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Objective:To study the prevalence of skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region (Inner Mongolia), and to provide reference for further prevention and treatment of skeletal fluorosis at this stage.Methods:From March to October 2019, a survey of skeletal fluorosis was carried out in all diseased villages of the eight diseased leagues (cities) in Inner Mongolia, including Alxa, Bayannur, Baotou, Ordos, Hohhot, Hulunbeier, Ulanqab and Xilingol. Permanent residents aged 18 years and above in the diseased villeges were investigated. Face to face questionnaires were used to collect the basic data of age, sex, epidemiological history, etc. of all subjects, and clinical examination of skeletal fluorosis was carried out. Drinking water samples were collected from residents for fluoride content testing.Results:A total of 123 166 residents aged 18 years and above were investigated, 1 781 cases of skeletal fluorosis were detected, and the detection rate was 1.45%. The degree of skeletal fluorosis was mild, accounting for 72.26% (1 287/1 781); the others were moderate and severe, accounting for 20.38% (363/1 781) and 7.36% (131/1 781), respectively. There were statistically significant differences in the detection rates of skeletal fluorosis among people of different water fluoride content, age, gender and regions (χ 2 = 565.96, 671.32, 4.38, 17 283.80, P < 0.05). Among them, the detection rates of skeletal fluorosis in water fluoride content > 4.0 mg/L, ≥56 years old and female population were relatively high, which were 5.21% (49/941), 2.26% (1 428/63 188) and 1.52% (905/59 555), respectively. The detection rates of skeletal fluorosis in Xilingol League and Baotou City were significantly higher, 25.48% (745/2 924) and 24.32% (225/925), respectively. Conclusion:The situation of skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Inner Mongolia has been effectively controlled, but there are still relatively many patients with skeletal fluorosis in some areas, and further targeted prevention and control work is needed.
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Objective:To understand the demographic characteristics and treatment intention, treatment status and therapeutic effect of patients with skeletal fluorosis in Inner Mongolia Autonomous Region (reffered to as Inner Mongolia) in order to provide a basis for next step treatment program.Methods:From March to June 2020, a face-to-face questionnaire survey was conducted among 3 570 patients with skeletal fluorosis in 11 leagues (cities) of Inner Mongolia to understand their basic information, treatment intention, treatment status and therapeutic effect. Patients with skeletal fluorosis of different demographic characteristics were compared with each other in their treatment intention and treatment status, and the therapeutic effects of different drugs were compared by χ 2 test. Results:A total of 3570 patients with skeletal fluorosis were investigated. There were slightly more women than men with skeletal fluorosis (1.29 ∶ 1.00, 2 014/1 556). The ages were mainly from 40 to 79 years old (95.4%, 3 406/3 570). Mongols patients accounted for 36.0% (1 285/3 570). Patients with low education (primary school and below) accounted for 82.2% (2 935/3 570). Eighty-five per cent (3 035/3 570) of the patients had drug treatment intention and 37.1% (1 325/3 570) of the patients had drug treatment. Thirty-seven point five per cent (1 338/3 570) of the patients had surgery intention and surgery was performed in 0.2% (8/3 570) of the patients. Combination therapy (98.5%, 194/197) and chondroprotective agents alone (98.3%, 173/176) were more effective than anti-inflammatory and analgesic agents alone (84.2%, 48/57) in the treatment of skeletal fluorosis ( P < 0.05). Surgery was effective (8/8). Conclusions:Most of the patients with skeletal fluorosis are middle-aged and elderly, and the patients with skeletal fluorosis in Mongols account for a certain proportion. At present, all the patients with skeletal fluorosis who have the will to be treated have not been effectively treated, and the means of treatment is relatively single. It should be advocated to carry out various forms of treatment of skeletal fluorosis, so that patients could relieve symptoms, reduce pain and improve their quality of life.
