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Implementing a geographical information system to assess endemic fluoride areas in Lamphun, Thailand

Authors Theerawasttanasiri N, Taneepanichskul S, Pingchai W, Nimchareon Y, Sriwichai S

Received 25 July 2017

Accepted for publication 21 November 2017

Published 25 January 2018 Volume 2018:11 Pages 15—24


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Kent Rondeau

Nonthaphat Theerawasttanasiri,1,2 Surasak Taneepanichskul,1 Wichain Pingchai,3 Yuwaree Nimchareon,4 Sangworn Sriwichai5

1College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand; 2Department of Health, Health Promotion Center Region 1, Chiang Mai, Thailand; 3Mueang Lamphun District Public Health Office, 4Pasang District Public Health Office, 5Ban Thi District Public Health Office, Lamphun, Thailand

Introduction: Many studies have shown that fluoride can cross the placenta and that exposure to high fluoride during pregnancy may result in premature birth and/or a low birth weight. Lamphun is one of six provinces in Thailand where natural water fluoride (WF) concentrations >10.0 mg/L were found, and it was also found that >50% of households used water with high fluoride levels. Nevertheless, geographical information system (GIS) and maps of endemic fluoride areas are lacking. We aimed to measure the fluoride level of village water supplies to assess endemic fluoride areas and present GIS with maps in Google Maps.
Methods: A cross-sectional survey was conducted from July 2016 to January 2017. Purpose sampling was used to identify villages of districts with WF >10.0 mg/L in the Mueang Lamphun, Pasang, and Ban Thi districts. Water samples were collected with the geolocation measured by Smart System Info. Fluoride was analyzed with an ion-selective electrode instrument using a total ionic strength adjustment buffer. WF >0.70 mg/L was used to identify unsafe drinking water and areas with high endemic fluoride levels. Descriptive statistics were used to describe the findings, and MS Excel was used to create the GIS database. Maps were created in Google Earth and presented in Google Maps.
Results: We found that WF concentrations ranged between 0.10–13.60 mg/L. Forty-four percent (n=439) of samples were at unsafe levels (>0.70 mg/L), and. 54% (n=303) of villages and 46% (n=79,807) of households used the unsafe drinking water. Fifty percent (n=26) of subdistricts were classified as being endemic fluoride areas. Five subdistricts were endemic fluoride areas, and in those, there were two subdistricts in which every household used unsafe drinking water.
Conclusion: These findings show the distribution of endemic fluoride areas and unsafe drinking water in Lamphun. This is useful for health policy authorities, local governments, and villagers and enables collaboration to resolve these issues. The GIS data are available at

Keywords: endemic fluoride area, water supply, Google Maps, safe drinking water, GIS

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