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| Tuesday, 28 September 2004 |
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Importance of a national programme to prevent Fluorosis in the Dry Zone by J. P. Padmasiri National Water Supply and Drainage Board The 4th International workshop of the prevention of fluorosis and defluoridation of water was attended by 100 technocrats from 10 countries in Colombo, from 2-6 March.
Fluoride is a natural environmental hazard in drinking water and excess Fluoride causes brown stained teeth in young children and skeletal fluorosis in adults. Recent studies carried out in Sri Lanka show that 7 out of 22 districts have the Fluorosis in endemic proportion. The prevalence of dental fluorosis in these districts is 55-71 percent. In these studies it is revealed that more than 50 percent of drinking water wells have fluoride levels exceeding 1.0 mg/1 which is not suitable for young children of age group 1-7 years. In some villages this figure exceeds 70 percent and some of the wells have fluoride content of 6-8 mg/1. According to medical sources there is ample evidence to show 55 to 77 percent among children in the age group of 5 to 16 years are victims of endemic Fluorosis and when the dental Fluorosis occurs there is an uneaesthetic stain on the teeth which at time intensifies to a brown or blackish stain causing embarrassment to the young in general mainly in young girls. In some villages, Fluoride content of some of the wells is 4-8 mg/1. If this water is taken continuously without checking the Fluoride levels it would in inevitably lead to skeletal fluorosis at a later stage beyond 40 years. This will cause abnormal posture deformities and other physical disabilities. It is necessary to state here that no curative measures are yet found in the medical repertoire. Several such cases of skeletal fluorosis were reported from areas such as Mahaelagamuwa and Kitulhitiyawa in Kekirawa, Jayanthipura, Medirigiriya in Polonnaruwa, Andarawewa in Nochchiyagama, Thambuttegama in Galgamuwa. The number of persons susceptible to the excess fluoride in drinking water can be approximated as follows according to the relevant districts (table 1). Number of persons at risk District Number of persons at rick Anuradhapura 95000 The proposal made here on defluoridation is affordable low cost technology developed using facilities available at the National Water Supply and Drainage Board. The filter medium used are the broken pieces of freshly burnt bricks available in the locality thereby falling into the category of appropriate technology. A simple household defluoridator is designed as a column, provided with a funnel attached to a down pipe arrangement, in order to allow for up flow filtration of Fluoride water through a medium of locally available brick pieces. The unit is made of PVC pipes of 1 m length and 20 cm diameter. The cost is Rs. 2000. Figure I show the diagram of the domestic deluoridator fabricated out of PVC pipes. The newly designed household defluoridator is 100 cm in height, 20 cm in diameter and is fabricated using PVC pipe. The inner pipe is 2 cm in diameter with a circular perforated plate fixed at 5 cm from the base of the filter. The outlet is fixed 5 cm below the top of the filter. The filter unit is packed with broken pieces of freshly burnt bricks of sizes 8-16 mm up to a height of 75 cm. The Fluoride rich water is fed through the inlet pipe. At the beginning the filter unit is filled with Fluoride rich water and kept for at least 12 hours to obtain an equilibrium. Thereafter when fresh Fluoride rich water is fed through the inlet pipe an equal volume of defluoridated water comes out automatically through the outlet pipe. The efficiency of the said defluoridator was further tested by anlaysing the fluoride rich water that was fed in and the defluoridated water that was collected from the outlet pipe at various time intervals. The filter unit is * Simple in design * Easy for operation by villagers * Maintenance not required at all * Change of filter media is easy. * Availability of filter media in the locality. * Easy access to burnt bricks * Frequency of changing filter medium average 03 months for a fluoride content of 2.5 mg/1. * Able to reduce fluoride content of 4.0 mg/1 to 0.5 mg/1. If the children of age group 1-5 years are provided with this defluoridators backed up by awareness and monitoring programme in fluoride rich areas with the assistance from Health Department, the dental Fluorosis problem could be alleviated in Sri Lanka. The strategies worked out in the extension programme of the defluoridation at the village level could be listed as follows: * Identifying the fluoride rich villages by carrying out awareness programme in schools. * Public health officer approached to identify families with children less than 5 years in the village. * Advising community not to give fluoridated tooth paste specially to children of age group 2-5 years in these areas. * Work with active NGOs, active public health officials, farmers associations, death donation societies, volunteer development womens groups. The strategies worked out in this programme by National Water Supply and Drainage Board is to convince the affected community that the fluoride problem is serious. The strategy consists of community education and orientation programmes. The programme is intended to create an awareness among public on safe drinking water with special reference to fluoride problems in the areas. As a result of awareness programmes more and more families in affected villages will be covered to accept the idea of using defluoridation water. It can be stated that the new generation living in these areas with excess fluoride in drinking water will not fear to smile to their hearts content in future. In the previous studies the selection criteria carried out are as follows. The first 2000 units were distributed free of charge to beneficiaries irrespective of socio economic levels. Another set of 1,000 units was distributed by getting a contribution of Rs.300 per unit. Evaluation and results of these are available and are published in the proceedings of the workshops. However in the 2nd stage, the poorest of the poor got eliminated. In these studies it was revealed that: i. Motivating of the user is a very important factor ii. In the second set poorest of the poor was eliminated as they were unable to pay Rs. 300. iii. NGOs in these areas are poorly funded hence it is difficult to get them involved in monitoring work. iv. Fluoride field test kits are not available in health units. The following are proposed to overcome these problems by i. Intensive training of the health care workers with the intention of motivating the user through them. ii. To study the frequency of visits to motivate the users. iii. To work out a strategy to pay in instalments for the poorest of the poor. iv. To work out a strategy of distributing the units in these remote villages. v. To work out a payment system for monitoring work. In conclusion it can be stated that it is essential to carry out awareness programmes and follow up services in affected villages to achieve sustainability. The joint efforts of the National Water Supply and Drainage Board, Department of Health, Department of Education, Non Government Organizations and the community leaders in the affected areas are needed to eradicate Fluorosis in Sri Lanka. (the writer is the regional Chemist, Kandy, of the National Water Supply and Drainage Board. The views expressed in this article are personal to him.) |
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Produced by Lake House |
The representatives were from India, China, Thailand, South Africa,
Japan, Denmark, Tanzania, Korea and Sri Lanka. The intention of this
article is to highlight the importance of a national programme to prevent
fluorosis in Sri Lanka.
