The effect of non-fluoride factors on risk of dental fluorosis: Evidence from rural populations of the Main Ethiopian Rift
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Elevated level of fluoride (F-) in drinking water is a well-recognized risk factor of dental fluorosis (DF). While considering optimization of region-specific standards for F-, it is reasonable, however, to consider how local diet, water sourcing practices, and non-F- elements in water may be related to health outcomes. In this study, we hypothesized that non-F- elements in groundwater and lifestyle and demographic characteristics may be independent predictors or modifiers of the effects of F- on teeth. Dental examinations were conducted among 1094 inhabitants from 399 randomly-selected households of 20 rural communities of the Ziway-Shala lake basin of the Main Ethiopian Rift. DF severity was evaluated using the Thylstrup-Fejerskov Index (TFI). Household surveys were performed and water samples were collected from community water sources. To consider interrelations between the teeth within individual (in terms of DF severity) and between F- and non-F- elements in groundwater, the statistical methods of regression analysis, mixed models, and principal component analysis were used.About 90% of study participants consumed water from wells with F- levels above the WHO recommended standard of 1.5mg/l. More than 62% of the study population had DF. F- levels were a major factor associated with DF. Age, sex, and milk consumption (both cow's and breastfed) were also statistically significantly (p<0.05) associated with DF severity; these associations appear both independently and as modifiers of those identified between F- concentration and DF severity. Among 35 examined elements in groundwater, Ca, Al, Cu, and Rb were found to be significantly correlated with dental health outcomes among the residents exposed to water with excessive F- concentrations.Quantitative estimates obtained in our study can be used to explore new water treatment strategies, water safety and quality regulations, and lifestyle recommendations which may be more appropriate for this highly populated region. © 2013 Elsevier B.V.
Published Version (Please cite this version)10.1016/j.scitotenv.2013.12.087
Publication InfoKravchenko, Julia; Rango, Tewodros; Akushevich, Igor; Atlaw, Behailu; McCornick, Peter G; Merola, R Brittany; ... Jeuland, Marc (2014). The effect of non-fluoride factors on risk of dental fluorosis: Evidence from rural populations of the Main Ethiopian Rift. Science of the Total Environment, 488-489(1). pp. 595-606. 10.1016/j.scitotenv.2013.12.087. Retrieved from https://hdl.handle.net/10161/14825.
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Associate Research Professor in the Social Science Research Institute
Associate Professor in the Sanford School of Public Policy
Marc Jeuland is an Associate Professor in the Sanford School of Public Policy, with a joint appointment in the Duke Global Health Institute. His research interests include nonmarket valuation, water and sanitation, environmental health, energy poverty and transitions, trans-boundary water resource planning and management, and the impacts and economics of climate change. Jeuland's recent research includes work to understand the economic implications of climate change for water
Professor of Earth and Ocean Sciences
My research aims to link environmental geochemistry and isotope hydrology in order to trace the sources and mechanisms of water contamination and relationships with human health. Current research includes global changes of the chemical and isotopic compositions of water resources due to human intervention and contamination, salinization of water resources in the Middle East and Northern Africa, naturally occurring contaminants (arsenic, fluoride, boron) and radioactivity in water resources, the
Professor of Environmental Sciences and Policy
Dr. Weinthal specializes in global environmental politics and environmental security with a particular emphasis on water and energy. Current areas of research include (1) global environmental politics and governance, (2) environmental conflict and peacebuilding, (3) the political economy of the resource curse, and (4) climate change adaptation. Dr. Weinthal’s research spans multiple geographic regions, including the Soviet successor states, the Middle East, South Asia, East Africa, and
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