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
HRD (State I) Survey (Stage II) Interventions (Stage III)
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 location in health delivery outlets
- Primary Health Centers (PHCs)
- Community Health Centers (CHCs)
- District Hospital
- Others, if any
- Public Health Engineers / Personnel of water supply department
- School teachers
- 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
- Nutritional counselling
- 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.
CONTACT FOR ASSISTANCE: Dr. A.K. Susheela - firstname.lastname@example.org