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Objective:To learn about the distribution of fluoride content in drinking water of residents in Inner Mongolia Autonomous Region, so as to provide scientific basis for formulation of refined prevention and control measures for drinking-water-type endemic fluorosis.Methods:From January 2017 to December 2019, water fluoride surveys were carried out in all natural villages of 103 banners (counties) in 12 leagues (cities) of Inner Mongolia Autonomous Region, and drinking water samples of residents were collected according to different water supply methods (engineering water supply, physical and chemical water improvement, and decentralized water supply). The ion selective electrode method was used for water fluoride detection, and whether the water fluoride exceeded the standard was determined according to the "Standards for Drinking Water Quality" (GB 5749-2006).Results:The survey was carried out in 36 625 natural villages in 103 banners (counties) of 12 leagues (cities) in the region, among which 24 682 were engineering water supply villages, accounting for 67.39%; 2 610 were physical and chemical water improvement villages, accounting for 7.13%; and 9 333 were decentralized water supply villages, accounting for 25.48%. The median values of water fluoride in the engineering water supply villages, the physical and chemical water improvement villages and the decentralized water supply villages were 0.62, 0.23, and 0.52 mg/L, respectively, and the difference between different water supply methods was statistically significant ( H = 2 809.95, P < 0.001); the qualified rates of water fluoride were 96.47% (23 810/24 682), 99.73% (2 603/2 610) and 96.37% (8 994/9 333), respectively, and there was significant difference between different water supply methods (χ 2 = 132.74, P < 0.001). All the 12 leagues (cities) in the region had villages with water fluoride exceeding the standard, among which Chifeng City and Ordos City had more villages with water fluoride exceeding the standard (479, 282). Conclusions:All the 12 leagues (cities) in Inner Mongolia Autonomous Region have villages with water fluoride exceeding the standard. It is necessary to urge relevant departments to carry out planning and management of villages with water fluoride exceeding the standard.
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Objective:To understand the change trend of people's condition in tea drinking endemic fluorosis area of Inner Mongolia Autonomous Region, and to provide scientific basis for formulating prevention and control strategies.Methods:From 2009 to 2018, a cross-sectional survey was conducted in 30 villages of 6 banners (counties) of drinking tea type of endemic fluorosis of Inner Mongolia Autonomous Region. The tea drinking habits of residents were investigated. Ten families were selected from each monitoring village to collect brick tea samples, and the fluorine content in brick tea was detected for health risk assessment. In each monitoring village, one water sample was collected from each drinking water source. Fluoride ion selective electrode method was used to detect fluorine in tea and water. The prevalence of dental fluorosis in children aged 8-12 years old was examined and the X-ray examination and analysis were carried out for all the permanent residents aged 36-45 years and living in the local area for more than 5 years.Results:From 2009 to 2018, a total of 3 000 brick tea samples were collected. The geometric mean value of tea fluorine was 522.01 mg/kg, and the annual per capita consumption of brick tea by permanent residents was 2.52 kg. The average daily intake of fluorine in brick tea was 4.11 mg. According to the standard of "Total Fluoride Intake of Population" (WS/T 87-2016), there were 6 years of risk quotient > 1 in 10 years, while according to the World Health Organization (WHO) recommend standard, there were 5 years of risk quotient > 1. From 2012 to 2018, 210 water samples were detected, and the geometric mean value of fluorine in water was 0.90 mg/L, and the qualified rate was 84.76% (178/210). A total of 5 384 children aged 8-12 years old were examined and 1 562 dental fluorosis patients were detected. The total detection rate of dental fluorosis in children was 29.01% (1 562/5 384), and the dental fluorosis index was 0.62 (very mild). A total of 1 890 adults aged 36 to 45 years old were examined by X-ray. The detection rate of skeletal fluorosis was 18.10% (342/1 890). There were 77 patients with moderate and severe skeletal fluorosis.Conclusions:The brick tea fluorine content of residents in Inner Mongolia Autonomous Region is high, and there are health risks. The dental fluorosis of children aged 8-12 years old is very mild, and there are still moderate and severe skeletal fluorosis patients in adults. Therefore, it is necessary to strengthen the supervision of brick tea market and strengthen health education for residents.
