Fluoride network nddb fluorosis saurashtra action sk ppt jan 1 2014

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Fluoride network nddb fluorosis saurashtra action sk ppt jan 1 2014

  1. 1. Action on Fluorosis in Saurashtra, Gujarat INREM Foundation Fluoride Knowledge and Action Network Presentation in NDDB, January 2 2014
  2. 2. Parts of presentation I) Fluorosis situation in ground: previous action and learning II) Concerted India – wide action on Fluorosis as a network III) Collaboration of NDDB with Fluoride Network
  3. 3. I) Fluorosis situation in ground: previous action and learning
  4. 4. Millions suffering in India Juvenile crippling is increasing
  5. 5. The real Fluoride picture is much more widespread than this 10 states are highly affected and 24 states report cases Estimated 65 million are exposed to high fluoride in drinking water Source: CGWB, 1999
  6. 6. Factors causing Fluorosis Fluoride intake around 10 mg/ day or more from water and food. Water standards are 1 mg/l Deficiency of Calcium and other minerals such as Magnesium, Vitamin C. Decreases Iron absorption
  7. 7. The (mal) Nutrition link Fluorosis affects intake and absorption of Calcium and Iron . In turn, Nutrition deficiency of Calcium, Vitamin C and antioxidants makes Fluorosis more severe Vulnerable sections being malnourished areas, women and children Fluorosis Malnutrition
  8. 8. As people understand People misunderstand Fluorosis as ‘Va’ Also, doctors mis-diagnose as Arthritis Dental stains taken as Tobacco or from poor hygiene Crippling is taken as hereditary or local curse
  9. 9. Steps in Detection Testing of drinking water Testing of food – nutrition & fluoride Dental & skeletal fluorosis surveys Blood and urinary fluoride testing X-rays of fore-arm & affected limbs
  10. 10. Approach to Tackle Fluorosis • Minimize intake of fluoride through water and food • Increase intake of Calcium and ways of absorbing Calcium • Reduce Fluoride action within body through better nutrition • Use indicators of fluorosis vulnerability to target interventions • Longer term action on social determinants of fluorosis
  11. 11. Community water filtration Domestic water filtration Rain water harvesting Protecting safe water sources
  12. 12. We can use the following Nutrition programme for Fluorosis: a) Pharma supplements of Ca, Mg, Vitamin D3 and Zinc b) Natural food rich In Calcium, Magnesium, Vitamin C: Amla (dried form and tablets), Soya, Til-Chikki, Cassia Tora (Puvadiya, Chakora) c) Ayurvedic and Herbal foods which help in better absorption of nutrients and detoxification of fluoride The best approach is to stress on local food sources and traditions as far as possible. Also fortification (flour, oil, water) using local food materials rich in nutrients is important
  13. 13. Nutrition enhancement Calcium, Magnesium supplements Dried Amla Amla tablets Green leaves Til Chikki
  14. 14. For this we need …. People knowing the meaning of ‘safe water’ and ‘good nutrition’ Information being available to people Better communication of ideas helps in changing people’s behaviour Children being the main messengers and change agents, and women acting on it
  15. 15. Impact of Safe water and Nutrition Intervention in Jhabua, MP May-2010 Dec-2012
  16. 16. Local institution for convergence – Fluorosis Mitigation Centre Health Service Diagnosis Counselling Periodic checkup Training Doctors / ASHA NGOs / PRIs Potters Fluorosis Mitigation Centre (FMC) Research Impact of mitigation Upscaling/Absorbment Communication Mass level Doctors Periodicals Teachers Technologies Locally made filters Nutrition enhancement
  17. 17. Learning from experiences on the field Combined approach of safe water and nutrition can help in prevention and cure of fluorosis– Convergence is needed Local context is needed based on local information on water sources and dietary habits - Customization of mitigation to local needs Children and women are most important for communication of fluorosis – Good communication in schools and women’s groups
  18. 18. II) Concerted India – wide action on Fluorosis as a network
  19. 19. Fluoride Knowledge and Action Network Formed for all of us to work together on Fluoride and Fluorosis in India Consists of subject experts, govt bodies, NGOs, academic and research bodies, institutions, philanthropic trusts, CSR, industry Formed in October 2013 with an initial meeting of members in New Delhi
