�

�

140

�����������

�

�

�

140

Chapter 5

Fluorosis in Nalgonda district

The fluorides, most active elements of halogen group were widely distributed

in nature and it has been estimated that the element fluorine in the form of

fluoride constitutes 0.32% of the earth’s crust (WHO, 1984). The fluoride belts

on land exists from Syria through Jordan, Egypt, Libya, Algeria, Sudan and

Kenya, from Iraq, Iran, Afghanistan, India, northern Thailand and China, as

well as in America and Japan (WHO, 2001). Muller and Gudson (1937) are

the first persons to report the incidence of a certain disease in sheep and

found that it was due to excess consumption of fluorine and named it as

Fluorosis.

As far as the human intake of fluoride is concerned, the main sources are

groundwater, food and beverages including black tea, black salt, tinned foods

and juices, drugs and cosmetics, pollutants coming from industrial emissions,

coal burning, fertilizers, pesticides and dusts of fluoride containing soils

(Kumar, 2008). The main source is groundwater. High concentration of

fluorides in groundwater is due to natural or anthropogenic activities.

Geological nature of the area forms a natural source for the fluorides. Fluoride

minerals such as fluorspar, fluorite, cryolyte, fluoroapatite, biotite and

hornblende in the rocks when weathered entered into the groundwater

through infiltration of rain and increases the concentration of fluorine (WHO,

2003). In most of the regions, fluoride in groundwater is added by the host

�

�

141

rocks which are naturally rich in fluoride. Because of the interaction between

rock and water, long residence time and evapotranspiration, the concentration

of fluoride increases in that particular area (Brindha and Elango, 2011). Apart

from that, fluorine also enters into the groundwater due to human activities

such as through fertilizers in the irrigated lands, combustion of coal and

improper disposal of fly ash (Brindha and Elango, 2011). On an average a

person may obtain about one milligram of fluorine daily from drinking water

which contains one ppm of fluorine. In addition, humans consume 0.25 to 0.35

mg of fluorine through foods like sea fish, cheese and tea.

More than 260 million people of the world, mostly from tropical countries, drink

water contaminated with more than1.0 mg/l fluoride (Teckle et al., 1995). The

fluoride concentration is more than 1.5 mg/l in about 14 countries in Africa,

eight in Asia, and Middle East and six in Americas (Frenckens, 1990). Grantic

rocks are the rich sources of fluorides around 500 and 1400 mg/kg (Koritinig

1978; Krauskopf and Bird, 1995).

Fluoride consumption in permissible limits prevents dental caries (WHO,

2003). Fluoride is essential for the formation of caries resistant dental enamel

and for the normal mineralization of bone. Several investigations however

indicated that long term ingestion of fluoride through drinking water cause

problems on skeletal tissues namely bones and teeth (Somboon and

Chinpitak, 2005). Thus, fluoride is often called as ‘double edged weapon’ as

its optimal and judicious use provides maximum protection to the teeth from

�

�

142

the dental caries while its excessive use may lead to the incidence of dental

and skeletal fluorosis (Devaranavadagi et al., 2007).

When a person drinks water with an excess of fluorine content, fluorine ion is

quickly spreads to the body and deposited in the body due to its high reactivity

with the calcium of teeth and bones. Further, it forms fluoropatite crystals and

leaves unbound calcium in the same tissue, which gets calcified. As a

consequence tissues and bones become stiff. Ultimately the bones get

twisted and weakened (Tiwari and Dubey, 2009). Even blood circulation gets

affected when excess fluorine exists in the blood vessels. Excess intake of

fluorine leads to diseases namely fluorosis, Paraplegia, arthritis and Genu

Valgum (Yiamouyiannis, 1993; Waldbott, 1998; Maurer et al., 1990; Cohn,

1992; Zhi Jl, 1995). Some studies also indicated that it affects intelligence of

the people, especially children who are mostly affected by early fluoride toxity

(Waldbott, 1998; Maurer et al., 1990; Cohn, 1992; Zhi Jl, 1995). The chronic

toxicity of these fluorides in human beings manifests prominently on dental

and skeletal tissues. Consumption of fluorine (less than 0.60) causes dental

caries, while intake of high quantities of fluorine (more than 1.20 mg/l) results

in dental and skeletal fluorosis (ISI Report, 1983). According to WHO (1996)

skeletal fluorosis is observed when drinking water comprises with 3 to 6 ppm

of fluorine and crippling skeletal fluorosis occur when fluorine content is above

