Prevention of Anemia by reduction of High Fluoride consumption - PowerPoint Presentation

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Prevention of Anemia by reduction of High Fluoride consumption - PPT Presentation

DrPradeep Saxena Additional DDG DteGeneral of Health Services Mo Health amp FWNew Delhi ID: 918134

fluoride fluorosis amp districts fluorosis fluoride districts amp nppcf diet skeletal water state editing health absorption nutrients manifestations pain

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Slide1

Prevention of Anemia by reduction of High Fluoride consumption

Dr.Pradeep

Saxena,

Additional DDG,

Dte.General

of Health Services,

M/o Health &

F.W.,New

Delhi

Slide2

ContentsBackgroundSources of FluorideClinical manifestations of Fluorosis.Changes in GI Tract due to high Fluoride.

Preventive Measures.

Steps to be followed in Ante Natal Clinic.

Role of Diet Editing .

Brief introduction about NPPCF.

Slide3

Fluorosis is a Public Health problem caused by excess intake of Fluoride mainly through drinking water or food products/drugs/ industrial pollutants over a long period of time.

It leads to health disorders like Dental

Fluorosis

, Skeletal

Fluorosis and Non-Skeletal Fluorosis. Desirable limit for Fluoride in drinking water, as per BIS standards, is 1.0 mg / Litre (1PPM). Permissible limit is 1.5 mg/ Litre (1.5PPM).Fluorosis impacts growth, development, economy and human resource development of the country

Background

Slide4

Natural - Leaching of Fluoride from geological crust into drinking water.

Food and Beverages -

Black tea, black salt,

supari

. Drugs- Some anesthetic agents, antibiotics, antidepressants, fluoride toothpaste.Pollution - Dust from fluoride containing soil, from Mining, Industrial emissions. Sources of Fluoride

Slide5

Fluorosis manifests as Dental, Skeletal and/or Non- Skeletal Fluorosis :-

Dental Fluorosis:

Chalky white teeth

Transverse yellow brown/dark brown bands Fluorosis Manifestations

Slide6

Skeletal Fluorosis : Severe pain and stiffness in neck and back bone.

Severe pain and stiffness in joints.

Severe pain and rigidity in the hip region (pelvic girdle).

Inability to squat.

Ugly gait and posture. Increased girth, thickening and density of bone by X-ray.Knock knees/ Bow legs.Fluorosis Manifestations

Slide7

Non skeletal Fluorosis Anemia and malnutrition.Gastro - intestinal problems:

Consistent abdominal pain, intermittent

diarrohea

/ constipation, blood in stool

Neurological manifestations: Nervousness & depression, tingling sensation in fingers and toes, excessive thirst and tendency to urinate frequently (Polydypsia and polyurea) Muscular manifestations: Muscle weakness & stiffness, pain in the muscle and loss of muscle power.

Slide8

Other Effects of Excess FluorideFluoride has multiple role in deranging metabolic activities, besides the well defined symptoms of

Dental Fluorosis, Skeletal Fluorosis and Non-Skeletal

Fluorosis.Its

other adverse effects on the body are:-

(i) Damage to G.I. Mucosa. (ii) Injury to RBCs. Both the above effects lead to Anaemia / Malnutrition. Consequences are maternal mortality, infant mortality, low birth weight babies.Elimination of Fluoride from the body leads to remarkable improvement.

Slide9

Showing Scanning

Electronmicrograph

(SEM) of the Intestinal lining

(Duodenal region) of a normal volunteer

Normal Mucosa

100% Absorption of Nutrients

NORMAL HUMAN

INTESTINE

F¯ <1.0 mg/l

Slide10

F¯ 1.2 mg/l

Showing Scanning

Electronmicrograph

(SEM) of the Intestinal lining

(Duodenal region) of volunteer consuming fluoride contaminated ground water

Absorption of Nutrients

20 %

DAMAGED

INTESTINE

Slide11

F¯ 3.2 mg/l

Showing Scanning

Electronmicrograph

(SEM) of the Intestinal lining

(Duodenal region) of volunteer consuming fluoride contaminated ground water

Upon withdrawal of F¯, microvilli regenerates in few days

Absorption of Nutrients

3 %

SEVERELY

DAMAGED

Slide12

Preventive Measures:-(1) SAFE DRINKING WATER(2) DIET EDITING

FOODS TO TAKE

Milk, Yoghurt, Green leafy vegetables, fruits, Lemon,

AMLA,orange, tomato, guava, papaya. FOODS NOT TO TAKE Black salt, betel nut, tobacco chewing, (3) Avoid use of Fluoride tooth paste. (4) Calcium,Magnesium,Vitamin Supplements (C,D3,E) (5) Behaviour change.

