Education is a core part of Tongan life
●Around the age of 12, students are allocated to schools based on
their examination results●Whilst there is a teacher training college in Tonga, most students
qualify abroad.

Number of primary schools in each island’s group.

●2007~
Malimali program
extended to
Vava’u and ‘EuaGroups.

33

19●1998~South Pacific
Medical Team
started Malimali
Program in
Tongatapu andHa’apai Groups

5Niuas Group

HistoryofMalimali
Programin
KingdomofTonga

Vava’u GroupHa’apai Group130Tongatapu Group‘Eua Group

6

Number of primaryschool students isabout 12,000.

The 1st DMFT survey for 12 year-old students
in Tongatapu (main land)by Tongan dental team and SPMT-JAPAN
in 2000
GENDER Number of The prevalence ratestudents
of dental caries

Mean DMFT

BOYS

4589%

4.40

GIRLS

2191%

5.81

To save the children,• What should we do?
• What can we do for them?

School-based
Malimali Program
1. Brushing teeth everyday
2. Fluoride mouth rinsing for
1 minute once a week

Malimali program
helps to protect
children’s teeth!!
.

Most families depend on rain water fordrinkingRain water tank

Mobile clinic in remote islands
Mobile clinic opens once threemonths for the people who live
in remote islands.

Tooth extraction on the boat.

Dr Sililo Tomiki, started the Malimali program withaid of the South Pacific Medical Team,
Drs.Koji Kawamura & Sayuri Kawamura.

Japanese NGO South Pacific Medical Team has helped and supported the program.

School Visiting Program(Malimali Program)
1. Brushing teeth
2. Fluoride mouth rinsing

We can meet
about 700
students / day !

The changes of DMFT of 12 year-old students
7 years after Malimali program startedin Tongatapu (main land)
76543210Prevalence rate ofdental caries

5.8

2000
2007

4.4

2.1

1.84

n=45

n=44

Boys
89%

70%

n=20

n=2091%

70%

Girls

Malimali program started as the joint program of Ministry of Health and Ministryof Education.
It is the 10th year since Malimali program has been implemented in Vava’u.
The program has been a part of regular educational program since 2014 .
Teachers have become very corporative in these days.

HEALTHEDUCATIONTEAM Malimali

Teachers are the professionals ofeducation.
Dentists are the professionals oforal health.
Let’s work together for brightly
smile as a team !

Children are great !

G.P.S. Tu’anukivale

Elder boy teaches younger boy how to brush teeth properly

School Visiting Oral Health Program• Dental staff teach children at school.
• Children teach children.
• Children teach adults at home.

Good habit spread from children to children and children to adults.

How to keep the bottles and tooth brushes

HINA : bottles

Fufulunifo : toothbrushMalimali Programin Preschools• Tooth brushing instruction• Fluoride mouth rinsing
0.05% NaF (5mls), 30 sec

It’s so easy, but worth to do
if we keep doing !

Prevention is better than cure.

Malimali Program has been on theSecond phase since 2013.
• Toothbrushing everyday at school instructedby dental staff• Fluoride mouth rinsing once a week instructedby dental staff• Delivering fluoride every week

• Instruction of toothbrushing , fluoride mouthrinsing, hand washing and exercise by dental
staff once in a week.

Dr. Sisilia Fifita is thechief in charge ofMalimali program of allof Tonga.

Four JICA (Japan International Corporative Agent) volunteer haveworked with us in Vava’u Malimali program in the past.

Takako (2007-2009)

Masako (2012-2014)

Ai (2009-2012)

Misaki (2014-2016)

The acquired good eating habit
with good teeth and oral function in their childhood
will prevent from suffering life-style related diseases
and might be a guarantee on the future healthy life.

G.P.S. Makave

Future plan
• Starting earlier prevention for pregnant
women (minus 1 year old) (cleaning, scalingetc.)• Oral survey for Class 1-6 students in GPS• Mobile Clinic for the children living in theouter islands

CONCLUSION• Malimali Program in Tonga contributed toimproving the children’s oral condition in 6yrs
to 12yrs old, and habit of tooth brush, habit ofhealthy diet and it is important to promoteoral health care strategies for school children
life style in Tonga.

Malimali Program at Neiafu G.P.S.