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Objective:To understand the current situation of water improvement and the prevalence of dental fluorosis in children aged 8 to 12 in drinking-water-type endemic fluorosis (referred to as drinking-water-type fluorosis) areas in Inner Mongolia Autonomous Region (referred to as Inner Mongolia), and to evaluate the effectiveness of prevention and control measures, and provide a basis for timely adjustment of prevention and control strategies.Methods:In 2019, a cross-sectional survey was conducted to investigate the situation of water improvement and water fluoride content in all villages of 85 drinking-water-type fluorosis banners (counties) in Inner Mongolia, and all the children aged 8 to 12 were examined for dental fluorosis.Results:Among the 9 623 disease affected villages in the region, the water improvement projects were completed in 8 547 villages, and the water improvement rate was 88.82%. There were 7 145 water improvement villages whose water fluoride content met the national drinking water hygiene standard, which accounted for 83.60% (7 145/8 547) of the total villages with water improvement projects. A total of 118 857 children aged 8 to 12 were examined, and 9 123 cases of dental fluorosis were detected. The detection rate of dental fluorosis was 7.68%, which was lower than the upper limit of the dental fluorosis detection rate of fluorosis area standards (30%).Conclusions:The accomplishment rate of water improvement projects in drinking-water-type fluorosis areas of Inner Mongolia is high, and the condition of children's dental fluorosis has been effectively controlled. However, it is still necessary to strengthen the water quality monitoring, improve the qualified rate of water improvement projects, and effectively implement various comprehensive prevention and control measures.
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Objective:To investigate the distribution of arsenic content in drinking water of residents in Inner Mongolia Autonomous Region, and to provide a scientific basis for formulation of detailed prevention and control measures for endemic arsenic poisoning.Methods:From 2017 to 2019, water arsenic survey was carried out in all natural villages in 103 banners (counties, districts) of 12 leagues (cities) in Inner Mongolia Autonomous Region, and drinking water samples were collected according to different water supply modes (engineering water supply, physical and chemical water purification, decentralized water supply). Among them, engineering water supply: one factory water sample was collected from each water modification project in dry season and wet season; and one terminal water sample was collected in historical arsenism area/high arsenic exposed villages covered by the project. Physical and chemical water purification: one water sample was collected from each household. Decentralized water supply: in historical arsenism area/high arsenic exposed villages, one water sample was collected from each household; in the villages with historical qualified water arsenic, one household was selected according to the five directions of east, south, west, north and middle, and one water sample was collected from each household. The content of arsenic in water was detected by atomic fluorescence spectrometry and a distribution map of water samples with excessive arsenic was drawn using ArcGIS 10.2 software.Results:A total of 90 455 water samples were collected, including 31 617 water samples for engineering water supply, 2 702 water samples for physical and chemical water purification, and 56 136 water samples for decentralized water supply. The medians of water arsenic content of engineering water supply, physical and chemical water purification, and decentralized water supply were 1.00, 1.00 and 0.50 μg/L, respectively, and the differences among different water supply modes were statistically significant (χ 2 = 1 147.831, P < 0.05). A total of 486 water samples with excessive arsenic were detected, the detection rate was 0.54% (486/90 455). The detection rates of water samples with excessive arsenic in engineering water supply and decentralized water supply were 1.48% (469/31 617) and 0.03% (17/56 136), the detection rate of water samples with excessive arsenic in engineering water supply was higher than that in decentralized water supply (χ 2 = 775.401, P < 0.05); there was no water samples with excessive arsenic in physical and chemical water purification. The top three areas with the detection rates of water samples with excessive arsenic were Bayannaoer [15.38% (343/2 230)], Hohhot [2.00% (86/4 293)], and Ordos [0.85% (50/5 848)]. ArcGIS 10.2 software showed that the water samples with excessive arsenic were mainly distributed in the western region in the shape of focal and block, and only existed sporadically in the eastern region. Conclusions:The detection rate of water samples with excessive arsenic in engineering water supply in Inner Mongolia Autonomous Region is high, the water samples with excessive arsenic are mainly distributed in the western region in the shape of focal and block, and sporadically in the eastern region. The management and supervision of engineering water supply should be strengthened, in areas where the water arsenic exceeds the standard, we should take physical and chemical water purification measures, such as change water sources, increase water purification equipment, and improve water purification technology to reduce arsenic hazards, so as to ensure that residents can drink qualified water.
