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Without running water, illness rates soar, CDC finds
Anchorage Daily News


April 08, 2008

Rural Alaska Natives in homes without running water experience far higher rates of pneumonia and other serious lower-respiratory-tract infections than do Natives in homes where water is readily available for bathing and hand-washing, a new study by the federal Centers for Disease Control and Prevention has found.

Areas where residents haul their water from a central source and dispose of wastewater in "honey buckets" also suffer higher rates of antibiotic-resistant staphylococcus aureus, or "staph," and other skin infections, the study found. The results were published this week in the American Journal of Public Health.

While it's long been known that access to modern sanitation services can reduce death from gastrointestinal illnesses, the study is believed to be the first in the United States to demonstrate a link between water availability and respiratory infections.

In villages with the lowest percentage of homes with running water, infants are hospitalized for pneumonia 11 times more often than those in the overall U.S. population, the study found.

In one unnamed region, 35 out of every 100 babies in villages with the lowest level of water service had to be hospitalized for lower-respiratory-tract infections.

Dr. Thomas Hennessy, the study's author and director of the CDC's Arctic Investigation Program in Anchorage, said it was "quite astounding" that one out of three babies there "gets hospitalized for breathing problems where they need to be brought into the hospital for oxygen and IV fluids and for fairly intensive care."

The problem doesn't appear to be bad water, Hennessy said. In fact, the study found areas where a high percentage of residents haul their own water did not show elevated rates of infectious diarrhea.

Instead, CDC researchers think the problem might be traced to some rural Alaskans' reluctance to use water for hygienic purposes when they have to haul it, sometimes over great distances, one five-gallon container at a time.

"The inconvenience of not having water and not being able to clean your hands and body perhaps in the same way you would if you had running water -- and the negative consequences that has for the spread of infectious diseases in a household -- is really quite telling," Hennessy said.

Such living conditions are now rare in the United States. By 2000, 99.4 percent of all U.S. homes provided basic sanitation services such as running water, flush toilets and kitchen sinks.

But complete sanitation services still were lacking in 6.3 percent of Alaskan households in 2000 -- a distinction that placed the state last in the nation.

The CDC study surveyed more than 12,000 homes in 128 Alaskan communities between 2000 and 2004. It was conducted in cooperation with the Indian Health Service and tribal health corporations in six regions: the Arctic Slope, the Northwest Coast, Norton Sound, Bristol Bay, the Yukon-Kuskokwim region and Southeast Alaska.

Overall, 73 percent of the rural homes studied had in-home water services. The incidence of respiratory infections and skin infections was highest in villages where less than 10 percent of the homes provided running water. Infants and the elderly were particularly vulnerable.

Hospitalization rates for infants with respiratory syncytial virus, or RSV, were five times higher than the national average.

The report suggests better public health might be as achievable as providing more villages with running water.

"What they're lacking," Hennessy said, "is something that 99.4 percent of the rest of us have."



E-mail George Bryson at gbryson(at)
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