Water systems, sanitation, and public health risks in remote communities: Inuit resident perspectives from the Canadian Arctic

A Semi-Interpenetrating Network Sorbent of Superior Efficiency for Atmospheric Water Harvesting and Solar-Regenerated Release

Water is readily available nearly anywhere as vapor. Thus, atmospheric water harvesting (AWH) technologies are seen as a promising solution to support sustainable water production. This work reports a novel semi-interpenetrating network, which integrates poly(pyrrole) doped with a hygroscopic salt and 2D graphene-based nanosheets optimally assembled within an alginate matrix, capable of harvesting water from the atmosphere with a record intake of up to 7.15 gw/gs. Owing to the incorporated graphene nanosheets, natural sunlight was solely used to enable desorption, achieving an increase of the temperature of the developed network of up to 71 °C within 20 min, resulting in a water yield of 3.36 L/kgS in each cycle with quality well within the World Health Organization standard ranges. Notably, after 30 cycles of sorption and desorption, the composite hydrogel displayed unchanged water uptake and stability. This study demonstrates that atmospheric water vapor as a complementary source of water can be harvested sustainably and effectively at a minimal cost and without external energy input.

Domestic water security in the Arctic: A scoping review

INTRODUCTION

More than 50 million people living in the Arctic nations remain without access to safely managed drinking water services. Remote northern communities, where large numbers of Indigenous peoples live, are disproportionally affected. Recent research has documented water and health-related problems among Indigenous communities, including poor water quality and insufficient quantities of water.

OBJECTIVE

The objective of this scoping review is to examine the extent of available water security evidence as well as identify research gaps and intervention priorities to improve access to domestic water in the Arctic and Subarctic regions of the eight Arctic nations (Canada, the Kingdom of Denmark (Greenland), Finland, Iceland, Norway, Sweden, Russia, and the United States (Alaska)).

METHODS

An extensive literature review was conducted to retrieve relevant documentation. Arctic & Antarctic Regions, Compendex, Geobase, Georef, MEDLINE and Web of Science databases were searched to identify records for inclusion. The initial searches yielded a total of 1356 records. Two independent reviewers systematically screened identified records using selection criteria. Descriptive analyses were used to summarize evidence of included studies.

RESULTS

A total of 55 studies, mostly conducted in Canada and the United States, were included and classified by four predetermined major dimensions: 1) Water accessibility and availability; 2) Water quality assessment; 3) Water supply and health; 4) Preferences and risk perceptions.

CONCLUSIONS

This scoping review used a global approach to provide researchers and stakeholders with a summary of the evidence available regarding water security and domestic access in the Arctic. Culturally appropriate health-based interventions are necessary to ensure inclusive water services and achieve the Sustainable Development Goals (SDG) targets for universal access to water.

The Phenomenon of Antibiotic Resistance in the Polar Regions: An Overview of the Global Problem

The increasing prevalence of antibiotic resistance is a global problem in human and animal health. This leads to a reduction in the therapeutic effectiveness of the measures used so far and to the limitation of treatment options, which may pose a threat to human health and life. The problem of phenomenon of antibiotic resistance affects more and more the polar regions. This is due to the increase in tourist traffic and the number of people staying at research stations, unmodernised sewage systems in inhabited areas, as well as the migration of animals or the movement of microplastics, which may contain resistant bacteria. Research shows that the presence of antibiotic resistance genes is more dominant in zones of human and wildlife influence than in remote areas. In a polluted environment, there is evidence of a direct correlation between human activity and the spread and survival of antibiotic-resistant bacteria. Attention should be paid to the presence of resistance to synthetic and semi-synthetic antibiotics in the polar regions, which is likely to be correlated with human presence and activity, and possible steps to be taken. We need to understand many more aspects of this, such as bacterial epigenetics and environmental stress, in order to develop effective strategies for minimizing the spread of antibiotic resistance genes. Studying the diversity and abundance of antibiotic resistance genes in regions with less anthropogenic activity could provide insight into the diversity of primary genes and explain the historical evolution of antibiotic resistance.

Headwater-to-consumer Drinking Water Security Assessment Framework and Associated Indicators for Small Communities in High-income Countries

Drinking water insecurity in small and rural, remote, or otherwise marginalized communities in Canada is pervasive and complex with multiple dimensions and impacts. These communities face challenges such as variable source water quality, lack of resources, inappropriate treatment technologies, lack of access to training, difficulties retaining qualified personnel, and ineffective governance structures. Currently, there is a gap in the academic literature with respect to drinking water security assessment frameworks or tools for small and rural, remote, or otherwise marginalized communities, particularly in high income countries. Thus, the objective of this study is to introduce a framework for assessing drinking water security, from headwater to consumer, in the context of small and rural, remote, or otherwise marginalized communities.

An indicator-based framework has been developed to evaluate drinking water security, prioritize actions and investments, and support decision-making. The framework builds on expert knowledge and a critical review of security, sustainability, and performance indices of water supply and treatment processes obtained from the literature. The framework is organised into four dimensions of drinking water security from headwaters to consumer: upstream watershed security; source water security; community needs and engagement; and treatment and distribution infrastructure. A list of relevant indicators for each dimension has been compiled to support framework application in a format that is accessible to decision-makers in small and rural, remote, or otherwise marginalized communities.