  20. 20. The seeding institutions INREM Foundation: Secretariat for the network. Located in Anand, Gujarat. Works on policy research, field innovation and community engagement in the subject of natural resource management with focus on Water quality and health, Hydrology and river basin management, Water and Livelihoods and Policy& Governance issues. Apart from these institutions, several others have shown Arghyam: It is a public charitable trust located in Bengaluru. It strives to interest and support sustainable efforts that enhance equity in access to water for all. participated in The initial support for the Secretariat for this network has been provided by the Initiation Arghyam. meeting of the network The Fluoride Knowledge and action Network is conceived as an open platform on the Fluoride and Fluorosis issue in India. It is forseen as a highly inclusive network with emphasis on both credibility as well as outreach and connectedness with communities
  21. 21. What are the initial network activities? Enabling knowledge exchange Portal Social media Workshops Newsletter Advocacy Regional Initiatives Initiating state level groups Synthesizing state level white papers Experiences from national fluorosis programme Community water treatment experiences State of Sector report for Fluoride and Fluorosis in India Working with Fluorosis Task force of ICMR Apart from these, the network responds to specific opportunities from members and helps facilitate new initiatives
  22. 22. How the network can help us in Gujarat? Experts are available on : technology such as filters and rainwater harvesting, for nutrition and health Support is available on community based organizations on experience from field Policy efforts are ongoing within network to facilitate larger environment that helps good efforts like in Gujarat
  23. 23. III) Collaboration of NDDB with Fluoride Network
  24. 24. Collaboration of NDDB with Fluoride Network in Gujarat Till Now Initial discussions on Fluoride and Fluorosis in November 2013 Writing of a Gujarat Position Paper on Fluoride and Fluorosis by INREM in December Agreeing to work together in Saurashtra on problem of Fluoride and Fluorosis
  25. 25. Suggested objectives of this collaboration 1. Helping to change people’s thinking and bring about mass awareness on Fluorosis for people and cattle 2. Building the capacity of people’s institutions such as Panchayat, Women’s groups, Anganwadis, Schools, PHC/CHCs, to work on Fluorosis in both detection and mitigation 3. Participate in development of solutions and promotion of these to people through people’s institutions
  26. 26. Overall Strategy Strategy 1: Focus on one district such as Amreli and work for a year on all aspects of the problem Strategy 2: Work in as many places as opportunity arises, but focus mainly on building awareness and giving messages to people Some combination of these two strategies or mid-way can also be thought of
  27. 27. Self assessment and awareness of Fluoride and Fluorosis Developing communication for people to understand in local language about Fluorosis and other water quality problems Giving people ability to self assess basic symptoms Simple testing of water quality by people and sample tested at main referral lab Procedure for suspected Fluorosis cases to refer to PHC/CHC or veterinary authority
  28. 28. Demonstration effect of Filters and other water solutions People will learn new habits by demonstration Local institutions such as Milk cooperatives, Panchayat, Schools, Anganwadis, Women’s centres, PHC, CHC , can be centres where solutions are demonstrated Some examples are filters, rainwater harvesting,
  29. 29. Promotion of local nutrition self reliance through nutrition gardens Good nutritious food change is a slow process It requires ‘model’ farms where such nutritious food is grown Nutrition gardens are now being developed across India for specific needs eg. Vision related, bone related, … Fluorosis specific ‘Nutrition gardens’ can be promoted for Calcium, Vitamin C and related nutrient rich local foods
  30. 30. Cattle health during checkups for Water quality related problems Fluorosis in cattle is not well documented Regular cattle health checkups should include Fluorosis screening in Endemic areas Screening and referral process can be developed for cattle for Fluorosis
  31. 31. Steps ahead 1. Deciding focal areas and preferred entry point institutions and approaches 2. Capacity building of local institutions by Fluoride Network 3. Developing a time plan for action and implementing through local institutions
  32. 32. Summary Fluorosis in India is a serious problem requiring convergence of many actors Fluoride knowledge and Action network is willing to collaborate with NDDB and provide support in Gujarat Focussed Strategy needed for Saurashtra on building people’s awareness, referral systems for better detection and creating model solutions for demostration and replication

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