10 ppm. Thus, the safe limit of fluorine content is between 0.60 and 1.20 mg/l

in drinking water, while more than 1.5 mg/l causes tooth mottling and further

increase in the consumption may be fatal (Kishore and Hanumantha Rao,

�

�

143

2010). According to WHO (1999, 2004) standards the upper limit of fluoride

concentration in drinking water is 1.5 mg/l. As per the Bureau of Indian

Standards (BIS), the safe limit is between 1.0 and 1.5 mg/l (BIS, 1991).

In epidemiological surveys mottling of teeth has been used as an index of

endemicity of Fluorosis in a region. The symptoms of dental Fluorosis include

loss of luster and shine of the dental enamel. Teeth are characterized by

chalky white patches separated by brown staining. The white tooth turns

yellow, brown to black. Discoloration is not uniform, it appears either as spots

or horizontal streaks (Chari and Naidu, 1998). Even the teeth may have a

corroded appearance in severe cases. As a final stage, the teeth get dropped.

Mottling is best seen on the incisors of the upper jaw. Dental Fluorosis is

easily identifiable.

In the case of skeletal fluorosis, when excessive fluoride is deposited in the

skeleton which is more in cancellous bone than cortical bone, it leads to

severe pain, rigidity and restricted movements of cervical and lumbar spine,

knee and pelvic joints and shoulder joints (Tiwari and Dubey, 2009). The

symptoms of this disease also include abnormal growth of bones at the joints,

inactive movements, and respiratory problems. The skeletal Fluorosis is

responsible for disorderly development and the twisting of skeletal bones.

Thus, in skeletal fluorosis the entire bony skeleton, particularly spinal column

of human being, will be affected which is a cripping disease (Park and Park,

1972). Other forms of this disease are formation of new bone in the form of

�

�

144

exostosis, calcification of tendons and ligaments as well as interosseous

membranes. In addition, a new syndrome characterized by Genu valgum

(Knock-knee syndrome) and osteoporosis of the lower limbs has been

reported among subjects suffering from fluorosis in some parts of India

(Krishnamachari and Krishnamswamy, 1973). It was further observed that

genu valgum was seen among people whose staple diet was sorghum than in

those whose staple food was rice.

Fluorosis problem is very severe in India as well as in China (Ayoob and

Gupta, 2006). First case of fluorosis in humans in India was reported by Short

et al. (1937) from Prakasam district of Andhra Pradesh. Later, several reports

indicated that more and more States are under the impact of Fluorosis

(Chakraborti et al., 2000). Susheela and Majumdar (1992) reported that

about 62 million people are suffering from various levels of Fluorosis, of which

6 million are children below the age of 14 years; they suffer from dental,

skeletal and/or non-skeletal Fluorosis. (Andezhath et al., 1999). India has 12

million tons of fluoride deposits out of 85 million tons of world deposits

(Chandrasekhar et al., 2012; Teotia and Teotia, 1994). In India, the fluoride

level in water ranges between 2 and 29 ppm (Tiwari and Dubey, 2009). As a

result, endemic Fluorosis became a public health problem, which reached

alarming proportions affecting at least 18 states out of 28 States and 7 Union

Territories. (Susheela, 1999). Among the States, it is a severe problem in

Andhra Pradesh (Jamode et al., 2005), Tamil Nadu (Shivakumar, 1977),

Rajasthan (Guptha, 1986) and Madhya Pradesh (Shukla, 1995). Almost 50-

�

�

145

100% of the districts of Andhra Pradesh, Tamil Nadu, Uttar Pradesh, Gujarat,

Rajasthan states are affected besides 30-50% districts of Madhya Pradesh,

Bihar, Haryana, Karnataka, Maharashtra, Punjab, Odisha, and West Bengal.

