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Fluorosis: Significant progress in the last 10 years, thousands still susceptible

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Data recently provided by the government in Lok Sabha indicates that the number of fluoride affected habitations have decreased by almost 80% in the last 10 years. Five-states make up for more than 80% of the affected habitations as on date. Despite the significant progress, thousands are still susceptible to the disease and there are 1.2 million suspected cases of fluorosis in the country. 

Fluoride is beneficial to humans when consumed at optimum levels as it helps prevent dental caries. However, exposure to fluoride in high concentrations frequently results in damage to the bones and teeth of humans apart from the other ill effects, such as crippling, staining and pitting of teeth. The disease caused by excess exposure is known as Fluorosis and is mainly of two types- Dental Fluorosis and Skeletal Fluorosis. As the names suggest, Dental Fluorosis is when the tooth enamel is damaged and Skeletal Fluorosis is when the bones are affected. Excessive fluoride accumulates in bones and causes the bones to weaken. Children and pregnant women are the most vulnerable to the condition. If detected at an early stage, the condition of the child can be reversed. But, in extreme cases, the person might even lose their ability to move. 

Both natural and human activities release fluoride into the atmosphere

Consumption of water with high concentration Fluoride has been identified to be the major cause of the disease. Naturally, weathering of rocks rich in Fluoride ends up in the groundwater, mainly in arid and semi-arid regions. At the foot of high mountains and in areas where the sea has made geological deposits, the concentration of Fluoride is generally higher. Apart from this, emission of fly ash and use of phosphate containing fertilizers which also end up in water sources result in contamination of the water bodies. Other industrial activities such as cement production and aluminium smelting, also release fluoride into the environment. 

Fluoride consumption through water is the prominent cause of the disease in India

Fluorosis is endemic in at least 25 countries, which lie in the natural Fluoride belts- one that stretches from Syria through Jordan, Egypt, Libya, Algeria, Sudan and Kenya, and another that stretches from Turkey through Iraq, Iran, Afghanistan, India, northern Thailand and China. There are similar belts in the Americas and Japan. In India, presence of excessive fluoride in drinking water is the main cause of the disease. However, in parts of Gujarat and Uttar Pradesh, industrial fluorosis is also evident. 

17 states in India have been affected by Fluoride contaminated drinking water

As per the latest data presented in the Lok Sabha in September 2020, a total of 5,485 habitations across 17 states are affected by fluoride contamination in drinking water across India. According to the Bureau of Indian Standards, the desirable limit of fluoride is 1 part per million or 1 milligram per litre. Nearly 54% of these affected habitations are in Rajasthan (2,956). In each of the five states of Rajasthan, Bihar, Madhya Pradesh, Tamil Nadu, and Punjab, more than 200 habitations were affected and these states together account for almost 83% of the habitations affected by fluoride contamination, as of September 2020. The data is self-reported by various state governments. 

In the last 10 years, the area affected by contamination has reduced

On a positive note, there has been a decline in the number of habitations affected by fluoride in drinking water in 2020, as compared to the same in 2010 and 2015. In the year 2010, a total of 26,131 habitations were affected which dropped to 13,440 in 2015 and further down to 5,485 in 2020. The number of states affected has also decreased from 20 (excluding Telangana in 2010) to 17 during the same period. 

Many states have shown a considerable improvement during this period. Rajasthan, Madhya Pradesh, Telangana, Karnataka, Andhra Pradesh, Uttar Pradesh, Odisha, Assam, Maharashtra, Kerala, and Gujarat are among those states which have reported a steady decline over the years. Meanwhile, the states of Bihar, West Bengal, and Jharkhand have shown a mixed trend with a decline in 2020. 

Telangana, Uttarakhand, and Gujarat reported zero fluoride affected habitations in 2020

The three states of  Telangana, Gujarat & Uttarakhand which reported fluoride affected habitations in 2015 have now reported that no habitation is fluoride affected in their respective states. The 2020 data indicates zero affected habitations in these states. Cabinet Minister of Telangana, K T Rama Rao tweeted how Telangana successfully managed to eliminate Fluorosis in the state through Mission Bhagiratha, a program to provide safe and sustainable piped drinking water to every household. Telangana reported 967 fluoride affected habitations in 2015 which is now down to zero. 

On the other hand, Tamil Nadu, which had reported only 20 affected habitations in 2010 has now in 2020 reported 236 fluoride affected habitations. Even in Punjab, the number has gone up from 7 in 2010 to 257 in 2015 and 211 in 2020. In Chhattisgarh, the number of habitations went up from 18 in 2010 to 788 in 2015 and fell to 154 in 2020. Haryana and Jammu and Kashmir have also reported an increase during this period. 

Karnataka accounts for lion’s share of fluorosis cases in India 

The number of suspected cases of Fluorosis reported across states shows that Karnataka accounts for nearly 60% of the dental fluorosis cases at the community level in India. It also accounts for more 72% of the skeletal fluorosis cases reported at the community level and 77% of the dental fluorosis cases at the school level across the country. Almost 27% of the dental fluorosis cases and 14% of the skeletal fluorosis cases at community level have been reported in Rajasthan. Moreover, both these states have witnessed an improvement in number of suspected cases as compared to the 2019 data published in the National Health Profile. The data is based on diagnosis activities conducted as part of National Programme for Prevention and Control of Fluorosis (NPPCF).

National Programme for Prevention and Control of Fluorosis was launched in 2009 

In the year 2009, Government of India rolled out a national programme for the prevention and control of fluorosis (NPPCF). The plan has targeted around 200 districts across 17 states by focusing on diagnostic activities, treatment, and rehabilitation at village and district level. Under the programme, the central government extends financial and technical support to States to strengthen their healthcare systems based on the requirements submitted by the States in their Programme Implementation Plans. 

Apart from this, the program also aims to educate and create awareness about fluorosis and build capacity for prevention, diagnosis, and management of the cases. Projects at the community level such as ensuring safe drinking water have also been rolled out in different parts of the country. Provision of safe drinking water coupled with nutrition supplements helps children fight fluorosis. Effective measures under the existing program are necessary since thousands of people in the country are still susceptible to the disease. 

Featured Image: Fluorosis Cases

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