This paper evaluated fluoride (F-) pollution in drinking groundwater sources, which causes severe fluorosis and other human health concerns in Swabi, Pakistan. We determined F- concentration, prevalence, enrichment, distribution, and health hazards from water ingestion in Swabi, Pakistan. Therefore, 126 groundwater and 18 surface water samples were collected to analyze F- and other geochemical tracers to understand groundwater enrichment and F- mobilization in aquatic systems. The range and mean values of F- in groundwater were 0.02 to 14.2 and 4.0mg/L, and those in surface water were 1.12-0.8 and 1.4mg/L. Most residents used groundwater for drinking purposes. Thus, groundwater results showed that 72.2% of samples had surpassed the WHO guidelines of F- 1.5mg/L. The fluoride pollution index (FPI) declared that 48.73% of samples showed a higher risk, 41.95% medium risk, and 9.32% lower risk. Mineral phases using PHREEQC interactive software determined mineral saturation revealing the dissolution of host rock minerals and unsaturation showed precipitation of minerals within the aquifer. The principal component analysis multilinear regression (PCA-MLR) model showed a five-factor solution: (a) geogenic processes, (b) mixed geogenic and anthropogenic inputs, (c) geochemical processes, (d) agriculture pollution, and (e) industrial effluents which would release F- in the aquifer. The health hazard due to higher F- revealed that children showed high-risk levels compared to adults in endemic areas. The spatial distribution of F- in drinking groundwater increases towards the northern side and decreases in the south to the southeastern side. Therefore, effective water management techniques would be required to safeguard groundwater resources and secure human health from dental and skeletal fluorosis and other associated problems caused by high F- groundwater with varying fluoride concentrations. This study will help the water management authority to safeguard depleted groundwater for drinking demands.
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