UTILIZATION OF FLUORIDE WATER AND ITS HEALTH CONSEQUENCES: A HEALTH SURVEY IN PENNAGARAM TALUK, PJAEE, 17 (7) (2020) DISTRICT,

UTILIZATION OF FLUORIDE WATER AND ITS HEALTH CONSEQUENCES: A HEALTH SURVEY IN PENNAGARAM TALUK, , TAMIL NADU

M. Kalaiselvan Ph.D, Research Scholar, Post Graduate and Research Department of Geography, Government Arts College (A), Affiliated to Bharathidasan University, Kumbakonam, .

Dr. S. Vadivel Assistant Professor, Post Graduate and Research Department of Geography, Government Arts College (A), Affiliated to Bharathidasan University, Kumbakonam, India

M. Kalaiselvan, Dr. S. Vadivel: Utilization Of Fluoride Water And Its Health Consequences: A Health Survey In Pennagaram Taluk, Dharmapuri District, Tamil Nadu -- Palarch’s Journal Of Archaeology Of Egypt/Egyptology 17(7), 1-14. ISSN 1567- 214x Key words: Fluoride Water, Health Problem, Factor Analysis, Water Quality

ABSTRACT Background: Safe and pure water is essential for all people. The natural property of underground water depends upon the temperature, rainfall, parental rocks of an area. This natural phenomenon induces the fluoride content in Pennagaram taluk. It is obvious that those who consume the fluoride contented underground water are getting many types of health problems in long run. In Pennagaram taluk the fluoride concentrations is >1mg/l which is harmful to health. With this background, this present study examines the consumption of fluoride water and its health consequences in Pennagaram taluk. Objectives: The objectives of the present study is to examine 1) the consumption of water 2) to analyse the impact of Fluoride water on human health 3) to investigate the drinking water problem and 4) to scrutinize the psychological condition of people in Pennagaram taluk, Dharmapuri District, Tamil Nadu. Methodology: Primarily, the fluoride content is identified in 30 water sample. Secondly, information was collected randomly from 900 people through questionnaire survey using 5 point Likert scale. Further, the collected information has been transformed into SPSS. Finally, factor analysis was employed. Results: The findings of present study validate that the consumption of fluoride water creates many health problems in this region. The people are aware of fluoride impacts on health and drinking fluoride content water intentionally because of scarcity of water. They feel discomfort while drinking this water. For these reasons people like to move away from this place. However, to overcome the fluoride problem the government authority supplies non-fluoride water by the Integrated Hogenakkal-Cauvery River project for a short period of time. However, for a long period of time the people of this region are using underground fluoride water.

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INTRODUCTION Safe and pure water is essential for all people. The natural property of underground water depends upon the temperature, rainfall, parental rocks of an area. These natural phenomenon are induces the fluoride content in Pennagaram taluk. It is obvious that those who consume the fluoride contented underground water are getting many types of health problems in long run. India is one of the countries in the world where about 62 million people including 6 million children are affected with dental, skeletal and other types of fluorosis problems. According to Indian standard the maximum permissible limit of fluoride is <1mg/l, but many places of Pennagaram taluk has >1mg/l of fluoride level and it is harmful to health. Hence, this present study examines the consumption of fluoride water and its health consequences in Pennagaram taluk. REVIEW In India, north-western and southern states are severely affected with fluorosis [1,2]. Weathering of rocks rich in fluoride is the common natural cause for the fluoride in groundwater. Fluoride epidemic has been reported mostly in granite and gneissic geological formation of different states in India [3,1,4]. The high fluorides occur in top aquifer system and have reached to endemic level in most of the states [1]. Excessive exposure to fluoride in drinking water can give rise to a number of adverse effects ranging from mild dental fluorosis to crippling skeletal fluorosis [5]. Long exposure to fluoride in water are known to cause health hazards including skeletal and dental fluorosis, dental caries, teeth mottling as well as deformation of bones both in humans and animals [6]. When patients came from an area with high fluoride levels in the water, fluoride toxicity should be suspected when there were complaints of repeated miscarriages or still births, male infertility and dental fluorosis with discolouration of the enamel of the front teeth, the central or lateral incisors of the upper and lower jaws [7]. Women are at four times greater risk of developing osteoporosis related hip fractures than males [8]. The advanced stage of fluoride intoxication results in crippling fluorosis. The Crippling deformities are kyphosis, flexion deformity of the hips, flexion deformity of the knees and fixation of the chest in the position of inspiration due to calcification of cartilages. The quadriplegic patient bent with kyphosis and with restricted movements of his spine, with contractures of hips and knees [9]. The cause of ventricular fibrillation and eventual death are often encountered in cases of fluoride poisoning [10]. The irritation of the gastric mucosa is attributed to fluoride forming hydrofluoric acid in the acidic environment of the stomach [11,12].The behaviour of fluoride in hormone chemistry and to the possible clinical disturbances of endocrine function, particularly the thyroid gland [13]. The neurological manifestations have been exclusively reported in India from the fluoride regions [14, 15, 16,17]. Freni found that a statistically significant association between decreasing total fertility rate and increasing fluoride levels in municipal drinking water [18]. Another study found significantly decreased serum testosterone levels in 30 men diagnosed with skeletal fluorosis [19]. Several epidemiological studies are available on the possible association between fluoride in drinking water and cancer rates

