PT  - JOURNAL ARTICLE
AU  - Foat, Anna
AU  - Stevens, Claire
AU  - George, Grace
AU  - Massawe, John
AU  - Mhina, Ally
AU  - Gray, William K.
AU  - Mmbaga, Blandina T.
AU  - Rwakatema, Deogratias S.
AU  - Sallis, Paul
AU  - Jarvis, Helen
AU  - Haule, Irene
AU  - Benedict, Daniel
AU  - Walker, Richard
TI  - Prevalence of Skeletal Fluorosis in Northern Tanzania: A Follow-Up Study
AID  - 10.9745/GHSP-D-22-00342
DP  - 2023 Dec 22
TA  - Global Health: Science and Practice
PG  - e2200342
VI  - 11
IP  - 6
4099  - http://www.ghspjournal.org/content/11/6/e2200342.short
4100  - http://www.ghspjournal.org/content/11/6/e2200342.full
SO  - GLOB HEALTH SCI PRACT2023 Dec 22; 11
AB  - Key FindingsNine years after an initial prevalence study in Tindigani village in Northern Tanzania and following increased use of low fluoride piped drinking water, skeletal fluorosis (SF) is still an ongoing issue, as evidenced by the emergence of new cases.Although the etiology of SF is complex and multifactorial, fluoride exposure through drinking water appears to be the largest contributing factor, with high levels of fluoride found in well and borehole water sources.Of the individuals screened, 3.3% had SF, a decrease from 4.4% in 2009.Key ImplicationsProvision of low fluoride water sources requires collaboration between public health officials and local water authorities.There is a need to raise awareness about the causes and prevention of SF among the population in this area, as well as among public health officials, local water authorities, and health care professionals.This study can be used to highlight the importance of low fluoride piped water and may be a reproducible model for other endemic areas in Tanzania and other countries along the East African Rift Valley that have high fluoride water sources.Objectives:Skeletal fluorosis is a metabolic bone disease caused by excessive exposure to fluoride, predominantly through contamination of drinking water. This study aimed to identify all cases of skeletal fluorosis in Tindigani village situated in Northern Tanzania. This was done following changes in drinking water sources after a previous prevalence study in 2009 in this population.Methods:In a door-to-door cross-sectional study of Tindigani village, a sample of residents was assessed for skeletal fluorosis and dental fluorosis. Diagnosis of skeletal fluorosis was based on pre-defined angles of deformity of the lower limbs. Dental fluorosis was diagnosed and graded using the Thylstrup and Fejerskov Index. Samples from current drinking water sources underwent fluoride analysis.Results:Tindigani village had a population of 1,944 individuals. Of the 1,532 individuals who were screened, 45 had skeletal fluorosis, giving a prevalence of 3.3% (95% confidence interval [CI]=2.4, 4.3). Dental fluorosis was present in 82.5% of those examined (95% CI=79.8, 85.3). Dental fluorosis was present in all individuals with skeletal fluorosis and at higher grades than in the rest of the population. Drinking water samples were collected from 28 sources. These included piped, surface, well, and borehole water sources. Fluoride concentrations ranged from 0.45–38.59 mg/L of fluoride.Conclusions:Skeletal fluorosis is an ongoing but preventable health problem in the current population. The delivery of sustainable low fluoride piped water to this community would be of clear health benefit. This has been addressed at a local level.