Project Report

of

Capacity Building of SHG

Members for Improving Health
Status.
A project Report of Jhund village of Sanganer Block,
Jaipur District

Written by:
Namrata Nayak
under
Diploma in Nutrition and Health Education (DNHE)
IGNOU- Jaipur

PREFACE AND ACKNOWLEDGMENT

Within the scope of employment in the Students Relief Society (SRS) I had the chance to
conduct this project of IGNOU DNHE Programme with women Self help Groups of Jhund
Village of Sanganer Block. This project report should provide valuable insights in the impact
of the conducted project and in the health status of the rural women, not only for my project
work but for everybody whos interested in it too.
I would like to thank the entire staff of SRS, especially Rajendra Kumar Sharma for his effort
and support on our fieldtrips, Priyanka Bharsham (SHG Programme Coordinator) for her initial
guidance and Mr. P.N. Sharma (Director) for providing the resources to accomplish the study.
Further special thanks to Shoba Gupta, Kailash Gurjar, and Kishan Kumar for their effort to
organize the meetings and their assistance. Finally I want to thank the interviewed villagers and
SHG-members of Jhund, for their participation and sincerity toward the project.
The cases were a rich experience and without the generous contribution of the above
mentioned individuals this report could not have been prepared. The Project is based on theme5 Using Case Studies of as per practical Course DNHE 04. I have tried to limit the project in
the above cited theme; however tools of other themes were also used such as IEC and message
media, Participatory Approaches as per the requirement and need of time.
Jaipur, 16th of May, 2016,

Index
S.#

Title

Page No.

4-6
4
5
6
6
7-18
7
7
7-8
8-9
10-11
12

Introduction
1.1 Background
1.2 Profile of Project Area
1.3 Targeted Community
Objective
Methodology
3.1Identification Of Area
3.2Identification Of Problem
3.3 Identification Of Suspects Fluoride problem
3.4 Meeting with Suspects
3.5 Designing Of Questionnaire
3.6 Collecting Information about their current
Sanitation practices, dietary intakes and health
Problems.
3.7 Awareness building water, Health and
sanitation through IEC material
3.8 Educating the group on their daily dietary to
prevent fluorosis
3.9 Data collection after diet editing
Description of studies
4.1 Before the diet Editing
4.2 After the diet Editing
Analysis

6
7

5.1Before the diet Editing

5.2After the diet Editing
Conclusion
Annexure (Forms)

22
22
23-24
24

2
3

12-16
17-18
18
19-21
19
20-21
22

1 Introduction
1.1 Background
With the rapid growth of population and economy, the gap between water demand and
supply has been widening. Despite India has met the drinking water target for its
Millennium Development Goal (MDG 7c) commitment, it has not been able to ensure
access, adequacy, quality and equitable distribution [1]. The 69th report of National
Sample Survey Organization (December 2013) shows that 88.5 percent of rural
households and 95.3 percent of urban households in India having improved drinking
water sources. In drinking water facility, only 791 per 1,000 households in rural
Rajasthan have access to improved sources of drinking water while just 747 households
receive sufficient drinking water throughout the year. In urban areas, 928 households
per thousand have access to drinking water from improved sources but only 814 get it
throughout the year. Improved source of drinking water means pipe water reaching the
house or sourced from a protected well and/or spring. Among other information on
drinking water, it emerged that in parts of rural Rajasthan, only 39% households have
drinking water facilities within their premises. Nearly 32% families travel half-akilometer daily to fetch drinking water.
In Rajasthan the level of Ground water is continuously falling. Unplanned water
extraction has created an imbalance. Consequently, the area comes in water scarcity
zone. Drinking water is not adequately available. The higher content of fluoride in
available drinking water is causing disabilities of fluorosis.
Fluorosis, a public health problem is caused by excess intake of fluoride through
drinking water/food products over a long period. It results in major health disorders like
dental fluorosis, skeletal fluorosis and non-skeletal fluorosis. The late stages of skeletal
and dental fluorosis effects being permanent and irreversible in nature are detrimental
to the health of an individual and the community, which in turn has adverse effects on
growth, development & economy of the country.
The desirable limit of fluoride as per Bureau of Indian Standards (BIS) is 1ppm (1 mg
per liter). Fluoride may be kept as low as possible as high fluoride is injurious to health.
High levels of Fluoride were reported in Sanganer block of Jaipur District of Rajasthan.
The population at risk as per population in habitations with high fluoride is 6,663,971
(data from 2011 census). It affects men, women and children of all age groups.