12511 UTILIZATION OF FLUORIDE WATER AND ITS HEALTH CONSEQUENCES: A HEALTH SURVEY IN PENNAGARAM TALUK, DHARMAPURI PJAEE, 17 (7) (2020) DISTRICT, TAMIL NADU

among the population. International Agency for Research on Cancer (IARC) evaluated these studies on fluoride and carcinogenticity in humans [20,21]. With this backdrop the present study analyse the consumption of fluoride water and its health consequences in people of Pennagaram taluk.

STUDY AREA The Pennagaram taluk is chosen as a study area for present study. According to the 2011 census, it had a population of 234,406 with 123,101 males and 111,305 females. There were 904 women for every 1000 men. The taluk had a literacy rate of 57.62 per cent. Child population in the age group below 6 was 13,967 Males and 12,370 Females.

OBJECTIVES The objectives of the present study is to examine 1) the consumption of water 2) to analyse the impact of Fluoride water on human health 3) to investigate the drinking water problem and 4) to scrutinize the psychological condition of people in Pennagaram taluk, Dharmapuri District, Tamil Nadu.

METHODOLOGY Primarily, the fluoride content areas are identified in 30 water sample (village’s bore wells). Secondly, to achieve the objectives of present study the information were collected randomly from 900 people who lives in high fluoride content (>1.0mg/l) areas through questionnaire survey using 5 point Likert scale. The questionnaire schedule contains socio-economic backgrounds, water supply, health problem of fluoride water, health awareness of fluoride and psychological variables. Further, the collected information has been transformed into 68 variables and entered into SPSS. Finally, factor analysis was employed and 37 out of 68 variables were extracted with nine dimensions. The factor loading matrix was used to describe the association and the variance of each attributes with all other variables.

RESULTS The factor analysis for this study is very useful in sorting the major dimensions of health effects of drinking fluoride water on people of Pennagaram taluk. Nine factors are extracted with a total variance of 51.482 per cent. An Eigen value of 1.0 is taken as a cut-off point to launch the number of factors to be extracted. The correlation matrix has shown the occurrence of several coefficients above 0.4. The Kaiser-Meyer-Olkin (KMO) value is a Measure of Sampling Adequacy (MSA). As a result, the KMO value (Table 1) is 0.787 (Kaiser, 1970) exceeding the recommended value of 0.6 (Andony and Rao, 2007) and the Barlett’s Test of Sphericity value is 0.001 reached statistical significance and supporting the factorability of the correlation matrix. Principal components analysis revealed the presence of nine components with Eigen values exceeding 1.0. Table 1 KMO and Bartlett's Test Kaiser-Meyer-Olkin Measure of Sampling 0.787 Adequacy. Approx. Chi-Square 7719.453

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Bartlett's Test of df 666 Sphericity Sig. 0.001 Factor I: Physical Problems of Drinking Fluoride Water Water is precious and it is essential for life on earth. At present, getting safe and enough drinking water is a challenging one due to many factors. Hence, the first factor: ‘physical problems of drinking fluoride’ water has been emerged as a most vital factor with the total variance of 8.366 per cent and an Eigen value of 3.095 per cent (Table 2). Eight out of 37 variables are positively loaded on this factor specifically fatty tumour (0.665), blockage in blood vessel (0.640), cardiovascular problem (0.575), bone fracture (0.571), kidney problem (0.543), diabetic (0.527) and thyroid (0.433) and joints and bones pain (0.428). Hence, this study evidently proved that the people in this region are having health problems due to the utilization of fluoride content groundwater for drinking purpose. Table 2: Factor I: Physical Problems of Drinking Fluoride Water Variable Factor Variable Name Communalities No. Loading Hp11 Fatty tumour 0.665 0.487 Hp12 Blockage in blood vessel 0.640 0.513 Hp13 Cardiovascular problem 0.575 0.405 Hp5 Bone fracture 0.571 0.397 Hp6 Kidney problem 0.543 0.413 Hp15 Diabetic 0.527 0.361 Hp10 Thyroid 0.433 0.522 Hp14 Joints and bones pain 0.428 0.413 Eigen value: 3.095 Total Variance: 8.366 Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization.a a. Rotation converged in 9 iterations. Factor II: Attitude towards Fluoride Contain Drinking Water In Pennagaram taluk, people are using fluoride contained underground bore well water for drinking purpose through public water supply. The second most important factor ‘attitude towards fluoride contain drinking water’ appeared with total variance of 7.656 per cent and an Eigen value of 2.833 per cent (Table 3). The variables I regret my health problem by drinking fluoride water (0.727), I am unable to laugh due to dental fluorosis (0.644), I am unable to walk due to skeletal fluorosis (0.610), my health problems are mainly due to drinking fluoride contained water (0.602), I used to spend a lot of money to get drinking water (0.457), I have to travel a long distance to fetch drinking water (0.440) and I have decayed tooth (0.400) are positively loaded on this factor. Therefore, it is clearly demonstrating that the people’s health is affected by fluoride substance water and they are drinking deliberately because of water scarcity. Table 3: Factor II: Attitude towards Fluoride Contain Drinking Water Variable Factor Variable Name Communalities No. Loading I regret my health problem by drinking fluoride Psy8 0.727 0.631 water Psy9 I am unable to laugh due to dental fluorosis 0.644 0.503

