National Health Profile 2019 says 19 of its 30 districts are affected with fluorosis
Karnataka has high incidence of fluorosis in more than half of its districts, according to the National Health Profile released in October 2019.
Out of the state’s 30 districts, 19 are under National Programme for Prevention and Control of Fluorosis for the period 2018-2019. The districts are: Ballari, Mysuru, Chikkballapura, Koppal, Davanagere, Tumakuru, Bagalkot, Bengaluru Urban, Bengaluru Rural, Vijayapura, Raichur, Chitradurga, Gadag, Kalaburagi, Hassan, Kolar, Mandya, Ramanagara and Shimoga. The state has the second highest number of districts, both in terms of number and percentage, after Rajasthan under the programme.
Other states under the programme include Andhra Pradesh, Telangana, Chhattisgarh, Punjab, and Bengal.
The report states that out of the 13,17,088 cases examined, 5,49,988 were suspected to be of dental fluorosis; 1,97,563 were suspected to be of skeletal fluorosis.
Dr Roopashree S, a fluorosis consultant in Bengaluru Urban district, informed The Observer: “Karnataka is one of the endemic states for fluorosis. The rural drinking water supply ministry checks water for fluoride content. If fluoride is more than 1 ppm (parts per million), then it can cause fluorosis. Sometimes, fluoride-rich foods like junk food can aggravate the situation.”
Asked about the measures being taken, she said: “In fluoride-rich belts, we ask people to take more Vitamin C and D. In each district, there is a district fluorosis consultant and district lab technician in the district fluorosis cell. Water samples are checked in labs, and the suspects screened for urine fluoride. Every month, school and community surveys are undertaken.”
ASHA workers’ help is also taken to promote awareness. Tests such as Coin test, chin test and stretch tests are given to confirm the cases. PHCs and local officials are informed. Calcium tablets are given to the patients for three months. After three months, there is a follow-up by checking urine samples.
Dr Kalavathi, a health officer in BBMP, said: “For now, there is no separate fluorosis officer in BBMP. In Bengaluru, fluorosis prevalence is not there as there is more piped water supply rather than groundwater usage.”
Data from NHP- 2019 show that 156 districts across 19 states are under the National Programme for Prevention and control of Fluorosis (NPPCF) up to 2018-2019.
Dr Edmond Fernandes, CEO of the Center for Health and Development, Mangaluru said: “Dental symptoms appear first, starting with staining and pitting. In severe cases, (there is) damage of enamel. Skeletal fluorosis leads to fluoride accumulation, causing pain in joints and bones. In severe cases, there is calcification of ligaments, resulting in severe pain and impairment of movement.”
There is no established treatment for fluorosis. “Although dental fluorosis can be concealed with cosmetic procedures such as tooth whitening and bonding, damage to enamel is permanent. Skeletal fluorosis reversal depends on extent of damage. Stopping fluoride intake can reduce accumulation in bone and enhance elimination by urine.”
About the situation in Bengaluru, Dr Fernandes said: “Bellandur is one of the worst-hit areas. Any area with fluoride contamination carries a higher risk of fluorosis. Treatments for fluorosis are usually cosmetic and expensive, therefore not affordable to many.”
The Times of India had in March 2019 reported that “Data released by the central ministry of drinking water and sanitation show Karnataka has 365 fluoride-affected habitations, the most in South India and the fourth highest in the country.” The paper on November 2 reported that nearly 4 lakh children in Karnataka’s schools suffered from dental fluorosis.
NPPCF, a health initiative during 11th Five-Year Plan, is being expanded in a phased manner, according to the National Health Mission website. It is a part of other non-communicable diseases under National Health Mission.
Fluorosis is caused by excessive intake of fluoride, mostly through drinking water. There are three types of fluorosis: dental, skeletal and non-skeletal. The effects include abdominal pain, excessive saliva, nausea and vomiting, seizures and muscle spasms, according to the WHO website.
National Health Profile is an annual publication of Central Bureau of Health Intelligence. According to its website, “the purpose is to provide relevant information for planning and decision-making on an informed basis to planners, policymakers, health administrators, research workers and others engaged in raising the health and socio-economic status of the community.”