1.2

Profile of Project Area:

Jhund Village is rural area in Sanganer block of the Jaipur district in Rajasthan.
Geographically, the region is semi arid, agriculture depends on rainwater and water is in
shortage. Ground water level is falling continuously. Unplanned water extraction has
created an imbalance. Consequently, the area comes in water scarcity zone. Since
employment opportunities are limited as people are mainly dependent on agriculture that is
being worst hit by drought, they are forced to migrate to adjoining towns and cities.
Women and children are silent victims of the whole situation. Illiteracy and ignorance
coupled with social malpractices (a few traditions) worsen their life style (SRS, Voluntary
organisation in the block Sanganer). Drinking water is not adequately available. The higher
content of fluoride in available drinking water is causing disabilities. The absence of rains
for four consecutive years has created severe drought conditions and has affected
agriculture, employment, fodder, fire and fuel wood as well. . Most of the population
depends on Agriculture and are poor, therefore not able to get proper education. As per the
record, in 1996 female literacy rate of Sanganer block was only 12.54%. From the point of
health and education villages of sanganer block are backward.

1.3

Targeted Community:

The children and women of 20-40years age groups are the main victims of fluoride
poisoning.
In the project I have focused on group of 10 women with the age group of 20-40 years.
The aimed to sensitization these women for improving the health status of family.
Reduction in the harms of fluoride born diseases through diet editing and awareness
generation amongst these women for healthy life.

2 Objectives

Promotion of good health hygiene practices

Sensitisation on water born disease and their treatment.
Capacity building of Self Help Group (SHG) members on health related issues.
Fluoride in caries prevention
6

3 Methodology
3.1 Identification of Area
3.2 Identification of problem
3.3 Identification of suspects fluoride problem.
3.4 Meeting with suspects.
3.5 Designing of Questionnaire
3.6 Collecting information about their current health & Sanitation practices
3.7 Awareness building water, Health & Sanitation through Some IEC Material.
3.8 Educating the group on their daily dietary to prevent fluorosis.
3.9 Data Collection after diet editing
3.1 Project area:
Jhund Village, Sanganer Block, Jaipur District Rajasthan (India)
3.2 Identification of problem
As per the study of field with SRS team, it came out that each single person of Jhund
village is suffering from joint pain and 70 of villages have dental fluorosis. Not just
human, animal are also being affected from excessive fluoride in their body.
Fluoride
There are two type of fluoride: Calcium fluoride and Sodium fluoride. When taken in
excess, both types can be harmful to health. It is found naturally in underground waters
sources. In sufficient concentrations, it can actually weaken bones and teeth rather than
protecting them, however it is less toxic and damaging to health when it is counterpart.
Fluoride Effect
Fluoride been found to weaken the immune system and can damage the kidneys and liver.
Symptoms fluoride toxicity are similar to fibromyalgia, including fatigue, muscle pain,
memory loss and insomnia. It can also cause nausea, diarrhea, sickness, adnominal pain
and increased thirst.
Fluoride acts as a Trojan horse, carrying aluminum across the blood brain barrier where it
can be responsible for lower IQ and Alzheimers disease. Once in the brain, fluoride can
calcify the pineal gland which is responsible for the natural production of melatonin.
Without sufficient melatonin, the body is deprived of sound sleep and the thyroid will not
function correctly.
Even in areas where fluoride is not been a content of water, it may still be part of your daily
diet. Fluoride is used as a pesticide and fumigant and is sprayed onto food crops. It is a
component of home insecticides and is even added to bottled water, toothpaste and baby
foods. Crops watered by fluoride-laden water are even more heavily contaminated.
3.3 Identification of suspects fluoride problem-

