Environ Geochem Health (2007) 29:155–162
DOI 10.1007/s10653-006-9070-0
ORIGINAL PAPER
Medical geology in tropical countries with special reference
to Sri Lanka
C. B. Dissanayake Æ Rohana Chandrajith
Published online: 26 January 2007
Ó Springer Science+Business Media B.V. 2007
Abstract Sri Lanka provides an ideal opportu-
nity for the study of the effect of geology on
human health. The vast majority of the people of
Sri Lanka still live in rural areas within areas
termed geochemical provinces. Very broadly, one
could say that a geochemical province has char-
acteristic chemical composition in soil, water
stream sediments and rocks, enabling their delin-
eation from others. The chemical composition is
presumed to be have an impact on the health of
the inhabitants of the particular geochemical
province, particularly because of the fact that
their food and water are obtained mostly from the
terrain itself. This leads to the concept of
‘‘diseases of geochemical origin’’. Among these
are dental fluorosis, iodine deficiency disorders
(IDDs) and selenium-based diseases. The Dry
Zone of Sri Lanka has several areas rich in
groundwater fluoride, the ingestion of which leads
to dental fluorosis. Iodine deficiency diseases are
more common in the Wet Zone, though their
aetiologies are more complicated. Interestingly, it
has also been observed that significant propor-
tions of the female population of Sri Lanka are
C. B. Dissanayake (&)
R. Chandrajith
Department of Geology, University of Peradeniya,
Peradeniya 20400, Sri Lanka
e-mail: cbdissa@hotmail.com
R. Chandrajith
e-mail: rohanac@pdn.ac.lk
selenium-deficient, which could well be related to
the geological environment. Chronic renal failure
(CRF) has been observed in some areas of the
Dry Zone of Sri Lanka, where there is a
relationship of CRF with the mineral content of
drinking water. This subject matter falls under the
auspices of Medical Geology, a scientific disci-
pline still in its infancy, and much more concerted
studies are needed to attract the attention of
medical research.
Keywords Geochemical provinces
Climatic
zones
Dental fluorosis
Defluoridation
Iodine
deficiency disorders (IDDs)
Selenium
geochemistry

