An Integrated Approach to Address Endemic Fluorosis in Jharkhand, India

Luke H. MacDonald, Gopal Pathak, Burton Singer, Peter R. Jaffé

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DOI: 10.4236/jwarp.2011.37056                

Abstract

This paper presents the grounds for an integrated approach to address endemic fluorosis in Jharkhand, India, an approach that encompasses health monitoring, community-based water systems management, and locally synthesized hydroxyapatite, a sustainable water treatment technology. The results of this study, focusing on kinetics and sorption isotherms, demonstrate that an inexpensive, locally synthesized hydroxyapatite effectively removes fluoride from water and that the Dean Index, a measure of dental fluorosis, of school children provides a sensitive, rapid biometric to track the success of a fluoride water treatment intervention. Previous efforts to manage the fluoride problem in Jharkhand were unsuccessful, largely due to lack of accountability and inadequate community involvement. This paper explores how integrating the production of a locally synthesized hydroxyapatite with community health monitoring via the Dean Index fits into a management strategy with robust accountability mechanisms and community participation that, as historical examples suggest, is likely to succeed in Jharkhand.

Keywords

Community Participation, Dean Index, Fluoride, Fluorosis, Hydroxyapatite, Rural Water Supply

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	United Nations Human Development Programme, “Be- yond Scarcity: Power, Poverty and the Global Water Crisis,” Human Development Report, United Nations Human Development Programme, Washington, 2006, p. 440.
[2]	Department of Economic and Social Affairs, “World Urbanization Prospects: The 2007 Revision,” Department of Economic and Social Affairs, New York, 2008.
[3]	S. Ayoob and A. K. Gupta, “Fluoride in Drinking Water: A Review on the Status and Stress Effects,” Critical Reviews in Environmental Science and Technology, Vol. 36, No. 6, 2006, pp. 433-487. doi:10.1080/10643380600678112
[4]	L.S. Yang, et al., “Developing Environmental Health Indicators as Policy Tools for Endemic Fluorosis Management in the People’s Republic of China,” Environmental Geochemistry and Health, Vol. 25, No. 3, 2003, pp. 281-295. doi:10.1023/A:1024543819240
[5]	R. Chandrajith, et al., “Fluoride in Ceylon Tea and Its Implications to Dental Health,” Environmental Geochemistry and Health, Vol. 29, No. 5, 2007, pp. 429-434. doi:10.1007/s10653-007-9087-z
[6]	M. L. Gomez, M. T. Blarasin and D. E. Martinez, “Arsenic and Fluoride in a Loess Aquifer in the Central Area of Argentina,” Environmental Geology, Vol. 57, No. 1, 2009, pp. 143-155. doi:10.1007/s00254-008-1290-4
[7]	G. Pathak, M. S. Nathawat and U. Jha, “A Comprehensive Survey on the Water Quality of Vishrampur, Chainpur, Pandu & Daltonganj Block of Palamau District & Bhaw Nathpur, Ranka, Bhandaria, Kharanndhi, Nagar, Maghiav of Garwa District with Focus on Fluoride,” United Nations Children’s Fund, Ranchi, 2005.
[8]	R. Tekle-Haimanot, et al., “The Geographic Distribution of Fluoride in Surface and Groundwater in Ethiopia with an Emphasis on the Rift Valley,” Science of the Total Environment, Vol. 367, No. 1, 2006, pp. 182-190. doi:10.1016/j.scitotenv.2005.11.003
[9]	B. C. Bates, et al., “Climate Change and Water,” Technical Paper of the Intergovernmental Panel on Climate Change, IPCC Secretariat, Geneva. 2008, p. 210.
[10]	A. L. Khandare, R. Harikumar and B. Sivakumar, “Severe Bone Deformities in Young Children from Vitamin D Deficiency and Fluorosis in Bihar-India,” Calcified Tissue International, Vol. 76, No. 6, 2005, pp. 412-418. doi:10.1007/s00223-005-0233-2
[11]	M. T. Alarcon-Herrera, et al., “Well Water Fluoride, Dental Fluorosis, and Bone Fractures in the Guadiana Valley of Mexico,” Fluoride, Vol. 34, No. 2, 2001, pp. 139-149.
