Presentation fluorosis bankura

NATIONAL PROGRAMME

FOR PREVENTION AND CONTROL OF FLUOROSIS

Dr. Jagannath Dinda Dibyendu Dutta Chief Medical Officer of Health District consultant(NPPCF) Bankura Bankura

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 affected10-40 % 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

PREAMBLEPersons suffers from Fluorosis in India : 6 Million

(Dr. Raja Reddy , NIN , Hyderabad)

Persons suffers from Fluorosis in West Bengal: 2.20 LakhPersons Suffers from Fluorosis in Bankura: 90,742 Current Status of Fluorosis In Bankura

DistrictTot.

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 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

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 walkingLimitation of joint movement. Inability to close

the fistSpinal stiffness and kyphosis developed in a few

patients. Flexion of spineNeurological 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 FluorosisIdentification

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

INTERVENTION1.Safe Water Supply bellow<1.5 mg/L 2. Domestic Filter3. Small defluoridation Plant

4. Nutrition and Proper Diet 5. Supplementary Medicine vit- C vit- D Ca Antioxident6. Clinical Interventiona. Screeningb.Diagnostic Testc.Identificationd.Surgery and Medication

INTERVENTIONProper Nutrition and Diet1. 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.D1.Surface Water Utilization for Drinking2.Aluminum Sulfate Filter Distribution3.Long Term Water Plant , based on

Surface Water 4.Rain water HarvestingMore Over Distribution of Pure Fluoride free water supply

ROLE OF DISTRICT HEALTH AND FAMILY WELLFARE SAMITY(DH&FWS) Survey1. At least 20 House Hold survey for identification of

Dental as well as skeletal fluorosis2. School Survey for identification of Dental Fluorosis

among school children.Screening and Symptomatic IdentificationDiagnostic Test2. 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

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