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Fluoride contamination in ground water

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Fluoride Contamination in Ground Water – The Problem and its Integrated Management

Fluoride Contamination in Ground Water – The Problem and its Integrated Management

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  • 1. Fluoride Contamination in GroundWater – The Problem and Integrated Management Dr.Ashok Ghosh Dept. of Environment & Water Management A. N. College, Patna www.ancollege.org
  • 2. FLUOROSIS IS NOT TREATABLE BUT FLUOROSIS IS PREVENTABLEwww.ancollege.org
  • 3. Fluorine• Fluorine is the most electronegative element, distributed ubiquitously as fluorides in nature. Water is the major medium of fluoride intake by humans.• Fluoride can rapidly cross the cell membrane and is distributed in skeletal and cardiac muscle, liver, skin and erythrocytes.• Fluorosis is a major public health problem resulting from long-term consumption of water with high fluoride levels.• It is characterized by dental mottling and skeletal manifestations such as crippling deformities, osteoporosis, and osteosclerosis. www.ancollege.org
  • 4. World Wide Fluoride Distributionwww.ancollege.org
  • 5. Fluoride Contamination -India Fluoride Contamination in Ground WaterMost Affected:• Rajasthan• Gujarat• Andhra Pradesh www.ancollege.org
  • 6. State Number of Districts Assam 02 Andhra Pradesh 17 Bihar 09 Delhi 04 Gujarat All Except 1 Haryana 12Number ofDistricts Known to Jammu & Kashmir 01be Endemic For Karnataka 03Fluorosis in Kerala 03Different States of Maharashtra 10India(Source:Dr.Raja Reddy,2009) Orissa 03 Punjab 13 Rajasthan All Except 1 Tamil Nadu 08 Uttar Pradesh 07 West Bengal 04 www.ancollege.org
  • 7. FLUORIDE IN GROUND WATER• About 203 districts in 20 states of the country are affected with fluoride contamination.• Around 66.62 million people in these states (six million children below the age of 14) live under this ominous shadow• Those suffering from fluorosis complain of fatigue and typically the bones of the backbone, neck, hands or legs of the affected person become fragile and lead to deformity. It becomes difficult to stand, run, walk or carry a load. www.ancollege.org
  • 8. FLUORIDE CONTAMINATION IN BIHAR Fluoride contaminated aquifers in dry areas of following Districts of Bihar is confirmed:–• Gaya• Nawada• Rohtas• Katihar• Munger• Bhagalpur• Jehanabad• Aurangabad• Jamui www.ancollege.org
  • 9. Clinical Outcomes of Endemic Fluorosis• Dental Fluorosis in Children• Skeletal Fluorosis in Adults• Non Skeletal Fluorosis www.ancollege.org
  • 10. Fluoride poisoning and the biological response leading to ill effects depend on the following factors:• Excess concentration of fluoride in drinking water.• Low Calcium and high alkalinity in drinking water.• Total daily intake of fluoride• Duration of exposure to fluoride• Age of the individual• Expectant mothers and lactating mothers are the most vulnerable groups as, fluoride crosses the placenta because there is no barrier and it also enters maternal milk.• Derangement in hormonal profile either as a result of fluoride poisoning or as a cause, aggravate the disease. Important hormones for healthy bone formation and bone function are clacitonin, parathormone, vitamin - D and cortisone. www.ancollege.org
  • 11. Different fluoride doses (long term ingestion through water) and their effects on human bodyFluoride (mg/l) Effects on human bodyBelow 0.5 Dental Caries0.5 to 1.0 Protection against dental caries. Takes care of bone and teeth1.5 to 3.0 Dental fluorosis3 to 10 Skeletal fluorosis (adverse changes in bone structure)10 or more Crippling skeletal fluorosis and severe osteoclerosiswww.ancollege.org
  • 12. Dental Fluorosiswww.ancollege.org
  • 13. Very mild fluorosis : Opaque, paper-white areas scattered irregularly over the tooth.www.ancollege.org
