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 (OR = 3.4, 95% CI 1.2-11.7; OR = 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.

How are perceptions associated with water consumption in Canadian Inuit? A cross-sectional survey in Rigolet, Labrador

“…Water from this central facility is then collected by residents in personal containers for storage in the household. Water storage containers vary greatly in size and shape; an examination of water storage in Rigolet is described by Wright et al (2017).…”

“…Lastly, water from the PWDU contains no free chlorine residuals; while this can improve aesthetic appeal, chlorine residuals are crucial for inactivating microbial contaminants that may enter water after initial treatment (Health Canada, 2006). PWDU water is therefore vulnerable to recontamination between source and point-of-use, potentially increasing risk of exposure to waterborne pathogens (Wright et al, 2017). Future risk assessments, cost-benefit-analyses, and discussions on water policy and public health messaging should take these contextually unique factors into consideration.…”

“…Given the disproportionate water-related challenges in northern Canada, and the complex 111 yet poorly understood factors that may impact water consumption patterns in Inuit communities, 112 further work is needed to understand how to improve consumer satisfaction and trust in municipal 113 water. While research exists assessing drinking water contamination in some Inuit communities 114 (Martin et al, 2007;Wright et al, 2017), a gap exists in assessing how perceptions of safety and 115 quality impact water consumption patterns. The goal of this research, therefore, was to characterize drinking water perceptions and consumption patterns in the Inuit community of Rigolet, Canada.…”

What conditions are associated with household water vulnerability in the Arctic?

“…Water vulnerability due to poor water access or availability has been shown to diminish human health because households are forced to make do with limited water resources, which may be of poor quality. In Labrador, acute gastrointestinal illness is associated with household practices of drinking water storage and challenges related to the quality of municipal drinking water (Wright et al 2017). In Finland, 76% of waterborne outbreaks in drinking water occurred in small and remote groundwater systems with inadequate disinfection treatment (Kløve et al 2017).…”

“…A household is defined as a social unit that pools and shares its resources (Netting et al 1984;Wutich et al 2017). In the Arctic, households are commonly multi-generational, and resources like food and water are shared among extended family members (Wright et al 2017). While a household may experience water vulnerability as a social unit, the lack of water may be felt more by certain members of the household, such as those who experience greater mental distress or who choose to sacrifice water consumption for other family members.…”