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Objective:To master the operating situation of water-improvement, water fluoride content and the disease trends in drinking-water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region.Methods:From 2009 to 2018, 30 diseased villages (Tun, hereinafter referred to as village) in 11 cities (districts, banners and counties) were selected as fixed monitoring sites in Inner Mongolia Autonomous Region for 10 consecutive years to investigate the operation status of the water-improvement project and water fluoride content; the prevalence of dental fluorosis in all children aged 8 to 12 in the monitoring sites were checked.Results:From 2009 to 2018, the water-improving rate of monitoring villages increased from 70.00% (21/30) in 2009 to 86.67% (26/30) in 2018, the ratio of beneficiary population raised from 82.94% (20 921/25 224) to 96.84% (18 513/19 118); the normal operation rate of water-improvement project increased from 85.71% (18/21) to 95.65% (22/23), and the water fluoride qualification rate of the water-improvement project increased from 61.90% (13/21) to 82.61% (19/23). The water fluoride content of the village with water-improvement project was 1.00 - 1.44 mg/L, and that of the village without water-improvement project was 2.15 - 2.69 mg/L. The water fluoride content of the village with water-improvement project was lower than that of the village without water-improvement project in each year ( P < 0.05). From 2009 to 2018, the total detection rate of dental fluorosis was 27.95% (2 610/9 339), the community fluorosis index was 0.56, and the epidemic intensity was marginal. There was significant difference in the detection rate of children's dental fluorosis between different years (χ 2 = 484.195, P < 0.05). There were statistically significant differences in the detection rate of dental fluorosis of villages with normal operation of water-improvement project and qualified water fluoride, villages with abnormal operation of water-improvement project or excessive water fluoride content, and villages without water-improvement (χ 2 = 210.73, 143.60, 22.67, P < 0.01). The results showed that the detection rate of children's dental fluorosis in the villages with normal operation of water-improvement project and qualified water fluoride content was lower than that in the villages with abnormal operation of water-improvement project or excessive water fluoride content and the villages without water- improvement ( P < 0.05). Conclusions:The improvement of water quality and the reduction of fluoride in Inner Mongolia Autonomous Region have achieved remarkable results, but there are still some water-improvement projects and villages with serious water fluoride exceeding the standard. The fluorosis has not been fully controlled, and it is still necessary to further strengthen the work of water-improvement, and the management and protection after water-improvement.
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Inner Mongolia is a region where drinking-water-type endemic fluorosis is seriously prevalent.Huge sums of manpower and financial resources have been invested by Inner Mongolia government in prevention and control of drinking-water-type endemic fluorosis since 1980s,from which some remarkable achievements have been made.However,the current prevention and control work is still difficult due to the wide distribution and complex geological and geomorphological conditions of the drinking-water-type endemic fluorosis.After recent investigation of the disease area conditions,the author has grasped the actual problems in the disease area and the prevention and control work,and pondered the corresponding prevention and control countermeasures.The results are summarized to provide some ideas for prevention and control of endemic fluorosis.
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Objective To understand the operating condition of water-improvement projects and the prevalence trends of dental fluorosis of children aged 8 to 12 in drinking-water-type fluorosis areas in Inner Mongolia Autonomous Region (Inner Mongolia),and to evaluate the effectiveness of control measures.Methods In 2013-2016,ten counties were sampled from all fluorosis counties in Inner Mongolia,and 3 villages were then sampled as fixed monitoring villages in each selected county.The monitored villages were divided into 3 groups according to the condition whether the village had improved water quality,the project operating condition and whether the fluorine content of water was qualified.The operating condition of water-improvement projects,the fluorine content of water and the prevalence of dental fluorosis of all children aged 8 to 12 were investigated.Results Both the number of water improvement-projects (22,22,23 and 24 projects) and the number of villages with water-improvement projects (22,23,24 and 26 villages) were increased from 2013 to 2016,the normal operation rates of water-improvement projects were 90.91％ (20/22)-95.83％ (23/24).The water fluoride content was compared among qualified water-improved villages,unqualified water-improved villages and water-unimproved villages [(0.83 ± 0.27),(1.77 ± 0.72),(2.31 ± 1.02) mg/L],the differences were statistically significant (F =60.889,P ＜ 0.05),the water fluorosis content of qualified water-improved villages was lower than that of unqualified water-improved villages and water-unimproved villages,respectively (P ＜ 0.05).The detection rate of children's dental fluorosis was compared among the 3 groups [21.48％ (441/2 053),48.68％ (240/493),37.02％ (308/832)],the differences were statistically significant (x2 =171.889,P ＜ 0.05),the detection rate of children's dental fluorosis of qualified water-improved villages was lower than that of unqualified water-improved villages and water-unimproved villages,respectively (P ＜ 0.01).Conclusion The prevalence of children's dental fluorosis in Inner Mongolia has been controlled to some degree,and the water-improvement projects that in good working condition play an important role in prevention and control of dental fluorosis.