Introduction
Sri Lanka is located within the confines of the
tropical belt. Geochemically, tropical environ-
ments display unique characteristics. Of particu-
lar importance is the very strong fractionation of
chemical elements caused by periodic heavy
rainfall and droughts. This characteristic geo-
chemical partitioning can result in either severe
depletion of elements or accumulation to toxic
levels. Some of the world’s most underdeveloped
counties lie in the tropical belt, and the poor
agricultural productivity is clearly a result of
this extreme fractionation of the elements. The
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chemical weathering of rocks is often so intense
that the weathered overburden reaches depths of
over 150 m. The accompanying severe depletion
of essential chemical nutrients, notably potas-
sium, is a characteristic of tropical soils. Further-
more, the extensive clay formations found in
tropical terrains aggravate the depletion of these
essential elements. Kaolin and gibbsite are of
particular significance in complexing these ele-
ments.
Kronberg, Fyfe, Leonardos Jr, and Santos
(1979) observed that, so long as smectite clays
are present with abundant unweathered minerals,
many trace elements (e.g. Zn, Cu, Pb, Cs) are
concentrated in the weathering process. When the
primary minerals are leached and their surface
areas are reduced to the point where groundwater
solution concentrations drop below their meta-
stable solubilities, the smectite and other complex
clays begin to degrade, with kaolin increasing in
abundance in the soil. This type of process is most
commonly seen in humid tropical environments.
Among the elements that are geochemically
fractionated are those classified as essential and
toxic. Humans and animals very often suffer from
diseases caused by either excess or deficiency of
such elements, and their distribution in soil,
plants and water are controlled to a great extent
by geochemical parameters. What is of critical
importance is the dosage of the element con-
cerned. Even essential elements, if ingested in
excessive quantities, cause ill health, as exempli-
fied by debilitating diseases such as skeletal
fluorosis caused by the ingestion of excess fluo-
rides from drinking water.
Depending on the abundance of chemical
elements in rocks, soils, water and plants, terrains
could be geochemically classified as ‘‘geochemical
provinces’’. Some terrains, for example, may
show very high levels of copper and zinc, while
others may display severe paucity of these and
other elements. Geochemical atlases are thus very
useful in delineating areas that may be prone to
diseases of geochemical origin, the arsenic distri-
bution maps of Bangladesh and West Bengal
being good examples (Bhattacharya, Chatterjee,
& Jacks, 1997). The dependence of the aetiology
of certain diseases on the geology of the terrain
concerned is particularly well seen in under
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Environ Geochem Health (2007) 29:155–162
developed counties in the tropics, where large
populations live in close contact with the physical
environment.
Geochemical provinces of Sri Lanka
The concept of geochemical provinces becomes
very useful in the study of the distribution of
diseases linked to geology and geochemistry. It
has been recognized that imbalances resulting
from deficiencies or excesses of elements from
dietary sources are linked to anomalies in the
inorganic element composition of various food
chains. This, in turn, arises from the composi-
tional nature of the geochemical environment
closely associated with the food chains. Very
broadly, one could define a geochemical province
as a geological terrain consisting of a character-
istic chemical composition in soil, rocks, water
and stream sediments. Each such geochemical
province could be delineated from the other.
Each population living in these delineated prov-
inces could, therefore, be susceptible to diseases
caused by the chemical imbalances characteristic
of that geochemical province.
In Sri Lanka, four major geochemical prov-
inces can be delineated, based on the geochem-
ical maps of the country (Dissanayake &
Weerasooriya, 1986). What is apparent is the
heavy influence of climate on the nature of the
chemical composition of the geochemical prov-
inces. Even though the primary rocks basically
influence the chemical composition of the geo-
logical materials in the terrain, the climate
markedly changes the final composition of the
soils and water on account of the intense effects
of either leaching or evaporation. The Dry Zone
in Sri Lanka is therefore chemically markedly
different from the Wet Zone in terms of general
geochemistry, and this is reflected in the
incidence of some diseases.
Fluoride geochemistry and dental health
Fluorine is classified as an essential element,
though health problems could arise from either a
deficiency or excess (Fig 1). Unlike most other
Environ Geochem Health (2007) 29:155–162 157

Fig. 1 Mechanism for fluoride ingestion in arid and semi-arid areas (modified after Ramesam and Rajagopalan, 1985)

trace elements, much of the fluorine entering the

human body is obtained from water. This is of
particular importance to Sri Lanka, because the
majority of the population uses ground and
surface water for their domestic needs. Pipe-
borne water is still a rarity in most parts of Sri
Lanka (Dissanayake, 1991).
Table 1 shows the concentrations of fluorides
that have an impact on the health of people. The
mechanism for fluoride ingestion in arid and
semi-arid areas (Ramesam & Rajagopalan, 1985)
Fig. 2 A case of dental fluorosis showing the marked
is applicable to the Dry Zone of Sri Lanka, where brown staining of the teeth. This photograph was taken in
dental fluorosis is prevalent (Fig. 2). The degree of the Dambulla area in the Dry Zone of Sri Lanka, where
weathering and the leachable F- in a terrain is of dental fluorosis is prevalent
greater significance in the fluoride concentration
of water than the mere presence of fluorine- the Ca–Mg carbonate-bearing rocks in the Matale
bearing minerals in the soils and rocks. Christen- and Polonnaruwa districts as good sinks for the
sen and Dharmagunawardena (1986) considered fluoride ion.
The easy leachability of the fluoride ion causes
the soils in the Wet Zone to be depleted of the ion
Table 1 Impact of fluoride on health (source: WHO, and, hence, lower concentrations in the ground-
1971) water. The Dry Zone soils and water, on the other
Concentration of Impact on health hand, are particularly rich in fluorides, with a
fluoride in groundwater resulting fluoride-rich water. Fig. 3 illustrates the
distribution of fluoride in the deep wells of Sri
Nil Limited growth and fertility
0.0–0.5 mg/l Dental caries
Lanka, and it is quite apparent that there is a
0.5–1.5 mg/l Promotes dental health resulting marked enrichment of fluoride in the deep
in healthy teeth. Prevents groundwater of the Dry Zone.
tooth decay The fact that a majority of the population of Sri
1.5–4.0 mg/l Dental fluorosis (mottling of
teeth)
Lanka lives in a rural environment without
4.0–10.0 mg/l Dental fluorosis, skeletal central water-treatment plants supplying domes-
fluorosis (pain in back and tic water clearly highlights the need for simple,
neck bones) village level defluoridation techniques using
>10.0 mg/l Crippling fluorosis
locally available, cheap raw materials.