Less than 30% districts of J & K, Delhi, and Kerala are affected. People in

several districts in Rajasthan are consuming water with fluoride

concentrations of up to 24 mg/l. Fluorosis continues to be an endemic

problem. More and more areas are being discovered regularly that are

affected by Fluorosis in different parts of the country. In healthy young or

adults, about 50 percent of absorbed fluoride is retained and 50 percent is

excreted. However, children in the age group up to 12 years are more prone

to fluorosis because as much as 80 percent of fluoride will be retained in their

bodies (Eksterand et al., 1994a; 1994b). Investigations carried out by

Chinese scientists indicated that the human placenta does not prevent

passage of fluoride from preganant mother’s bloodstream to the fetus. As a

consequence, even fetuses can be harmed by the ingested fluoride. Fetal

brain is one of the organs which will be effected by fluoride (Michael, 2012).

In Andhra Pradesh, 16 out of 23 districts are prone to Fluorosis. Those

districts are Cuddapah, Hyderabad, Krishna, Medak, Warangal, Anantapur,

Karimnagar, Kurnool, Nalgonda, Prakasam, Chittoor, Guntur, Khammam,

Mahaboobnagar, Nellore and Rangareddy

(www.fluorideandfluorosis/districts.html). The fluoride levels in these districts

range from 2 to 7 mg/l. People are affected by various physical deformities

such as genu varum, genu valgum, antero posterior bowing of tibia, kyphosis,

�

�

146

exostosis, etc., and muscular tenderness, neck rigidity, stiffness of joints and

mental retardness (Narayana et al., 2004). Of all the districts of AP, Nalgonda

is the highly fluoride endemic district. It is one of the poorest and most

drought-prone districts of Andhra Pradesh in southern India.

Nalgonda district was formerly known as Neelagiri (Blue Hill). The district is

located in the southern part of Telangana region of Andhra Pradesh bound by

16° 25´ and 17° 50´ N latitudes and 78° 40´ and 80° 05´ E longitudes (Fig.

5.1). The District is bordered by Medak and Warangal districts in the North,

Guntur and Mahaboobnagar districts in the South, Khammam and Krishna

districts in the East and Mahabubnagar and Rangareddy district in the West.

Administratively, the district is divided into 4 revenue divisions (Nalgonda,

Bhuvanagiri, Suryapet and Miryalaguda) and 59 mandals, 1155 revenue

villages and 3359 habitations.

The district covers an area of about 14,240 km2 accounting for 5.18% of the

total area of Andhra Pradesh. Out of the total area of the district, 5.6% of the

area is under forests, 7.8% is put to non-agricultural uses, and 4.3% is under

pasture and 21.2% under current fallows. As per the 2001 census, the total

population of the district is 3.45 million with a density of 242 persons per km2.

Nalgonda district is drained by the Krishna, Musi, Aleru, Dindi, Paleru and

Peddavagu rivers. The Krishna River enters at Yeleshwaram and traverses a

distance of about 85 kilometers in the district. The soils of the district are

�

�

147

�

Fig. 5.1 Location map of Nalgonda district

�

�

�

147

mainly 'red earths' comprising loamy sands, sandy loams and sandy clay

loams. The soils in some parts of Nalgonda district are sandy and consist of

granite associated with fluorite (Siddique, 1955).

The district is under hot and dry climatic conditions throughout the year except

during the Southwest monsoon season. May is the hottest month with mean

maximum temperature of about 40°C and the mean mini mum of about 28°C.

December is the coldest month with the mean maximum and minimum

temperatures being 35°C and 20°C, respectively. The average rainfall in the

district is around 772 mm, about 71% of which is received during the

Southwest monsoon season (i.e., June to September). September is the

rainiest month. Nalgonda district is under high frequency of droughts during

the past 15 years (Kareemulla et al., 2008).