  • 14. Moderate fluorosis : The enamel surfaces of the teeth show marked wear and brown stain is frequently a disfiguring feature.www.ancollege.org
  • 15. Severe fluorosis worn areas and brown stains are wide spread; the teeth often have a corroded appearance.www.ancollege.org
  • 16. The 3 Stages of Skeletal Fluorosis Phase 1: sporadic pain; stiffness of joints; osteosclerosis of pelvis and vertebral column Phase 2: chronic joint pain; arthritic symptoms; slight calcification of ligaments; increased osteosclerosis/cancellous bones; with/without osteoporosis of long bones. Phase 3: Crippling Skeletal Fluorosis: limitation of joint movement; calcification of ligaments/neck and vertebral column; crippling deformities of spine and major joints; muscle wasting; neurological defects/ compression of spinal cord www.ancollege.org
  • 17. Skeletal Fluorosis -Children of Kachariya Dih, Nawada,Biharwww.ancollege.org
  • 18. Skeletal Fluorosis -Children of Kachariya Dih......www.ancollege.org
  • 19. Trauma of Kachariya Dih, Nawada ,Biharwww.ancollege.org
  • 20. Radiologic changes in bone - FluorosisJaw bone shows prominent marrow spaces Skull bone showing thicken inner and outer table www.ancollege.orgBarrowing of long bone Source: Rawlani et al,2010
  • 21. LM IMAGE Non-skeletal Fluorosis• Muscle degeneration is especially interesting.• Effect on red blood cells due to fluoride intoxication.• Membrane degeneration induced by SEM Image fluoride turns erythrocytes into “echinocytes” with a shrunken membrane (amoeba shaped) and a much shorter lifespan, capable of causing severe anaemia.• Recently it has been confirmed that high fluoride content in body lowers RBC cell wall changes the IQ of children (Echinocytes) www.ancollege.org
  • 22. Prevention of Fluorosis• Early detection• Detection of source of fluoride• Identification of factors responsible for severity of fluorosis• Integrating fluorosis prevention program in health care program• Withdraw the source of Fluoride / provision of safe drinking water(Progression of the disease arrested)• To promote, supplementation of diet with essential nutrients, vitamins & antioxidants www.ancollege.org
  • 23. Social cycle of disease prevention Implementation Survey Fluoride Planning Analysis Advocacy Disseminationwww.ancollege.org
  • 24. Community DiagnosisFirst indicator DF survey in school DF in Children for fluorosis mapping Water fluoride Followed by Industrial activity Dietary habits Water fluoride testingMonitoring indicator for DF prevalence Establishing cause SF prevalence and effect relation & Urinary fluoride prevention through Water fluoride safe water www.ancollege.org
  • 25. INTREGRATED FLUOROSISMANAGEMENT AND PREVENTIONwww.ancollege.org
  • 26. Prevention of Fluorosis Placing fluorosis on health agenda Early detection Detection of source of fluoride Identification of factors responsible for severity of fluorosis Integrating fluorosis prevention program in health care program www.ancollege.org
  • 27. WATER PANCHAYAT HEALTH f AGRICULTURE EDUCATION INDUSTRYwww.ancollege.org
  • 28. HEALTH SERVICES Intra MEDICAL IEC SERVICES sectoral MEDICAL EDUCATIONwww.ancollege.org
  • 29. Provision of safe drinking water Possibility I Safe and unsafe drinking water co-existing and how to go about? Possibility II Only unsafe water / fluoride contaminated water existing and then how to go about. Other possibilities: • If a perennial river flowing through the state, infiltration wells can be dug in the river bed – location based strategy (Water Supply Agencies deal with such issues) • Rain Water Harvestingwww.ancollege.org
  • 30. Hi-tech de-fluoridation plant…….kaput as usualwww.ancollege.org
  • 31. Water supply• Water conservation and recharging• Water chemistry monitoring• Early detection and timely sustained action• Planning with irrigation and agriculture• Planning with industry• Converge with health activities www.ancollege.org
  • 32. Alternate Source for Fluoride Free Water – Open Water Bodies – Ponds,Lakes,etcwww.ancollege.org