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Fig. 3 Distribution of fluoride in the deep wells of Sri
Lanka (after Dissanayake, 1991)
Phantumvanit, Songpaisan, and Moller (1988),
who developed a defluoridator for individual
households in Northern Thailand, noted that the
shortcomings of most defluoridation methods are
(a) high cost of plant, (b) high operational and
maintenance costs, (c) low capacity for removing
fluoride, (d) lack of selectivity for fluoride, (e)
undesirable effects on water quality, (f) genera-
tion of sludge that is difficult to handle, (g)
complicated procedures.
In Sri Lanka some attempts have been made to
defluoridate household drinking water, even
though techniques for the defluoridation of fluo-
ride-rich waters in remote parts of developing
countries, where dental fluorosis is most common,
has inherent problems.
Padmasiri and Dissanayake (1995) discussed
the use of burnt bricks as the defluoridating agent.
The filter constructed is simple in design and is
fabricated from a 225 mm diameter, 1 m PVC
pipe length, 20 mm diameter, 1 m PVC pipe
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Environ Geochem Health (2007) 29:155–162
length and an elbow bend. In order for there to br
a longer retention time of water to pass through
the defluoridating material, i.e. burnt bricks,
upward flow technology was used. The use of this
filter should retain the high-fluoride water for a
minimum period of 12 h in the defluoridator.
Then, the high fluoride water is fed into the
column and the defluoridated water comes out
from the outlet. This simple technique has been
quite successfully used in the remote areas of Sri
Lanka affected by dental fluorosis resulting from
the intake of high-fluoride water.
Medical geochemistry of selenium
Selenium is considered necessary for several
metabolic functions and is an essential compo-
nent of the biologically important glutathione
peroxidase enzymes (GSH-Px) known to act as
anti-oxidants preventing the degeneration of bio-
logical membranes. An intake of selenium of less
than 0.04 lg per day is considered deficient, while
a dose in excess of 900 lg per day is considered
toxic to human health (Yang & Xia, 1995).
Keshan disease, a degenerative heart disease
and Kashin–Beck disease, a disease causing
deformity of joints, are known to be related to
imbalances of selenium in the body. As noted by
Fordyce, Johnson, Navaratne, Appleton and Dis-
sanayake (1998), Se has been implicated in the
aetiology of cancer, muscular sclerosis and mus-
cular dystrophy. In recent years, it has been
suggested that selenium deficiency may be an
important factor in the onset of goitre and other
iodine deficiency disorders (IDDs). Fordyce,
Johnson, Navaratne, Appleton and Dissanayake
(2000) studied the selenium geochemistry in
relation to IDD for the first time in Sri Lanka.
In their study they determined the chemical
differences in the environment (measured in soil,
rice and drinking water) and the selenium status
of the human population (demonstrated by hair
samples from women) from 15 villages. The
villages were characterized by low (<10%), mod-
erate (10–25 %) and high (>25%) goitre inci-
dence (NIDD, MIDD and HIDD, respectively).
Their results from analysis of 75 soil samples
showed that concentrations of total Se and iodine
Environ Geochem Health (2007) 29:155–162 159