[12]	E. B. Bassin, et al., “Age-Specific Fluoride Exposure in Drinking Water and Osteosarcoma (United States),” Can- cer Causes & Control, Vol. 17, No. 4, 2006, pp. 421-428. doi:10.1007/s10552-005-0500-6
[13]	J. A. Varner, et al., “Chronic Administration of AlumiNum-Fluoride or Sodium-Fluoride to Rats in Drinking Water: Alterations in Neuronal and Cerebrovascular Integrity,” Brain Research, Vol. 784, No. 1-2, 1998, pp. 284-298. doi:10.1016/S0006-8993(97)01336-X
[14]	X.Z. Xiong, et al., “Dose-Effect Relationship between Drinking Water Fluoride Levels and Damage to Liver and kidney Functions in Children,” Environmental Research, Vol. 103, No. 1, 2007, pp. 112-116. doi:10.1016/j.envres.2006.05.008
[15]	B. K. Shrivastava and A. Vani, “Comparative Study of Defluoridation Technologies in India,” Asian Journal of Experimental Sciences, Vol. 23, No. 1, 2009, pp. 269- 274.
[16]	K. Ravindra and V. K. Garg, “Hydro-Chemical Survey of Groundwater of Hisar City and Assessment of Defluoridation Methods Used in India,” Environmental Monitoring and Assessment, Vol. 132, No. 1-3, 2007, pp. 33-43. doi:10.1007/s10661-006-9500-6
[17]	X. Fan, D. J. Parker and M. D. Smith, “Adsorption Kinetics of Fluoride on Low Cost Materials,” Water Research, Vol. 37, No. 20, 2003, pp. 4929-4937. doi:10.1016/j.watres.2003.08.014
[18]	WHO, “Guidelines for Drinking Water Quality,” World Health Organization, Geneva, 2006.
[19]	R. K. Daw, “Experiences with Domestic Defluoridation in India,” Proceeedings of the 30th WEDC International Conference on People-Centered Approaches to Water and Environmental Sanitation, Vientiane, 25-28 October 2004, pp. 467-473.
[20]	S. Ghorai and K. K. Pant, “Equilibrium, Kinetics and Breakthrough Studies for Adsorption of Fluoride on Activated Alumina,” Separation and Purification Technology, Vol. 42, No. 3, 2005, pp. 265-271. doi:10.1016/j.seppur.2004.09.001
[21]	T. F. Lin and J. K. Wu, “Adsorption of Arsenite and Arsenate within Activated Alumina Grains: Equilibrium and Kinetics,” Water Research, Vol. 35, No. 8, 2001, pp. 2049-2057. doi:10.1016/S0043-1354(00)00467-X
[22]	T. Aoba, “The Effect of Fluoride on Apatite Structure and Growth,” Critical Reviews in Oral Biology & Medicine, Vol. 8, No. 2, 1997, pp. 136-153. doi:10.1177/10454411970080020301
[23]	C. S. Sundaram, N. Viswanathan and S. Meenakshi, “De- fluoridation Chemistry of Synthetic Hydroxyapatite at nano Scale: Equilibrium and Kinetic Studies,” Journal of Hazardous Materials, Vol. 155, No. 1-2, 2008, pp. 206- 215. doi:10.1016/j.jhazmat.2007.11.048
[24]	B. H. Singer and M. C. de Castro, “Bridges to Sustainable Tropical Health,” Proceedings of the National Academy of Sciences of the United States of America, Vol. 104, No. 41, 2007, pp. 16038-16043. doi:10.1073/pnas.0700900104
[25]	J. Cao, et al., “Brick Tea Fluoride as a Main Source of Adult Fluorosis,” Food and Chemical Toxicology, Vol. 41, No. 4, 2003, pp. 535-542. doi:10.1016/S0278-6915(02)00285-5
[26]	S. Godfrey, et al., “Health-Based Risk Targets for Fluorosis in Tribal Children of Rural Madhya Pradesh, India,” 32nd WEDC International Conference: Sustainable Development of Water Resources, Water Supply and Environmental Sanitation, Colombo, 2006.
[27]	B. Sen, R. Khanna and K. Kapoor, “Jharkhand: Addressing the Challenges of Inclusive Development,” Report No. 36437-IN, The World Bank, 2007.
[28]	A. K. Singh, et al., “Major Ion Chemistry, Weathering Processes and Water Quality Assessment in Upper Catchment of Damodar River Basin, India,” Environmental Geology, Vol. 54, No. 4, 2008, pp. 745-758. doi:10.1007/s00254-007-0860-1
[29]	B. Das, et al., “Fluoride and Other Inorganic Constituents in Groundwater of Guwahati, Assam, India,” Current Science, Vol. 85, No. 5, 2003, pp. 657-661.
