Insights to promote safe drinking water behavioural changes in zones affected by fluorosis in the East-African Rift Valley

The presence of fluoride in drinking water can have beneficial effects in reducing the incidence of dental caries when its concentration lies in the optimal range of 0.5–0.7 mg/L. However, fluoride intake below and above this range can have negative effects on tooth enamel and skeletal fluorosis in case of prolonged exposure to high concentrations. Unfortunately, in some areas of the world, such as rural communities of the East-African Rift Valley (EARV), water is dramatically contaminated by fluoride which may cause dental and skeletal fluorosis because its concentration is often well above the maximum threshold of 1.5 mg/L recommended by the World Health Organisation. To tackle this problem experts and policy makers have attempted to introduce defluoridation techniques that, as well as being cost-effective, allow end users to drastically reduce the level of fluoride below the above-mentioned threshold. However, the adoption of these techniques remains quite low because behavioural factors influencing people's safer water consumption in these areas of the world is poorly understood. To fill such a gap in this study we explore how these factors can influence the adoption of a new defluoridator in Kenyan and Tanzanian rural communities of the EARV. To achieve this objective 75 people belonging to Maasai and Meru ethnic groups were interviewed running nine focus groups where these factors were investigated using the RANAS (Risk, Attitude, Norm, Ability, Self-Regulation) model. Results show that the drinking behaviour of people living in the EARV is dramatically affected by contextual factors and exacerbated by the high level of fluoride naturally contained in drinking and cooking water. Behavioural insights into how policy makers and marketers could reverse this unhealthy drinking behaviour introducing technological devices that can cut the quantity of fluoride contained naturally are discussed arguing in favour of the possibility of using different behaviour changing techniques.