PROGRAMME STRATEGY OF NPPCF

DIBYENDU DUTTACONSULTANT NPPCF

BANKURA

Training on Fluorosis Mitigation Programme Under National Programme

for Prevention and Control of Fluorosis(NPPCF) Bankura

Fluorosis: Adverse Health Affect & its causes

1. Patient complain fatigue / Weakness due to destruction of muscle structure by fluoride decomposition in muscle

2. Patient complain tiredness ,unenthusiastic and a feelings of depression due to destroying RBC resulting anemia and eventually depression.

3. Stomach & intestine inner mucosal membrane destroy by decomposition of fluoride resulting the GI mucosal destruction.

4. kidney disfunction cause polydipsia & polyurea

5. A female patient complain of repeated miscarriage / still birth due to deposition of fluoride - foetal blood vessel blocking.

6. Anemia patient complain of not being able to conceive due to husband sperm count is being low (Oligospermia) / non (azospermia) and blunt end of sperm

National Programme for Prevention and Control of Fluorosis Bankura West Bengal

• This national programme will be covered 7 District in West Bengal in the first phase as per GOI guideline.

• This districts are Bankura (as a pilot phase) , Dakhsin Dinajpur ,Birbhum ,Purulia,(already implemented) Malda,Uttar Dinajpur ,Murshidabad. After that Burdwan and another 2 district will be added up to 2017.

• Fund allotted for this programme directly sanctioned from president fund of Ministry of Health & FW GOI. As per GOI letter it is confirmed that this national programme has already been extended up to 2017 and this phase is the 2nd Five years plan 2012 to 2017.

• The responsible committee of this programme is : DGHS (Chairmen ) ,Advisor, Nutrition & IDD cell (Secretary) , Research Officer IDD & Nutrition cell (Controller) , National Consultant (NPPCF) GOI (Direct controller of District Consultant via state programme officer)

• District Programme Officer : CMOH • District Nodal Officer & Public Health Officer : Dy. CMOH-II • District Consultant : Programme Consultant act as a co-ordinator and responsible person to

Central including CMOH of the district.(eyes of the programme)• In the district Bankura these programme has been implemented on Jan 2011 after the

recruitment of Consultant and Lab. Tech.

Programme Structure :Intimation to the coordinating departmentCollection of reportsPreparation of Six months survey plan , on the

basis of its report this national programme granted by GOI for further promotion in this district.

Survey including screening, sample collection , cases diagnosis, line listing of the patient.

Establish the fully equip. Fluorosis Control Laboratory.

National Programme for Prevention and Control of Fluorosis Bankura West Bengal

Training of Medical and non medical staff for the work-out

Arrange District Level Advocacy MeetingSupervision & monitoring the Block Level Advocacy

Meeting.Arrange the district level Monitoring & Review

MeetingSupervision & monitoring the Block Level Monitoring

& Review MeetingIECBCC (Sensitization of ASHA / AWW / PRI / Teacher /

Students etc.)

NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF FLUOROSIS BANKURA WEST BENGAL

HRD Survey Interventions

(Stage I) (Stage II) (Stage III)

PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE DETECTION SURVEY IN THE FIELD

STAGE I: Human Resource Development 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

Block Primary Health Centers (BPHCs), Primary Health Centers (PHCs), District Hospital, Others, if any

Public Health Engineers / Personnel of water supply department School teachers Para medical workers NGOs, and Social workers / any other (If any)

PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE DETECTION SURVEY IN THE FIELD

STAGE II: Survey What does it involve?

Microplan of Survey :

The information on fluorosis endemic areas along with fluoride level in the drinking water sources is to be obtained from Public Health Engineering Department (PHED) of respective endemic states.

Fluoride level in all the drinking water sources is to be estimated by PHED.

Based on the level of fluoride content, the villages will be stratified in the following 3 strata as under:

Strata Fluoride Level   I 1 - 3 ppm

II 3.1 – 5 ppmIII > 5 ppm

PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE DETECTION SURVEY IN THE FIELD

Strategy of Micro plan Preparation:For prevalence of fluorosis cases, 10% villages of each

strata will be selected randomly. If number of villages is up to 20, then all the villages will be surveyed. If number of villages is more than 20, then 10% of villages from each strata (at least 20 villages in total) will be surveyed.

All the children in the age group of 6 to 11 years from the primary school (3rd to 5th standard) in the selected villages of the district will be surveyed for prevalence of dental fluorosis.

Survey for skeletal and non-skeletal fluorosis cases would also be carried out in 20 households of randomly selected villages of the district where dental fluorosis is prevalent in school children.

PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE DETECTION SURVEY IN THE FIELD

Screening Strategy :Case detection in the field:Dental Fluorosis

Chalky white teethTransverse yellow brown/dark brown bandsPitting of dental enamel

PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE DETECTION SURVEY IN THE FIELD

Skeletal Fluorosis:Any case with a history of residing in an endemic area along with

one or more of the following:Severe pain and stiffness in neck and back bone.

(Patient has to turn the whole body towards that side to see)Severe pain and stiffness in joints.Severe pain and rigidity in the hip region

( pelvic girdle)Knock knee/ Bow legUgly gait and posture

PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE DETECTION SURVEY IN THE FIELD

Non Skeletal Fluorosis:ConstipationHeadacheTingling sensation in feet & fingers Nervousness & Depression

Sample Collection & TestWater of the area (Normal Range 1.5 PPM as per

*BIS)Urine Sample (Normal Range 0.1 PPM)Blood Sample (Normal Range 0.15 PPM * singer )

PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE DETECTION SURVEY IN THE FIELD

COIN TEST: The subject is asked to lift a coin from the floor without bending the knee. A fluorotic subject would not be able to lift the coin without flexing the large joints of lower extremity

CHIN TEST: The subject is asked to touch the chin with the chest. A fluorotic subject would not be able to do so, if there is pain or stiffness in the neck.

Identification of fluorosis cases in the field by Test

STRETCH TEST: The individual is made to stretch the arms sideways, fold the arm and try to touch the back of the head. If there is pain or stiffness in the shoulder joint and backbone, the exercise will be difficult, suggesting possibility of fluorosis

Confirmation with X-ray

Ossified Interosseous Membrane

NPPCF Scenario in West Bengal

Bankura Birbhum Daxindinajpur Purulia Malda South 24 Pargana

Uttar 24 Pargana

0

5

10

15

20

25

12.69

20.24

7.588.28

4.53

1.81 1.87

Fluoride (PPM)

Fluoride Level in Drinking Water in WB

Concise Reports of NPPCF Performance , Bankura

Total Village

Surveyed

Clinically found

fluorosis Cases

Total School

Surveyed

Clinically Found

Fluorosis Cases

38 81.69 31 90.86

Grand Report (School + Community) NPPCF Survey  

No. of Blocks

SurveyedNo. of GPSurveyed

No. of Village/

Habitation Surveyed

No. of PrimarySchool

Surveyed

Total No. of

Persons Surveye

d

No. of Dental

Fluorosis Found

No. of Skeletal

Fluorosis Found

Joint Pain

&Back Pain

Found

No. of Urine

SampleAnalyse

d

Clinically

Fund Positive

% of Clinicall

yFound

Positive Cases

8 19 38 31 3087 2298 224 994 2050 1766 86.15

NPPCF Scenario of Bankura District

Simlap

al

Hirban

dh

Talda

ngra

Khatra

Banku

ra-II

Banku

ra-I

Raipur

Chhatn

aMeji

a

Indpu

r

Sona

mukhi

Onda

Salto

ra

G.Gha

ti

Barjor

a

Raniba

ndh

Sare

nga

0

2

4

6

8

10

12

14

12.69

10.810.45

5.124.9 4.62 4.55

4 3.94.41

3.4 3.03 3 2.67 2.512.161.98000000000001

Graphical representation of Maximum fluoride level of different Blocks of Bankura dis-trict

Fluoride (PPM)

Fluoride level of Different Blocks of Bankura District

Total Block Affected

Village Affected

Habitation Approx. people affected

17 out of 22 Blocks

361 1005 More than 1 Lakhs

Total

no. o

f per

sons

scre

ened

Dental

fluor

osis

foun

d

Skele

tal flu

oros

is fo

und

Non Sk

eletal

fluor

osis

foun

d0

1000

2000

30003087

2298

224944

Graphical representation of fluorosis patient out of total surveyed

Graphical representation of fluo-rosis patient out of total surveyed

Over all Fluorosis Status in Bankura District

IEC & BCC Done by DH&FWS

IEC & BCC Done by DH&FWS

Dental Fluorosis in Bankura District

Skeletal fluorosis in Bankura

Adviser (Nutrition) GOI

National Consultant (NPPCF) GOI

Director of Health Services W.B

Addl. Director of Health Services (PH & CD) W.B

Deputy Director of Health Services (PH & CD) W.B

Asst. Director of Health Service (MPHWS) & SPO (NPPCF) W.B

Chief Medical Officer of Health Bankura & District Programme Officer NPPCF .Bankura

Deputy Chef Medical Officer of Health-II & Nodal Officer (NPPCF) Bankura.

Programme Holder in Chronological Way NPPCF

District Consultant NPPCF & District Lab. Tech NPPCG in District Fluorosis Control Unit Bankura

District Fluorosis Control Unit