Fluoride and Fluorosis Mitigation Programme: Blue Print
Location: Village/habitation in an endemic block / district
To provide safe drinking water
To prevent and control Fluorosis
To improve health
Stages to follow for Implementation for a project
Survey (Stage II)
STAGE I: Human Resource Development (HRD)
What does it involve?
Human resource development/capacity building
Objectives - to impart knowledge; to develop skills; to bring about attitudinal changes.
Who should be trained?
Doctors/health professionals posted in the locationin health delivery outlets
Primary Health Centers (PHCs)
Community Health Centers (CHCs)
Others, if any
Public Health Engineers / Personnel of water supply department
Para medical workers
NGOs, if any
Social workers / any other
Who will impart training?
Responsibility of FR and RDF, through the best talents available in the country.
Shall induct local talents, if available
Duration of training?
Duration depends upon the number of trainees
Minimum of 3 days to a maximum of 4-5 days (depends upon the blocks/villages to be covered.
STAGE II: SURVEY
What does it involve?
The trained man power will undertake 3 different surveys to obtain baseline information. All requisite material for survey i.e Precoded forms, water collection of bottels, technical handouts, flip-charts to be procured and made available to the trainees on the last day of training.
Type I: School Dental Fluorosis survey & water sample for testing (to be carried out by trained school teachers only)
To identify endemic locations
To record dental fluorosis prevalence in school children.
Middle and secondary schools to be listed. (not primary schools)
Children above 8 years of age to be surveyed.
School dental fluorosis survey information to be recorded in specially designed proforma.
Type II: House to house survey to record ill-health complaints
To assess the magnitude of the health problems.
To identify those having early warning signs of fluoride poisoning,
Health survey of every member of the families, living in the identified villages are carried out by the para medicals / NGOs /social workers under the supervision of the health professionals in pre-coded proforma.
Type III: Water quality survey
To assess the drinking water contamination with fluoride in all sources in a village
To identify safe and fluoride contaminated sources
Every drinking water source, Government or privately owned are tested for water quality focusing only on fluoride
A map is prepared for every village
Review Meeting: The data emerged from Stage II are reviewed by Water Supply Agencies, Funding Agencies, FR & RDF and any other agency involved; and implementation strategy(ies) is/are planned.
Survey Data Analysis:
Dental Fluorosis survey data for schools reveal:
Children enrolled = 500; children examined = 400.
Children with dental fluorosis = 175
% Dental fluorosis prevalence = 43%
Children came from 3 villages including the village where the school is located.
All the 3 villages are enddemic as children have Dental Fluorosis
House to house survey data reveals
Total households in the village = 12
Total population = 96
Number of people suffering from dental fluorosis = 66
Number of people suffering from skeletal fluorosis = 27
Number of people suffering from non-skeletal fluorosis = 80
Total disease prevalence = 173
Water quality analysis data on fluoride reveals
Hand pumps = 3
Open well = 1
Total = 4 sources
Fluoride content of drinking water sources
Hand pump a = 6.8 ppm
Hand pump b = 12 ppm
Hand pump c = 4 ppm
Open well = 0.7 p
Review of information /data collected suggests:
43% of school children have dental fluorosis i.e. very high
Health survey indicate
80% of the population suffer from non-skeletal fluorosis
66% from dental fluorosis
27% from skeletal fluorosis
Water quality testing of 4 sources for fluoride indicate that all hand pumps were contaminated with fluoride.
Open well near the school is a safe source.
Therefore, 1 safe source; 3 contaminated sources.
Decisions to be arrived at in consultation with the community
Can the water available in the open well be used for providing 10 liter / capita for cooking and drinking purposes?
Or community prefers domestic filters using activated Alumina? / bucket treatment (Nalgonda)
Cost sharing need to be considered
Village facility for regeneration of activated alumina of the filter to be set up.
An individual, educated, unemployed youth to be trained for regeneration; payment of honorarium to the youth to be decided by the village committee.
Operation and maintenance would be the community responsibility and should be managed through village committee.
STAGE III: Practise of Intervention
Interventions to be practised are:
Provision of safe water on a sustainable basis
FR & RDF / any other to provide a one day workshop Nutritional counselling prior to the grass root level functionaries entering the field.
Special counselling material needs to be provided.
Monitoring impact assessment
First impact assessment to be conducted on 15th day or thereabouts to find relief felt by the community.
Second and third impact assessments: 3 months and 6 months later, then the victim would have relieved from almost 90% from the complaints.
APPENDIX 1: Material required for 3 types of Survey (Stage II activities)
Dental Fluorosis survey
School dental fluorosis survey: pre-coded format to be printed in sufficient quantity to hand over to school teachers at the end of the training (HRD - Stage I), so that they start survey the very next day.
One pre-coded proforma (1 leaf) is enough to record information of 10 children. There shall be (1) Class summary (2) School summary & (3) Block summary.
Depending upon the number of children - 8 years and above and the number of schools to be surveyed, forms need to be printed.
House to house survey
Pre-coded family survey forms (2 leaves) to be printed and adequate quantity is made available for distribution to para medical workers and others on the last day of HRD - Stage I.
One proforma has the provision for recording information of one family only (with 8 members) and summary of health complains will also be recorded.
Total population of the block or district divided by 8, the number of forms to be printed.
Water quality survey
100 ml capacity plastic bottles for water sample collection ought to be procured.
Johnson adhesive tape to be fixed on it - 3" x 3 " for writing the details of the source with a pencil.
Quantity - approximate number to be assumed. The bottles can be reused.
The code number on the water bottle label should be the same on the Health Survey forms.