The existence of fluoride in Nalgonda district is mostly attributed to the nature

of geological structure of the aquifer and the depth from which water is drawn

(Brinda et al., 2010). The fluoride content in granitic rocks of Nalgonda varies

between 325 to 3200 ppm. In the soils, it varies between 28 and 1780 ppm

and in the groundwater it ranges between 0.4 and 20 ppm. In some parts of

the district, the groundwater has 10 to 15 parts per million (ppm) of fluoride in

contrast to a maximum permitted level of just 1.5 ppm (BBC, 2003). Some

studies indicated that the fluorine content in the groundwater in Nalgonda

district ranged between 0.1 to 8.8 mg/l, and excess concentration is due to

accelerated weathering of rocks and evaporation (Brindha et al., 2011).

�

�

148

However, the excess fluoride in the groundwater turned toxic especially in the

rural areas of the district. Earlier studies indicated that 48 out of 59 revenue

mandals have fluoride affected villages in the district. As per a 1992 survey,

about 1122 habitations in the district were fluoride affected. Around 885

villages and 600,000 people are severely affected and 10,000 people are

totally crippled (en.wikipedia.org/wiki/Nalgonda district). According to the

records of District Medical and Health office of Nalgonda district, the total

number of fluorosis cases in the district were 11,169, out of which 1,605 were

of skeletal fluorosis and 9,564 were of dental fluorosis.

Table 5.1 Number of habitations & average amount of fluoride in the groundwater in different mandals of Nalgonda district

S# Name of the Mandal

No.of Habitations

Population (2001Census)

Average Fluoride content ( in p.p.m)

1 B.Ramaram 30 34114 2.89

2 M Turkapalle 20 32142 2.93

3 Rajapet 12 40612 2.07

4 Yadagirigutta 28 52010 2.50

5 Alair 14 50242 2.40

6 Gundala 8 36279 1.90

7 Thirumalagiri NA 47482 NA

8 Thungathurthi NA 52922 NA

9 Nuthankal 2 51453 2.05

10 Atmakur (S) 9 49419 2.09

11 Jaji Reddi Gudem NA 40878 NA

12 Saligouraram 14 42606 1.87

13 Mothkur 8 55638 1.79

14 Atmakur(M) 13 38813 2.04

15 Valigonda 4 53010 2.67

16 Bhuvanagiri 23 99715 2.30

17 Bibinagar 27 45992 2.48

18 Pochampalle 13 44379 2.11

19 Choutuppal 23 65825 2.32

20 Ramannapeta 13 52322 2.19

21 Chityal 21 53102 2.32

22 Narkatpalle 25 46150 2.89

23 Kattangoor 23 40613 2.04

24 Nakrekal 11 55030 1.85

25 Kethepalle 9 34844 1.95

26 Suryapet 11 140662 1.97

27 Chivvemla 12 44301 2.01

28 Mothey 8 42680 2.54

29 Nadigudem 6 39543 1.87

30 Munagala 3 43116 2.00

31 Penpahad 7 38541 1.78

32 Vemulapalle 12 43003 1.70

33 Thipparthi 26 45373 2.42

34 Nalgonda 20 163382 2.66

35 Munugode 41 41614 2.84

36 Narayanapur 62 41064 2.72

37 Marriguda 49 36946 4.14

38 Chandur 39 47189 2.87

39 Kangal 16 38303 2.14

�

�

149

S# Name of the Mandal

No.of Habitations

Population (2001Census)

Average Fluoride content ( in p.p.m)

