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Presentation fluorosis 6.9.'11

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Gaurab Roy Dy II DDJ

Presentation fluorosis 6.9.'11

  1. 1. <ul><li>Essentials of Fluorosis Mitigation </li></ul><ul><li>G. Roy DPH MAE </li></ul><ul><li>Dy.CMOH-II, D/Dinajpur </li></ul><ul><li>September-2011 </li></ul>
  2. 3. Normal Requirement of Fluorine <ul><li>Fluorine is abundant in nature, found in compound form like fluoride </li></ul><ul><li>Fluorine is essential for mineralization of bones & formation of dental enamels </li></ul><ul><li>Fluorine deficiency: Dental caries </li></ul><ul><li>96% of fluoride of body found in bones & teeth </li></ul><ul><li>Normally small amount of fluoride is required (0.5 to 0.8 mg/lit) in drinking water </li></ul>
  3. 4. What is Fluorosis ? <ul><li>Fluorosis is a major public health </li></ul><ul><li>problem caused by intake of excess </li></ul><ul><li>amount of fluorides over a long period </li></ul><ul><li>resulting permanent and irreversible </li></ul><ul><li>damages like dental, skeletal and non- </li></ul><ul><li>skeletal fluorosis </li></ul>
  4. 5. Dental Fluorosis
  5. 6. Skeletal Fluorosis
  6. 7. Skeletal Fluorosis Source: An intervention study conducted in Mandla district, MP, by ICMR
  7. 8. Sources of Fluoride <ul><li>Contaminated drinking & cooking water, agricultural & food products, drugs and industrial emissions & pollutants </li></ul><ul><li>Contaminated ground water is the main source </li></ul>
  8. 9. Permissible Limit of Fluoride <ul><li>Permissible limit of fluoride in drinking water: One mg. / liter or one p.p.m. in drinking water as per Bureau of Indian Standard (BIS) </li></ul>
  9. 10. Suspected Cases of Dental Fluorosis <ul><li>Chalky white teeth </li></ul><ul><li>Transverse yellow brown or dark brown bands </li></ul>
  10. 11. Images of Dental Fluorosis
  11. 12. Suspected Cases of Skeletal Fluorosis <ul><li>Severe pain & stiffness in the neck & back bone </li></ul><ul><li>Severe pain & stiffness in joints </li></ul><ul><li>Severe pain & rigidity in pelvic girdle </li></ul><ul><li>Increased girth, thickening & density of bone seen in X- Ray </li></ul><ul><li>Genu valgum & osteoporosis </li></ul><ul><li>Knock knee / Bow leg </li></ul><ul><li>Inability to squat </li></ul><ul><li>Defective gait & posture </li></ul>
  12. 13. Images of Skeletal Fluorosis
  13. 14. Skeletal Fluorosis – Radiological diagnosis
  14. 15. Suspected cases of Non – skeletal Fluorosis <ul><li>Gastro –intestinal problems : Consistent abdominal pain, intermittent diarrhoea/constipation, blood in stool </li></ul><ul><li>Neurological manifestations: Nervousness & depression, tingling sensation in fingers & teeth, polydypsia, polyurea </li></ul><ul><li>Muscular manifestations: Muscle weakness & stiffness, pain in the muscle, loss of muscle power </li></ul>
  15. 16. Confirmation of Fluorosis <ul><li>Any suspect case with high level of fluoride in urine (>1mg/L) </li></ul><ul><li>Any suspect case with inter-osseous membrane calcification in the forearm confirmed by X-ray </li></ul>
  16. 17. Prevention of Fluorosis I <ul><li>Abandoning contaminated source </li></ul><ul><li>Discarding use of ground water </li></ul><ul><li>Using treated water from rivers, canals, ponds etc. surface water </li></ul><ul><li>Using de-fluoridated ground water where surface water not available </li></ul><ul><li>Conservation and harvesting of rain water for agriculture and household use </li></ul>
  17. 18. Prevention of Fluorosis II <ul><li>Restrict fluoride rich food: black tea, black salt, rock salt, tobacco, brittle nut </li></ul><ul><li>Avoid fluoride rich cosmetics & drugs </li></ul><ul><li>Intake calcium, iron and vitamin rich food: milk, milk products, green vegetables, citrus & other fruits </li></ul><ul><li>Banning fluorinated toothpaste for children in endemic areas </li></ul>
