Transcript
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
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