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Spatial Fluoride Mapping For Karnataka-2
Spatial Fluoride Mapping For Karnataka-2
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RSH0010.1177/1757913915626744Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effectsSpatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects
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Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects
Copyright © Royal Society for Public Health 2016 Month 2016 Vol XX No X l Perspectives in Public Health 1
SAGE Publications
ISSN 1757-9139 DOI: 10.1177/1757913915626744
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Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects
water is higher than 1.5 ppm, then the (the deionised water was checked for and printed. The electrode was clamped
possibility of dental fluorosis increases. any traces of fluoride present). The to a stand in order to retain its lower
Variable ecosystems, lifestyles and TISAB II solution was prepared using body immersed in the solution for
climatic changes influence the availability 5.80 g of NaCl, 0.30 g of NaOH, 0.40 g of 5.0 min., and the reading was recorded
and intake of fluoride in humans, and trans-1,2-diaminocyclohexane at a stable potential for the sample. The
hence, estimated values of fluoride N,N,N′,N′-tetra-acetate monohydrate calibration curves, their gradients and
bioavailability may differ in view of (CDTA), and 5.70 ml of acetic acid resulting sample F− concentrations,
seasonal variations. Therefore, there is a (glacial), and then adjusted to a final together with responses to the standard
major requirement for health researchers volume of 100.0 ml with deionised water. solutions were taken for every set of
and healthcare professionals to gain samples and checked for any abnormal
relevant knowledge regarding the fluoride Water sample collection variations; any errors detectable were
concentration of drinking water available The source was water samples collected recorded. The necessary measures were
in order to promote good oral and from 5 equidistant sites within each of 29 taken in order to ensure the validity of
general health. districts located within 4 zones (north- data acquired, together with
In view of the above considerations, east, north-west, south-east and south- maintenance of the specificity and
this study aimed to investigate the west) of Karnataka. Each zone was sensitivity of the electrode. The F−
fluoride concentrations of drinking waters identified from Karnataka state concentration in the deionised water was
from natural sources, and also to geographical areas. The north-east, analysed before estimating that in
develop an effective and reliable spatial north-west, south-east and south-west individual samples. Finally, any very low
mapping profile of available drinking zones contained 6, 5, 9 and 9 districts, trace deionised water F− levels
water fluoride concentration (and hence respectively. Distances between-districts- detectable were deducted from those of
the prevalence of fluoride-related health within-zones ranged from 600 to 900 km. the samples tested in this manner.
effects) in differing districts of India’s The water collected was from the same
Karnataka state. source as that available for the local
population to acquire for drinking Statistical analysis of experimental
purposes. drinking water sample fluoride levels
Materials and Methods The experimental design for this
Water sample collection and investigation was a two-factor model
preparation Analysis of water samples with a with districts (n = 5–11) ‘nested’ within
A total volume of 50 ml of special fluoride ion-selective electrode the four zones (north-east, north-west,
polypropylene containers (Chemtron Samples were analysed for their F− south-east and south-west, Model I).
Analytical Instrument Private Limited, concentrations using standard methods Variance component analysis comprised
New-Delhi, India) were employed to in the Fluoride Research Division of the these two main effect factors (‘between-
collect the samples. Prior to collection, Department of Oral Biology and Genomic zones’, and ‘between-districts-within-
these containers were thoroughly Studies at AB Shetty Memorial Institute zones’) and fundamental error. Analysis
cleansed and washed with deionised of Dental Sciences, Nitte University, of variance (ANOVA) was performed on
water and then autoclaved in order to Mangalore, India. both the untransformed dataset, and
sanitise them. While collecting the This analysis was performed using an that subjected to the Box–Cox
samples, the container was washed 3 ion-specific electrode (ISE) purchased transformation, the latter to further
times with water from the same source from ELIT Ion-selective Electrodes, satisfy assumptions of normality,
as the sample collected. The samples Nico2000 Ltd, UK. The analysis of F− variance homogeneity
were labelled with the following was performed by an adaption of the (homoscedasticity) and additivity. A
information: source of drinking water, method described in Rajković and further ANOVA model employed involved
date of collection and temperature, Novaković.17 A fresh standard solution of only the four zones as a main ‘between-
together with the weather condition of analytical grade Na+/F− was prepared zones’ effect factor, and analysis was
the day of collection and the location of with final concentrations of 10, 100 and again performed on both untransformed
the district. A dust-free environment and 1,000 ppm. Freshly prepared TISAB was and Box–Cox transformed datasets
uniform temperature (monitored by a added to the standard fluoride solutions (Model II). Further analysis of the
thermometer) were maintained within the in order to adjust the pH of the sample differences between the mean values of
laboratory during F− determination and to chelate trace levels of potentially all factor classifications was performed
experiments. interfering, F−-complexing metal ions by Tukey’s honestly significantly
such as iron(III) and aluminium(III). The difference (HSD), Fisher’s least significant
Preparation of F− standard solutions instrument was calibrated with three of difference (LSD), and the Bonferroni and
Deionised water was employed to adjust the standard solutions followed by Dunn–Sidak tests.
the volume of the total ionic strength- analysis of the water sample(s), and the Primarily, Pearson correlation coefficients
adjusted buffer (TISAB), and standard ratios displayed on the personal (r values) between each of the district
solutions were also prepared using this computer (PC) monitor were checked temperature, rainfall, district area (km2) and
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Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects
water source F− variables were computed Indeed, very highly significant levels was small and positive, although
in order to investigate the significance of differences in water fluoride weakly statistically significant (r = .193,
any relationships between them. concentration were found ‘between- p = .021). No significant relationship was
Subsequently, partial correlation zones’ and ‘between-districts-within- found between drinking water F− content
coefficients (i.e. rab(c) values) and their zones’ with our Model I analysis (p = 10−9 and the overall areas (size in km2) of the
corresponding two-tailed significance (p) for both the ‘between-zones’ and districts tested.