Students Relief Society is a non-profit, non government, non-political, volunteer

organisation, working from last 38 years in Rajasthan for the deprived community. SRS
is working with 160 self help groups (SHGs) in 36 Villages of Sanganer block for
various income generation activities on individual level. A self help group is a group of
7

about 12-20 persons from a homogenous background who come together for addressing
the common problems. Each group meet once in a month to discuss group progress and
field team of S.R. society organise the meetings under its SHG Programme. In Jhund
Village there are SRS is working with 10 SHGs in Jhund village which includes 1138
women.
S.#
1.
2.
3.
4
5
6
7.
8.
9.
10.
Total

Name of Group
Saraswati
Ganga
Ramsagar
Radha
Pura Baba
S R Bagda
Jagruk
Kishori
Nirala
Durga

No. of women
10
19
17
11
12
17
11
08
19
14
138

Date of Formation
05.05.2001
07.08.2002
07.08.2003
17.07.2007
08.01.2008
08.01.2008
08.11.2008
08.02.2010

3.4 Meeting with suspects.

A meeting was organised, with Saraswati Group of Jhund Village on 20.10.2015
Saraswati is the oldest group of Jhund Village and consist of 10 women. Saraswati was
identified to conduct the studies under the project work.

(From left to Right- Mr. Rajendra Kumar Sharma (Field Coordinator), Mr. Prem
Narayan Sharma (Director), Mrs. Priyanka Bharsham (SHG Programme Coordinator),
Namrata Nayak (DNHE Student), Mrs. Shobha Sharma, Community Organiser)

(From left to Right- Mr. Rajendra Kumar Sharma (Field Coordinator), Namrata Nayak
(DNHE Student), Mrs. Shobha Sharma, Community Organiser, SHG Women of
Saraswati Group)
The main problem in the jhund village are as below:

1. Dental Fluorosis ( in children ):

Chalky white teeth / white spots on the white enamel surface
Transverse yellow, brown / black bands or spots on the enamel surface
2. Skeletal Fluorosis
Severe pain and stiffness in neck, back bone (lumbar region), shoulder, knee and hip
region. Pain may commence either in 1 or 2 or more joints. Patient has restricted
mobility of cervical and /or lumbar spine and has to turn the whole body towards that
side to see Knock knee/ Bow leg (In children, adolescents )
Inability to squat ( advanced stage of Skeletal Fluorosis )
Ugly gait and posture ( advanced stage of Skeletal Fluorosis )
3. Non-Skeletal Fluorosis
Any case with a history of residing in an endemic area along with one or more of the
following health complaints.
Gastro-intestinal
problems:
Consistent
abdominal
pain,
intermittent
diarrhea/Constipation, bloated feeling, nausea, loss of appetite.

3.5 Designing of Questionnaire

A questionnaire was designed in the same meeting with the help of Coordinator of S.R.
society and with the consent of SHG members to collect the adequate and relevant
information of current status of Saraswati group members.
Part-1 Before diet Editing
Name

: ______________________________________________

Age

: ______________________________________________

Qualification

: ______________________________________________

Occupation

: _____________________________________________

Marital Status

: _____________________________________________

If married, No. of
Children with
their age

Address

: ______________________________________________

Annual Income

: ______________________________________________

Major Health
Problem

Main food f Daily Diet (Please mentioned, if had any of below as well )
Tea Leaves, Pickles, Spinach, Grape Juice, Black rock Salt, Source of Water, White,
fruit, rice, green vegetable

____________________________________________
_____________________________________________
______________________________________________
______________________________________________
______________________________________________
Any other
information

______________________________________________
______________________________________________

10

Paste photo
here

Part 2 After Diet Editing

Major Health
Problem

Main food f Daily Diet (Please mentioned, if had any of below as well )

____________________________________________
_____________________________________________
______________________________________________
______________________________________________
______________________________________________
Any other
information

