PROGRAMME STRATEGY OF NPPCF DIBYENDU DUTTA CONSULTANT NPPCF BANKURA Training on Fluorosis Mitigation Programme Under National Programme for Prevention and Control of Fluorosis(NPPCF) Bankura
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