40 Nidamanur 5 52454 1.87

41 Thripuram 9 44969 1.65

42 Miryalaguda 8 158910 2.94

43 Garidepalle 5 54515 2.72

44 Chilkur 2 37770 1.80

45 Kodad 9 116358 2.32

46 Mellacheruvu 4 66145 2.20

47 Huzurnagar 1 57433 1.60

48 Mattampalle 4 41857 1.60

49 Neredcherla 4 65856 1.85

50 Dameracherla 7 61576 1.74

51 Anumula 10 61922 2.12

52 Peddavoora 43 65231 2.35

53 Pedda Adisherlapalle 38 41061 1.92

54 Gurrampode 26 39667 2.18

55 Nampalle 39 38801 2.46

56 Chinthapalle 50 44053 3.14

57 Devarakonda 38 86584 2.07

58 Gundlapalle 12 41677 2.41

59 Chandampet 43 49834 2.33

Total 1019 3247982

Table 5.1 and Fig. 5.2 show the fluorine concentration levels at 1019

habitations of the district during 2003. The analysis indicated that the

groundwaters of all the habitations contain more than 1.5 ppm of fluoride. The

average fluoride in the mandals ranges between 1.6 to 4.14 ppm. From the

analysis, it was found that highest concentration is existing in Marriguda,

Chinthapalle, Miryalaguda, M.Turakapalle, Narketpalle and Munugode when

compared with other mandals.

Though the data on fluoride content is available, data on number of fluorosis

cases are not available for the entire Nalgonda district. Of the four revenue

divisions of the district, data were available from Nalgonda division only. Thus,

for the present study, fluorosis disease epidemiology study was carried out for

Nalgonda division of Nalgonda district.

Nalgonda revenue division is one of the four such divisions of Nalgonda

district, located in the western part of the district. It extends between 16° 40´

�

�

150

�

Fig. 5.2 Mandal-wise average fluorine distribution in Nalgonda district

�

�

�

150

and 17° 25´ N latitudes and 78° 40´ and 79° 25´E lo ngitudes. The division

comprises twenty revenue mandals namely Chandur, Chadampet,

Chintapally, Chityala, Devarakonda, Gundlapalli, Gurropode, Kanagal,

Kattangoor, Kethepally, Marriguda, Munugode, Nalgonda, Nakrekal,

Nampally, Narayanapur, Narketpally, Pedda Adisherlapally, S.Gowraram and

Thipparthy (Fig. 5.3).

Data on Fluorosis cases and Fluorine concentration levels in the Nalgonda

revenue division were collected from the sample survey made by the District

Medical and Health Office at Nalgonda district headquarters and some of the

data were also downloaded from internet sources (www.nalgonda.org). In

areas where data on fluorine concentration were not available, water samples

were collected and analysed in the laboratory to find out the fluorine content

of that particular area. Data on number of cases on dental as well as skeletal

Fluorosis were collected for the year 2003 (Table 5.2). Graphical as well as

geospatial maps were prepared in GIS environment.

Table 5.2 Fluoride content in Nalgonda division of Nalgonda district

S# Name of theMandal

No. of habitations surveyed

Fluoride range (ppm)

1 Thipparthi 26 1.60 – 3.80

2 Narketpalle 25 1.60 – 6.40

3 Nalgonda 20 1.60 – 4.40

4 Narayanapur 62 1.60 – 7.00

5 Nampalle 39 1.60 – 5.20

6 Munugode 41 1.60 – 9.50

7 Marriguda 49 1.70 – 6.30

8 Gurrampode 26 1.60 – 4.00

9 Chinthapalle 50 1.60 – 13.00

10 Chandur 39 1.60 – 5.60

11 Chityala 21 1.60 – 4.50

12 Kattangoor 23 1.60 – 3.20

13 Saligouraram 14 1.60 – 5.40

14 Kethepalle 9 1.60 – 3.30

�

�

151

�

�

�

�

�

�

Fig. 5.3 Location map of Nalgonda division, Nalgonda district

�

�

�

�

�

�

151

S# Name of theMandal

No. of habitations surveyed

Fluoride range (ppm)

15 Nakrekal 11 1.60 – 2.60

16 Kangal 16 1.60 – 3.20

17 Devarakonda 38 1.60 – 4.30

18 Pedda Adisherlapalle 38 1.58- 4.00

19 Gundlapalle 12 1.60 – 4.80

20 Chandampet 43 1.60 – 6.00

602

The spatial spread of fluorine in the groundwater indicated that fluorine levels

range between 1.6 and 13.0 in the Nalgonda revenue division. Geospatial

map of fluorine distribution in the groundwater was represented in Fig. 5.4.

