FLUOROSIS AND SOCIO-ECONOMIC CONDITIONS OF PEOPLE IN NUAPADA DISTRICT OF ODISHA, INDIA SUBHASHREE PRADHAN MAY 2013 A MASTER’S RESEARCH PAPER Submitted to the faculty of Clark University, Worcester, Massachusetts, in partial fulfillment of the requirements for the degree of Master of Science in the Department of International Development, Community and Environment And accepted on the recommendation of Barbara Goldoftas, Chief Instructor ABSTRACT FLUOROSIS AND SOCIO-ECONOMIC CONDITIONS OF PEOPLE IN NUAPADA DISTRICT OF ODISHA, INDIA SUBHASHREE PRADHAN The current study was conducted to figure out the relationship between the socio- economic conditions of respondents and fluorosis in nine fluorosis-identified villages of Nuapada district in Odisha. It was observed that 100 percent of the respondents were affected with various degree of skeletal fluorosis. Fluorosis has deteriorated the respondents’ health, thereby affecting their work productivity, income and quality of life. However, there are variations in the severity of fluorosis according to sex, age, weight, education and income and nutritional status of the respondents. It was observed that the number of fluorosis cases increased steeply with increase in age. The vulnerable age group of fluorosis was 41-50 years. Fluoride impact severity, however, negatively affected the body weight of the respondents. Similarly, in the lower income group and non-educated respondents, fluorosis was more vividly seen. It was interesting to note that educated and aware people were willing to pay for obtaining clean water. According to the respondents, fluorosis prevented them for performing strenuous physical activities such as farming and working as wage laborers. There is an urgency of provision of safe drinking water in the study area. ________________________________ Barbara Goldoftas, Ph.D Chief Instructor ACADEMIC HISTORY Name: Subhashree Pradhan Date: March 26, 2013 Place of Birth: Odisha, India Date: December 9, 1984 Baccalaureate Degree: Bachelor of Science in Botany Source: College of Basic Science and Humanities, Odisha University of Agriculture and Technology, Bhubaneswar, Odisha, India Date of Conferred: May 2005 Master’s Degree: Master of Science in Environmental Science Source: Utkal University, Bhubaneswar, Odisha, India Date of Conferred: June 2007 Occupation Since date of Master’s Degree Worked as Program Officer with Sahabhagi Vikash Abhiyan (SVA), Odisha, India from 2008-2011 Worked as Research Associate with People’s Science Institute (PSI), Uttarakhand, India from 2007-2008 Academic Connection Clark University, Worcester, MA, August 2011-May 2013 Fellowship Awards Ford Foundation International Fellowship Program India, 2011-2013 DEDICATION I dedicate this work to my parents and my family members. iv ACKNOWLEDGEMENTS This paper would not have been possible without support from many people. First of all, I extend my heartfelt thanks and sincere gratitude to Clark University and Ford Foundation International Fellowships Program, India for giving me the opportunity to conduct this research. I am thankful to the Director and the staffs of Sahabhagi Vikash Abhiyan (SVA) for facilitating the process of my research and extending their support throughout. I specially thank Professor Barbara Goldoftas for her continuous support, guidance and efforts in supervising me to accomplish this fine work. I would also like to thank my parents, everyone in my family, and friends for their love, support and strong encouragement in fulfilling this work. v TABLE OF CONTENTS LIST OF ILLUSTRATIONS .................................................................... viii LIST OF TABLES ....................................................................................... ix CHAPTER 1: INTRODUCTION ............................................................... 1 1.1 Research Questions ................................................................................................... 4 1.2 Research Paper Outline ............................................................................................. 4 CHAPTER 2: BACKGROUND .................................................................. 5 2.1 Fluorosis- An Introduction ........................................................................................ 5 2.2 Sources of Fluoride ................................................................................................... 7 2.3 High Fluoride in Groundwater: A Geogenic Phenomenon....................................... 8 2.4 Factors Affecting the Degree of Fluorosis (Mild, Moderate or Severe) ................... 9 2.5 Social Costs of Fluorosis: Health, Opportunity and Treatment costs ....................... 9 2.6 Fluorosis and Age ................................................................................................... 10 2.7 Fluorosis and Income .............................................................................................. 11 2.8 Fluorosis and Nutrition ........................................................................................... 11 2.9 Fluorosis and Education .......................................................................................... 12 2.10 Prevention of Fluorosis ......................................................................................... 13 CHAPTER 3: METHODOLOGY ............................................................ 15 3.1 Study Area .............................................................................................................. 15 3.2 Sampling ................................................................................................................. 16 3.2.1 Selection of Villages ........................................................................................ 16 3.2.2 Selection of Participants .................................................................................. 16 3.3 Field Methods ......................................................................................................... 17 3.3.1 Quantitative Methods ....................................................................................... 17 3.3.1.1 Door to door survey .................................................................................. 17 3.3.2 Qualitative Methods ......................................................................................... 19 3.3.2.1 Focus Group Discussion ........................................................................... 19 3.4 Data Analysis .......................................................................................................... 19 3.4.1 Quantitative Analysis ....................................................................................... 19 3.4.1.1 Estimation of Fluoride Impact Severity (FIS) or the Degree of Fluorosis 19 3.4.1.2 Simple Distribution of Respondents’ Socio-economic Conditions and the Occurrence of various degree of Fluorosis ........................................................... 20 vi 3.4.2 Qualitative Analysis ......................................................................................... 20 3.4.2.1 Perception of Villagers towards Fluorosis ................................................ 20 3.5 IRB Approvals and Informed Consent ................................................................... 21 CHAPTER 4: RESULTS ........................................................................... 22 4.1 Overall Socio-economic Status of the Respondents ............................................... 22 4.2 Fluoride Impact Severity/ Degree of Fluorosis among the respondents ................. 22 4.3 Self Report of Participants’ Primary Drinking Water Sources ............................... 23 4.4 Relationship of Fluorosis with Respondents’ Age and Sex: ................................... 24 4.5 Relationship of FIS with Respondents’ Education ................................................. 25 4.6 Relationship of Fluorosis with Respondents’ Body Weight ................................... 26 4.7 Self Report of Respondents’ Occupation before Fluorosis and now ...................... 27 4.8 Self-Reported Income of Respondents before Fluorosis and now .......................... 28 4.9 Respondents’ Monthly Expenditure on Treatment of Fluorosis ............................. 29 4.10 Qualitative Results ................................................................................................ 30 4.10.1 Health Effects due to Fluorosis ...................................................................... 30 4.10.2 Treatment Costs due to Fluorosis .................................................................. 31 4.10.3 Loss of Productivity and Wages/Income ....................................................... 31 4.10.4 Awareness on Fluorosis ................................................................................. 32 4.10.5 Income and Fluorosis ..................................................................................... 32 4.10.6 De-fluoridation of Water and its Effects ........................................................ 34 CHAPTER 5: DISCUSSION ..................................................................... 35 CHAPER 6: CONCLUSION ..................................................................... 39 APPENDICES ............................................................................................. 40 BIBLIOGRAPHY ....................................................................................... 45 vii LIST OF ILLUSTRATIONS Figure 1: Dental and skeletal