______________________________________________
______________________________________________

11

3.6 Collecting information about their current Sanitation practices, dietary intakes
and health Problems.

As above cited the designed questionnaires were distributed to SHG members and
collected the information.
Frequency of Below Mentioned Details
Daily-1
Alternet days 2
Once in a Week-3
Once in Week-4
Some Time-6
S.# Name of SHG Member Joint pain Abdominal Diarrhea Constipation Headache
Pain
1. Smt. Rekha Devi
(1)
(2)
(6)
(2)
(1)
2. Smt. Nathi Devi
(1)
(4)
(2)
(6)
(6)
3. Smt. Beena Devi
(1)
(2)
(6)
(2)
(6)
4. Smt. Geeta Devi
(1)
(2)
(6)
(2)
(3)
5. Smt. Phoolbati Devi
(1)
(4)
(6)
(3)
(3)
6. Smt. Chandra kanta Devi
(1)
(4)
(6)
(3)
(3)
7. Smt. Kiran Devi
(1)
(2)
(2)
(6)
(3)
8. Smt. Sunita Devi
(1)
(4)
(6)
(3)
(3)
9. Smt. Supyar Devi
(1)
(4)
(6)
(3)
(4)
10. Smt. Sampati Devi
(1)
(4)
(6)
(3)
(3)
The above mentioned information is summarized on the basis of information
collected in forms.
Page 1 of Forms, attached as Annexure A.
3.7 Awareness building water, Health & Sanitation through Some IEC Material
In the next meeting Some IEC Material were distributed, amongst the SHG members to
sensitized on fluorosis. Also this activity was conducted to know the status weather the
groups are suffering from fluorosis or not, as the project aims to reduce the excessive
fluoride content from human body through diet editing, so that the health staus can be
improved.

12

13

14

15

16

3.8 Educating the group on their daily dietary to prevent fluorosis.

SHG members were educated on some steps towards curbing their fluoride intake.

Namrata Nayak, IGNOU Student- DNHE, Educating SHG Women on Diet

Management
Drinking Purified water-Drinking purified water is recommended.
Installing a Water purifier or fluoride filtering system to home.
Reduce Your Black & Green Tea Consumption (and/or Drink Tea with Younger
Leaves)
Avoid Cooking with Non-Stick (Teflon) Pans
Minimize Consumption of Chicken
Avoid Fluoridated Salt
Exercise is good, allowing the body to eliminate all types of toxins, including fluoride,
from the body in sweat. Ive put together a workout plan that I personally use (Burst
Training Plan)
Tamarind is commonly used in Ayurvedic medicine. The pulp, bark and leaves are used
to make teas, which have been shown to eliminate fluoride through urine.
Magnesium is a useful supplement as it inhibits the absorption of fluoride into the cells.
Boron is known to be an effective way to detox fluoride. It can be added to pure water
in small amounts of around 1/32 to teaspoon per liter. (Many plant-based foods offer
decent to wonderful amounts of boron. Some of the best include: chickpeas, almonds,
beans, vegetables, bananas, walnuts, broccoli, prunes, oranges, red grapes,
apples, raisins, pears, and many other beans and legumes)
Organic Strawberries,Raw, Organic Cheese,
Organic Potatoes. Boiled Eggs, banana
17

Recommended Foods

DO NOT EAT

(proteins, carbohydrates, essential,

micronutrients and antioxidants to eat on a daily

Black tea (with or without lemon)

Black rock salt in
salad/raita/fruits/baked or steamed corn

basis) Balanced Diet

Calcium: Milk, Yogurt (Dahi), Paneer, ,

Green leafy vegetables ( specially
amaranth, fenugreek and drumstick
leaves) til seeds, ragi etc.

Black rock salt containing food and

snacks e.g Samosa
Chole Bhature
Golgappe/ Pani Poori
Bhel poori/ Papdi Chat
Namkins/ Bhujia/ Dalmoth
Jaljeera/ Nimboo pani added with
black rock salt
Achar with black rock salt
Readymade masala packet with black
salt e.g. /Garam masala/chat masala/
Rajma Masala/ Chole Masala, Pav
Bhaji Masala etc.
Hajmola/ Churan/Imli and other
digestive tablets laced with black rock
salt
Canned Fruit Juices/ Fruit juice with
masala salt/ preserved food items

Iron:, All Green leafy vegetables, cereals

and millets especially bajra and ragi,
pulses
Vitamin C: Amla, Lemon, Guava, orange,
.

lime, grapes, Tomato, Pineapple etc.

Sprouted dals.
Other Antioxidants present in: All Fruits
+ Vegetables
Magnesium: Nuts, cereals, pulses , green
leafy vegetables , Lotus stem, mango etc.
Zinc: Pulses, Legumes, mushrooms,
pumpkin etc.

