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

Bibliographical note

This study was conducted with the financial support of the Higher Education
Commission of Pakistan, and the University of Peshawar, Pakistan. We greatly
acknowledge with deep gratitude this financial support


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


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