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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Published Version (Please cite this version)

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

Akushevich

Igor Akushevich

Research Professor in the Social Science Research Institute
Weinthal

Erika S. Weinthal

John O. Blackburn Distinguished Professor

Dr. Weinthal specializes in global environmental politics and environmental security with a particular emphasis on water and energy. Areas of research include (1) global environmental politics and governance, (2) environmental conflict and peacebuilding, (3) the political economy of the resource curse, (4) climate change adaptation, and (5) global energy transitions). 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 co-authored Oil is not a Curse (Cambridge University Press 2010) and Water Quality Impacts of the Energy-Water Nexus (Cambridge University Press 2022). She has co-edited Water and Post-Conflict Peacebuilding: Shoring Up Peace (2014), The Oxford Handbook on Water Politics and Policy (Oxford University Press 2017) and The Oxford Handbook of Comparative Environmental Politics (2023). She was a founding Vice President of the Environmental Peacebuilding Association. In 2017 she was a recipient of the Women Peacebuilders for Water Award under the auspices of “Fondazione Milano per Expo 2015”. 

Vengosh

Avner Vengosh

Nicholas Distinguished Professor of Environmental Quality

Avner Vengosh is a Distinguished Professor and Nicholas Chair of Environmental Quality at the Nicholas School of the Environment. He is the chair of the Division of  Earth and Climate Sciences. Professor Vengosh and his team have studied the energy-water nexus, conducting pioneer research on the impact of hydraulic fracturing and coal ash disposal on the quantity and quality of water resources in the U.S. and China. He has also investigated the sources and mechanisms of water contamination in numerous countries across the globe, including salinity and radioactivity in the Middle East, uranium in India, fluoride in Eastern Africa, arsenic in Vietnam, and hexavalent chromium in North Carolina and China. As part of these studies, his team has developed novel geochemical and isotopic tracers that are used as fingerprints to delineate the sources of water contamination and evaluate potential risks for human health. Currently, his team is engaged in studying phosphate rocks geochemistry and the impact of fertilizers on soil and water quality, unconventional sources of critical raw materials, and potential environmental effects of lithium mining from hard rocks and brines. He is a Fellow of the Geological Society of America (GSA) and International Association of Geochemistry (IAGC). In 2019, 2020 and 2021 he was recognized as one of the Web of Science Highly Cited Researchers. He serves as an Editor of GeoHealth and on the editorial board of the journal Environmental Science and Technology. He has published 171 scientific papers in leading international journals. His recent cross-disciplinary book “Water Quality Impacts of the Energy-Water Nexus” (Cambridge University Press, 2020) provides an integrated assessment of the different scientific and policy tools around the energy-water nexus. It focuses on how water use, and wastewater and waste solids produced from fossil fuel energy production affect water quality and quantity. Summarizing cutting edge research, the book describes the scientific methods for detecting contamination sources in the context of policy and regulations.

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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