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Psy10 I am unable to walk due to skeletal fluorosis 0.610 0.519 My health problems are mainly due to drinking Psy7 0.602 0.534 fluoride contained water I used to spend a lot of money to get drinking Psy6 0.457 0.414 water I have to travel a long distance to fetch drinking Psy5 0.440 0.487 water Hp9 I have decayed tooth 0.400 0.494 Eigen value: 2.833 Total Variance: 7.656 Factor III: Scarcity of Drinking Water Water is very essential for day to day activities for human, animal and agricultural activities. Therefore, the third factor ‘scarcity of drinking water’ comes in to view with the total variance of 7.265 percent and an Eigen value of 2.688 per cent (Table 4). The variable water is precious. So, I am using cautiously (0.697), I am unable to do agricultural practise due to water scarcity (0.668), it is very expensive to have own a bore well or a well (0.587), no alternate sources to bring good drinking water without fluoride content (0.586), it is very difficult to rear domestic animals due to water scarcity (0.599), I don’t have money to install water purifier (0.521) and I found taste differences in drinking water before and after rain (0.418) are positively loaded on this factor. As a result, it is undoubtedly confirmed that the people in this area are having drinking water problem. Table 4: Factor III: Scarcity of Drinking Water Variable Factor Variable Name Communalities No. Loading Psy12 Water is precious. So, I am using cautiously 0.697 0.556 I am unable to do agricultural practise due to Psy3 0.668 0.549 water scarcity. It is very expensive to have own a bore well or a Psy13 0.587 0.620 well. No alternate sources to bring good drinking Psy11 water 0.586 0.548 without fluoride content. It is very difficult to rear domestic animals Psy14 0.559 0.507 due to water scarcity. Psy4 I don’t have money to install water purifier. 0.521 0.423 I found taste differences in drinking water before Aw6 0.418 0.529 and after rain (summer and winter). Eigen value: 2.688 Total Variance: 7.265 Factor IV: Fluoride in Drinking Water In this region, fluoride substances were found in underground water naturally and people are using this water for drinking purpose. Thus, the variables (Table 5) specifically I found white sediment traces after storing or boiling water (0.700), I am drinking fluoride content water (0.671), drinking water in my area is containing fluoride (0.655) and are you affected by fluorosis? (0.401) are positively loaded on the factor ‘fluoride in drinking water’ with an Eigen value of 2.270 per cent and the total variance of 6.134 per cent. Hence, it is confirmed that this taluk people are drinking fluoride content water.

12514 UTILIZATION OF FLUORIDE WATER AND ITS HEALTH CONSEQUENCES: A HEALTH SURVEY IN PENNAGARAM TALUK, DHARMAPURI PJAEE, 17 (7) (2020) DISTRICT, TAMIL NADU

