FLUORIDE & FLUOROSIS WITH ITS AFFECT ON

HEALTH Consultant NPPCF Bankura

DISTRICT : BANKURATraining of Medical Officers on Fluorosis Mitigation

Programme

WHAT IS FLUORIDE Fluorine is the an element (F-)    In nature it is not available as fluorine ,it is an strong oxidizing agent and 

always found in compound form with other element.  Inorganic fluorine containing compounds are called fluorides. Inorganic chemicals : Cryolite (Na3AlF6)                                                Sulfuryl fluoride (SO2F2)                                               Sulfur hexafluoride Organic chemicals : Organofluorine  polytetrafluorethylene(Teflon)                                          polychlorotrifluoroethylene (moisture barriers),                                          Efavirenz (pharmaceutical used for treatment of HIV)

        fluoxetine (an  antidepressant) 5-fluorouracil(an  anticancer  drug), hydrochlorofluorocarbons  and  hydrofluorcarbons  (refrigerants,  blowing  agents and propellants).

Fluoride is usually found naturally in low concentration in drinking water and In foods

WHAT IS FLUOROSIS Fluorosis is a slow, progressive and crippling malady affecting 

most of the organs in the body where fluoride in drinking water is > 1.5 ppm (WHO)

BIS=1.0 ppm (We follow BIS) Fluorosis is a crippling Disease Slow –Progressive -Cripple Affect all age. Health Complain-Overlapping many diseaseImpact depends on

a. Ageb. Hormonal Statusc. Nutritional Statusd. Efficiency of Kidney

Fluorosis is three types: 1) Dental Fluorosis 2) Skeletal Fluorosis

3) Non Skeletal Fluorosis

MAGNITUDE OF THE PROBLEMScenario of West Bengal

TOTAL AFFECTED BLOCKS : 17

MAGNITUDE OF THE PROBLEMDistrict Scenario

Minimum village Affected

Medium village Affected

Maximum village Affected

PREVALANCE IN BANKURAMost affected groups are: Age Group between 4-11 and > 40 aged people. Dental Fluorosis Present in Age group 4-11Dental and Skeletal Fluorosis Present in age group  >40

In children mainly Dental Fluorosis are present (5-8 yrs)

Headache, cconstipation,   vague body pains, backache,  joint rigidity & general weakness. 

These were followed by multiple  joint pains, mostly  in the feet, knees, and back.

Difficulty in walking Limitation of joint movement.  Inability to close the fist Spinal stiffness and kyphosis developed in a few patients.  Flexion of spine Neurological complication

Clinical symptoms Clinical Symptoms

WORLD SCENARIO OF FLUOROSIS STATUS

• Affected Countries : 25 countries in the worldWorld

• No of affected District 204 (21 States /UT)

• people affected, 62 million ( 6 million children)India

• 45 Blocks in 7 Districts• Total People affected: 2.20

Lakhs

West Bengal

SCENARIO OF BANKURA DISTRICTFluoride contaminated Blocks of Bankura District & Its maximum fluoride concentration:

Name of the Blocks Fluoride (PPM)

Simlapal 12.69

Hirbandh 10.80

Taldangra 10.45

Khatra 5.12

Bankura-II 4.90

Bankura-I 4.62

Raipur 4.55

Chhatna 4.00

Mejia 3.90

Indpur 4.41

Sonamukhi 3.40

Onda 3.03

Saltora 3.00

G.Ghati 2.67

Barjora 2.51

Ranibandh 2.16

Sarenga 1.98

Affected 17 Blocks out of 22 Blocks of Bankura District

FLUOROSIS: IMPACT ON HEALTH

Types of Fluorosis

Dental Skeletal Non skeletal

Affection starts mostly when fluoride level is 3to 8 Mg/Lit in drinking water

Dental fluorosis Normal:The enamel surface is smooth, glossy and usually a pale creamy white in color.

Mild: The white opacity of the enamel of the teeth is more extensive, but covers less than 50% of the tooth surface .

Moderate:The enamel surface of the teeth shows marked wear and tear with brown stain and is frequently a disfiguring feature .

Severe: The enamel surface is badly affected and hypoplasia is so marked that the general form of the tooth may be affected. There are pitted/worn out areas and widespread brownish discoloration with the teeth often having a corroded appearance.

Genu valgum (KNOCK KNEES) Legs are bowed inwards in the standing position. The bowing usually occurs at or around the knee, and when standing with knees together, the feet are far apart.

Genu VarumLegs are bowed outwards in the standing position. The bowing usually occurs at or around the knee. When standing with the feet together, the knees remains far apart.

Types of skeletal fluorosis

Tingling sensation in fingers and toesExcessive thirstPolydypsia and polyureaNervousness & Depression

Non Skeletal Manifestation

Fluorosis: Adverse Health Affect & its causes

1. Patient complain fatigue / Weakness due to destruction of muscle structure by fluoride decomposition in muscle 

2. Patient  complain  tiredness  ,unenthusiastic  and  a  feelings of depression due to destroying RBC resulting anemia and eventually depression.

3. Stomach & intestine inner mucosal membrane destroy by decomposition  of  fluoride  resulting  the  GI  mucosal destruction.

4. Ant-  diuretic  hormone  and  kidney  disfunction  cause   polydipsia & polyurea

5. A female patient complain of repeated miscarriage / still  birth  due  to  deposition  of  fluoride  -  foetal  blood vessel blocking.

6.  Anemia  patient  complain  of  not  being  able  to conceive  due  to  husband  sperm  count  is  being  low (Oligospermia) / non (azospermia) and blunt end of          sperm 

Fluorosis Diagnostic TestIn Adult :

Fluoride to be tested in Drinking Water ( to collect in plastic bottle only )Blood (Serum) [ fasting not required] Urine (spot urine sample)

Confirmative Test:

Radiograph of the fore-arm Hemoglobin

In Children:

Fluoride in the drinking water of the child / OR if an infant or new born.

