Table 3 overview of themes and subthemes with illustrative quote

Provide skills-based health education

Developing skills

“….but as a teacher before even in class you stand, you get a stick, you tell them this is how we brush. You take upside down the other part the inner part and so on”. Interview 10

“……there is also a topic in p2 which when you are teaching you should demonstrate the style of brushing teeth”. Interview 16

“The teacher will get a brush, will ask learners to go and get some small-small sticks to come and make your own brush then the teacher will demonstrate how to brush properly. So that the learners know how to brush”. Interview 17

Raise health awareness to prevent oral disease

“they talk about types of the teeth that is; milk teeth, permanent teeth all those the molars the premolars, incisors, diseases of teeth, how to control them they are there in that syllabus”. Interview 03

“I think from school here we try our best to advocate for the hygiene of the mouth, I could say it, we encourage them to brush their teeth regularly, after meals”. Interview 12

“the tooth decay I may tell them that you can eat things like biscuits, sweets, sugar cane but not in large amount. Just eat so that I helps your body to…to have nutrients but know that if you eat too much of it, you are likely to get tooth decay because that germ likes things which are sweet and if you don’t brush your teeth the food remains are going to remain in your…….if you don’t keep on brushing they are piling and now the germs will get a way of entering and then you will automatically get tooth decay”. Interview 17

So that one, you know normally we follow curriculum. So that curriculum about teeth falls under science so strictly it is done under science but now you will bring others in the class when you, it will not even stop you, like when you want to talk about how they should keep their teeth clean and so on. You can bring that like interlude in your lesson. You know for us teachers you just bring them as if it is an interlude. Interview 03

Provide access to health services

Dental examination

Yeah. We have what is called morning health parade. In the morning, if the schools are running normally, in the morning parade that is where you have to check on the hygiene of the child: the mouth, the fingernails, the hair if it is clean, even the clothing but we only advise. Interview 11

Treatment, monitoring and referral

“But now for us what we could do was just to refer them because we don’t know anything which is causing those kinds of things. So, we could…. if it is about the bad smell yes, we could fight it but what is happening…. what is causing that thing to….to bleed we do not know, so we need to refer them. We just say ahh please the parents, this thing is like this can you take the child to medical personnel so that is what we are doing”. Interview 05

“….., like when a child has not brushed, you can even see and identify it. Then you send that child to brush immediately, you send them, you just get…. You just say, let us go and get some sticks, these sticks, you break and then you use it, and at least you see at least it is fairly done”. Interview 1

Engage health, education and community leaders

Engaging parents

“Yeah, when we organise parent meetings, we give that sensitisation to them and during athletics when we gather a large number of parents, so we pass the message…….”. Interview 16

“.it is one of our priority here that we must make sure that if any problem is there that we have already noticed….we need to share with the parents…. others could go up to the SMC and the PTA. In their meeting it is also presented, the school is having this and that, what should we do?” Interview 05

Engaging oral health professionals

“Like sometimes we have been hosting those ones from the health centre there, they can come here. They train these pupils. Like all teachers are called to sit together with the children then they help those health workers to explain certain things to the children” Interview 14

“ We invited a dentist…, who came here and checked most of our children especially their teeth, the gums and the rest of it…”. Interview 02

Engaging other school staff

“……., you pick one child then you get clean water you go may be under the tree then the child, you demonstrate to the child what he does from home”. Interview 02

“Yes, we have noticed that it started reducing because we found it, it was already a problem then we had to tell them exactly what they are supposed to do like: they are supposed to brush regularly, and also……”, Interview 09

Provide a safe healthy environment

Provide social and psychological support

The health club is a club which is formed by these students and they have a matron and patron and then they have to look for activities around to keep the health of the learners, that is, we have a team with the chairperson and then the other members in that structure whereby we also draw a program for them weekly. Interview 15

I feel it…. and it is very important because if…….I knew if I visited……if my father had taken me to a dentist other than extracting the tooth they would have refilled, and I would not have lost the tooth. But I lost the tooth then when I become older myself when I visited a dentist, I got better knowledge, so I choose to now follow the dentist advise other than removing a tooth…………………, and I always refer to myself. Had I not been following I would have lost many teeth. Interview 04