  • 33. Construction of Rain Water Harvesting Structures for:• Roof top rainwater harvesting (for domestic consumption)• Artificial rainwater harvesting (to increase recharge to dilute groundwater)• Recharge of bore wells (to dilute groundwater)• Direct aquifer recharge (to dilute groundwater)• Farm ponds (to increase recharge to dilute groundwater) www.ancollege.org
  • 34. Rain Water Harvestingwww.ancollege.org
  • 35. Rain Water Harvestingwww.ancollege.org
  • 36. Artificial Catchements The colour of water is the colour of sky !!!!!!!www.ancollege.org
  • 37. Artificial Farm Ponds The colour of water is the colour of the earthwww.ancollege.org
  • 38. Open Dug Wellwww.ancollege.org
  • 39. Defluoridation of Water 2 A Terracotta domestic 1 filter for removal of fluoride (Activated Alumina System ) Nalgonda – Bucket treatment • From the existing safe water sources in the village, the water can also be stored 3 in an overhead reservoir. • From the reservoir water can be supplied through a central stand post with multiple taps.4 Reverse Osmosis though expensive is available as Domestic Filters Reverse Osmosis Technology (RO Filter) is the only technology5 which would remove fluoride and other chemical contaminants www.ancollege.org
  • 40. 4 Stage Adsorption Filteration 4 stage Adsorption Water filters remove fluoride, chlorine and heavy metals using KDF carbon GAC and activated alumina.www.ancollege.org
  • 41. 5 Stage RO Domestic Filter • 5 Stage Reverse Osmosis Water Filter with a storage tank. • It can purify 50 gallons of water/day • This filter removes chlorine and heavy metals such as chromium and cadmium. • The storage tanks are very useful because it can be filtering your water constantly so that you don’t run out. • When the storage tank is full, it has an automatic close off valve that stops the filtering process so waterwww.ancollege.org
  • 42. Double Reverse Osmosis Systemwww.ancollege.org
  • 43. These Do NOT Remove Fluoride• Brita, Zero B, Aquaguard, and most other filters.• Some websites about fluoride removal state otherwise, but I checked the products in my lab to confirm that fluoride is left in the water.• Boiling Water -This will concentrate the fluoride rather than reduce it.• Freezing Water - Freezing water does not affect the concentration of fluoride. www.ancollege.org
  • 44. Health Department• Sensitization workshop for Policy makers• Skill development- trainings• Development of diagnostic facility• Fluorosis Mapping – school Health• Fluoride Mapping-Water supply• High endemic area - Calcium supplementation - along with Diet counseling• Diagnosis and treatment of cases at treatment facility• IEC and BCC• Monitoring• Intersectoral co ordination www.ancollege.org
  • 45. Supplementation• Supplementation of Calcium to Pregnant and breast feeding women• During 7th, 8th and 9th month of pregnancy and 1st month of PP• Calcium tablet 500 mg per day Iodised salt to ANC and BF women Vit.A supplement to PNC www.ancollege.org
  • 46. Information Education Communication/ Behavior Change Communication (IEC/ BCC)• State health IEC action plan includes Fluorosis• Health and water board – common message• Mass media to inter personal communication • Fluorosis manifestations • Sources of fluoride • Prevention of fluorosis • Dietary precautions • Importance of supplementation for Antenatal Care (ANC) & Postnatal Care (PNC) • Centers with diagnostic and treatment facilities www.ancollege.org
  • 47. School Intervention (Education Department)• Detection through health check up• Mapping of problem• Safe drinking water supply at schools• Nutrition counselling at schools• Supplementation at schools (Calcium & Vit.C)• Safe water supply (Processed) for Village• Training of school children www.ancollege.org
  • 48. Agriculture and Irrigation intervention• (Primary Prevention) Use of low fluoride containing water for irrigation• Drip irrigation promotion• Soil chemistry study and Calcium ,Ph balancing• Monitoring www.ancollege.org
