fluoride network nddb fluorosis saurashtra action sk ppt jan 1 2014
TRANSCRIPT
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Action on Fluorosis in Saurashtra, Gujarat
INREM Foundation
Fluoride Knowledge and Action Network
Presentation in NDDB,
January 2
2014
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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
Parts of presentation
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I) Fluorosis situation in ground: previous action and learning
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Millions suffering in India
Juvenile crippling is increasing
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The real Fluoride picture is much more widespread than this
Source: CGWB, 1999
10 states are highly affected and 24 states report cases
Estimated 65 million are exposed to high fluoride in drinking water
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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
Factors causing Fluorosis
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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
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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
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Testing of drinking water
Steps in Detection
Testing of food – nutrition & fluoride
Dental & skeletal fluorosis surveys
Blood and urinary fluoride testing
X-rays of fore-arm & affected limbs
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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
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Domestic water filtration
Community water filtration
Rain water harvestingProtecting safe water sources
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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
We can use the following Nutrition programme for Fluorosis:
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
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Amla tabletsCalcium, Magnesium supplements
Dried AmlaTil Chikki
Nutrition enhancement
Green leaves
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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
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May-2010 Dec-2012
Impact of Safe water and Nutrition Intervention in Jhabua, MP
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Fluorosis
Mitigation
Centre (FMC)
Training
Doctors / ASHA
NGOs / PRIs
Potters
Research
Impact of mitigation
Upscaling/Absorbment
Health Service
Diagnosis
Counselling
Periodic checkup
Technologies
Locally made filters
Nutrition enhancement
Communication
Mass level
Doctors
Periodicals
Teachers
Local institution for convergence – Fluorosis Mitigation Centre
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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
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II) Concerted India – wide action on Fluorosis as a network
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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
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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.
Arghyam: It is a public charitable trust located in Bengaluru. It strives to
support sustainable efforts that enhance equity in access to water for all. The initial support for the Secretariat for this network has been provided by Arghyam.
Apart from these institutions, several others have shown interest and participated in the Initiation 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
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What are the initial network activities?
Enabling knowledge exchange
Regional Initiatives
Advocacy
PortalSocial mediaWorkshopsNewsletter Initiating state level
groupsSynthesizing state level white papers
Experiences from national fluorosis programmeCommunity water treatment experiencesState of Sector report for Fluoride and Fluorosis in IndiaWorking with Fluorosis Task force of ICMR
Apart from these, the network responds to specific opportunities from members and helps facilitate new initiatives
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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
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III) Collaboration of NDDB with Fluoride Network
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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
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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
Suggested objectives of this collaboration
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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
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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
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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,
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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
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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
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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
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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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