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Water quality and health in northern Canada: stored drinking water and acute gastrointestinal illness in Labrador Inuit

Abstract

One of the highest self-reported incidence rates of acute gastrointestinal illness (AGI) in the global peer-reviewed literature occurs in Inuit communities in the Canadian Arctic. This high incidence of illness could be due, in part, to the consumption of contaminated water, as many northern communities face challenges related to the quality of municipal drinking water. Furthermore, many Inuit store drinking water in containers in the home, which could increase the risk of contamination between source and point-of-use (i.e., water recontamination during storage). To examine this risk, this research characterized drinking water collection and storage practices, identified potential risk factors for water contamination between source and point-of-use, and examined possible associations between drinking water contamination and self-reported AGI in the Inuit community of Rigolet, Canada. The study included a cross-sectional census survey that captured data on types of drinking water used, household practices related to drinking water (e.g., how it was collected and stored), physical characteristics of water storage containers, and self-reported AGI. Additionally, water samples were collected from all identified drinking water containers in homes and analyzed for presence of Escherichia coli and total coliforms. Despite municipally treated tap water being available in all homes, 77.6% of households had alternative sources of drinking water stored in containers, and of these containers, 25.2% tested positive for total coliforms. The use of transfer devices and water dippers (i.e., smaller bowls or measuring cups) for the collection and retrieval of water from containers were both significantly associated with increased odds of total coliform presence in stored water (ORtransfer device = 3.4, 95% CI 1.2–11.7; ORdipper = 13.4, 95% CI 3.8–47.1). Twenty-eight-day period prevalence of self-reported AGI during the month before the survey was 17.2% (95% CI 13.0–22.5), which yielded an annual incidence rate of 2.4 cases per person per year (95% CI 1.8–3.1); no water-related risk factors were significantly associated with AGI. Considering the high prevalence of, and risk factors associated with, indicator bacteria in drinking water stored in containers, potential exposure to waterborne pathogens may be minimized through interventions at the household level.

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Acknowledgements

Sincerest thanks are extended to the residents of Rigolet for welcoming us into their community and homes, and for their ongoing support of the research in Nunatsiavut, which is a part of the larger international Indigenous Health Adaptation to Climate Change (IHACC) project. Thank you also to the Rigolet Inuit Community Government for continued partnership with the IHACC research team and to Rob Jamieson and Lisbeth Truelstrup Hansen for lending their supplies and expertise in water testing and analysis. This research was funded by the Indigenous Health Adaptation to Climate Change (IHACC) project (funded by the International Development Research Centre and Canadian Tri-Council Agencies [Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and the Social Sciences and Humanities Research Council]) and the Inuit Traditional Knowledge for Adapting to the Health Effects of Climate Change (IK-ADAPT) project (funded by the Canadian Institutes of Health Research). The design and conduct of this study were independent of the funding sources.

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Correspondence to Carlee J. Wright or Sherilee L. Harper.

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Informed consent was obtained from all respondents or a proxy respondent for children under 12 years of age.

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The authors declare that they have no conflict of interest.

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Responsible editor: Philippe Garrigues

Other members of the Indigenous Health Adaptation to Climate Change Research Team include: Lea Berrang Ford, Cesar Carcamo, Alejandro Llanos, Shuaib Lwasa, and Didacus Bambaiha Namanya

Khosrow Farahbakhsh is former faculty at the School of Engineering, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada.

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Appendix A. Equations

Appendix A. Equations

Eq. (A.1) Annual incidence rate

$$ \frac{\#\mathrm{cases}}{\frac{1}{2}\left[\left(\mathrm{number}\ \mathrm{at}\ \mathrm{risk}\right)+\left(\mathrm{number}\ \mathrm{at}\ \mathrm{risk}-\mathrm{cases}\right)\right]}\times \frac{365}{28-\mathrm{day}\ \mathrm{recall}\ \mathrm{period}} $$

Eq. (A.2) Standard error (rate)

$$ \sqrt{\frac{\mathrm{cases}}{{\mathrm{person}\ \mathrm{years}}^2}} $$

Eq. (A.3) 95% confidence interval

$$ p\pm 1.96\ \left(\mathrm{SE}\right) $$

Eq. (A.4) Annual incidence proportion

$$ 1-{\left(1- X\right)}^{\frac{365}{28}},\kern0.5em \mathrm{where}\ X=\frac{\#\mathrm{cases}}{\mathrm{Number}\ \mathrm{at}\ \mathrm{risk}-\frac{1}{2}\mathrm{withdrawals}} $$

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Wright, C.J., Sargeant, J.M., Edge, V.L. et al. Water quality and health in northern Canada: stored drinking water and acute gastrointestinal illness in Labrador Inuit. Environ Sci Pollut Res 25, 32975–32987 (2018). https://doi.org/10.1007/s11356-017-9695-9

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  • DOI: https://doi.org/10.1007/s11356-017-9695-9

Keywords

  • Indigenous
  • Drinking water
  • Waterborne disease
  • Point-of-use
  • Coliforms
  • Recontamination