  • 49. Health Indicators of Effective Fluorosis Control• Children born after program are free from DF• No new case of crippling SF• Community gets relief from pains, aches and stiffness of joints• Physical efficiency improves• Foetal wastage rate declines• Renal stone rate declines• Bone fracture rate declines• Cardiac problem indicative of artery blockage rate declines www.ancollege.org
  • 50. Treatment of Fluorosis !• Using DF as a epidemiological warning• NSF (Nephrogenic Systemic Fibrosis) diagnosis through systematic screening• Early skeletal fluorosis detection• Adequate Calcium, Vitamin C & Anti oxidant intake can protect from early and severe form of skeletal fluorosis• Ortho corrections• Surgical corrections are some times possible but that is not a treatment it is a relief www.ancollege.org
  • 51. Treatment of Skeletal Fluorosis !• Skeletal fluorosis is irreversible and un treatable• If early detection is done further progress can be prevented• Surgical corrections are some times possible but that is not a treatment it is a relief• Adequate calcium intake can protect from early and severe form of skeletal fluorosis www.ancollege.org
  • 52. Diet and Nutrition Education All level of Prevention• Education about high Fluoride containing food articles• Education about inclusion of food articles rich in Calcium and antioxidents• Educating for food fluoride in Ready to eat / packed food• Education for need of Iodised salt in Fluorosis affected regions www.ancollege.org
  • 53. Why antioxidants are promoted?Antioxidants are phytochemicalsScavengers and removes free radicalsProtects the body from diseasesPharmaceutical products are notrecommended; Antioxidant intake throughdietary sources are promotedRecovery is rather rapid www.ancollege.org
  • 54. To consume more of calcium and iron rich items:Dairy products and vegetableswww.ancollege.org
  • 55. Vitamin C • Amla • Amrud • Lemon • Oranges, • Tomato, • Coriander leaf & other GLV • Sprouted pulseswww.ancollege.org
  • 56. Vegetables and fruits rich in antioxidants : (1) Papaya, (2) Carrot, (3) Pumpkin, (4)Palak and other leafy vegetables, (5) Garlic, (6) Spring onion, (7) Chilly (8) Pepper, (9) Apple, (10) Cherry, (11) Oranges (12) Ginger etcwww.ancollege.org 43
  • 57. List of antioxidants1. β – carotene in: ● Papaya ● Carrot ● Pumpkin ●Mango and ● Sweet Potato.2. Glutathione: Spinach (palak) and other leafy vegetables3. Quarcetin: White Onion4. Allicin: ● Garlic, ● Onion, ● Spring Onion ● Leek5. Capasaicin: ● Chilly, ● Pepper6. Ellagic acid: ● Apple, ● Cherry, ● Orange, ● Strawberrie7. Gallic acid and Epicatechin: Cocoa.8.*Lycopene : ● Tomatoes , ● Pink Guava, ● Watermelon, ● Red papaya and ● Palm oil * [ Protects osteoblasts ]9. Sulphoraphane: ● Broccoli, ● Cabbage, ● Brussels sprouts and ● Cauliflower [ideal for breast cancer patients also] www.ancollege.org
  • 58. 58 Snacks with rock salt Daalmothwww.ancollege.org
  • 59. Steps to Reduce Fluoride Exposure• Dont take fluoride supplements.• Read labels on bottled beverages -Unless they are made using distilled or reverse-osmosis water, they are probably made with fluoridated public water.• Consider using unfluoridated toothpaste.• Avoid drinking black or red tea -There are many health benefits associated with chemical compounds found in tea, but this may be a beverage to avoid if you need to reduce your fluorine intake. Black and red tea come from two different types of plants, but both leaves naturally contain high amounts of fluorine.
  • 60. Steps to Reduce Fluoride Exposure……..• Be wary of tinned fish and canned food items - Fluoride may be used as a preservative.• Avoid black or red rock salt or items containing black or red rock salt.• Avoid using chewing tobacco.• Avoid long term use of medication that contains fluorine.• Certain antidepressants and medications for osteoporosis contain fluorine.
  • 61. Thanks