Excessive fluoride consumption increases haematological alteration in subjects with iron deficiency, thalassaemia, and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency

Fluoride contamination of groundwater and its threat to health of villagers and their domestic animals and agriculture crops in rural Rajasthan, India

In India, Rajasthan is the largest state and has seven divisions, namely Ajmer, Bharatpur, Bikaner, Jaipur, Jodhpur, Kota and Udaipur. Villagers of these regions, generally, used groundwater for drinking and irrigation purposes. The basic sources of groundwater in rural areas are hand pumps, step wells and borewells. Water of most of these sources is contaminated with fluoride (F) with varying amounts. Water of > 60% these sources has F beyond the recommended country standard (1.0 or 1.5 ppm) especially in tribal rural areas of Rajasthan. The highest F range, 0.1-34.0 ppm, has been found in groundwater of these sources in the villages of Ajmer division and the lowest 0.1-6.8 ppm in the Kota. Drinking of fluoridated groundwater for a long time is not safe for health and causes serious fluorosis disease in humans and domestic animals. In Rajasthan, around 40 lakh people are affected with fluorosis which is the highest in the country. At the F range of 1.3-6.7 ppm, the maximum prevalence of dental and skeletal fluorosis in villagers and bovine animals was found 84.0% and 32.7% and 88.9% and 37.8%, respectively. Using fluoridated groundwater in irrigation is also harmful and reduces crops productivity. In this communication, division-wise F distribution in groundwater of rural Rajasthan, F-induced diverse adverse health consequences in villagers and their domesticated animals and agriculture crops and preventive measures for control of F intoxication are critically reviewed. Findings of this review are useful in implementation of health policy for the mitigation of F poisoning in rural Rajasthan.

Systematic review of the clinical manifestations of glucose-6-phosphate dehydrogenase deficiency in the Greater Mekong Subregion: implications for malaria elimination and beyond

INTRODUCTION

To achieve malaria elimination in the Greater Mekong Subregion (GMS) by 2030, proper case management is necessary. 8-aminoquinolines, such as primaquine, are the only available medicines effective in preventing relapse of the hypnozoite stage of Plasmodium vivax, as well as the onward transmission of Plasmodium falciparum. However, primaquine can cause haemolysis in individuals who have glucose-6-phosphate dehydrogenase deficiency (G6PDd). We conducted a systematic review on the reported clinical manifestations of G6PDd to provide a comprehensive overview of the situation in the GMS.

METHODS

The protocol for this systematic review was registered on PROSPERO: International prospective register of systematic reviews (CRD42016043146). We searched the PubMed/MEDLINE, CINAHL, and Web of Science databases for published articles describing the clinical manifestations of G6PDd in the GMS. We included articles of all study designs from inception until 31 July 2016, reporting the clinical manifestations of G6PDd. We then performed a narrative synthesis of these articles.

RESULTS

We included 56 articles in this review, 45 of which were from Thailand. Haemolysis in G6PD-deficient individuals was caused not only by primaquine but also by other medicines and infections. Other clinical manifestations of G6PDd that were found were favism, neonatal jaundice and chronic non-spherocytic haemolytic anaemia. G6PDd also influenced the clinical presentations of genetic disorders and infections, such as thalassemia and typhoid fever.

CONCLUSION

As G6PDd also affects the clinical presentations of other infections, the benefits of G6PD testing and proper record keeping transcend those of malaria case management. Therefore, healthcare workers at the community level should be made familiar with complications resulting from G6PDd as these complications extend beyond the scope of malaria.