were highest in the HIDD villages. The soil clay
and organic matter content, however, appeared to
inhibit the bioavailability of these elements.
Interestingly, the study by Fordyce et al.
(2000) also showed that significant proportions
of the Sri Lankan female population may be
selenium deficient (24%, 24% and 40% in the
NIDD, MIDD and HIDD villages, respectively).
Table 2 shows the summary of selenium abun-
dance.
Fordyce et al. (2000) were of the opinion that,
although Se-deficiency is not restricted to areas
where goitre is prevalent, a combination of iodine
and selenium deficiency could be involved in the
pathogenesis of goitre in Sri Lanka.
The iodine cycle and iodine deficiency disorders
In a large number of tropical countries, iodine
deficiency disorders are rated as a major health
problem (Fig 4). The geochemistry of iodine and
its bioavailability influence the prevalence of
IDDs, and geological and mineralogical factors
play a key role in this process.
Among these factors are:
(a) intense rainfall
(b) high temperatures and their marked diurnal
variations
(c) very high rates of weathering and leaching of
rocks and soils
(d) clay organic interactions
(e) greater fractionation of elements in the
physical environment
Poverty and poor dietary habits are the main
non-geological factors that influence IDD.
The surface soils in tropical terrains receive
more iodine from the atmosphere via rainwater
than from the rocks. Rainfall, therefore, plays a
critical role in the iodine cycle of tropical envi-
ronments. It brings down more iodine to the
terrestrial environment than does the dry depo-
sition. The intensity of the leaching, however,
impoverishes the soil of iodine, and, in tropical
soils such as those in the Wet Zone of Sri Lanka,
iodine content is particularly low.
Figure 5 illustrates the endemic goitre belt of
Sri Lanka. The climate, and also, perhaps, the
heavily leached soils such as the lateritic soils are
related to the incidence of goitre in Sri Lanka.
Groundwater in the tropical environment rapidly
removes the iodine from the already leached soils,
thereby severely impoverishing the soils of iodine.
Areas subjected to periodic water logging and
areas in which there is a strong downward
movement of the groundwater, particularly
through highly porous media, are especially
depleted in iodine.
Figure 6 illustrates the geochemical cycle of
iodine, and it is worthy of special note that the
central mountain belt may have a major influence
in the geochemical cycling of iodine in Sri Lanka.

Table 2 Summary of iodine and Se determinations in soil, incidence, MIDD moderate goitre incidence, HIDD high
rice, water and hair in the incidence of goitre in village goitre incidence, nd no data)
groups (Fordyce et al., 2000) (NIDD no/low goitre

Group Sample Minimum Maximum Geo- Number Minimum Maximum Geo- Number
type Se Se mean iodine Iodine mean
Se iodine

NIDD Soil(ng/g) 113 663 226 25 130 10000 2260 25

Rice(ng/g) 6.8 150 42 25 45 58 51 5
Water(lg/l) 0.06 0.24 0.11 5 53 84 66.5 5
Hair (ng/g) 104 765 294 25 nd nd nd
MIDD Soil(ng/g) 310 5238 875 24 130 2008 2008 25
Rice(ng/g) 0.1 776 55 25 <38 <38 <38 5
Water(lg/l) 0.06 0.09 0.07 5 3 23.5 5.5 5
Hair (ng/g) 118 2652 389 25 nd nd nd
HIDD Soil(ng/g) 276 3947 1124 25 1000 9600 3914 25
Rice(ng/g) 0.1 127 25 25 <38 <38 <38 5
Water(lg/l) 0.06 0.09 0.07 5 3.3 7.02 7.02 5
Hair (ng/g) 111 984 302 25 nd nd nd