Highest concentration of fluorine ranging between 1.6 and 13.0 ppm occurs

around Chintapalle mandal in the northwestern parts of the district. The

fluorine content is also high in Munugode mandal (1.60 to 9.50 ppm),

Narayanpur (1.60 to 7.00 ppm), Narketpalle (1.60 to 6.40 ppm), Marriguda

(1.70 to 6.30 ppm), Chadampeta (1.60 to 6.00 ppm), Chadur (1.60 to 5.60

ppm) and Nampalle (1.60 to 5.20 ppm) mandals. In the remaining mandals

the fluoride content ranges between 1.60 and 4.80 ppm.

5.1 Fluoride in Groundwater Vs Fluorosis Cases in Nalgonda division

Spatial distribution of fluoride and number of fluorosis cases were represented

in the map generated in GIS environment (Fig. 5.5). The spatial distribution of

fluorine and fluorosis indicates that high incidence of fluorosis is associated

with the high concentration of fluorine content in the groundwater in the study

area (Table 5.3). Analysis of data on Fluorosis indicated that during 2003, a

total of 9432 Fluorosis cases were reported in Nalgonda division, out of which

8022 cases were related to dental Fluorosis and 1410 cases were related to

Skeletal Fluorosis (Fig. 5.6a).

�

�

152

�

Fig. 5.4 Geospatial distribution of Fluorine in groundwater Nalgonda division, Nalgonda district

�

�

�

�

�

�

�

153

�

�

�

Fig. 5.5 Fluorine levels in groundwater Vs Fluoride Cases in Nalgonda division, Nalgonda district

�

�

�

�

�

�

�

�

�

154

�

Fig. 5.6a Fluorosis cases in Nalgonda division. Red coloured cone indicate number of dental fluorosis cases and green coloured cone represents skeletal fluorosis cases

�

Fig. 5.6b Mandal-wise incidence of Dental and Skeletal Flurosis Vs Average Fluorine content

�

�

�

152

Mandal-wise incidence of Dental fluorosis and Skeletal fluorosis and

concentration of fluorine in the groundwater in Nalgonda division shows the

high incidence of Dental fluorosis is mostly coincidence with the high

concentration of fluorine in the groundwater, particularly at the mandals

namely Chintapalle, Nakatpalle, P.A.Palle, Narayanapur and Marriguda. The

same is true with Skeletal fluorosis. However, incidence of Dental fluorosis is

higher than Skeletal fluorosis which indicates that high concentration of

fluorine causes Dental fluorosis rather than skeletal fluorosis (Fig. 5.6b).

Table 5.3 Groundwater fluoride Vs Dental fluorosis cases in Nalgonda division

S# Name of theMandal

DentalFluorosis

(2003)

Fluoride in groundwater(ppm)

