The effect of non-fluoride factors on risk of dental fluorosis: Evidence from rural populations of the Main Ethiopian Rift

Abstract

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.

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10.1016/j.scitotenv.2013.12.087

Publication Info

Kravchenko, Julia, Tewodros Rango, Igor Akushevich, Behailu Atlaw, Peter G McCornick, R Brittany Merola, Christopher Paul, Erika Weinthal, et al. (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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Scholars@Duke

Igor Akushevich

Research Professor in the Social Science Research Institute
Weinthal

Erika S. Weinthal

Professor of Environmental Policy and Public 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 North America. Dr. Weinthal is author of State Making and Environmental Cooperation: Linking Domestic Politics and International Politics in Central Asia (MIT Press 2002), which received the 2003 Chadwick Alger Prize and the 2003 Lynton Keith Caldwell Prize. She has co-authored Oil is not a Curse (Cambridge University Press 2010) and co-edited Water and Post-Conflict Peacebuilding (Earthscan Press, 2014) and The Oxford Handbook on Water Politics and Policy (Oxford University Press 2018). She is a member of the UNEP Expert Group on Conflict and Peacebuilding and a co-editor of Global Environmental Politics. In 2017 she was a recipient of the Women Peacebuilders for Water Award under the auspices of “Fondazione Milano per Expo 2015”. 

Jeuland

Marc A. Jeuland

Professor in the Sanford School of Public Policy

Marc Jeuland is a 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 resources projects on transboundary river systems, a range of primary data collection projects related to analysis of adoption of environmental health improving technology, and analysis of the costs and benefits of environmental health interventions in developing countries. He has conducted multiple field experiments on issues such as: the role of water quality information in affecting household water and hygiene behaviors; the demand for, and impacts of cleaner cookstoves on household well-being; the long-term sustainability and effects of rural sanitation and water supply projects. He has also collected data on preferences for a range of environmental health improvements including cholera vaccines, household water treatment technologies and improved cookstoves. In the energy and development domain, he is currently working on several projects with the Energy Access Project at Duke, and is a co-founder of the Sustainable Energy Transitions Initiative (SETI), along with Professor Subhrendu Pattanayak and scholars from Chile, China and Ethiopia. His energy portfolio includes work related to evaluation of cleaner cooking interventions, measuring energy access and reliability, and reviews of the drivers and impacts literature related to energy. 

Jeuland has worked in the past with the World Bank, USAID, the Millennium Challenge Corporation, UNICEF, and many field-based NGOs and community-based implementing organizations.

Prior to his graduate studies and work with the World Bank, Jeuland was a Peace Corps volunteer in Mali, West Africa, where he designed and monitored construction of a pilot wastewater treatment system and trained management personnel at the plant’s managing firm.


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