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Fig. 4 Typical case of endemic goitre in Sri Lanka. This
photograph was taken in the Angunawala area near
Kandy, where endemic goitre is prevalent
Fig. 5 The endemic goitre belt of Sri Lanka (after
Dissanayake and Chandrajith 1996)
Another factor that could influence the bio-
availability of iodine is the presence of goitrogens.
These are substances capable of producing thy-
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Environ Geochem Health (2007) 29:155–162
roid enlargement by influencing the synthesis of
thyroid hormone. The pituitary responds by
increasing its output of thyroid-stimulating hor-
mone (TSH), and this indicates hypertrophy in
the gland in an effort to increase thyroid hormone
production (Underwood, 1977).
Goitrogens can be biological or mineralogical,
and the latter is of particular interest to geochemists.
In Sri Lanka, the prevalence of iodine deficiency
disorders displaying geographical distribution and
as isolated pockets, notably in the Kalutara and
Kandy regions, point to the possible existence of
geological and geochemical goitrogens.
Kalutara has a goitre incidence of nearly 40%
(Fernando, Balasuriya, Herath, & Katugampola,
1987), although it lies close to the sea—the major
source of iodine. This enigma clearly points to the
presence of geochemical goitrogens in the region.
In the tropical soils, clay minerals and humic
substances are two of the most important iodine
fixers. As the vast majority of the population of Sri
Lanka, as in the case of other developing counties,
lives in close association with the geological envi-
ronment, the iodine-fixing potential of the soil is of
great importance from the point of view of the
occurrence of iodine deficiency disorders.
More research is needed, therefore to identify
clearly the causes that lead to the poor bioavail-
ability of iodine in the geological environment.
Chronic renal failure—geochemical basis
Chronic renal failure (CRF) is an irreversible
deterioration in renal function. It is known to
affect (a) regulation of water content of the body
and the nature of the body fluids, (b) regulation of
the electrolyte content of the body, (c) mainte-
nance of the normal acid–base balance of the
body fluids, (d) retention of substances vital to
body economy (glucose, amino-acids, phosphates,
proteins) and (e) hormonal and metabolic
functions.
The quality of the drinking water in relation to
CRF is now a subject of increasing interest
to medical geologists. A study undertaken by
‘‘Action contre la Faim’’ (Lapegue, 2001) in the
Trincomalee district, where CRF among the
people is significantly high, shows a relationship
Environ Geochem Health (2007) 29:155–162
Fig. 6 A schematic diagram showing the iodine geochemical cycle in the tropical environment (after Dissanayake,
Chandrajith, & Tobschall, 1998)
with the mineral content of the drinking water.
The areas chosen for study were Gomaranka-
dawela, Kebitigollewa and Padaviya-Siripura.
Among the suspected causes linked to the geo-
chemistry of the groundwater were (a) sulphides
and pH (deep and shallow groundwater), (b) Pb
(deep and shallow water), (c) Cd (only in deep
water). Even though no direct cause for the CRF
could be identified, the combination of high rates
of sulphide and acidic conditions needs to be
more thoroughly investigated.
Table 3 shows the incidence of CRF in the
study areas of the Trincomalee district. The
alarming increase, notably in the Padaviya-Siri-
pura area, is thought to be caused by the
unsuitable quality of the drinking water. Pesticide
toxicity is another factor that merits further
consideration in these studies, particularly in the
Padaviya-Siripura area. Interestingly, all patients
from the Kebitigollewa area obtained their
drinking water supplies from tube wells, while
Table 3 The incidence of
Reference hospital
CRF in the Trincomalee
district (Lapegue, 2001)
Programme reference area
CRF cases/1,000 in 1999
Change in rate of CRF cases/1,000/
year in the past 5 years
161
this was not the case in Gomarankadawela. In
Padaviya-Siripura, open wells were used.
Conclusions
Medical geology as a research field is still in its
infancy. The effect of geology on the geographical
distribution of some diseases has been observed
in many parts of the world, notably in the tropical
countries. Some diseases, such as dental and
skeletal fluorosis and cancer of the oesophagus
and bowels, are caused by excessive nitrate
intake. Endemic goitre, and other iodine defi-
ciency disorders, and chronic renal failure appear
to be related to the geochemistry of the immedi-
ate physical environment. The excessive abun-
dance of some diseases is related to chemical
elements in the groundwater, and, hence, the
drinking water, soils and vegetation are linked to
anomalous incidence of these diseases.
Trincomalee Anuradapura Padaviya–
hospital hospital Siripura hospital
Gomarankadawela Kebitigollewa –
1.6 17 21.1
–0.025 +0.86 +4.22
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In Sri Lanka, in view of the fact that it is a
tropical country with markedly defined geochem-
ical provinces, such geochemistry–disease corre-
lations are more visible. With better health data
and other medical statistics, coupled with proper
site investigations for geological and geochemical
parameters, geochemists would be in a better
position to contribute towards the study of the
origin of diseases.
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