[30]	C. Verwilghen, et al., “Preparation of High Specific Surface Area Hydroxyapatite for Environmental Applications,” Journal of Materials Science, Vol. 42, No. 15, 2007, pp. 6062-6066. doi:10.1007/s10853-006-1160-y
[31]	D. C. Sheng and D. W. Smith, “Analytic Solutions to the Advective Contaminant Transport Equation with Non- Linear Sorption,” International Journal for Numerical and Analytical Methods in Geomechanics, Vol. 23, No. 9, 1999, pp. 853-879. doi:10.1002/(SICI)1096-9853(19990810)23:9<853::AID-NAG993>3.0.CO;2-Q
[32]	R. G. Rozier, “Epidemiologic Indices for Measuring the Clinical Manifestations of Dental Fluorosis: Overview and Critique,” Advances in Dental Research, Vol. 8, No. 1, 1994, pp. 39-55.
[33]	S. Sarkar, et al., “Community-Based Wellhead Arsenic Removal Units in Remote Villages of West Bengal, India,” In: S. Ahuja, Ed., Arsenic Contamination of Ground Water: Mechanism, Analysis, and Remediation, Wiley, Hoboken, 2008, pp. 305-327. doi:10.1002/9780470371046.ch13
[34]	A. Akash, “Process for Making Ceramic, Mineral, and Metal Beads from Powder,” U.S. Patent, 2009, p. 7.
[35]	E. Michel-Crosato, M. G. Biazevic and E. Crosato, “Relationship between Dental Fluorosis and Quality of Life: A Population Based Study,” Brazilian Oral Research, Vol. 19, No. 2, 2005, pp. 150-155. doi:10.1590/S1806-83242005000200014
[36]	B. Shomar, et al., “Fluorides in Groundwater, Soil and Infused Black Tea and the Occurrence of Dental Fluorosis among School Children of the Gaza Strip,” Journal of Water and Health, Vol. 2, No. 1, 2004, pp. 23-35.
[37]	C. Chairat, et al., “Fluorapatite Surface Composition in Aqueous Solution Deduced from Potentiometric, Electrokinetic, and Solubility Measurements, and Spectroscopic Observations,” Geochimica et Cosmochimica Acta, Vol. 71, No. 24, 2007, pp. 5888-5900. doi:10.1016/j.gca.2007.09.026
[38]	C. Chairat, et al., “Kinetics and Mechanism of Natural Fluorapatite Dissolution at 25 Degrees C and pH from 3 to 12,” Geochimica et Cosmochimica Acta, Vol. 71, No. 24, 2007, pp. 5901-5912. doi:10.1016/j.gca.2007.08.031
[39]	B. D. Turner, P. Binning and S. L. S. Stipp, “Fluoride Removal by Calcite: Evidence for Fluorite Precipitation and Surface Adsorption,” Environmental Science & Te- chnology, Vol. 39, No. 24, 2005, pp. 9561-9568. doi:10.1021/es0505090
[40]	R. A. Yokel, “The Toxicology of Aluminum in the Brain: A Review,” Neurotoxicology, Vol. 21, No. 5, 2000, pp. 813-828.
[41]	C. Exley, “Aluminum and Alzheimer’s Disease,” The Journal of Alzheimer’s Disease, Vol. 3, No. 6, 2001, pp. 551-552.
[42]	E. T. Jansson, “Aluminum Exposure and Alzheimer’s Disease,” The Journal of Alzheimer’s Disease, Vol. 3, No. 6, 2001, pp. 541-549.
[43]	Anonymous, “President Rule Follows Major Political Crisis in Jharkhand,” 2009. http://news.outlookindia.com/item.aspx?652106
[44]	Anonymous, “Maoists Release Train with 700 Passengers in East Indian State,” PTI News Agency, New Delhi, 2009.
[45]	S. Sarkar, et al., “Arsenic Removal from Groundwater and Its Safe Containment in a Rural Environment: Validation of a Sustainable Approach,” Environmental Scie- nce & Technology, Vol. 42, No. 12, 2008, pp. 4268-4273.
[46]	State Health Mission, “Programme Implementation Plan 2006-2012,” 2008. http://www.mp.gov.in/health/nrhm/pip-nrhm.pdf
[47]	A. Srivastava, et al., “Identification of Malaria Hot Spots for Focused Intervention in Tribal State of India: A GIS Based Approach,” International Journal of Health Geographics, Vol. 8, No. 30, 2009. doi:10.1186/1476-072X-8-30
[48]	S. Ramani, et al., “Geographic Information Systems and Genotyping in Identification of Rotavirus G12 Infections in Residents of an Urban Slum with SubSequent Detection in Hospitalized Children: EmerGence of G12 Genotype in South India,” Journal of Clinical Microbiology, Vol. 45, No. 2, 2007, pp. 432-437. doi:10.1128/JCM.01710-06