During early 2002 Public Health engineering Department, Assam carried out State and District level sensitisation programme. Later it  has drawn up a Three Phased Programme in collaboration with UNICEF in Karbi Anglong and Nagaon districts to tackle the problem of fluoride. Fluorosis Research and Rural Foundation of India, Delhi provided the scientific and technical input to the programme and the services of the best experts available in the country were utilised.

Phase I

Human Resource Development which was completed in Nagaon district in September 2002 and in Karbi Anglong in October 2002.

Phase II

Survey

It comprises of

1. Water quality survey

2. School dental fluorosis survey

3. House to house health survey

The three surveys have been completed and analysis of the the results have been carried out.

Block wise Details of Water Quality Status

1. Water quality survey: In Nagaon district 8698 Nos. of water source were tested out of which 3352 Nos. were public sources and 5346 Nos. were private sources. In Karbi Anglong district, 5325 Nos. water source were tested which also included both public and private sources. It has been observed that 11.8% of sources in Nagaon district and 6.4% of sources in Karbi Anglong district have excess fluoride above 1 mg / l.

Block wise Details of School Dental Fluorosis

2. School dental fluorosis survey:  258 Nos. of school in Nagaon district and 236 Nos. in Karbi Anglong district were surveyed for dental fluorosis. The survey result reveals that 7.3% students in Nagaon district and 4.6% students in Karbi Anglong district have dental fluorosis.

Details of House to House Health Survey

3. House to house health survey: House to house health survey  was conducted in 4 blocks of Nagaon district and 8 blocks of Karbi Anglong district. Total 65,150 Nos. of family in Nagaon district and 19,745 Nos. in Karbi Anglong district were surveyed for the purpose of ascertaining the impact of fluorosis. The survey has revealed that 93.1% of the families consume safe water (<1mg / l) and more than 90% blocks have presence of fluoride in ground water within safe limit. It was noted that 1.2% of population had symptoms of dental fluorosis and majority of them belong to the age group 6-14 years (41.4%). Again, 0.3% percent of the population had Genuvalgum and the majority belong to the age group 19-49 years (39.5%). Genuvalgum has been found common among older people due to prolonged intake of fluoride contaminated water.

While enumerating the symptoms of skeletal fluorosis it has been found that 0.5% of the population can not touch the chest with chin, 0.7% can not bend forward, 0.8% can not sit up and 0.6% can touch the back of their head. A majority of these population belong to the age group 19-49 years, indicating that skeletal changes are common among middle aged group.

Among symptoms of non-skeletal fluorosis loss of appetite, gas in stomach, pain in stomach and constipation are the major manifestations and majority of the population showing these manifestations belong to the age group 19-49 years. Other features like diarrhoea, headache, polyurea, extreme weakness and still birth are common, but direct linkage between these features and consumption of fluoride contaminated water could not be ascertained.

A large proportion of population are regularly consuming black tea, supary (betel nuts) and tobacco (46.8, 38.2 & 20.0% respectively) and consumption of these items can lead to fluorosis if associated with simultaneous consumption of fluoride contaminated water.

It has also been noticed an increasing trend in the prevalence of the diseases (particularly dental fluorosis and genuvalgum or bowing of legs) among household members consuming fluoride contaminated water (> 1 mg / l).

Phase III

Designing the intervention based on survey data

This is to achieve through ensuring safe water and nutritional supplementation through dietary sources.