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Objective To provide a basis for development of preventive measures through dynamical monitoring of the changing trends of endemic fluorosis areas and the prevalence of drinking-water-borne endemic fluorosis.Methods Using simple random sampling method,thirty monitoring villages in 11 counties of Inner Mongolia were selected as fixed monitoring villages from 2012 to 2016.The operation of water improvement projects was investigated,and water fluoride content was tested.Dental fluorosis of all 8 to 12-year-old students was diagnosed in the villages.Stratified random sampling by age was used to select 50 adults over 25-year-old in each monitoring village,and skeletal fluorosis was examined by X-ray.Results ①In 2012-2016,the water-improved rate of monitoring villages was 78.67％ (118/150).Of all the water-improved projects,normal operating projects accounted for 92.98％ (106/114).The exceeded rate of water fluoride in water-improved village was 31.36％ (37/118).②The detection rate of dental fluorosis and community fluorosis index (CFI) in children aged 8-12 of the villages with normal operating projects and qualified fluoride content were 20.88％ (533/2 553) and 0.41;the detection rate of dental fluorosis and CFI of the villages with water-improved projects under abnormal operation or excessive fluoride were 49.53％ (318/642) and 0.98;the detection rate of dental fluorosis and CFI of the villages without water-improved projects were 37.14％ (442/1 190) and 0.76.③The detection rate of X-ray skeletal fluorosis in adults of the villages with normal operating projects and qualified fluoride content was 18.97％ (140/738);the detection rate of X-ray skeletal fluorosis in adults of the villages with water-improved projects under abnormal operation or excessive fluoride was 31.53％ (111/352);the detection rate of X-ray in adults of the villages without water improvement projects was 31.17％ (96/308).Conclusions Up to now,in Inner Mongolia Autonomous Region,some villages have not yet improved their drinking water quality,water fluoride content in some projects has exceeded the standard seriously,the prevalence of dental fluorosis in children aged 8-12 is very mild,there are still moderate and severe endemic areas.So the orevention and control measures of the water-improved defluoridation need to be further strengthened.
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Objective To understand the trend of drinking-tea type fluorosis in the diseased areas in Inner Mongolia Autonomous Region,and to evaluate the effect of prevention and control measures.Methods In 2009 and 2012,6 monitored counties were selected in Inner Mongolia Autonomous Region; 5 diseased villages were selected in each monitored county,and 10 families were selected in each monitored village; fluorine content of brick tea was tested,and dental fluorosis conditions of all 8 to 12-year-old students and skeletal fluorosis conditions of all 36 to 45-year-old adults were examined.In 2012,in each monitored village,1 water sample of the drinking water source was collected respectively from five positions(east,south,west,north and the central of the village),and fluoride content of drinking water wastested.Results In 2009,the mean of brick tea fluorine content was 541.48 mg/kg in the monitored villages,and the fluoride content ≤ 300 mg/kg accounted for 17.62％.(49/278).In 2012,the mean of brick tea fluorine content was 536.06 mg/kg,and the fluoride content ≤300 mg/kg accounted for 11.00％(33/300).Total exceeding standard rate of the water fluoride content was 40.00％(12/30).In 2009,the detection rate of the children's dental fluorosis was 52.39％ (274/523),very mild,mild,moderate and severe cases accounted for 9.56％(50/523),19.86％(104/523),21.03％(110/523) and 1.91％(10/523),respectively.In 2012,the detection rate of the children's dental fluorosis was 35.71％(200/560),very mild,mild,moderate and severe cases accounted for 14.11％ (79/560),11.43％ (64/560),9.64％ (54/560),and 0.54％ (3/560),respectively.Compared with 2009,the proportion of moderate and severe cases reduced in 2012(W =40 696.0,P ＜ 0.01).In 2009,the detection rate of adult skeletal fluorosis was 23.52％ (167/710),mild,moderate and severe cases accounted for 17.32％(123/710),4.51％(32/710) and 1.69％(12/710),respectively.In 2012,the detection rate of adult skeletal fluorosis was 20.12％ (103/512),mild,moderate and severe cases accounted for 17.38％ (89/512),2.54％ (13/512) and 0.20％ (1/512),respectively.Compared with 2009,the proportion of moderate and severe cases reduced in 2012(W =12 797.5,P ＜ 0.01).Conclusion The drinking-tea type fluorosis in Inner Mongolia Autonomous Region has been controlled to some degree,but still serious in some areas;prevention and control measures need to be further strengthened.