Pollution of Drinking Water due to Fluoride and the Health Hazards in Palam Area of New Delhi (2000 - 2003):

Executive Summary of the Project

The Project “Drinking Water Pollution due to Fluoride and Health hazards in Palam area” in the National Capital Territory of Delhi (NCTD) was undertaken by the Foundation during the period 13.12.2000 to 12.12.2003 (3 yrs) under the aegis of the Ministry of Environment and Forests, Government of India

Fluorosis awareness camps for school children

  • Prevalence of dental fluorosis amongst school children
    • Data was obtained from 7407 school children from 8 schools in the Palam area, during Phase I of the project.
    • All the children were aged 8 years or above.
    • Prevalence of dental fluorosis is between 4.5 to 37% of the students.
  • Fluoride content in drinking water
    • Fluoride content in drinking water of 576 sources brought by the school children, both from the home and schools were tested.
    • 112 sources (20%) were contaminated. 464 sources (80%) were safe as the fluoride content in the water was less than 1.0 mg/L.
    • The extent of contamination ranged from 1.1 mg/L to 12.45 mg/L.
  • Fluoride levels in blood and urine in 45 children afflicted with dental fluorosis were assessed to evaluate the seriousness of fluoride poisoning in these children
    • 42 of the 45 children were consuming fluoride-contaminated ground water.
    • The level of fluoride in the urine and blood of all the 45 school children was high.
    • The detection of high fluoride levels in the urine and blood of the 3 children who did not consume fluoride contaminated ground water, suggest that consumption of fluoride contaning food viz. chat items containing black rock salt, use of fluoridated dental products as well as fluoride containing medications.

Villages endemic for fluorosis in Palam area

  • 7 villages were identified as being endemic for fluorosis through the survey on dental fluorosis amongst school children. The villages are
    1. Maharani Enclave
    2. Mohan Garden
    3. Deepak Vihar (Vikas Nagar)
    4. Palam Extension (Harizen Basti)
    5. Om Vihar (Uttam Nagar)
    6. Sureksha Vihar (Vikas Nagar)
    7. Hastal Village
  • This information is important because diseases related to fluorosis do not have any cure or treatment but can be prevented if detected early.

  • 335 families comprising 1128 members from the 7 villages were interviewed using a pre-coded (field tested) format for recording health complaints suggestive of fluoride poisoning.
  • Every water source which had a link to the family interviewed in each of the 7 villages was tested for fluoride content. The information on whether the source of water was safe or unsafe for drinking was communicated to the family.
  • Adequate information in the form on Information, Education and Communication material printed both in Hindi and English languages were provided to the community for consuming safe drinking water as well as nutritional interventions for prevention and control of fluorosis.

Common health complaints reported during the family health survey

  • Pain in the major joints. Possibly due to onset of Skeletal Fluorosis / or any other bone disorder.
  • Gastro - intestinal discomfort. One of the earliest signs of Fluoride poisoning is highly prevalent.
  • Excessive thirst and tendency to urinate more frequently. These symptoms, which are common in diabetes mellitus, are also an indicator of fluoride poisoning.
  • Fatigue and muscle weakness.
  • Inability to carry out routine domestic activities. This may occur due to destruction of gastro-intestinal lining resulting in low absorption of nutrients culminating in low haemoglobin as well as destruction of muscle structure and mitochondria. Fluoride poisoning results in extreme fatigue which does not respond to any drugs, tonics and vitamin intake.
  • Frequent headache. Gastro-intestinal discomfort may be followed by frequent headache

These complaints would disappear within a fortnight on withdrawal of fluoride entry into the body.

Incidence of health complaints related to fluorosis

  • Joint pains - 19.5 to 32%
  • Gastro-intestinal discomfort - 40 to 56%
  • Excessive thirst and excessive tendency to urinate - 2.3 to 7.4%
  • Fatigue and muscle weakness - 30.4 to 48%
  • Frequent headaches - 4.9 to 20%
  • Children afflicted with dental fluorosis - 2 to 34.8%
  • Adults afflicted since childhood and revealing dental fluorosis - 2.3 to 34.8%

Estimation of fluoride content in drinking water in these 7 villages

  • Water samples were collected in plastic bottles from all families who participated in the project from the 7 villages
  • Testing for fluroide was carried out using Potentiometric methods using fluoride ion specific electrode and the concentration measured through Ion 85 Ion Analyzer of Radiometer (Copenhagen).
  • Safe as well as contaminated sources of drinking water were detected in all the 7 villages except Om Vihar where all the 5 sources tested were contaminated.
  • The extent of fluoride concentration in the drinking water collected in these villages ranged from 1.0 mg/l to 12.89 mg/l

Concentration of fluoride in drinking water sources in the 7 villages

    Name of the village
    Total sources tested for fluoride
    No. of sources of safe drinking water
    No. of sources of contaminated water
    Range of Fluoride contamination (mg/l)
    Maharani Enclave

    128

    22

    106

    1.10 - 12.59

    Mohan Garden

    83

    32

    51

    1.10 - 2.21

    Deepak Vihar

    45

    2

    43

    1.10 - 8.75

    Palam Extension

    74

    10

    64

    1.10 - 8.24

    Om Vihar

    5

    -

    5

    1.58 - 6.25

    Sureksha Vihar

    30

    17

    13

    1.10 - 4.48

    Hastal Village

    122

    21

    101

    1.10 - 12.89

    TOTAL

    487

    104

    383

    1.10 - 12.89

  • In the 7 villages, 487 sources of ground water were tested for fluoride.
  • Of these, 104 sources (21%) were not contaminated with fluoride
  • While the remaining 383 sources (79%) were contaminated with fluoride.
  • The extent of fluoride contamination ranged from 1.10 mg/l to 12.89 mg/l.
  • In India, 1.0 mg/l is considered as the upper limit of fluoride in drinking water that the body can tolerate.

Action initiated following the detection of fluoride contamination in the drinking water in the villages in the Palam area

Reporting back to the family

  • The status of the quality of the water source for drinking, was informed to the head of the family.
  • If the source was contaminated with fluoride, the family was informed that the water could be used for domestic purposes but not for cooking or drinking.
  • The family members were informed about the safe source of drinking water in the neighbourhood and that they should utilise for cooking and drinking purposes till the Government makes alternative arrangements for safe water supply.

Reporting back to the authorities

  • It is also to put on record that the water quality data generated for the 7 villages in the Palam area of the National Capital Territory of Delhi has been shared with Chief Engineer of Delhi Jal Board
  • The community in the Palam area which include the Principals and Teachers of schools and the individual families in the 7 villages have also been provided with IEC (Information, Education and Communication) material specially designed and brought out both in Hindi and English languages on the “ Dos ” and “Dont’s” for prevention and control of Fluorosis disease.

Summary of the project

  • The project carried out in Palam area in 8 schools and 7 villages is one of the most comprehensive, meaningful projects ever carried out in the country integrating water and health aspects focusing on prevention and control of Fluorosis.
  • The approach / methodology / procedure followed to sensitize the school principals and teachers and adopting school children for detecting Fluorosis, as well as identifying endemicity in the area is perhaps one of the mile stones in the success achieved in the project.

This model is worth replicating in other Fluorosis endemic states / districts / blocks / villages / habitations in the country.