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This study was conducted to investigate the high incidence of mottled teeth among residents of an area with hot springs in the Choma District of the Southern Province of Zambia. A survey involving 128 pupils was conducted at a Basic School to collect data on pupil's backgrounds and their main sources of drinking water between birth and age 7. A dental specialist examined the pupils' teeth and samples of drinking water were collected from locations where the majority of the pupils lived. It was analysed for fluorides and other drinking water quality parameters. Results of the survey showed a highly significant (P < 0.001) association between pupils' main sources of drinking water between birth and age 7 and the incidence of discoloured teeth. All (100%) pupils who drank water from hot springs before age 7 had moderate to severe fluorosis, while the majority (96.7%) of the pupils who drank water from other sources had no dental fluorosis. Fluoride concentrations ranged from 5.95 to 10.09 mg/l in water from hot springs, and from 0.03 to 0.6 mg/l in water from other sources. Fluoride levels in water from hot spring water samples exceeded the 1.5 mg/l WHO guideline value for drinking water, while those in water from other sources were significantly (P < 0.05) lower than this. We conclude that the high prevalence of mottled teeth among residents of the study area is a case of endemic dental fluorosis associated with drinking water from hot springs containing high concentrations of fluoride.

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This review paper covers the issues of pit latrine emptying national policies and regulations with a focus on Malawi and Zambia. With 2.4 billion people worldwide still lacking improved sanitation facilities, developing countries need to look at policy, regulation and practice for household sanitation service provision with a new lens. What happens "next," when improved sanitation facilities eventually become full? An emphasis on faecal sludge management has multiplied this important issue in the past few years. The authors compare the pit latrine emptying situation in Malawi and Zambia with a focus on status, challenges and opportunities. To build this comparison, a desk review of national policies, local regulations and peer-reviewed journal papers was conducted. The paper concludes that existing national policies and regulations taking faecal sludge management into account are weak and have wide gaps in the two study countries. For the future, it is recommended, first, that household pit latrine emptying should be seen as an opportunity to address national sanitation gaps and, second, national policies and regulations need to be evaluated and updated.