Fluoride in the drinking water of Pakistan and the possible risk of crippling fluorosis

To explore the possibility of fluoride toxicity, 747 water samples were collected from surface water and groundwater sources of 16 major cities of Pakistan, adopting a uniform sampling design with distribution of samples: Lahore (79), Kasur (46), Faisalabad (30), Khushab (50), Chakwal (51), Mianwali (30), Jhelum (53), Bahawalpur (60), Karachi (60), Mirpur Khas (55), Peshawar (38), Risalpur (35), Quetta (81), Ziarat (21), Loralai (21), and Mastung (37). Comparison of analytical findings with WHO Guidelines of Drinking Water for Fluoride (i.e., 1.5 ppm) has concluded that 16% of the monitored water sources have fluoride concentration beyond the permissible safe limit of 1.5 mg L 1 falling in the concentration range of 1.6–25 mg L 1. The highest fluoride contamination (22%) is detected in the Balochistan province followed by 19% in Punjab province. Comparatively higher fluoride levels of > 20% in the groundwater sources like hand pumps supported the possibility of increased groundwater contamination as excessive fluoride concentrations are expected to come from calcium-poor aquifers and in areas where fluoride-bearing minerals are common or where cation exchange of sodium for calcium occurs. Field observations have also indicated the prevalence of fluoride-associated health implications in the study areas with excessive fluoride in water sources. Findings of this study have provided bidirectional vision for the epidemiological investigations as well as to mitigate the issues in the affected vicinities of fluoride-rich areas.