Globally, 200 million people are at risk of adverse health effects from drinking groundwater contaminated with high fluoride concentrations that exceed the World Health Organization's maximum contaminant limit (WHO MCL=1.5ppmF-). Although many defluoridation technologies have been demonstrated to work in lab, most have proven inappropriate for impoverished rural regions of developing countries because they are cost-prohibitive, require skilled labor, or are difficult to scale. The authors submit evidence for the use of bauxite, an aluminum-rich ore, as a potentially inexpensive, effective, and scalable defluoridation technology. Specifically, we present results from experimental studies that characterize globally diverse bauxite ores, elucidate fluoride removal mechanisms, and establish proof of concept that mildly processed bauxite can cost-effectively remediate field-relevant fluoride concentrations in synthetic and real groundwater matrices at field-relevant kinetics. We discuss practical implications of these research findings and highlight remaining challenges and unknowns that need to be further studied before implementing the proposed defluoridation process in the field.

Globally, 200 million people drink groundwater contaminated with fluoride concentrations exceeding the World Health Organization's recommended level (WHO-MCL = 1.5 mg F^-/L). This study investigates the use of minimally processed (dried/milled) bauxite ore as an inexpensive adsorbent for remediating fluoride-contaminated groundwater in resource-constrained areas. Adsorption experiments in synthetic groundwater using bauxites from Guinea, Ghana, U.S., and India as single-use batch dispersive media demonstrated that doses of ∼10-23 g/L could effectively remediate 10 mg F^-/L. To elucidate factors governing fluoride removal, bauxites were characterized using X-ray fluorescence, X-ray diffraction, gas-sorption analysis, and adsorption isotherms/envelopes. All ores contained gibbsite, had comparable surface areas (∼14-17 m²/g), had similar intrinsic affinities and capacities for fluoride, and did not leach harmful ions into product water. Fluoride uptake on bauxite -primarily through ion-exchange- was strongly pH-dependent, with highest removal occurring at pH 5.0-6.0. Dissolution of CaCO₃, present in trace amounts in India bauxite, significantly hindered fluoride removal by increasing solution pH. We also showed that fluoride remediation with the best-performing Guinea bauxite was ∼23-33 times less expensive than with activated alumina. Overall, our results suggest that bauxite could be an affordable fluoride-remediation adsorbent with the potential to improve access to drinking water for millions living in developing countries.

India represents one-third of the world's fluorosis burden and is the fifth global producer of bauxite ore, which has previously been identified as a potential resource for remediating fluoride-contaminated groundwater in impoverished communities. Here, we use thermal activation and/or groundwater acidification to enhance fluoride adsorption by Indian bauxite obtained from Visakhapatnam, an area proximate to endemic fluorosis regions. We compare combinatorial water treatment and bauxite-processing scenarios through batch adsorption experiments, material characterization, and detailed cost analyses. Heating Indian bauxite above 300 °C increases available surface area by > 15× (to ∼170 m²/g) through gibbsite dehydroxylation and reduces the bauxite dose for remediating 10 ppm F^- to 1.5 ppm F^- by ∼93% (to 21 g/L). Additionally, lowering groundwater pH to 6.0 with HCl or CO₂ further reduces the average required bauxite doses by 43-73% for ores heated at 300 °C (∼12 g/L) and 100 °C (∼77 g/L). Product water in most examined treatment scenarios complies with EPA standards for drinking water (e.g., As, Cd, Pb, etc.) but potential leaching of Al, Mn, and Cr is of concern in some scenarios. Among the defluoridation options explored here, bauxite heated at 300 °C in acidified groundwater has the lowest direct costs ($6.86 per person per year) and material-intensity.

Throughout the developing world, over 200 million people drink groundwater containing fluoride concentrations surpassing the World Health Organization's maximum recommended contaminant level (WHO-MCL) of 1.5 mg F^-/L, resulting in adverse health effects ranging from mottled tooth enamel to debilitating skeletal fluorosis. Existing technologies to remove fluoride from water, such as reverse osmosis and filtration with activated alumina, are expensive and are not accessible for low-income communities. Our group and others have demonstrated that minimally-processed bauxite ores can remove fluoride to safe levels at a fraction of the cost of activated alumina. We report results from testing for some technical challenges that may arise in field deployment of this technology at large scale, particularly in a sufficiently robust manner for application in development contexts. Anticipating possible modes of failure and addressing these challenges in advance in the laboratory is particularly important for technologies for vulnerable communities where the opportunity to re-launch pilot projects is limited and small failures can keep solutions from the people that need them most. This work addresses three potential technical barriers to reliable removal of fluoride from drinking water with bauxite ore from Visakhapatnam, Andhra Pradesh, India. We evaluate competition from co-occurring ions, adsorption reversibility, and potability of the product water with regards to leaching of undesirable ions during treatment with various adsorbent materials including raw and thermally activated bauxite, and synthetic gibbsite (a simple model system). Under the conditions tested, the presence of phosphate significantly impacts fluoride adsorption capacity on all adsorbents. Sulfate impacts fluoride adsorption on gibbsite, but not on either bauxite adsorbent. Nitrate and silicate (as silicic acid), tested only with gibbsite, do not affect fluoride adsorption capacity. Both thermally activated bauxite and gibbsite show non-reversible adsorption of fluoride at a pH of 6. Raw bauxite leached arsenic and manganese in a TCLP leaching test at levels indicating the need for ongoing monitoring of treated water, but not precluding safe deployment of bauxite as a fluoride remediation technology. Understanding these phenomena is crucial to ensure field deployment over large diverse geographical areas with aquifers varying in groundwater composition, and for ensuring that the appropriate engineering processes are designed for field implementation of this innovation.

The world is not on track to meet Sustainable Development Goal 6.1 to provide universal access to safely managed drinking water by 2030. Removal of priority microbial contaminants by disinfection is one aspect of ensuring water is safely managed. Passive chlorination (also called in-line chlorination) represents one approach to disinfecting drinking water before or at the point of collection (POC), without requiring daily user input or electricity. In contrast to manual household chlorination methods typically implemented at the point of use (POU), passive chlorinators can reduce the user burden for chlorine dosing and enable treatment at scales ranging from communities to small municipalities. In this review, we synthesized evidence from 27 evaluations of passive chlorinators (in 19 articles, 3 NGO reports, and 5 theses) conducted across 16 countries in communities, schools, health care facilities, and refugee camps. Of the 27 passive chlorinators we identified, the majority (22/27) were solid tablet or granular chlorine dosers, and the remaining devices were liquid chlorine dosers. We identified the following research priorities to address existing barriers to scaled deployment of passive chlorinators: (i) strengthening local chlorine supply chains through decentralized liquid chlorine production, (ii) validating context-specific business models and financial sustainability, (iii) leveraging remote monitoring and sensing tools to monitor real-time chlorine levels and potential system failures, and (iv) designing handpump-compatible passive chlorinators to serve the many communities reliant on handpumps as a primary drinking water source. We also propose a set of reporting indicators for future studies to facilitate standardized evaluations of the technical performance and financial sustainability of passive chlorinators. In addition, we discuss the limitations of chlorine-based disinfection and recognize the importance of addressing chemical contamination in drinking water supplies. Passive chlorinators deployed and managed at-scale have the potential to elevate the quality of existing accessible and available water services to meet "safely managed" requirements.