Using Eggshell Calcium to Mitigate Fluorosis in Ethiopia

Worldwide, 50M people suffer from fluorosis, which affects teeth, bones, joints, and brain functions. In countries where manual labour is essential, fluorosis reduces mobility and thus affects livelihoods. In Sub-Saharan Africa, widespread malnutrition is compounded by fluorosis. 14M Ethiopians have fluorosis but defluoridation requires costly infrastructure. Diets rich in calcium (Ca) may reduce the severity of symptoms by binding fluoride (F). No attempt has been made to confirm this effect at the community level. Our innovation is to use an age-old source of Ca, eggshell (2000 mg/egg), as dietary Ca to bind F from food and beverages, preventing its absorption. Additionally, Ca is a limiting nutrient in most of the country, especially for women of reproductive age. Diet diversity is poor and sources of calcium such as millet, milk, and green vegetables are not consumed frequently. Eggs are promoted as an ideal animal source food needed by infants (6-24 mo) every day. Eggs are a culturally acceptable food and with the promotion of chickens to rural farmers, as we are doing, eggshells are available. Mothers taught to use ground eggshell mixed with food are accepting it. Sustainability of eggshell use will occur with introduction of chickens into communities, as this has financial benefits. The impact of eggshell use can be measured in fluorosis-affected areas as decreased body fluoride load (reflected in less urine F excretion) and in mitigation of fluorosis symptoms.