A review of groundwater fluoride contamination in Pakistan and an assessment of the risk of fluorosis

Zia Ur Rahman, Bushra Khan*, Iqbal Ahmada, Ishaq Ahmad Mian, Anwar Saeed, Amer Afaq, Abdullah Khan, Pete Smith, Afaq Ahmad Mianh

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

10 Citations (Scopus)
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The fluoride ion (F) is an important anion and a major pollutant of groundwater, affecting millions of people around the globe. Groundwater contaminated with F is the main source of F exposure for the development of fluorosis in humans.Various natural and anthropogenic activities are responsible for the F contamination of groundwater sources. At concentrations greater than the permissible limits, F has adverse impacts on human health with various manifestations of fluorosis, especially in children. In Pakistan, the F content in groundwater sources varies considerably from the World Health Organization (WHO) and national standard value of 1.5 mg/L. In addition to the climatic conditions of an area, the factors controlling the F concentration in groundwater sources include the weathering and leaching of F-bearing minerals and rocks. F contamination of groundwater sources in Pakistan is widespread and is often intense with the highest mean concentration being 28.24 mg/L in the Chachro and Diplo sub-districts in Tharparkar. The lowest value was 0.29 mg/L in Peshawar. High mean values were found for the Estimated Daily Intake (EDI) and the Hazard Index (HI) [HI=EDIwater/RfD] in both children and adults (EDI: 0.406 mg and 0.098 F/kg bw/day; HI: 6.77 and 1.638, for children and adults, respectively). Children in Pakistan are at a higher risk than adults for developing fluorosis due to F contamination of ground water. The determination of the F status in all the drinking water sources in Pakistan is urgently required.

Original languageEnglish
Pages (from-to)171-181
Number of pages11
Issue number2
Publication statusPublished - 1 Apr 2018


  • contamination
  • estimated daily intake
  • fluoride
  • groundwater
  • health
  • Hazard index
  • risk assessment


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