values were computed between a MV ‘between-districts-within-zones’ factors
dataset containing the district for both untransformed and Box–Cox
temperature, rainfall and water source F− transformed datasets). Similarly, for Discussion
concentration dataset (since the district Model II, the ‘between-zones’ factor was In this investigation, we have explored
area (km2) variable was not found to highly significant for both the the spatial distribution status of drinking
exert any significant, nor even minor untransformed and Box–Cox water fluoride concentrations in all of the
influence on drinking water F− levels, it transformed datasets (p = 9.03 × 10−6, Indian state of Karnataka’s zones and
was excluded from this analysis). All and < 10−9 respectively). These results districts. We collected replicated samples
statistical analyses of our datasets were are displayed in Figures 2(a) and (b); for of drinking water from all these districts
performed with XLSTAT2014. Figures 2(c) and (d), deviations of the and determined the fluoride level using
zone mean from the overall Karnataka an F− ion-selective electrode. Overall, an
Ethical approval state value are shown, so that positive effective spatial distribution/fluoride
Ethical clearance for this study was and negative mean zonal values reflect mapping of this Indian state was
obtained from the Central Ethics higher and lower values, respectively, provided, and much evidence for
Committee of Nitte University, Mangalore, than that of the overall state. substantial and very highly significant
India. Partial correlation coefficients (and their ‘between-zone’ and ‘between-district-
corresponding two-tailed significance (p) within-zone’ components of variation
values) were computed between a was provided.
Results multivariate (MV) dataset containing the The fluoride level of drinking water
The drinking water concentrations of mean district temperature, mean district recommended by the Bureau of Indian
F− in the different districts of Karnataka rainfall and individual water source F− Standards (BIS) is 1.5 ppm, although it
ranged between 0.07 ppm (lowest) and concentration dataset in order to explore should be noted that the Indian Council
5.70 ppm (highest), with the overall inter-relationships and similarities/ of Medical Research (ICMR)
mean value being 0.83 ppm; the dissimilarities between these three recommends a concentration of 1.0 ppm.
distribution of fluoride in drinking water variables. Partial correlation was selected Similarly, the Committee of Public Health
collected from different zones of as an optimal method for the Engineering, Government of India also
Karnataka state is shown in Table 1. The investigation of these relationships since recommends that drinking water should
mean fluoride concentration of drinking it serves to provide realistic have a level of 1.0 ppm. However, the
water is the highest in the north-eastern representations of relationships between World Health Organization (WHO)
zone (1.61 ppm), and that in the south- pairs of the above three parameters recommends that drinking water should
eastern one is 0.79 ppm, followed by independent of the influence of (i.e. contain a fluoride concentration of
0.65 ppm in the north-western, and co-correlations with) the third (potentially between 0.8 and 1.5 ppm.18 According
0.41 ppm in the south-western zones of interfering) variable, unlike simple to the US Center for Disease Control and
this state. For rapid and convenient Pearson correlation coefficients. The Prevention (CDC), when the fluoride level
reference purposes, the spatial map corresponding partial correlation of drinking water exceeds 1.5–2.0 ppm,
shown in Figure 1 has been developed coefficient (rab(c)) matrix between these the risk of developing fluorosis is
in order to visually demonstrate the variables is shown in Table 2. enhanced, especially in children of age
overall distribution of fluoride ion Although all partial correlation <8 years.4 This observation has been
concentration in drinking water in each coefficients computed were low, those corroborated by the International Society
district of Karnataka state. Clearly, the between the drinking water sample F− of Fluoride Research (ISFR) and the
drinking water supply available in the concentration and (1) district temperature British Fluoridation Society.19–21 In view of
Koppal and Kolar districts of this state (rab(c) = −.175) and (2) geographic rainfall this consideration, we elected to visit
have markedly elevated F− level values (rab(c) = −.259) were significant some of the fluorosis-prone districts of
concentrations, and for the latter one, (p = .038 and .002 respectively), the latter Karnataka, and for this preliminary
the mean district value recorded was as highly so. Corresponding Pearson examination found that 98% of
high as 5.7 ppm. This spatial map also correlation coefficients (r values) between schoolchildren within the 12- to 15-year-
demonstrates that there is a marked the F− water level variable and their age group had dental fluorosis in these
and clear ‘between-district-within-zone’ localised temperature and rainfall areas (Figure 3) – the Tumkur district of
variation in these fluoride parameters were −0.221 (p = .008) and Pavagada featured in Figure 3 is located
concentrations, in addition to that −0.290 (p = .004) respectively. That in the south-eastern zone (although the
notable ‘between-zones’. between district temperature and rainfall mean drinking water F− level is only
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Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects
Table 1
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Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects
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Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects
Figure 2
(a) and (b), Plots of mean (untransformed) drinking water fluoride concentrations and associated 95% confidence
intervals (CIs) determined in Zones and Districts of the Indian state of Karnataka. This analysis was performed according
to the Model I ANOVA experimental design, and p values for the ‘between-Zones’ and ‘between-Districts-within-Zones’
components of variance were both <10−9. (c) and (d), Plots of standardised coefficients and associated 95% CIs for the
four Zones investigated according to the Model II ANOVA design for both untransformed (p = 9.03 × 10−6) and Box–Cox
transformed (p < 10−9) datasets respectively. The zero value on the ordinate (y) axes represents a mean-centred overall
mean value for the complete dataset
Table 2
Partial correlations between district drinking water fluoride concentrations, mean rainfall levels and temperatures
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Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects
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Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects
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