Slide13

Suggested Steps for Pregnant women in Antenatal Clinic

6 Steps

Step 1: Test

using portable HemoglobinometerStep 2: Test – Urine Fluoride level. if > 1.0 mg/LStep 3: Test Water for Fluoride

Step 4: Introduce Diet Editing + Diet counselling

Step 5: On every visit to ANC = Retrieve UFL





(iron + folic acid, hospital to supply)

Step 6: Record birth weight + other details from Labour room

Slide14

Pregnancy outcome

Diet Editing +

Diet Counselling

Iron & Folic acid supplementation Diet Counselling + Iron & Folic acid supplementation

Iron + Folic acid supplementation does not have the desired impact due to

non-absorption of nutrients ;

If excess Fluoride is eliminated , leads to better absorption of nutrients & correction of malnutrition /

undernutrition

Slide15

The Secret

Behind

Fluorosis

Prevention

Reinforce

Diet Editing

Diet Counseling

Slide16

Goal :- To Prevent and Control Fluorosis in the country. Objectives :-To collect, assess and use baseline survey data of fluoride levels from Ministry of Drinking Water and Sanitation for starting the project.

Comprehensive management of

Fluorosis

in the selected areas.

Capacity building for prevention , diagnosis and management of Fluorosis cases. National Programme for Prevention and Control of Fluorosis (NPPCF)

Slide17

Surveillance of Fluorosis in the community. Capacity Building

at District level:-

Consultant(1),

Lab.Technician

(1) & Field Investigators (3) for six months.Establishment of diagnostic facilities through labs. in the affected Districts. Management of Fluorosis cases including treatment, surgery, reconstruction & rehabilitation. Health Education for prevention and control of Fluorosis.

NPPCF: Strategy

Slide18

S.No.

State

Total districts in the State

No. of districts under

NPPCF

Names of Districts under NPPCF

Andhra Pradesh

Nellore, Guntur,

Prakasam

Ananthapur

, Kurnool, Krishna, Chittoor, Visakhapatnam, Srikakulam

Assam

Nagaon,

Kamrup

Karbi

Anglong,

Dhubri, Nalbari,

Karimganj

Bihar

Nawada

, Banka, Aurangabad, Bhagalpur, Gaya,

Jammui

, Nalanda,

Shekhpura

Kaimur

, Munger,

Rohtas

Chhattisgarh

Durg

( now shifted to

Balod

) ,

Kanker

Kondagaon

Korba

Mahasamund

Gujarat

Jamnagar,

Sabarkantha

, Vadodara,

Banaskantha

Haryana212Mehendragarh, Mewat7.J & K.221Doda8Jharkhand2413Palamu, Garhwa, Chatra, Hazaribagh, Ranchi, Pakur, Sahebgann, Ramgarh, Jamtara, Simdega, Dhanbad, Giridih, Godda

States/Districts under NPPCF

Slide19

Sl. No.

State

Total districts in the State

No. of districts under

NPPCF

Names of Districts under NPPCF

Karnataka

Bellary, Mysore,

Chikballapur

Koppal

Davangere

Tumkur

Bagalkote

, Bengaluru (U), Bengaluru (R),

Bijapur

, Raichur,

Chitradurga,Gadag,Gulbarga, Hassan, Kolar, Mandya

, Ramanagara

, Shimoga

Kerala

Palakkad,

Alapuzha

Madhya Pradesh

Ujjain,Chindwada

, Mandla, Dhar,

Seoni

Betul

Jhabua

Raigarh

Sehore

Alirajpur,Dindori

Khargoan

Raisen

Shajapur

Ratlam

Maharashtra

Nanded, Chandrapur, Latur,

Washim

Yavatmal. Beed, Nagpur13.Rajasthan3330Nagaur, Ajmer, Bhilwara,Churu (Ratangarh) Dausa, Dungarpur, Rajsamand, Tonk, Bikaner, Jalore, Jaisalmer, Jodhpur, Jaipur, Pali, Sikar Udaipur, Swaimadhopur, Banswara, Karauli, Chittaurgarh, Ganganagar, Jhalawar, Jhunjhunu, Barmer, Alwar, Bharatpur, Kota, Sirohi, Bundi, Pratapgarh

Slide20

S.No.

State

Total districts in the State

No. of districts under

NPPCF

Names of Districts under NPPCF

Odisha

Nayagarh

Angul

Nuapada

Punjab