Low-cost glass ionomer cements for eco-friendly practice of dentistry in Kenya

In Kenya, the Oral Health Policy 2022-2030 developed by the Oral Health Department within the Ministry of Health identifies the promotion of the eco-friendly practice of dentistry as one of its objectives. A priority action area is to develop a national plan to phase down usage of dental amalgam while promoting mercury-free alternatives. To achieve this objective within the specified timeframe, the first five strategies have been adopted. 

With support from CARTA through its post-doctoral awards (re-entry grant), Dr. Olivia Osiro (cohort 6 graduate, University of Nairobi) is implementing a research project that aligns with the fourth dental amalgam phase down strategy – to promote research on affordable mercury-free alternative dental filling materials. Her project is titled Development of low-cost glass ionomer cements for dental restorations’. 

With support to the tune of USD 50,000, Olivia intends to complete pending work from her PhD project ‘Development of a prototype for a restorative dental cement in Kenya’. Between August and November 2022, Olivia attended a short research visit as an Honorary Lecturer at the Dental Physical Sciences Unit and Barts and the London School of Dentistry, Queen Mary, University of London, where she refined the proof of concept and conducted the required experiments that included synthesis and material tests according to ISO standards for dental cements. 

She is currently investigating the use of highly reactive aluminosilicate glasses mixed with soda-lime-silicate glass (bottle glass) to produce low-cost ionomer glasses. By reducing the ratio of the aluminosilicate glasses, and replacing it with bottle glass, the cost of production can be lowered by up to 60 – 80%. 

The rationale behind this is that only up to 20% of the ionomer glass is involved in the setting reaction on mixing with poly (acrylic acid). Bottle glass is thought to act as a cheap filler and is readily available in all aspects of day-to-day life. The present research has so far produced working formulations of mixtures of two types of highly reactive ionomer glasses and bottle glass with reasonable working and setting times for dental applications. She is optimistic about her research project and its potential to promote the eco-friendly practice of dentistry in Kenya.

On the research project, Olivia is working with Prof David Kariuki, Department of Chemistry, University of Nairobi, Kenya as the internal collaborator, and external collaborators – Prof Robert Hill, Dr. Saroash Shahid, Dr. Natalia Karpukhina of the Dental Physical Sciences Unit, Queen Mary University of London, London, UK. The research visit enabled close interaction with the external mentors as well as an opportunity to lead a research project as a postdoc, with potential to generate a couple of master’s projects.

The CARTA re-entry grants seek to support CARTA graduates returning to, or remaining at their institutions, to undertake a research project, receive strong mentoring and learn the demands of community and public engagement. Within 2022, CARTA awarded nine re-entry grants to its graduates from a total of fifteen post-doctoral opportunities. The other six were awarded as post-doctoral fellowships.

 

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Dubbed LEMIC, the ‘Lived Experiences of Migrating Informal Caregivers in a Tertiary Health Facility: Understanding and action for health systems improvement in Nigeria’ project is a research study that is funded by CARTA through the program’s re-entry grants. The funding, awarded to CARTA graduate, Dr. Kudus Oluwatoyin Adebayo is to the tune of $50,000 and is among 15 postdoctoral fellowships that were awarded to CARTA graduates in mid-2022.

On October 17, 2022, the LEMIC project was officially flagged off with an inception and familiarisation meeting. The meeting was held at the Oladele Ajose Building, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria. During the meeting, the project team engaged the university and hospital stakeholders on the overall aim of the project and garnered feedback on the research which seeks to explore how internally migrating caregivers experience hospital facilities while providing support to hospitalized patients.

Some of the attendees included Dr. Funke Fayehun (Chair of the CARTA Board, co-Focal Person of CARTA at the University of Ibadan, and current Head of the Department of Sociology); Dr. Molatokunbo Olutayo (Director of the Institute of African Studies); Prof Adesola Olumide (Researcher and Consultant Community Physician, Institute of Child Health and Director of the College of Medicine, Research and Innovation Management – CRIM); Dr. Oludayo Tade (Department of Sociology); Dr. Obaro Michael (Deputy Chairman – Research, Medical Advisory Committee – CMAC, University College Hospital), and Dr. Isaiah Ojo from the Office of the Director of Administration, University College Hospital.

In her remarks during the meeting, Dr. Fayehun discussed the work of CARTA at Ibadan, particularly the contributions of the Consortium towards building advanced research capacity of doctoral researchers, staff training, institutionalization of innovations, collaborations, research, infrastructural supports, and many others. She explained that being a highly competitive grant, CARTA’s re-entry grant supports innovative ideas with potential to impact public and population health and quality health systems functioning and effectiveness.

Other participants praised the team for sharing their proposal but offered critical comments and recommendations, largely on methodological plans and ethical considerations. The project team promised to reflect on and integrate as much of the input as possible.

The implementation of the LEMIC project will be led by Kudus as the PI. He will have support from the co-PI, Dr. Mofeyisara Omobowale of the Institute of Child Health, Prof Ayodele Samuel Jegede of the Department of Sociology – the internal mentor and Prof Sharon Fonn (CARTA Co-Director) of the School of Public Health, University of the Witwatersrand, South Africa – the external mentor. Rukayat Usman, a graduate student at the Institute of African Studies, is the Project Assistant.

