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Fluoride in Drinking Water in Upper North, Thailand 2010

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Fluoride in Drinking Water in Upper North, Thailand 2010 ASSOCIATION BETWEEN MATERNAL FLUORIDE LEVEL AND PRETERM DELIVERY AND LOW BIRTH WEIGHT AMONG PREGNANCY AT ENDEMIC FLUORIDE AREAS IN LAMPHUN, THAILAND : A PREGNANCY- BIRTH COHORT STUDY Mr. Nonthaphat Theerawasttanasiri 19024905 A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Program in Public Health College of Public Health Sciences Chulalongkorn University Academic Year 2017 Copyright of Chulalongkorn University 19024905 ความสัมพันธ์ระหว่างระดับฟลูออไรด์ในมารดา กับการคลอดก่อนก้าหนดและทารกแรกเกิดน ้าหนักน้อย ในกลุ่มหญิงตั งครรภ์พื นที่มีฟลูออไรด์ในจังหวัดล้าพูน ประเทศไทย : การศึกษาไปข้างหน้า นายนณธภัทร ธีระวรรธนะสิริ 19024905 วิทยานิพนธ์นี เป็นส่วนหนึ่งของการศึกษาตามหลักสูตรปริญญาสาธารณสุขศาสตรดุษฎีบัณฑิต สาขาวิชาสาธารณสุขศาสตร์ วิทยาลัยวิทยาศาสตร์สาธารณสุข จุฬาลงกรณ์มหาวิทยาลัย ปีการศึกษา 2560 ลิขสิทธิ์ของจุฬาลงกรณ์มหาวิทยาลัย 19024905 vi ACKNOWLEDGEMENTS Undertaking my Ph.D. has been possible, I would like to take this opportunity to acknowledge sincere appreciation to the person who help, support or guidance me in the direct ACKNOWLEDGE MENTS or indirect way of my study and research. Firstly, I would like to greatly appreciate my thesis advisor Prof. Surasak Taneepanichskul and Doctor Robert S. Chapman (QE advisor) for the continuous support of my Ph.D. study and related research for his patience, motivation, and enormous knowledge. His guidance helped me during study research and writing of this thesis. I would like to thank the rest of my thesis committee: Assoc. Prof. Dr.Ratana Somrongthong, Prof. Dr.Sathirakorn Pongpanich, Asst. Prof. Dr.Nutta Taneepanichskul and Doctor Nanta Auamkul for their insightful comments and encouragement, but also for the hard question which incented me to widen my research from various perspectives. Also, I am gratefully acknowledged Prof. Dr. Andezhath 19024905 Susheela Executive Director of the Executive Director of India’s Fluorosis Research and Rural Development Foundation and Dr. Michael Connett, Executive Director of Fluoride Action Network who support and advise me about the fluoride study. I greatly appreciate the scholarship support of Department of Health, Ministry of Public Health for tuition fee and allow full-time study. I am also gratefully acknowledged the funding for received towards my Ph.D. from the 90th Anniversary of Chulalongkorn University Research Study Scholarship Batch# 33 Round 3/2016, the funding received through National Research Council of Thailand (NRCT) for FY2017 Thesis Grant for Doctoral Degree Student to undertake my Ph.D. research study, the Scholarship for oral presentation in Salovakia of Graduate School of Chulalongkorn University and College of Public Health Science, Chulalongkorn University and Scholarship for oral presentation in Japan (full support) of Kyoto University. Finally, I would like to thank all everyone who actively involved in this research including Lamphun Hospital, Pasang Hospital, Ban Thi Hospital, District Public Health Office Subdistrict and Health Promotion Hospital of Mueang Lamphun, Pasang, Banthi, Intercountry Center of Oral Health and mother-newborns dyads who participate in this study and made this study possible. CONTENTS Page THAI ABSTRACT ............................................................................................................................. iv ENGLISH ABSTRACT .......................................................................................................................v ACKNOWLEDGEMENTS ................................................................................................................. vi CONTENTS ..................................................................................................................................... vii LIST OF TABLES .............................................................................................................................. x LIST OF FIGURES .......................................................................................................................... xii CHAPTER I INTRODUCTION ....................................................................................................... 1 1.1 Background and Rational ................................................................................................. 1 19024905 1.2 Research Question ............................................................................................................ 5 1.3 Research Objectives .......................................................................................................... 5 1.4 Research Hypothesis ......................................................................................................... 6 1.5 Conceptual Framework .................................................................................................... 7 1.6 Benefit and Application ................................................................................................... 7 1.7 Operational Definition ...................................................................................................... 8 CHAPTER II LITERATURE REVIEW .............................................................................................. 9 2.1 Water Fluoride and Safe Drinking Water....................................................................... 9 2.2 An Adequate Fluoride for Human ............................................................................... 14 2.3 Metabolism of Fluoride .................................................................................................. 15 2.4 Biomarker of Fluoride ..................................................................................................... 22 2.5 Analysis of Fluoride......................................................................................................... 26 2.6 Factors Effect to Fluoride Intake, Excretion and/or Fluoride-reduced Toxicity . 31 2.7 Effect of Fluoride ............................................................................................................. 32 viii Page 2.8 Effect of Fluoride in Pregnant ....................................................................................... 38 2.9 Maternal and child health service in Thailand and Lamphun .............................. 45 2.10 Risk Factor of Premature Delivery and/or LBW ...................................................... 51 2.11 Research on Preterm Delivery and LBW and Fluoride .......................................... 62 2.12 GIS Technology and Application ................................................................................ 69 CHAPTER III METHODOLOGY ................................................................................................. 73 3.1 Research Design ............................................................................................................... 73 3.2 Study Area ........................................................................................................................ 74 3.3 Study Population ............................................................................................................. 75 19024905 3.4 Sample Size Calculation ................................................................................................ 76 3.5 Sampling technique ........................................................................................................ 79 3.6 Measurement Tools ........................................................................................................ 80 3.7 Data Collection ................................................................................................................ 84 3.8 Data Analysis .................................................................................................................... 93 3.9 Ethical Consideration ...................................................................................................... 95 CHAPTER IV RESULT ................................................................................................................. 96 4.1 Water Fluoride and Village Water Supply System ................................................... 97 4.2 GIS Data and Geo-graphical of Endemic Fluoride Areas ....................................... 102 4.3 Baseline Demographic and Characteristics............................................................... 110 4.4 Clinical Characteristic of Pregnant Women before Delivery and Newborn....... 115 4.5 Comparison of Maternal Urine Fluoride Level between the two groups. ........ 119 4.6 Association of MUF Level and Preterm Delivery. ................................................... 120 4.7 Association of MUF Level and LBW. .......................................................................... 121 ix Page 4.8 Comparison Incidence of Preterm Delivery and LBW between the two groups .............................................................................................................................. 122 CHARPTER V DISUSIONS ......................................................................................................... 124 5.1 WF, Endemic fluoride areas GIS and Geo-visual maps .......................................... 124 5.2 Comparison of MUF between the two groups........................................................ 125 5.3 Association of MUF level with Preterm delivery and LBW ................................... 127 5.4 Incidences of Preterm delivery and LBW ................................................................
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