Background: Since 2009, the Ministry of Health of the People's Republic of China had organized 29 provinces to carry out the monitoring of endemic drinking water-born fluorosis. Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention was responsible for organizing work. This work was funded by the Chinese Ministry of Finance through the project of transfer payments. Objective: To accurately keep informed on the progress of the implementation, the quality of the prevention measures and the variation tendency of drinking water¬-born fluorosis in China. Methods: (1) The progress of defluoridation and water supplies projects was monitored in drinking water¬-born fluorosis areas. Each province established database using a village as a unit in all areas of endemic fluorosis. The information of each village was acquired by the investigation of Ministry of Water Resources.(2) The operating condition of water supplies projects and fluoride content in drinking water were monitored. In the whole country, 136 counties were defined as national monitoring counties according to stratified random sampling method. 10 projects were randomly selected from defluoridation and water supplies projects in each monitoring county. For each project, the size and the operating condition of the water supplies projects were evaluated. The fluoride content of tap water was determined and the criteria was based on the sanitary standard for drinking water (GB5749-2006). (3) Three villages were randomly selected as fixed monitoring stations in each monitoring county of fluorosis. The investigation of water supplies projects and the prevalence of dental fluorosis in each fixed monitoring station was conducted. Dental fluorosis was diagnosed by Deans fluorosis index. In the first year, the survey for X-ray diagnosis of adult skeletal fluorosis was also carried out and the diagnosis was based on the diagnostic criteria for endemic skeletal fluorosis (WS192-2008). Results: (1) By the end of 2010, there were 86,549 fluorosis villages in 28 provinces (lack the data of Chongqing ), involving 76.39 million people. Water supplies projects had been finished in 70,832 fluorosis villages. The provision rate of water was 81.9%. Water supplies projects had been conducted in 32,524 villages of moderate and severe diseased areas, and the provision rate of water was 88.3%. (2) In 2009, 1,393 water supplies projects were monitored, in which 1,303 projects were under normal operation, accounting for 93.54%. Fluoride content in water of 959 projects was qualified with a pass rate of 68.84%. In 2010, 1,381 water supplies projects were monitored, in which 1,287 projects were under normal operation, accounting for 93.19%. Fluoride content in water of 1,504 projects was qualified with a pass rate of 76.32%. In 2011, 1,408 water supplies projects were monitored, in which 1,334 projects were under normal operation, accounting for 94.74%. Fluoride content in water of 1,116 projects was qualified with a pass rate of 79.26%. (3) From 2009 to 2011, the detectable rates of children’s dental florosis (8-12 years old) were 32.43%, 26.97% and 24.98% respectively in the monitoring villages. In those villages, water supplies projects were under normal operation and fluoride content in water was qualified. But in the villages without water supplies projects, the detectable rates of children’s dental florosis were 38.43%, 46.08% and 45.51% respectively from 2009 to 2011. In 2009, 11,066 people in the villages with water supplies projects were examined by X-ray and the detectable rate of skeletal fluorosis was 16.28%. In the same year, 6,605 people in the villages without water supplies projects were also examined by X-ray and the detectable rate of skeletal fluorosis was 18.91% (The next monitoring of skeletal fluorosis will be carried out in 2014). Conclusion: The provision rate of water was 81.9% in drinking water¬-born fluorosis areas of China. The rate of the water supplies projects under normal operation was maintained between 93% to 95%. Fluoride content in drinking water was qualified with a increased pass rate year by year. The pass rate was increased from 68.84% to 79.26% in 2009 and 2011 respectively. After the provision of water, the detectable rate of children’s dental fluorosis decreased significantly, 40% before the provision of water and 25% after the provision of water. It wa suggested the implementation of safe drinking water projects in China rural areas effectively alleviated the hazards of drinking water-born fluorosis.

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