Chips/Kurkure and other salty packaged

snacks (Packet would reveal the
ingredients)

3.9 Data collection after Diet editing

Same forms were distributed to the women and asked them to fill their 7 days diet on the
forms and changes they felt, asked to continue the same diet for at-least six month
Page 2 of forms attached in Annexure A

18

4 Descriptions of Case Studies

Fluoride containing food, snacks and beverages has become very popular among the masses. As
per the study use of black rock slat containing spices are used in regular at home (rich and Poor)
to cook vegetables and dal. It is used to sprinkle over curd, pickle and all street food- viz. Bhel
Puri, pani puri, chat, fruit juices and even cut fruits on road side smear black rock salt. The
community does not know that excessive fluoride is poison.

4.1 Before the Diet Editing

After 7 days collected the form from SHG members of Saraswati group, as per the study of data
most of women consume Pickles, Spinach, Tea Leaves, Carrots, Oats, Chicken barley, wheat,
bajra, moth and some vegetables, most of the women is using ground water which has high
content of fluoride in it.
S.# Name of SHG White and Chalky
Brown Joints Abdomin Diarrhea Constipati Headac
Member
yellow spot
white
and black pain al pain
on
he
on teeth appearance Spots
of teeth

1. Smt. Rekha

2.
3.
4.
5.

6.
7.
8.
9.
10.

Devi
Smt. Nathi
Devi
Smt. Beena
Devi
Smt. Geeta
Devi
Smt.
Phoolbati
Devi
Smt. Chandra
kanta Devi
Smt. Kiran
Devi
Smt. Sunita
Devi
Smt. Supyar
Devi
Smt. Sampati
Devi
Total

10

19

10

10

10

10

4.2 After the diet Editing

S.# Name of SHG White and Chalky
Brown Joints Abdomin Diarrhea Constipati Headac
Member
yellow spot
white
and black pain al pain
on
he
on teeth appearance Spots
of teeth

1.
2.
3.
4.
5.

6.
7.
8.
9.
10.

Smt. Rekha
Devi
Smt. Nathi
Devi
Smt. Beena
Devi
Smt. Geeta
Devi
Smt.
Phoolbati
Devi
Smt. Chandra
kanta Devi
Smt. Kiran
Devi
Smt. Sunita
Devi
Smt. Supyar
Devi
Smt. Sampati
Devi
Total

04

02

02

08

03

01

01

03

As per above mentioned data received after diet editing 01 woman out of 10 got
complete relief from Dental fluorosis. Rest of the women still has sign of Dental
Fluorosis but difference in the visibility of stains or spots can be seen easily.

20

Frequency of Below mentioned details

Daily-1
Alternet days 2
Once in a Week-3
Once in Week-4
Some Time-6
S.#

Name of SHG
Member

Joints pain

1.

Smt. Rekha Devi

(6)

2.

Smt. Nathi Devi

(6)

3.

Smt. Beena Devi

(6)

4.

Smt. Geeta Devi

Abdominal
pain

Diarrhea

Smt. Phoolbati Devi (6)

6.

(6)

7.

Smt. Chandra kanta

Devi
Smt. Kiran Devi

8.

Smt. Sunita Devi

(6)

9.

Smt. Supyar Devi

(6)

10.

Smt. Sampati Devi

(6)

Headache
(3)

(4)

5.

Constipation

(6)

(4)
(3)

(6)
(6)
(6)

After the diet editing no. of women effected from particular disease was decreased.
02 women out of 10 completely got relief from Joints pain.
06women out of 10 completely got relief from abdominal pain.
09women out of 10 completely got relief from Diarrhea.
09women out of 10 completely got relief from Constipation.
07women out of 10 completely got relief from Headache.

21

5 Analysis
5.1 Before diet editing
S.#

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Name of SHG Member

Age

Smt. Rekha Devi

Smt. Nathi Devi
Smt. Beena Devi
Smt. Geeta Devi
Smt. Phoolbati Devi
Smt. Chandra kanta Devi
Smt. Kiran Devi
Smt. Sunita Devi
Smt. Supyar Devi
Smt. Sampati Devi

38 Years
40 Years
30 Years
29 Years
25 Years
36 Years
34 Years
35 Years
36 Years
26 Years

No. of Women effected

Dental
Skeletal

10

Skeletal
Fluorosis

10

NonSkeletal

10

As per the result almost 100% of above mentioned SHG members of Saraswati
group, are facing fluorosis problem after the diet editing and recommendations it
falls down.
5.2After Diet Editing
S.# Name of SHG Member