 

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CARTA has adapted a general approach to enhance sustainability of its interventions (Joint Advanced Seminars -JASes; Supervisors’ Workshop -SW; Graduate Workshop – GW; and the Academic, Professional and Administrative Staff Seminars -APAS) through respective Training of Trainers (ToT). The series of ToTs kicked off in June 2022 following a review of its interventions and development of ToT programs that had been in progress since 2021.  

On August 1-5, 2022, CARTA held the supervisors’ ToT in collaboration with the Kamuzu University of Health Sciences (KUHeS), Malawi. A total of 54 participants attended the ToT; 27 under the program and 27 brought in by the University of Malawi (UNIMA) Consortium from its affiliate universities. The participants included university professors, associate professors and senior lecturers selected from the vice chancellors’ office, and heads of institutions of CARTA partner institutions.

During the opening ceremony, Prof. Sharon Fonn (University of the Witwatersrand and CARTA Co-Director) highlighted the need and benefit of partner institutions’ mainstreaming CARTA interventions so as to change the narrative of how research is conducted in Africa. She noted that when conducting research, it is important to understand the what (the current situation), why (reasons for the current situation) and how (best approaches to change the situation). 

Over the years, CARTA has regularly convened PhD supervisors from its eight African partner universities to enhance their supervisory skills, and exchange approaches in supervision. The intervention’s importance has been acknowledged over time thus the need to mainstream the approach and benefit more supervisors across the institutions. 

Because a number of participants had not attended a supervisors’ workshop before, the participants were given an overview of CARTA’s andragogical approaches and its SW course. Presentations on the content of the course, as well as other sessions, generated informative discussions. One area of interest was on ethical dilemmas in supervision. To encourage participation and find practical solutions to the issue, the facilitators gave the team the opportunity to explore and suggest possible solutions and best practices to consider for adoption.  

In unpacking the training methodologies used in CARTA for experiential learning, participants benefited from a video demonstration on CARTA approaches in training; presentations by various facilitators; role play; generating ideas using world cafe; the ‘but why’ approach in exploring scientific integrity; and group work on quality assurance in PhD supervision. Included in each session was a participatory discussion on issues that were raised in relation to learning experience, and best practices to address them. 

Teams took time to draw plans to cascade the training in their universities using a common template provided to them. The ideas were presented using the ‘marketplace of ideas’ approach with the aim of generating constructive feedback from the participants on each of the institution’s plans. At the end, a discussion emerged on how best to document the process – possibly a common online platform to continuously discuss progress, challenges, new approaches and so on, in changing PhD supervision in Africa.

The supervisors’ ToT follows a successful APAS ToT held at the Makerere University School of Public Health, Uganda from June 6 to 10, 2022. With the SW ToT completed, CARTA is looking to follow up on the institutionalization plans drawn and how these interventions will be implemented, funding on the same, and the impact generated towards changing the research ecosystem at the institutions. 

The remaining ToTs for JASes and GW are slated for August 29 to September 2, and November 28 November to December 3 respectively. Ultimately, CARTA hopes to have a team (for each intervention) that will train various personnel at their own institutions.

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Recently, Cohort 9 fellows completed CARTA’s series of Joint Advanced Seminars (JASes 1-4), marked by a residential phase of JAS 4 that took place between July 18-29, 2022 at the ResilientAfrica Network (RAN) Lab, in the Makerere School of Public Health, Uganda. During the two weeks, 22 CARTA fellows were capacitated on professional development including skills necessary to manage and teach large class sizes; raise and manage research funds; grant writing and research leadership; and communicating to policymakers. The face-to-face seminar was preceded by 4 weeks of virtual sessions.

JASes are designed to enhance the skills and knowledge of CARTA fellows, to guide and propel them through the research process; and provide a foundation for building networks of researchers, peers, and mentors. The JAS requirement promises to produce strong common quality expertise that can help the long-term disciplinary cohesion of scholars, who come from different universities and with varied quality in previous education.

JAS courses are offered sequentially for four years to each Cohort, and build skills and conceptual depth from year to year as follows:

  • JAS 1 builds critical thinking, technical skills, and other core research competencies, and introduces students to the essential research and methodologies.
  • JAS 2 focuses on data management and analysis. Fellows learn to use software packages for qualitative and quantitative data management and analyses. Practice sessions use real research data and current software packages for hands-on training.
  • JAS 3 focuses on data presentation, the doctoral dissertation, and scientific writing and communication skills to facilitate results dissemination and policy engagement.
  • JAS 4 addresses professional development including skills necessary to raise and manage research funds, grant writing, development of courses, management of large class sizes, and supervision of graduate students. This seminar is also an opportunity for senior fellows to mentor junior fellows through discussion and laboratory sessions, software training, and general information sharing.

With many of the cohort 9 fellows at the tail end of their PhD work, CARTA sought to gather how the JAS experience has influenced their PhD and professional journeys. Watch highlights from some of the fellows:

Detailed reflections can be read here: https://sites.google.com/cartafrica.org/cohort9reflections/home

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