Impact of In-home Water Service on the Rates of Infectious Diseases

INTRODUCTION: Approximately 20% of rural Alaskan homes lack in-home piped water; residents must haul water to their homes. Recent studies in Alaska have demonstrated associations between increased rates of skin and respiratory tract infections and lack of in-home piped water, presumably due to a reduced quantity of water available for handwashing, bathing and laundry (termed “water-washed” infections). We assessed rates of water-related infections in residents of communities transitioning to in-home piped water.

METHODS: Residents of four communities (labeled A, B, C, D) consented to review of medical records for the period 3 years before and 3 years after the community received piped water. (Only about half of Community D received piped water). We selected health encounters (community clinic visits and hospitalizations) with ICD-9CM codes for gastrointestinal, respiratory and skin infections. We calculated annual illness episodes for each infection category after adjusting for age and removing repeat encounters within 14 days of initial report.

RESULTS: Among 1043 individuals (74% of the total 2010 four-community population), there were 10,310 illness episodes with at least one respiratory, skin, or gastrointestinal infection Respiratory infections were listed for 8,544 (83%) with rates approximately five times higher than skin infection rates, and thirty times higher than gastrointestinal illness rates. Analysis of residents of all homes receiving piped water showed significant (p<0.05) declines in respiratory infection rates (from 1.52 to 1.37 encounters per person/year), skin (from 0.31 to 0.25) and gastrointestinal (from 0.05 to 0.03). Communities A, B and C individually showed substantial declines in most infection categories while Community D (partially piped) showed no changes in any infection category in both piped and un-piped homes.

CONCLUSIONS: We demonstrated significant declines in respiratory, skin and gastrointestinal infection rates. This study reinforces the importance of adequate quantities of water to address the morbidity caused by water-washed infections.