1 Thipparthi 13 1.60 – 3.80

2 Narkatpalle 541 1.60 – 6.40

3 Nalgonda 310 1.60 – 4.40

4 Narayanapur 1073 1.60 – 7.00

5 Nampalle 400 1.60 – 5.20

6 Munugode 1371 1.60 – 9.50

7 Marriguda 2312 1.70 – 6.30

8 Gurrampode 67 1.60 – 4.00

9 Chinthapalle 946 1.60 – 13.00

10 Chandur 43 1.60 – 5.60

11 Chityala NA 1.60 – 4.50

12 Kattangoor NA 1.60 – 3.20

13 Saligouraram NA 1.60 – 5.40

14 Kethepalle NA 1.60 – 3.30

15 Nakrekal NA 1.60 – 2.60

16 Kangal NA 1.60 – 3.20

17 Devarakonda NA 1.60 – 4.30

18 Pedda Adisherlapalle 946 1.58- 4.00

19 Gundlapalle NA 1.60 – 4.80

20 Chandampet NA 1.60 – 6.00

5.2 Dental Fluorosis

The study reveals that in the entire Nalgonda division, concentration of

fluoride in the groundwater is more than 1.5 ppm. It very high in Chintapalle

mandal (ranges between 1.60 and 13.0 ppm). High prevalence of dental

Fluorosis cases were recorded at Marriguda with 2312, Munugode with 1371

�

�

153

and Narayanpur with 1073 and Chintapalle and Peda Adisherlapalli with 946

cases each. Maximum incidence is associated with those mandals where high

concentration of fluoride had occurred. The other mandals namely

Naraketpalle, Nampalle, and Nalgonda recorded 541, 400 cases and 310

cases of dental fluorosis, respectively (Fig.5.7). Data on disease incidence

were not available for the remaining mandals of the division. A survey carried

out by Kishore and Hanumantha Rao (2010) indicated that most of the

residents of the Thipparthy mandal suffer from dental discoloration, early tooth

decay and bone deformations (Plate XII). Further, it was reported that dental

fluorosis was more common among female population than in male population

(Kishore and Hanumantha Rao, 2010).

5.3 Skeletal Fluorosis

Skeletal fluorosis is less prevalant in Nalgonda division when compared with

dental fluorosis. Data on the incidence were available only for 10 out of 20

mandals in the division (Plate XIII A, B & C).

Table 5.4 Groundwater fluoride Vs Skeletal fluorosis cases in Nalgonda

division

S# Name of theMandal

SkeletalFluorosis

(2003)

Fluoride range (ppm)

1 Thipparthi 33 1.60 – 3.80

2 Narkatpalle 132 1.60 – 6.40

3 Nalgonda 21 1.60 – 4.40

4 Narayanapur 195 1.60 – 7.00

5 Nampalle 86 1.60 – 5.20

6 Munugode 3 1.60 – 9.50

7 Marriguda 759 1.70 – 6.30

8 Gurrampode 4 1.60 – 4.00

9 Chinthapalle 109 1.60 – 13.00

10 Chandur 68 1.60 – 5.60

�

�

154

�

�

�

�

Fig. 5.7 Spatial incidence of Dental Fluorosis in Nalgonda division, Nalgonda district

�

�

�

�

�

�

�

�

154

S# Name of theMandal

SkeletalFluorosis

(2003)

Fluoride range (ppm)

11 Chityala NA 1.60 – 4.50

12 Kattangoor NA 1.60 – 3.20

13 Saligouraram NA 1.60 – 5.40

14 Kethepalle NA 1.60 – 3.30

15 Nakrekal NA 1.60 – 2.60

16 Kangal NA 1.60 – 3.20

17 Devarakonda NA 1.60 – 4.30

18 Pedda Adisherlapalle NA 1.58- 4.00

19 Gundlapalle NA 1.60 – 4.80

20 Chandampet NA 1.60 – 6.00

Skeletal Flourosis is predominent in Marriguda mandal with 759 cases

followed by Narayanpur with 195, Narkatpalli with 132 and Chintapally with

109 cases. The other mandals namely Nampally, Narketpally, Thipparthy,

Nalgonda and Chandur consist of less than 100 cases, while Munugode and

Gurrampode mandals have less than 5 cases. Data on skeletal fluorosis is not

available for Chityala, Kattangoor, Saligouraram, Kethepalle, Nakrekal,

Kangal, Devarakonda, Pedda adisherpalle, Gundlapalle and Chandempeta

mandals (Table 5.4 and Fig.5.8). Incidence of skeletal fluorosis is also

associated with the mandals having high fluorine concentraion in the

groundwater (Fig. 5.8).

5.4 Morbidity analysis of Fluorosis

In the epidemological studies, it is not possible to give a clear cut definition to

illeness or morbidity as in the case of mortality which is an end point in the

natural history of a disease. Morbidity is an episodic event. According to the

sixth report of WHO Expert Committee on Health Statistics, morbidity or

illness is defined as ‘any departure, subjective or objective, from the state of

physiological well-being’. In the morbidity statistics, to measure the frequency

�

�

155

�

Fig. 5.8 Spatial incidence of Skeletal Fluorosis in Nalgonda division, Nalgonda district

�

�

�

155

of illness, the incidence and prevalance rates can be estimated (Park and

Park, 1977).

In the present study, point prevalance rate (PPR) of fluorosis has been

worked out to dental as well as skeletal fluorosis of Nalgonda revenue division

in order to measure the morbidity of fluorosis in the Division. PPR is the

percentage ratio of total number of cases (old and new) at a given point of

time and population exposed at that time of risk. The following equation was

adopted to calculate the point prevalance rates.

