Health Impact of Supplying Safe Drinking Water Containing Fluoride Below Permissible Level on Fluorosis Patients in a Fluoride-endemic Rural Area of West Bengal

Author:Kunal Kanti Majumdar
Source:Indian Journal of Public Health, October-December, 2011

Abstract


Background: The problem of high fluoride concentration in groundwater resources has become one of the most important toxicological and geo-environmental issues in India. Excessive fluoride in drinking water causes dental and skeletal fluorosis, which is encountered in endemic proportions in several parts of the world. World Health Organization (WHO) guideline value and the permissible limit of fluoride as per Bureau of Indian Standard (BIS) is 1.5 mg/L. About 20 states of India, including 43 blocks of seven districts of West Bengal, were identified as endemic for fluorosis and about 66 million people in these regions are at risk of fluoride contamination. Studies showed that withdrawal of sources identified for fluoride often leads reduction of fluoride in the body fluids (re-testing urine and serum after a week or 10 days) and results in the disappearance of non-skeletal fluorosis within a short duration of 10–15 days.

Objective: To determine the prevalence of signs and symptoms of suspected dental, skeletal, and non-skeletal fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among participants taking water with fluoride concentration above the permissible limit, and to assess the changes in clinical manifestations of the above participants after they started consuming safe drinking water.

Materials and Methods: A longitudinal intervention study was conducted in three villages in Rampurhat Block I of Birbhum district of West Bengal to assess the occurrence of various dental, skeletal, and non-skeletal manifestations of fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among the study population and the impact of taking safe water from the supplied domestic and community filters on these clinical manifestations. The impact was studied by follow-up examination of the participants for 5 months to determine the changes in clinical manifestations of the above participants after they started consuming safe drinking water from supplied domestic filters and community filter with fluoride concentration below the permissible limit. The data obtained were compared with the collected data from the baseline survey.

Results: The prevalence of signs of dental, skeletal, and non-skeletal fluorosis was 66.7%, 4.8–23.8%, and 9.5–38.1%, respectively, among the study population. Withdrawal of source(s) identified for fluoride by providing domestic and community filters supplying safe water led to 9.6% decrease in manifestation of dental fluorosis, 2.4–14.3% decrease in various manifestations of skeletal fluorosis, and 7.1–21.5% decrease in various non-skeletal manifestations within 5 months. Following repeated motivation of participants during visit, there was also 9.7–38.1% decrease in the usage of fluoride containing toothpaste, and 9.8–45.3% and 7.3–11.9% decrease in the consumption of black lemon tea and tobacco, respectively, which are known sources of fluoride ingestion in our body and have an effect on the occurrence of various manifestations of fluorosis following drinking of safe water from domestic and community filters. Conclusion: Increased prevalence of dental, skeletal, and non-skeletal fluorosis was found among the study population. Withdrawal of source(s) identified for fluoride by supplying domestic and community filters, dietary restriction, and other nutritional interventions led to decrease in manifestation of the three types of fluorosis within 5 months.

Key words: Diet, Fluorosis, Health impact, Intervention, Safe water key words:

Introduction


Fluoride is one of the important factors in water quality management due to its adverse health effects. The problem of high fluoride concentration in groundwater resources has become one of the most important toxicological and geo-environmental issues in India. Excessive fluoride in drinking water causes dental and skeletal fluorosis, which is encountered in endemic proportions in several parts of the world.1 World Health Organization (WHO) guideline value and the permissible limit of fluoride as per Bureau of Indian Standard (BIS) is 1.5 mg/L.2 About 20 out of 35 states and union territories of India were identified as endemic for fluorosis3 in these regions are at risk of fluoride contamination. Fluorosis is known to occur due to the entry of excess fluoride into the body. It is a slow, progressive, crippling malady that affects every organ, tissue, and cells in the body, and results in health complaints that overlap with several other disorders. Most of the fluorides are readily soluble in water. Prolonged ingestion of fluoride above permissible level through water is the major cause of fluorosis.

