| ObjectiveUnderstand the current situation of prevention and treatment of drinking-water type fluorosis in Yunnan province,analyze and find out the problems and shortcomings in prevention and treatment,and provide scientific basis for timely adjustment of drinking-water type fluorosis prevention strategies and measures in the whole province.MethodsThree counties with the most serious cases of drinking-water fluorosis in the history of Yunnan province—Yuanmou county,Mouding county and Eryuan county—were selected to investigate the implementation and operation of the main drinking water sources,fluoride reduction and water-improving for defluoridation in the affected areas.The incidence of dental fluorosis in all children aged 8-12,sample the urine fluoride content of children aged 8-12 years,knowledge of health education about fluorosis in primary school students and housewives.Select national standard or line standard method to carry out dental fluorosis diagnosis,water fluoride and urine fluoride content detection.Evaluate the disease area control according to endemic fluorosis area control standard.Use Excel 2019,Epi info3.5.4,SPSS 25.0,ArcGIS 10.6 software for data entry and statistical analysis.Results1.Investigation of the main drinking water sources and water-improving and defluorination project implementation in survey spotsThere were 213 main drinking water sources in 85 natural villages in the disease areas,and the wells,surface water and spring water were 121,40 and 52 respectively.The median water fluorine was 0.60mg/L,the exceeding rate was 27.40%(57/208),The population exceeding the standard water source accounted for 18.18%(6801/37418)of the total population of the ward.The water-improving rate of the ward was 91.76%(78/85),the normal operation rate of the water improvement project was80.85%(76/94),and the median water fluoride content at the end of the water improvement project was 0.53 mg/L,the qualified rate of fluoride content in water was84.88%(73/86).A total of 24 central primary schools were investigated for drinking water,the median water fluoride content was 0.47 mg/L,the qualified rate of fluoride content in school water was 87.50%(21/24).2.Dental fluorosis detection and urine fluoride content test results in childrenThe detection rate of dental fluorosis in children aged 8-12 years was 10.02%(155/1547),the index of dental fluorosis was 0.18,and the prevalence was negative.The detection rates of children aged 8-12 years in Yuanmou,Mouding and Eryuan were12.38%,4.86%and 7.88%,respectively.The prevalence of dental fluorosis in Yuanmou county was higher than that in Mouding and Eryuan(P<0.05).The detection rates of dental fluorosis in children aged 8-12 years were 7.51%,9.31%,8,65%,12.79%,and12.11%,respectively,and the difference was not statistically significant(?~2=6.975,P=0.137).The detection rates of dental fluorosis in male and female children were 10.05%and 9.99%,respectively,and the difference was not statistically significant(?~2=0.002,P=0.966).In the water-improving villages with detection rate of 10.36%,in the no water-improving villages with detection rate of 3.75%,and the difference was not statistically significant(?~2=3.678,P=0.055).In the villages where project under normal service conditions with detection rate of 10.24%,in the villages where project could not under normal service conditions with detection rate of 11.63%.It couldnot be considered that there was a difference in the condition of dental fluorosis between the two(?~2=3.930,P=0.140).In the villages where project under normal service conditions and water fluorine contents were qualified with detection rate of 10.71%,in the villages where water fluorine contents exceeded standard with detection rate of 6.02%.it couldnot be considered that there was a difference in the incidence of dental fluorosis between the villages with qualified water fluorine contents and standard exceeding villages(?~2=2.867,P=0.090).Logistic regression analysis was performed on the results of dental fluorosis test(disease,no disease)in children aged 8-12 years,county,age,sex,water-improving or no water-improving,water fluoride and other factors in the ward.The variables of county and age were statistically significant(P<0.05),and the other variables were not statistically significant(P>0.05).A total of 876 instant urine samples were detected in children aged 8 to 12 years.The geometric mean of urinary fluoride was 0.66 mg/L.The geometry mean of urinary fluoride in children in the 3 counties was<1.4 mg/L,and the urinary fluoride results were within the normal range of urinary fluoride in the normal range.The geometric mean urinary fluoride of children aged 8 to 12 years was 0.58 mg/L,0.63 mg/L,0.67mg/L,0.67 mg/L,and 0.73 mg/L,respectively.The younger the children,the lower the urinary fluoride content(r_s=0.119,P<0.001).The geometric mean of urinary fluoride in male and female children was 0.70 mg/L and 0.61 mg/L,respectively.The urinary fluoride content in males was slightly higher than that in female students(U=107058.000,P=0.003).There was a weak positive correlation between the urinary fluoride content and the diagnosis of dental fluorosis in children aged 8 to 12 years(r=0.114,P=0.001).The higher the urinary fluoride content was,the more serious the dental fluorosis was.3.Knowledge of health education on endemic fluorosisThe awareness rate of health education knowledge on primary school students and housewives was 64.05%and 69.55%,respectively.The awareness rate of housewives was higher than that of primary school students(?~2=9.173,P=0.002).4.Evaluation of ward control effectsThe detection rates of dental fluorosis in yuanmou,moding and eryuan counties were 33.32%,61.18%and 70.32%,respectively,when the survey was conducted between 1984 and 1992,and now the detection rates were 12.38%,4.86%and 7.88%,respectively.The detection rates of dental fluorosis in the three counties decreased by20.92,56.34 and 62.42 percentage points,respectively.After the water improvement measures were implemented,the condition of dental fluorosis in yuanmou,mouding and eryuan decreased significantly(P<0.001).According to the drinking-water type endemic fluorosis area control standard,71.76%(61/85)of the 85 villages in the three counties reached the control standard.Conclusion:1.Most of the disease areas have completed water improvement,and the prevalence of fluorosis in children has been greatly reduced compared to the pre-water improvement.92.94%of the fluorosis in the areas have reached the control standard,indicating that the effect of fluorosis in the areas have been significant.2.Primary school students and housewives have a low awareness rate of health education knowledge of fluorosis and the awareness rate of primary school students is lower than that of housewives.It is necessary to increase the promotion of health education in the disease areas.3.There are still some disease areas that have not completed water improvement,some of the water improvement projects have been scrapped or the water fluorine content exceeds the standard.Two of the three counties have not reached the control standard,and the prevention and control work still needs to be strengthened. |
