Thank to Dr.Dinda Formar CMOH Bankura

1. 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

3. 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

4. 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.

5. Programme Structure :
 Intimation to the coordinating department
 Collection of reports
 Preparation 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

6.  Training of Medical and non medical staff for the work-
out
 Arrange District Level Advocacy Meeting
 Supervision & monitoring the Block Level Advocacy
Meeting.
 Arrange the district level Monitoring & Review Meeting
 Supervision & monitoring the Block Level Monitoring &
Review Meeting
 IEC
 BCC (Sensitization of ASHA / AWW / PRI / Teacher /
Students etc.)
NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF
FLUOROSIS
BANKURA WEST BENGAL

7. HRD Survey Interventions
(Stage I) (Stage II) (Stage III)
PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE
DETECTION SURVEY IN THE FIELD

8.  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

9. 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 ppm
III > 5 ppm
PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE
DETECTION SURVEY IN THE FIELD

10. 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

11.  Screening Strategy :
Case detection in the field:
Dental Fluorosis
Chalky white teeth
Transverse yellow brown/dark brown bands
Pitting of dental enamel
PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE
DETECTION SURVEY IN THE FIELD

12. 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 leg
 Ugly gait and posture
PRESENTATION OF HOW TO PERFORM FLUROROSIS CASE
DETECTION SURVEY IN THE FIELD

13. Non Skeletal Fluorosis:
Constipation
Headache
Tingling sensation in feet & fingers
Nervousness & Depression
Sample Collection & Test
Water 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

14. 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

15. 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

16. NPPCF Scenario in West Bengal

17. 12.69
20.24
7.58
8.28
4.53
1.81 1.87
0
5
10
15
20
25
Bankura Birbhum Daxindinajpur Purulia Malda South 24 Pargana Uttar 24 Pargana
Fluoride (PPM)
Fluoride Level in Drinking Water in WB

18. 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
Surveyed
No. of GP
Surveyed
No. of Village/
Habitation
Surveyed
No. of
Primary
School
Surveyed
Total No.
of
Persons
Surveyed
No. of
Dental
Fluorosis
Found
No. of
Skeletal
Fluorosis
Found
Joint
Pain
&
Back
Pain
Found
No. of
Urine
Sample
Analysed
Clinically
Fund
Positive
% of
Clinically
Found
Positive
Cases
8 19 38 31 3087 2298 224 994 2050 1766 86.15

19. NPPCF Scenario of Bankura District

20. 12.69
10.8
10.45
5.12
4.9
4.62 4.55
4 3.9
4.41
3.4
3.03 3 2.67 2.51
2.16 1.98
0
2
4
6
8
10
12
14
Graphical representation of Maximum fluoride level of different Blocks of Bankura district
Fluoride (PPM)
Fluoride level of Different Blocks of Bankura District

21. Total Block
Affected
Village Affected Habitation Approx. people
affected
17 out of 22 Blocks 361 1005 More than 1 Lakhs
3087
2298
224
944
0
500
1000
1500
2000
2500
3000
3500
Total no. of
persons
screened
Dental fluorosis
found
Skeletal
fluorosis found
Non Skeletal
fluorosis found
Graphical representation of fluorosis patient out of total surveyed
Graphical representation of fluorosis
patient out of total surveyed
Over all Fluorosis Status in Bankura District

22. IEC & BCC Done by DH&FWS

23. IEC & BCC Done by DH&FWS

27. Dental Fluorosis in Bankura District

28. Skeletal fluorosis in Bankura

30. 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