INTRODUCTION
•Fluoride, is a mineral and naturally present in many foods and available as a dietary supplement.
•Fluorosis is caused by too much of fluoride consumption over a long period of time.
•Fluorosis is a public health problem and caused by excessive 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 to children and discolour and disfigures the teeth.
•Teeth could be chalky white and may have white, yellow, brown and black spots or streaks on enamel surface.
•Discolouration is away from gums.
•Skeletal fluorosis affects the bones and major joints of the body like neck, back bone, shoulder, hip and knee joints with severe pain.
•Rigidity and stiffness in joints. Non-skeletal fluorosis is an earlier manifestation of fluorosis seen as gastro-intestinal complaints
PROGRAMME COVERAGE
•NPPCF was a new health initiative during 11th five year plan, initiated in 2008-2009 and is being expanded.
GOALS AND OBJECTIVES
•NPPCF aims to prevent and control fluorosis cases in the country.
•Objectives are as follows-
1.To collect, assess and use the baseline survey data of fluorosis of ministry of drinking water. Capacity building for prevention, diagnosis and management of fluorosis cases.
STRATEGY
•At different levels of health care delivery system for early detection, management and rehabilitation of fluorosis cases, the strategy is made.
•Training- various types of training, advocacy and sensitization for various categories of health professionals/ personnel at different levels of health care facilities such as health workers, ASHA, anganwadi workers etc.
•Trainers for laboratory monitoring/ techniques (estimation f fluoride in urine).
•Survey will be conducted by district contractual staff.
•Establishment of diagnostic facilities in the district/medical hospitals for early detection and confirmation of fluorosis cases.
BENEFICIARIES AND ELIGIBILITY CRETERIA
•All people residing in areas with high fluoride content in drinking water in the districts covered so far under the programme.
MANAGEMENT OF FLUOROSIS CASES INCLUDING TREATMENT, SURGERY, REHABILITATION
•Early detection- people identified by physical changes.
•Laboratory tests (urine and water analysis).
•Radiological examination (x-ray).
•Prompt intervention- awareness of fluoride and fluorosis, medical management (supplementation of vitamin C and D, calcium, antioxidants etc.
EXPECTED OUTCOME
•No. of fluorosis cases managed and rehabilitated.
•Capacity for laboratory testing for fluoride in water, urine to be developed.
SURVEY OF FLUOROSIS IN A COMMUNITY
•Under the NPPCF, the district laboratory is established for confirmation of fluorosis cases, the district cell under district nodel officer is created, staffed with consulted, lab technician and field officer and funds are provided.
CASE DEFINITION
1. Dental fluorosis- any case with a history of residing in an endemic area along with one or both of the followings-
•Chalky white teeth/white spots on the enamel surface.
•Transverse yellow/brown/black bands or spots on the enamel surface.
•Discoloration is away from the gums.
2. Skeletal fluorosis-
any case with a history of residing in an area of high fluoride.
•Severe pain and stiffness in neck, backbone.
•Knock knees.
•Inability to squat.
3. Non-skeletal fluorosis- any case with a history of residing in an endemic area along with one or both of the followings-
•Gastrointestinal complaints- abdominal pain, diarrhoea, constipation, nausea, bloated feeling, loss of appetite.
•Neurological manifestation- nervousness, depression, tingling sensation in fingers and toes excessive thirst, urinate frequently etc.
•Muscular manifestation- muscle weakness and stiffness, pain in the muscle and loss of muscle power, unable to work or walk.
•Peele daant, haddi jam, ye hai pani me fluoride ka kaam.
•Doodh dahi, hari sabzi khao, fluorosis se mukti pao.
•Pene ke paani me fluoride hai Jahan, fluorosis hai vaha.
•Peene ke pani ki jaanch karo, apne aapko fluorosis se bachao.
DIET COUNSELLING
•Diet counselling is very important aspect in prevention.
•Besides bringing in change towars drinking of safe water it is also important that food with high fluoride levels are avoided.
| DO NOT EAT | RECOMMENDED FOODS |
| Black tea (with or without lemon) | Balanced diet |
| Black rock salt | Calcium rich foods- yogurt, milk, eggs, paneer, seeds etc |
| Samosa, chole bhature, golgappe, bhelpuri etc. | Iron rich foods |
| Jaljeera, nimbupani etc | Vitamin C rich foods |
| Achar with black rock salt | Antioxidants |
| Readymade masala | Magnesium rich foods- nuts, cereals, GLVs, etc |
| Hajmola, churan, imli and other digestive tablets | Zinc rich foods- pulses, mushrooms, pumpkins |
REFERENCES
•NPPCF revised guidelines 2014, by directorate general of health services, ministry of health and family welfare, Government of India.