Number of persons who are sick (old and new) at a given time ________________________________________ X 100 PPR =

Population exposed to risk at that time

Table 5.5 Point Prevalance Rates of Dental Fluorosis in Nalgonda division

S# Name of theMandal

Population (2001 census )

DentalFluorosis

(2003)

Period Prevalence

Rate

1 Thipparthi 45373 13 0.03

2 Narkatpalle 46150 541 1.17

3 Nalgonda 163382 310 0.18

4 Narayanapur 41064 1073 2.61

5 Nampalle 38801 400 1.03

6 Munugode 41614 1371 3.29

7 Marriguda 36946 2312 6.25

8 Gurrampode 39667 67 0.26

9 Chinthapalle 44053 946 2.2

10 Chandur 47189 43 0.09

11 Chityala 53102 NA NA

12 Kattangoor 40613 NA NA

13 Saligouraram 42606 NA NA

14 Kethepalle 34844 NA NA

15 Nakrekal 55030 NA NA

16 Kangal 38303 NA NA

17 Devarakonda 86584 NA NA

18 Pedda Adisherlapalle 41061 NA NA

19 Gundlapalle 41677 NA NA

20 Chandampet 49834 NA NA

�

�

156

Table 5.5 and Fig. 5.9 show the point prevalence rates of fluorosis of

Nalgonda revenue division. The point prevalence rate ranges between 0.03

and 6.25. Of all the mandals of the division, Marriguda indicated the highest

prevalent rate of 6.25 percent, followed by Munugode (3.29%) and

Narayanapur (2.61%), Chintapalle (2.2%) and Naketpally (1.17%). In the

remaining mandals, PPR is at a minimum. This shows that Marriguda and

Munugode are highly prone to Dental fluorosis in the division.

Table 5.6 Point Prevalance Rates of Skeletal fluorosis in Nalgonda Division

S# Name of theMandal

Population (2001 census )

DentalFluorosis

(2003)

Point Prevalence

Rate

1 Thipparthi 45373 33 0.07

2 Narkatpalle 46150 132 0.29

3 Nalgonda 163382 21 0.01

4 Narayanapur 41064 195 0.47

5 Nampalle 38801 86 0.22

6 Munugode 41614 3 0.01

7 Marriguda 36946 759 2.05

8 Gurrampode 39667 4 0.01

9 Chinthapalle 44053 109 0.25

10 Chandur 47189 68 0.14

11 Chityala 53102 NA NA

12 Kattangoor 40613 NA NA

13 Saligouraram 42606 NA NA

14 Kethepalle 34844 NA NA

15 Nakrekal 55030 NA NA

16 Kangal 38303 NA NA

17 Devarakonda 86584 NA NA

18 Pedda Adisherlapalle 41061 NA NA

19 Gundlapalle 41677 NA NA

20 Chandampet 49834 NA NA

Table 5.6 and Fig. 5.10 reveal that based on point prevalence analysis, the

skeletal fluorosis is comparatively not severe in Nalgonda division. The point

Prevalence ranges between 0.01 and 2.05 percent. Marriguda indicates the

highest prevalence rate with 2.05 followed by Narayanapur 0.47 percent.

�

�

157

Fig. 5.9 Mandal-wise Point Prevalence Rate of Dental fluorosis in Nalgonda division, Nalgonda district

Fig. 5.10 Mandal-wise Point Prevalence Rate for Skeletal fluorosis in Nalgonda division, Nalgonda district

�

�

�

157

Based on this study, it may be inferred that Nalgonda revenue division in the

Nalgonda district is endemic to fluorosis and there is a correlation between

the fluorine content in the groundwater and number of fluorosis cases.

Incidence of Dental fluorosis is more than skeletal fluorosis. Marriguda,

Munugode, Narayanpur, Chintapalle and Peda Adisherlapalle mandals have

recorded maximum dental fluorosis cases. However Marriguda has recorded

highest number of skeletal fluorosis cases also.

*****