Table 5: Factor IV: Fluoride in Drinking Water Variable Factor Variable Name Communalities No. Loading I found white sediment traces after storing Aw5 0.700 0.571 or boiling water. Aw4 I am drinking fluoride content water. 0.671 0.512 Aw3 Drinking water in my area is containing fluoride. 0.655 0.506 Hp1 Are you affected by fluorosis? 0.401 0.444 Eigen value: 2.270 Total Variance: 6.134 Factor V: Experience in Water Quality and its Impact By experience, people in this area are familiar with the water quality and its health problem through the consumption of drinking fluoride water. In connection with this the fifth factor ‘experience in water quality and its impact’ come forward with the total variance of 4.738 per cent and an Eigen value of 1.753 per cent. The variables (Table 6) are positively loaded on this factor particularly Do you have any problem in Brain? (0.603), do you feel that your bones are weakening? (0.586), I found taste differences in drinking water before and after rain (0.527) and do you have decayed tooth? (0.483). As a result, the people in this area are having experience of negative impact on their health. Table 6: Factor V: Experience in Water Quality and its Impact Variable Factor Variable Name Communalities No. Loading Hp2 Do you have any problem in Brain? 0.603 0.466 Hp4 Do you feel that your bones are weakening? 0.586 0.472 I found taste differences in drinking water Aw6 0.527 0.529 before and after rain (summer and winter). Hp9 I have decayed tooth 0.483 0.494 Eigen value: 1.753 Total Variance: 4.738 Factor VI: Discomfort The consumption of fluoride water makes discomfort for the people in this region. It is understood very well by the variables loaded on this factor ‘discomfort’. This factor emerged with the total variance of 4.693 per cent with an Eigen value of 1.737 per cent (Table 7). The variables namely do you have head ache often? (0.724) and do you have stomach pain? (0.586) positively loaded on this factor. This result has confirmed that the people in this taluk are having discomfort because of drinking fluoride contented underground water. Table 7: Factor VI: Discomfort Variable Factor Variable Name Communalities No. Loading Hp3 Do you have head ache often? 0.724 0.584 Hp7 Do you have stomach pain? 0.586 0.499 Eigen value: 1.737 Total Variance: 4.693 Factor VII: Fond of Resettlement Living environment encourages or discourages human settlement in an area. In this situation the Pennagaram taluk is discouraging human settlement owing to shortage of safe drinking water supply and fluoride water too. Therefore, the data set confirm that the seventh factor ‘fond of resettlement’

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comes out with the total variance of 4.340 per cent and an Eigen value of 1.606 per cent (Table 8). The variables that is to say I would like to migrate from this area due to fluoride content in water (0.801) and I would like to leave from this place due to water scarcity (0.697) positively loaded on this issue. Accordingly, this study has proven that the people of this region like to move away from this study area. Table 8: Factor VII: Fond of Resettlement Variable Factor Variable Name Communalities No. Loading I would like to migrate from this area due to Psy1 0.801 0.682 fluoride content in water. I would like to leave from this place due to Psy2 0.697 0.576 water scarcity. Eigen value: 1.606 Total Variance: 4.340 Factor VIII: Awareness of Fluoride The eighth factor ‘awareness of fluoride’ appeared with the variance of 4.160 per cent and Eigen value of 1.539 per cent (Table 9). I am aware of the health problems of drinking fluoride contained water (0.752) and I know what fluoride is? (0.746) are the variable positively loaded on this factor. Hence, it obviously proves that the people in this area are aware of fluoride and its impact on health. Table 9: Factor VIII: Awareness of Fluoride Variable Factor Variable Name Communalities No. Loading I am aware of the health problems of drinking Aw2 0.752 0.685 fluoride contained water. Aw1 I know what fluoride is? 0.746 0.654 Eigen value: 1.539 Total Variance: 4.160 Table 10: Factor IX: Solution of Government Variable Factor Variable Name Communalities No. Loading Does the government or private organization makes any other alternate source for drinking Aw8 0.745 0.629 water other than your local water source(s)? Does the government or private organization Aw7 makes any awareness about the impact of 0.714 0.618 fluoride in your area? Eigen value: 1.528 Total Variance: 4.130 Factor IX: Solution of Government The state and central government have come to know that the Pennagaram taluk have fluoride water content in underground water which is not suitable for drinking purpose and it creates health problem for people lives in this region. In connection with this the ninth important factor ‘solution of government’ emerged with the variance of 4.130 per cent and an Eigen value of 1.528 per cent (Table 10). The variables specifically asks: does the government or private organization makes any other alternate source for drinking water other than your local water source(s) (0.745) and does the government or private organization makes any awareness about the impact

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of fluoride in your area? (0.714) are positively loaded on this factor. Thus, the government authority supplies non-fluoride water from the Integrated Hogenakkal-Cauvery River project for a short period of time. However, for a long period of time the people of this region are using underground fluoride water. CONCLUSION The findings of present study validate that the consumption of fluoride water creates many health problems in this region. The people are aware of fluoride impacts on health and they drink fluoride content water intentionally because of scarcity of water. They feel discomfort while drinking this water. For these reasons people like to move away from this place. However, to overcome the fluoride problem the government authority supplies non-fluoride water by the Integrated Hogenakkal-Cauvery River project for a short period of time. However, for a long period of time the people of this region are using underground fluoride water. Further, the local and state government should take necessary initiative to supply non-fluoride drinking water and to reduce the health problems of people in this region.

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