Fluorosis disease can occur in three forms: dental fluorosis, skeletal fluorosis and non-skeletal fluorosis. Dental fluorosis occurs in the permanent teeth in children after 8 years of age.3,4 Skeletal fluorosis affects the bones and major joints of the body.5,6 Non-skeletal fluorosis affects invariably all the soft tissues, organs, and systems of the body.7 Dental fluorosis is a good indicator of exposure to excessive amounts of fluoride. The main natural source of inorganic fluorides in soil is the parent rock. Fluoride can also enter the through food and fluoridated dental products as well as drugs. To confirm diagnosis of fluorosis, the fluoride is mainly estimated in serum, drinking water, and urine.7 10–40% districts are affected in Assam, Jammu & Kashmir, Kerala, Chattisgarh and West Bengal.8 In West Bengal, fluoride was first detected at Bhubanandapur in Nalhati I block of Birbhum district in 1996. During a rapid assessment survey by Public Health Engineering Department, Government of West Bengal (2005), 729 sources were found to be contaminated with fluoride above 1.5 ppm in 43 blocks of seven districts of West Bengal, with the affected population being approximately 2.26 lakhs. Fluoride level in West Bengal varies from 1.1 to 4.47 Studies show that withdrawal of sources identifi ed mg/L.9for fluoride often leads to reduction of fluoride in the body fluids (re-testing urine and serum after a week or 10 days) and results in the disappearance of non-skeletal fluorosis within a short duration of 10–15 days.9

Fluorosis is an impending public health problem in West Bengal affecting a large number of population, and Birbhum is one of the affected districts with seven affected blocks. It is evident from previous studies that withdrawal of source(s) identified for fluoride leads to reduction of fluoride in body fluids and shall result in disappearance of health problems emanating from non-skeletal fluorosis within a short period.7 As intervention studies are scarce to prove the above hypothesis, the present intervention study was conducted to see the impact of drinking safe water which is the main known intervention for prevention and treatment of the toxicity caused by clinical course of fluorosis.

Objectives


To determine the prevalence of signs and symptoms of suspected dental, skeletal, and non-skeletal fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among participants taking water with fluoride concentration above permissible limit.

To determine the changes in clinical manifestations of the above participants after consumption of safe drinking water.

Materials and Methods


A longitudinal intervention study was started in the month of December 2008 in Junitpur, Kamdebpur, and Noapara villages in Rampurhat Block I of Birbhum district of West Bengal and completed in the month of September 2009 to assess the occurrence of various dental, skeletal, and non-skeletal manifestations of fluorosis and the impact of taking safe water on these manifestations.

Seven blocks of Birbhum district of West Bengal were endemic for fluorosis. Out of these seven blocks, Rampurhat Block I was selected randomly for the study. Within this block, all the three affected villages, i.e. Junitpur, Noapara, and Kamdevpur, with the fluoride content in their tube wells varying from 2.6 to 11 mg/L (PHED report 2008) and with a permissible limit of

Latest

बीएमसी ने पानी कटौती की घोषणा की; प्रभावित क्षेत्रों की पूरी सूची देखें

देहरादून और हरिद्वार में पानी की सर्वाधिक आवश्यकता:नितेश कुमार झा

भारतीय को मिला संयुक्त राष्ट्र का सर्वोच्च पर्यावरण सम्मान

जल दायिनी के कंठ सूखे कैसे मिले बांधों को पानी

मुंबई की दूसरी सबसे बड़ी झील पर बीएमसी ने बनाया मास्टर प्लान

जल संरक्षण को लेकर वर्कशॉप का आयोजन

देश की जलवायु की गुणवत्ता को सुधारने में हिमालय का विशेष महत्व

प्रतापगढ़ की ‘चमरोरा नदी’ बनी श्रीराम राज नदी

मैंग्रोव वन जलवायु परिवर्तन के परिणामों से निपटने में सबसे अच्छा विकल्प

जिस गांव में एसडीएम से लेकर कमिश्नर तक का है घर वहाँ पानी ने पैदा कर दी सबसे बड़ी समस्या