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Hidden hot springs likely impact rural water supplies in Malawi's Rift Valley with excess dissolved fluoride leading to localised endemic severe dental fluorosis. Predicting their occurrence is a challenge; Malawi's groundwater data archive is sporadic and incomplete which prevents the application of standard modelling techniques. A creative alternative method to predict hidden hot spring locations was developed using a synthesis of proxy indicators (geological, geochemical, dental) and is shown to be at least 75% effective. An exciting collaboration between geoscientists and dentists allowed corroboration of severe dental fluorosis with hydrogeological vulnerability. Thirteen hidden hot springs were identified based on synthesised proxy indicators. A vulnerability prediction map for the region was developed and is the first of its kind in Malawi. It allows improved groundwater fluoride prediction in Malawi's rift basin which hosts the majority of hot springs. Moreover, it allows dentists to recognise geological control over community oral health. Collaborative efforts have proven mutually beneficial, allowing both disciplines to conduct targeted research to improve community wellbeing and health and inform policy development in their respective areas. This work contributes globally in developing nations where incomplete groundwater data and vulnerability to groundwater contamination from hydrothermal fluoride exist in tandem. [ABSTRACT FROM AUTHOR]

Fluoride concentrations in Malawi's groundwater are primarily controlled by geogenic sources that are highly variable and may cause a heterogeneous fluoride occurrence and local-to-regional variations in fluorosis health risks posed. Our aim was to address the challenge of developing a national solution to predicting groundwater vulnerability to geogenic fluoride risk in the country of Malawi where incidences of fluorosis are reported and typical developing world problems of limited data and resources abound. Previously there have only been sporadic, local-scale studies linking fluoride occurrence with health risks in Malawi with no attempts to tackle the issue nationally. We hence develop a screening method for predicting groundwater vulnerability to geogenic fluoride in the form of detailed risk maps developed from statistical relationships shown between groundwater fluoride occurrence and known geogenic fluoride sources. The approach provides for dynamic update and informed acquisition of new data and hence on-going improving capacity to manage fluoride risks in Malawi. Our screening method provides a technical basis for redefining national fluoride policy to ensure commensurate management of health risks posed. Specifically, the approach provides a pathway for stepped progression from the current 6 mg/L Malawian standard for fluoride in drinking water to adoption of the World Health Organisation 1.5 mg/L guideline standard. [ABSTRACT FROM AUTHOR]