National Programme for Prevention and Control of Fluorosis

NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF FLUOROSIS

Fluorosis, a public health problem is caused by excess intake of fluoride through drinking water/food products/industrial pollutants over a long period. It results in major health disorders like dental fluorosis, skeletal fluorosis and non-skeletal fluorosis.

Problem: Dental Fluorosis affects children and discolours and disfigures the teeth. The teeth could be chalky white and may have white, yellow, brown or black spots or streaks on the enamel surface. Discoloration is away from the gums and bilaterally symmetrical. Skeletal Fluorosis affects the bones and major joints of the body like neck, back bone, shoulder, hip and knee joints with severe pain, rigidity or stiffness in joints. In severe forms results in marked disability. Non-Skeletal fluorosis is an earlier manifestation of fluorosis seen as gastro-intestinal complaints etc and may overlap with other diseases leading to misdiagnosis.

Prevalence: Fluoride prevalence was earlier reported in 230 districts of 19 States earlier. As per present data from Ministry of Drinking Water and Sanitation, there are 14,035 habitations (as on 1.4.2016) from 17 States which are yet to be provided with safe drinking water. The population at risk based on population in habitations with high fluoride in drinking water is 115.3 lakh.

Programme coverage: The Government of India started the National Programme for Prevention and Control of Fluorosis (NPPCF) as a new health initiative in the 11^th Five Year Plan (2008-09) with the aim to prevent and control Fluorosis in the country. 100 districts of 17 States were covered during 11^th Plan and additional 32 districts have been covered during the 12^th Five Year Plan. State wise list of districts under implementation of NPPCF is at

Annex-I.

Goal and Objectives:- The NPPCF aims to prevent and control Fluorosis cases in the country. The Objectives of the National Programme for Prevention & Control of Fluorosis are as follows:

Assess and use the baseline survey data of fluorosis of Ministry of Drinking water & Sanitation;
Comprehensive management of fluorosis in the selected areas;
Capacity building for prevention, diagnosis and management of fluorosis cases.

The strategy followed under the programme is surveillance of fluorosis in the community ; capacity building (Human Resource) in the form of training and manpower support ; establishment of diagnostic facilities in the district ; health education for prevention and control of fluorosis cases ; management of fluorosis cases including supplementation, surgery and

Activities :

Community Diagnosis of Fluorosis village/block/cluster wise.
Facility mapping from prevention, health promotion, diagnostic facilities, reconstructive surgery and medical rehabilitation point of view – village/block/district wise.
Gap analysis in facilities and organization of physical and financial support for bridging the gaps, as per strategies listed above.

(a) Diagnosis of individual cases and providing its management.

(b) Public health intervention on the basis of community diagnosis.

· Behaviour change by IEC.

· Training

Assistance provided to States:-

· Strengthening manpower in endemic district by providing for :

- Consultant

-Laboratory Technician

-Field Investigators (3) for six months

Achievements: -

132 districts of 19 States affected by Fluoride are covered under the Programme.
85 Districts have established Labs with ion Meter.
309 Health personnel i.e. State Nodal Officer, District Nodal Officer, District Consultant and Laboratory Technicians were trained at NIN, Hyderabad.
74 districts reported trainings for Medical Officers, Paramedical, ASHA/AWWs, teachers, VHSNC members.
Regional Review meeting of (Southern Region) cum capacity Building Workshop of State Programme Officers from five Fluorosis affected States for review of NPPCF was organized at Hyderabad in March, 2017 at Hyderabad.
A video documentary film on Fluorosis in 8 regional languages i.e. Assamese, Telugu, Gujarati, Kannada, Malayalam, Marathi, Oriya and Bengali is under progresS.

Annex 1

States/Districts under National Progrmme for Prevention and control of Fluorosis (NPPCF) -

S.No.	State	Total districts in the State	No. of districts NPPCF	Districts under NPPCF
1.	Andhra Pradesh	13	3	Nellore, Guntur, Prakasam
2	Telangana	9	3	Mehboobnagar, Nalgonda, Karimnagar
3.	Assam	26	4	Nagaon, Kamrup, Karbi Anglong, Dhubri
4.	Bihar	38	10	Nawada, Banka,.Aurangabad,Bhagalpur,Gaya, Jammui,Nalanda,Shekhpura, Kaimur .Munge
5.	Chattisgarh	27	4	Durg, Kanker, Kondagaon, Korba,
6.	Gujarat	33	4	Jamnaga, Sabarkantha, Vadodara, Banasklantha
7.	Haryana	21	2	Mehendragarh, Mewat
8.	Jammu & Kashmir	22	1	Doda
9	Jharkhand	24	13	Palamu,Garhwa,Chatra,Hazaribagh, Ranchi, Pakur, Sahebgann, Ramgarh, Jamtara, Simdega, Dhanbad, Giriih, Godda
10.	Karnataka	30	18	Ballary, Mysore, Chikballalpur, Koppal, Davangere, Tumkur,Bagalkote,Bangalore(U), Bijapur, Raichur, Chitradurga, Gadag, Gulbarga, Hassan, Kolar, Mandia, Ramanagara, Shimoga
11.	Kerala	14	2	Palakkad, Alapuzha
12	Madhya Pd.	51	15	Ujjain,Chindwada, Mandla, Dhar, Seoni, Betul Jhabua, Raigarh, Sehore, Alirajpur, Dindori, Khargoan, Raisen, Shajapur, Ratlam
13	Maharashtra	34	7	Nanded, Chandrapur, Latur, Washim, Yavatmal. Beed, Nagpur
14.	Rajasthan	33	28	Nagaur, Ajmer, Bhilwara, Churu (Ratangarh) Dausa, Dungarpur, Rajsamand, Tonk, Bikaner, Jalore, Jaisalmer, Jodhpur, Jaipur, Pali, Sikar, Udaipur, Swaimadhopur, Banswara, Karauli, Chittaurgarh, Ganganagar, Jhalawar, Jhunjhunu, Barmer, Alwar, Bharatpur, Kota, Sirohi
15.	Odisha	30	3	Nayagarh, Angul, Nuapada
16	Punjab	22	3	Sangrur, Firozepur, Patiala
17.	Tamil Nadu	31	1	Dharmapuri
18.	Uttar Pradesh	75	5	Unnao, Rae Bareli, Pratapgarh, Firozabad, Mathura
19.	West Bengal	18	6	Bankura, Purlia, Birbhum, D. Dinajpur, Maldha, Uttar Dinajpur
	TOTAL		132

Note: For further details, please visit NPCB website: www.npcb.nic.in

DIRECTORATE GENERAL OF HEALTH SERVICES

Health Programmes