Abstract
The Navajo Nation includes approximately 250,000 American Indians living in a remote high desert environment with limited access to public water systems. We conducted a pilot case-control study to assess associations between acute gastroenteritis (AGE) and water availability, use patterns, and quality. Case patients with AGE and non-AGE controls who presented for care to two Indian Health Service hospitals were recruited. Data on demographics and water use practices were collected using a standard questionnaire. Household drinking water was tested for presence of pathogens, coliforms, and residual chlorine. Sixty-one subjects (32 cases and 29 controls) participated in the study. Cases and controls were not significantly different with respect to water sources, quality, or patterns of use. Twenty-one percent (n = 12) of study participants resided in dwellings not connected to a community water system. Eleven percent (n = 7) of subjects reported drinking hauled water from unregulated sources. Coliform bacteria were present in 44% (n = 27) of household water samples, and 68% (n = 40) of samples contained residual chlorine concentrations of <0.2 mg/L. This study highlights issues with water availability, quality, and use patterns within the Navajo Nation, including sub-optimal access to community water systems, and use of water hauled from unregulated sources.
Highlights
Acute gastroenteritis (AGE), characterized by sudden onset of diarrhea, vomiting, nausea, and abdominal pain, is a major cause of morbidity in the United States
This pilot study describes the availability of community water systems, the use of hauled water for drinking, and issues related to water quality among healthcare-seeking persons in the central Navajo Nation
80% of study participants reported living in a household that was connected to a community water system, yet almost one-third of respondents chose to drink hauled water
Summary
Acute gastroenteritis (AGE), characterized by sudden onset of diarrhea, vomiting, nausea, and abdominal pain, is a major cause of morbidity in the United States. 179 million cases of AGE are estimated to occur. American Indian and Alaskan Native (AI/AN) children historically have had disproportionately high rates of AGE when compared to the general US population (Santosham et al ; Singleton et al ). Rates of AGE in AI/AN children living in the southwestern USA are some of the highest when. Grytdal et al | Water quality, availability, and acute gastroenteritis on the Navajo Nation
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