PROGRAMME FOR PREVENTION AND CONTROL OF FLUOROSIS Dr. Jagannath Dinda The Chief Medical Officer of Health . Bankura Govt. of West Bengal Mob No-
May 19, 2015
NATIONAL PROGRAMME
FOR PREVENTION AND CONTROL OF
FLUOROSIS
Dr. Jagannath Dinda The Chief Medical Officer of Health . Bankura Govt. of West Bengal Mob No-
INTRODUCTIONF L U O R O S I S :
A N E W P U B L I C H E A LT H P R O B L E M
Fluorosis is a slow, progressive and
crippling malady affecting most of the
organs in the body where flouride in
drinking water is > 1.0ppm.
More than 90% of rural drinking
water supply programmes are based
on ground water available, which is
being overexploited for agriculture,
causing a high influx of fluoride into
water.
Endemic fluorosis has been steadily
increasing ever since the disease was
discovered in India during the 1930s .
In West Bengal Birbhum , Bankura,
Purulia are grossly effected.
F L U O R O S I S I N I M M A G E
Fluorosis : An endemic burden World Wide
3
Magnitude of the problem 25 countries around the world.(DARK AREAS)
A crippling Disease1. Slow –Progressive Cripple 2. Affect all aged person.3. Health Complain-Overlapping
many disease4. Impact depends on
a. Ageb. Hormonal Statusc. Nutritional Statusd. Efficiency of Kidney
Arunachal Pradesh
Kerala21
Tamil Nadu28
Karnataka67
Andhra Pradesh70
Maharashtra31
Madhya Pradesh36 Oriss
a56
West Bengal22
Gujarat95
Rajasthan100.0
Punjab82Haryana 63
Delhi31
Uttar Pradesh22
Sikkim Nagalan
dManipurMizoramTripur
a
Himachal Pradesh
Jammu & Kashmir7
Bihar15
Assam9
Andaman Nicobar
70-100 % Districts affected
40-70 % Districts affected
10-40 % Districts affected
<10% Districts affected
Endemicity not known
Source:A Treatise on Fluorosis by Dr. A.K. Susheela
No of affected District 204 (21 States /UT)
people affected, 62 million ( 6 million children)
Causative factor, excess consumption of fluoride through drinking water (>1.0ppm) and diet.
BIS- Burro of Indian StandardBIS= Permissible Limit of Fluoride: 1.5 mg/L or PPM
Problem in India
Fluorosis : An endemic burden in West Bengal
In West Bengal Malda, Birbhum, Bankura, Purulia and South 24 Paraganas,Malda are affected.
Of them Purulia, Bankura, Birbhum & Daxin Dinajpur are worst affected.
Scenario in W.B: 45 Blocks in DistrictTotal People affected: 2.20 Lakhs
PREAMBLE
Persons suffers from Fluorosis in India : 6 Million
(Dr. Raja Reddy , NIN , Hyderabad)
Persons suffers from Fluorosis in West Bengal: 2.20 Lakh
Persons Suffers from Fluorosis in Bankura: 90,742 Current Status of Fluorosis In Bankura
District
Tot.
Blocks
Pop. Affected Block
Tot. Pop. Affected
Pop.
Tot. Village in Bankura
Tot. Pop.
Affected
Vill.
Affected. Pop.
Tot. Habitation
Affected
Habitation(Appr
ox)
Affected Pop.
(Approx)
22 31,92,695 15 20,21,341 90,742 3832 31,92,695 271 90,742 7778 1005 90,742
PREVALANCE IN BANKURA
Most 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
Initial symptoms : Headache, constipation, 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
IMPACT ON HEALTH
Types of Fluorosis
Dental Skeletal Non skeletal
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.
Skeletal Fluorosis
Identification
COIN TEST: The subject is asked to lift a coin from the floor without bending the knee. A fluorotic subject would not be able to lift the coin without flexing the large joints of lower extremity
CHIN TEST: The subject is asked to touch the chin with the chest. A fluorotic subject would not be able to do so, if there is pain or stiffness in the neck.
STRETCH TEST: The individual is made to stretch the arms sideways, fold the arm and try to touch the back of the head. If there is pain or stiffness in the shoulder joint and backbone, the exercise will be difficult, suggesting possibility of fluorosis
Confirmation with X-ray
Ossified Interosseous Membrane
Types of skeletal fluorosis - I
Genu valgum,
Genu varum,
Anterioposterior bowing of tibia (Saber tibia),
Scoliosis,
Paraplegia are severe forms of skeletal fluorosis
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
SKELETAL FLUOROSIS IN BANKURA
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 - II
Kyphosis: – Forward bending of spine. Fixed and rigid thoracic cage as well as spinal cord compression occur
Anterioposterior bowing of tibia
Types of skeletal fluorosis - III
Types of skeletal fluorosis - IV
Paraplegia: Spinal cord compression due to osteosclerosis with paraplegia as a result of endemic skeletal fluorosis
Tingling sensation in fingers and toes Excessive thirst Polydypsia and polyurea Nervousness & Depression
NON SKELETAL MANIFESTATIONS
INTERVENTION
1.Safe Water Supply bellow<1.5 mg/L
2. Domestic Filter
3. Small defluoridation Plant
4. Nutrition and Proper Diet
5. Supplementary Medicine
vit- C
vit- D
Ca
Antioxident
6. Clinical Intervention
a. Screening
b.Diagnostic Test
c.Identification
d.Surgery and Medication
INTERVENTION
Proper Nutrition and Diet
1. Green Vegetable should be taken large amount in a day.
2. Carrot and Tomato are the main source of antioxidant .
3. Milk and Small –fish are the rich source of Calcium.
Avoid Fluoride containt food, Cosmetics and tooth-pest.
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
ROLE OF DISTRICT HEALTH AND FAMILY WELLFARE SAMITY(DH&FWS) Survey
1. At least 20 House Hold survey for identification of Dental as well as skeletal fluorosis
2. School Survey for identification of Dental Fluorosis among school children.
Screening and Symptomatic Identification
Diagnostic Test
2. Water- Fluoride 2. Urine-fluoride 3. Blood-fluoride
* Medical Intervention by Surgery and Medication
*Behavioral changes through IEC
*Most of all Make People Awareness to come at nearest BPHC and PHC for primary Screening and Supplementary Medication
*Possible referral services will be made to the Medical College and Hospital .
CO-OPERATION BETWEEN HEALTH AND P.H.E.D
*Identification and Treatment of Fluorosis Affected People
*Provide them Pure fluoride free Water
*Treatment of malnutrition
*Surgery
*Good Health promotion and Pure water
*Sort and Long Term Measurement of water supply
THANK YOU
Have a Good Day