  18. 19. Treatment of Fluorosis <ul><li>Medical treatment : No specific treatment; treatment supplementation with vitamin C & D, antioxidants, calcium & correction of malnutrition </li></ul><ul><li>Treatment of deformities : Orthoses, surgical shoes, physiotherapy, reconstructive surgery </li></ul>
  19. 20. Mitigation of Fluorosis - I <ul><li>Closing contaminated water source </li></ul><ul><li>Arranging alternative safe water source </li></ul><ul><li>Flocculation, sedimentation, coagulation (with lime & alum), filtration of drinking water before use </li></ul><ul><li>Health education, dietary counseling & nutrition </li></ul><ul><li>Dietary supplementation of calcium, vitamin C, D3 & iron </li></ul>
  20. 21. Mitigation of Fluorosis - II <ul><li>Enhanced surveillance, early detection, proper treatment & rehabilitation </li></ul><ul><li>Rain & surface water harvesting for agriculture & household </li></ul><ul><li>Supply of pipeline river water from water treatment plant </li></ul><ul><li>Water treatment gadgets in tube wells where surface water is not available </li></ul>
  21. 22. Global Prevalence
  22. 23. Indian Scenerio <ul><li>1930 : First reported from Andhra Pradesh </li></ul><ul><li>1937 : First published report </li></ul><ul><li>19 states & UTs and 196 districts endemic </li></ul><ul><li>Birbhum, Purulia and Dakshin Dinajpur endemic in West Bengal </li></ul><ul><li>>66 million (>6.6 crores) population affected </li></ul><ul><li>2008 : National Programme for Prevention & Control of Fluorosis (NPPCF) </li></ul>
  23. 24. Goal of NPPCF <ul><li>Goal of National Programme for Prevention and Control of Fluorosis (NPPCF): To prevent and control of fluorosis cases in the country </li></ul>
  24. 25. Objectives of NPPCF <ul><li>To collect & use of baseline survey data of fluorosis </li></ul><ul><li>Comprehensive management of fluorosis in endemic areas </li></ul><ul><li>Capacity building for prevention, diagnosis & management of fluorosis cases </li></ul>
  25. 26. Programme Framework & Phasing <ul><li>Phase I (2008-09) : 5 districts </li></ul><ul><li>Phase II (2009-10) : 15 districts </li></ul><ul><li>Phase III (2010-11) : 40 districts </li></ul><ul><li>Phase IV (2011-12) : 40 districts </li></ul>
  26. 27. Strategies of NPPCF <ul><li>Training of field level health personnel </li></ul><ul><li>Capacity building of District Hospitals & Medical Colleges </li></ul><ul><li>Laboratory support development in District Hospitals & Medical Colleges </li></ul><ul><li>Information, Education & Communication (IEC) for the community </li></ul>
  27. 28. Activities under NPPCF-I <ul><li>Community diagnosis of fluorosis - village/block/cluster wise </li></ul><ul><li>Facility mapping from prevention, health promotion, diagnostic facilities, reconstructive surgery and medical rehabilitation point of view – village/block/district wise </li></ul>
  28. 29. Activities under NPPCF-II <ul><li>Gap analysis in facilitation & organization of physical & financial support for bridging the gaps </li></ul><ul><li>Diagnosis of individual cases & providing its management </li></ul><ul><li>Public health intervention on the basis of community diagnosis </li></ul><ul><li>Behavioral change by IEC </li></ul>
  29. 30. <ul><li>Thank You </li></ul>
  30. 31. Acknowledgement <ul><li>Communiqués of Nutrition & IDD Cell, DGHS, GOI </li></ul><ul><li>Preventive & Social Medicine – K. Park, 20 th Edition </li></ul><ul><li>Dr. Bhusan Chakraborty, ADHS(MPHWS), Govt. of W.B. </li></ul><ul><li>Dr. Tapas Chakma, Dy.Director, RMRC, Jabalpur </li></ul><ul><li>Dr. Asit Mandal, CMOH, Dakshin Dinajpur </li></ul><ul><li>Mr. D.Banerjee, Exe. Engineer(PHE), Dakshin Dinajpur </li></ul><ul><li>Mr. Biplob Goswami, Ex-HS, Dy.CMOH-II Office </li></ul><ul><li>Mr. Nilay Sarkar, DEO, IDSP, Dy.CMOH-II Office </li></ul><ul><li>Google Search </li></ul>

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