Fluoride in the drinking water of the mother. 

Blood (serum) of the child; if an infant or new born, the blood serum of the mother.

Urine of the child / infant.Additional Tests:Thyroid Stimulating Hormone (TSH)Iodine in urineThyroid hormone levels T3 and T4

INTERVENTION-11.Safe Water Supply bellow 1.5 mg/L of fluoride2. Use of Domestic Filter3. Small defluoridation Plant

4. Nutrition and Proper Diet 5. Supplementary Medicine     vit- C     vit- D     Ca     Antioxident6. Clinical Interventiona. Screeningb.Diagnostic Test (Urine & Blood)c.Identificationd.Surgery and Medication 7. IEC & BCC

INTERVENTION -2 Take Proper Nutrition and Diet1. Green Vegetable should be taken in large amount 2. Carrot and Tomato are the main source of antioxidant

.3. Milk and Small –fish are the rich source of Calcium.

AVOID FLUORIDE CONTAINING FOOD, COSMETICS AND TOOTH-PASTE

Black salt (Kalanamak)

Rock salt                                     Different names of rock salt are: 

Sandha namak Lahori namakVrat ka namakPakistani namak 

Tea      (without milk and with lemon)           Salted snacks smeared       with black salt viz.  Dalmoth

AVOID FLUORIDE CONTAINING FOODChanna dalNavratan Papri Chat Bhel puriPani puri Pickles smeared with black salt 

Masala's smeared with black salt

Chana masalaSabzi masalaMeat / Chicken masala Chunky chat masala 

Tava fry

Jal jeera masala 

ROLE OF DH&FW BANKURA

Survey to locate & ensure  the fluorosis affected population as per fluoride listed village by PHED Bankura.

Arrange training of M.O , BPHN/ PHN ,HS , ANM , BSI , Paramedicos , ASHA , AWW , Teachers etc. to promote the further root level investigation in the field with PIC (Personal Inter Communication) & IEC , BCC.

Arrange advocacy meeting at District level & remittance of fund for block level advocacy meeting and its supervision.

Arrange monitoring & review meeting in District PH MIES regarding fluorosis & remittance of fund for block level meetings meeting and its supervision.

IEC & BCC (Under BCC ASHA/AWW/PRI/Teachers/School, College Students to be sensitize)

Medicinal treatment including nutritional advice to the fluorosis suffered cases.

 Possible surgery & rehabilitation . 

ROLE OF P.H.E.D 1.Surface Water Utilization for Drinking 2.Aluminum Sulfate Filter Distribution 3.Long Term Water Plant , based on Surface Water  4.Rain water Harvesting

More Over Distribution of Pure Fluoride free water supply

CO-OPERATION BETWEEN HEALTH AND P.H.E.D

*Identification and Treatment of Fluorosis Affected People

*Provide them safe fluoride free Water

*Treatment of malnutrition *Surgery *Good Health promotion and Potable

water *Short and Long Term Measures of

safe water supply

FLUOROSIS IN BANKURA DISTRICT

FLUOROSIS IN BANKURA DISTRICT

Recent NIN study conducted in BiharChildren of 2-3 year were affected with sever forms of crippling bone

deformities

Children affected from fluorosis

Skeletal fluorosis in Assam

1. Proper diet and Nutrition2. Control of Malnutrition3. Fluoride free food intake4. Chana masala ,Black Salt , Rock Salt

avoid5. Lemon tea with Black Salt avoid6. Fluoridated cosmetics ,drugs ,toots pest

avoid

CONTROL OF FLUOROSIS

Rain water Harvesting Aluminum –sulfate domestic filter

distribution Fluoride free water supplement , Long

term ,Short-term measurement IEC Educational Camp Media Mangement Surface water utilization etc.

CONTROL OF FLUOROSIS

HOUSEHOLD LEVEL BONE CHAR DEFLUORIDATOR

This is very simple and inexpensive method conceived by staff of ICOH and WHO

Bore well water with 3.8 ppm fluoride after passing through this defluoridator reduced to 0.18 ppmThe pipe is 75 cm feet long and 90 cm diameter with 1kg Bone Char activated by heating

COMMUNITY BASED BONE CHAR DEFLUORIDATOR

Inauguration of Community Bone Char Defluoridator at

endemic village of Nalgonda District

COMMUNITY BASED BONE CHAR DEFLUORIDATOR AT KHUDABAKSHPALLI, NALGONDA, AP.

RAIN WATER HARVESTING ASBESTOS ROOF

1.Roof catchment 2.Gutters3.Downpipe and first flush pipe4.Storage tank5.Filter unit

The roof catchments are relatively cleaner when compared to the ground level catchmentsBuilt and maintained by the local communitiesAvailable at their door steps with least cost

OUR PLAN

Activity 1

Prevalence assessment

Exposure assessment

Risk deter

mination

Risk management

Activity 2

Strengthening

infrastructure

Activity 3

Capacity building

Human resource

ACTIVITY - 1

Case management

1. Diagnosis2. Management

3. Surgery4. Rehabilitation

ACTIVITY - 2Strengthening of infrastructure

Laboratory

Collaborating centres

Health system

ACTIVITY - 3

Capacity building

Human resource

ULTIMATE GOAL To provide safe house hold water to every

citizen of Fluoride affected areas of Bankura, a constant pursuance is planned to be under taken through “Intersectoral co-ordination” with the NGOs, General Administration, PRIs, PHED and related agencies.

And get rid of Fluorosis……by 2015!

THANK YOU

Have a Good Day