Provide water and sanitation

“We have got water, sanitizers, we check on their latrines. We check everywhere. Of course, even as we shall get out you get, we see we have talking compound as they are in the compound, they continue learning” Interview 01

“Like we have water even: we have the borehole and there are washing facilities also, uhm like for washing their hands. Yeah, the area for brushing is also there”. Interview 06

Act as role models

“I feel it…. and it is very important because if…….I knew if I visited……if my father had taken me to a dentist other than extracting the tooth they would have refilled, and I would not have lost the tooth. But I lost the tooth then when I become older myself when I visited a dentist, I got better knowledge, so I choose to now follow the dentist advise other than removing a tooth…………………, and I always refer to myself. Had I not been following I would have lost many teeth” Interview 04

Improve health promoting policy and practice

Supervised tooth brushing

“now when it comes to another strategy that we are doing especially last term……., we make sure that in the morning you must check them to make sure that everybody brushes [their teeth]”, Interview 05

“We try to follow up on them like the matrons should monitor them to make sure that each and every one does the brushing in the morning before going to class like that”. Interview 07

Inspection of school requirements

“The restrictions like we, those sweets in most cases we don’t encourage parents to pack for their children because the things that we normally encourage them to pack for their children are things like, some maybe appetizers: you can put “odii” for them that one there is no problem. So mainly those are the things we look at but issues to do with sweets what, what, we discourage parents to pack for their children”. Interview 07

“Now as the school the school tried to put some restriction that learners must not come with extra sugar in their cases. Sugar is always collected. The parents will bring sugar. Like when you get at the gate, you find that the teachers…… you have seen”. Interview 08

Rewarding good performance

“One example, you can cite that child as……you give that child as an example among the pupils. You say, you see a good……a clean child looks like this….like this one. You can select the best girl, the best boy, then you can motivate them, you talk to them, you make the……., children will start learning and change”. Interview 14

“Yeah, rewards in terms of appreciation like we speak positive things about that child…….” Interview 12

Improving health of communities

Focusing on community health concerns

“…….most of our children here suffer from this tooth ache because of eating sweet things, they like carrying sweets, eating biscuits. So you find them staying for…. after eating they don’t even brush, even from school here you need to remind them even to do [brush] ………” Interview 02

“You are a teacher, you are marking, and a child comes to you, a child is explaining something to you, automatically you will know that this child did not brush” Interview 03

“Yeah. A number of times we have been recording learners suffering especially from tooth ache, the most common one is tooth ache. And sometimes bad breath”. Interview 08

Participating in community health projects

“We invited a dentist……., who came here and checked most of our children especially their teeth, the gums……… we were also advised by him that we could constantly keep on checking those children in case we get anything we have to report to them so that they come here” Interview 02

“Like sometimes we have been hosting those ones from the health centre there, they can come here. They train these pupils……… sometimes children don’t see what you are telling as a teacher that it is true, so they first want to see from the medical workers. When they come here, they can handle and supplement on what the teacher has been doing.” Interview 14

Response to COVID-19 pandemic

What has changed

“……maybe because of this COVID-19 but previously we used to have these sessions.” Interview 07

“Hmm. since we started this year, we have not involved them [parents]” Interview 15

“Yeah. One, we have, like we have before “corona” we were having what we call health club. Yeah. We always giving assembly we like to…like this oral health. Yes. We try to teach them how we can wash our hands, how we can also brush our teeth. We always do because some people they …… some of them they brush their teeth just for one minute it is over. Yes, but we were just teaching them before corona but after corona we have not yet done”. Interview 18

What was not interrupted

“We told them they should brush at least after every three….after every meal, at least three times in a day because very early before coming to school they brush their teeth, then from here like we have a boarding section also here, and the candidates were all in boarding because of this COVID so we would also encourage them to brush in the morning” Interview 06

“Yes, we tell them, this one normally comes in when we are teaching, when we are handling science and it comes to that part of food and nutrition, we tell them and when it comes to human health,……teaching on the parts of the teeth, the human teeth; the causes of tooth decay; how to avoid tooth decay; care for the teeth. We all bring in those ones”. Interview 10

“….., we ask the parents to provide their children, especially those we cater for as boarders, to provide them enough things they use for cleaning themselves especially the mouth cleaning. So, we ask them to provide us enough toothbrushes…. the required toothpaste also. Interview 04