Abstract
Fluorosis is a major public health problem in the Rift Valley of Ethiopia. Low calcium (Ca) intake may worsen fluorosis symptoms. We assessed the occurrence of fluorosis symptoms among women living in high-fluoride (F) communities in South Ethiopia and their associations with dietary Ca intake. Women (n = 270) from two villages provided clinical and questionnaire data. Dental fluorosis examination was done using Dean’s Index, and skeletal and non-skeletal fluorosis assessment was carried out using physical tests and clinical symptoms. Daily Ca intake was estimated by a food frequency questionnaire. Food, drinking water and beverage samples were analyzed for F level. Many subjects (56.3%) exhibited dental fluorosis. One-third of the women were unable to perform the physical exercises indicative of skeletal fluorosis; about half had ≥2 symptoms of skeletal/non-skeletal fluorosis. The average F level in drinking water sources was ~5 mg/L. The F content in staple food samples varied from 0.8–13.6 mg/kg. Average Ca intake was 406 ± 97 mg/day. Women having ≤400 mg/day Ca intake had ~3 times greater odds of developing skeletal rigidity with joint pains [AOR = 2.8, 95%CI: 1.6, 5.0] and muscular weakness [AOR = 2.9, 95%CI: 1.3, 6.3] compared to those with higher intakes. No association of calcium intake was seen with dental fluorosis. As low dietary Ca intake was associated with symptoms related to skeletal and non-skeletal fluorosis, this warrants nutritional intervention on calcium intakes in this setting.
Highlights
Publisher’s Note: MDPI stays neutralDrinking water sources in the Rift Valley of Ethiopia contain fluoride (F) levels exceeding the World Health Organization (WHO) limit of 1.5 mg/L [1,2]
More than half of the women in this study had dental fluorosis as diagnosed using Dean’s index criteria [28]. This is in line with the findings of a recent systematic review which reported a high prevalence of dental fluorosis in the Ethiopian Rift Valley [7]
In contrast with Kravchenko et al [4], who reported an inverse association with milk intake in young adults living in the Rift Valley, we found no predictors of dental fluorosis
Summary
Drinking water sources in the Rift Valley of Ethiopia contain fluoride (F) levels exceeding the World Health Organization (WHO) limit of 1.5 mg/L [1,2]. Fluorosis is a major public health concern for developing countries including Ethiopia, as the infrastructure needed to remove the excess F ions is lacking or not widely accepted [13,14]. It can affect both children and adults [13]. Over 85% of Ethiopians living in the Rift Valley have been exposed to excess levels of F intake [7,15,16]. Drinking water is the dominant pathway of F exposure in Ethiopian Rift Valley areas, food with regard to jurisdictional claims in published maps and institutional affiliations
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