1.
Smt. Rekha Devi
2.
Smt. Nathi Devi
3.
Smt. Beena Devi
4.
Smt. Geeta Devi
5.
Smt. Phoolbati Devi
6. Smt. Chandra kanta Devi
7.
Smt. Kiran Devi
8.
Smt. Sunita Devi
9.
Smt. Supyar Devi
10.
Smt. Sampati Devi

Age
38 Years
40 Years
30 Years
29 Years
25 Years
36 Years
34 Years
35 Years
36 Years
26 Years

No. of Women effected

Dental
Skeletal

09

As per above mentioned data received after the diet editing

60% women got relief from Non-Skeletal Fluorosis.
20% women got relief from Skeletal Fluorosis.
10% women got relief from Dental- Fluorosis
22

Skeletal
Fluorosis

NonSkeletal

08

04

6 Conclusions
In Rajasthan, where there is water scarcity in general, it is an abnormal task to tell people
to take low fluoride water. People are used to consuming water from a variety of sources
like open ponds, bore wells and hand pumps. Due to low literacy level, most people are not
even aware of the reason for fluorosis and ground water quality issues.
The project was conducted to know the health conditions of rural women exacerbated due
to excessive fluoride in their body, what other fluoride source effecting them and
mobilization of these women to adopt recommended dietary to detox fluoride from their
body.
To meet the project objectives various activities were conducted with Saraswati SHG such
as study of ten women, awareness generation and dietary management etc. Over all
education on water Health & Sanitation to the women of Jhund Village for the prevention
and control of fluoride born disease was elaborated.
A study says each individual woman of jhund block is facing health problem, due to
excessive fluoride in their body. Out of which 10 women are sensitised for improving their
health.
.
Awareness generation and diet editing is mandatory to address the fluorosis issues. The
concept thar fluorosis is caused by drinking water fluoride content is true, but it only one of
the five main routes of fluoride entry to body. Many food sources are rich in fluoride such
as Tea Leaves: Tea can be introduced in the diet of children of a certain age group, and it
acts as a good source of fluorine. Pickles: Fluorine rich pickled cucumber can be added to
sandwiched, burgers, and salads. Grape Juice fluorine content is especially high in canned
juice, shall be avoided in the kids diet. Spinach: It Is also observed Green Leafy
vegetables like spinach absorb the soil fluorine and act as good sources of the mineral.
Tomato Products- Tomato products like salted sauces are easily incorporatable fluorine
sources. Carrots cooked with or without salt are sources of fluoride. Purification of
drinking Water is must to prevent this problem. Installing a water purification or fluoride
filtering system at home.
On other hand many food source such as Milk, Yoghurt (Dahi), Paneer, Green leafy
vegetables (Specially Amarnath, Fenugreek and Drumstick leaves), Til seeds, ragi etc. are
good source of food to mitigate fluorosis. Vitamin C: Amla, Lemon, Guava, Orange,
Lime, grapes, Tomato, Pineapple etc. Magnesium: Nuts, Cereals, Pulses, green leafy
vegetables, Lotus stem, Mango and etc. Zinc: Pulses, Legumes, Mushrooms, pumpkin etc.
Other antioxidants present in: all fruits+ vegetables.
23

The main motive behind this study to know the health status of rural women and effect of
fluoride on the same. IEC work was executed to sensitise the SHG women about fluoride
water born disease. Meeting and discussions were conducted to mobilize the SHG
members, as behavioral change is must for the recommended diet.

After the successfully implementation of project number of fluorosis affected cases studied
and managed by the project.

60% women got relief from Non-Skeletal Fluorosis.

20% women got relief from Skeletal Fluorosis.
10% women got relief from Dental- Fluorosis.
For the complete prevention of Skeletal Fluorosis, suspect shall continue
recommended dietary.
Over all 55% fluorosis was prevented from the target group of 10 women.
It was also observed that if a woman is educated about the dietary management of
fluorosis, she can improve the health status of entire family.
Quality of health has been changed and improved.

7 Annexure
Forms filled both side are attached Annexure A

24