Drinking water perception and consumption in Canadian subarctic Indigenous communities and the importance for public health

Resource development and climate change are increasing concerns regarding safe water for Indigenous people in Canada. A research study was completed to characterize the consumption of water and beverages prepared with water and identify the perception of water consumption in Indigenous communities from the Northwest Territories and Yukon, Canada. As part of a larger research program, data for this study were available from a 24-hour recall dietary survey ( n = 162), a health messages survey ( n = 150), and an exposure factor survey ( n = 63). A focus group was conducted with Elders in an on-the-land camp setting. The consumption of water-based beverages in winter was 0.9 L/day on average, mainly consisting of tea and coffee. Of the 81% of respondents who reported consuming water-based beverages in the previous 24 hours of the survey, 33% drank more bottled water than tap water. About 2% of respondents consumed water from the land (during the winter season). Chlorine smell was the main limiting factor reported to the consumption of tap water. Results from the focus group indicated that Indigenous knowledge might impact both the perception and consumption of water. These findings aim to support public health efforts to enable people to make water their drink of choice.

Water delivery system effects on coliform bacteria in tap water in First Nations reserves in Manitoba, Canada

About one-half of the homes on First Nations (FN) reserves in Manitoba, Canada, receive piped water from a water treatment plant (WTP). Many other homes (31%) are equipped with cisterns that are filled by a water truck, and our objective was to determine how the use of cisterns affects drinking water safety relative to drinking water piped directly to homes from the WTP. The study included belowground concrete cisterns, belowground fiberglass cisterns, and aboveground polyethylene cisterns stored in insulated shelters, and all the data collection methods showed that the tap water in homes with cisterns were relatively more contaminated with coliform bacteria than the tap water in piped homes. The frequency and severity of Escherichia coli and total coliform contamination were numerically greater in drinking water samples from belowground concrete and fiberglass cisterns than in piped water samples in each community, and the contamination of belowground cisterns by coliform bacteria was greatest in late spring. As well, data obtained under the Access to Information Act showed no statistical differences in the percent of satisfactory samples (no detects) between 2014 and 2018, suggesting no clear indication of improved water quality in any of the Tribal Councils in which these three and other communities are a member off. Our results point to the need for additional treatment of drinking water in homes supplied by belowground concrete or fiberglass cisterns and replacement of belowground cisterns with aboveground cisterns or piped water to reduce the risk of water-borne illnesses.

Health and social concerns about living in three communities affected by per- and polyfluoroalkyl substances (PFAS): A qualitative study in Australia

BACKGROUND

Exposure to per- and polyfluoroalkyl substances (PFAS) is a public health issue globally. In Australia high concentrations of PFAS have been found in environments close to sites where Aqueous Film Forming Foams (AFFF) were historically used for firefighting activities. This has resulted in significant community concern about the potential long-term health effects of these chemicals.

OBJECTIVE

We describe residents' perceptions and experiences of PFAS in three regional Australian towns where exposure has occurred.

METHODS

We conducted focus groups to generate free-flowing open discussion on PFAS in three affected communities, including some with significant numbers of First Nations Peoples. We recruited participants using a range of media outlets and postal services. Focus group transcripts were analysed thematically to identify major shared concerns using Atlas Ti.

RESULTS

One hundred and eighty residents attended fifteen focus groups that were conducted in the three communities. They included 69 First Nations People living in three communities near the town of Katherine in the Northern Territory. Study participants were concerned about potential physical health effects of exposure to PFAS, such as cancer clusters, unexplained deaths, potential exacerbation of existing health conditions, and the future health of their children. They expressed feelings of stress and anxiety about living with uncertainty related to the possible health and the socio-economic impacts of PFAS contamination in their communities.

CONCLUSION

While research has concentrated on the physical health effects of PFAS, more attention needs to be given to the immediate psychosocial impacts of living in an affected community.

Moving up the Sanitation Ladder while Considering Function: An Assessment of Indigenous Communities, Pit Latrine Users, and Their Perceptions of Resource Recovery Sanitation Technology in Panama

As households move up the sanitation ladder, health risks presumably decline but the corresponding technologies may require increasing operation and maintenance costs. One critique of the ladder is that it prioritizes technology and could be improved if it included a functional approach to monitoring, such as including aspects of environmental sustainability that consider resource recovery. Using analyses of data obtained from semi-structured interviews, surveys, and field observations, this study examines the functional transition toward improved sanitation technology as a household moves up the sanitation ladder with the added function of resource recovery (from pit latrines to composting latrines). The study took place in six indigenous Ngäbe communities in Panama. The results reveal that of 103 pit latrines studied, 88% were completed and in use, but only 35% were operated appropriately. Approximately 60% of pit latrine owners reported that they would use composting latrines, with compost as the primary perceived benefit. Barriers to adoption include lack of prior experience, user disgust of working with excrement, and the perceived amount of work required for operation. Overall, these findings indicate the importance of establishing demonstration projects and culturally aligned training for more complex sanitation technologies that enable resource recovery. The results have broad implications for understanding sanitation technology transitions in rural and indigenous settlements in other world regions.

A State-of-the-Art Review of Indigenous Peoples and Environmental Pollution

Indigenous peoples (IPs) worldwide are confronted by the increasing threat of pollution. Based on a comprehensive review of the literature (n = 686 studies), we present the current state of knowledge on: 1) the exposure and vulnerability of IPs to pollution; 2) the environmental, health, and cultural impacts of pollution upon IPs; and 3) IPs' contributions to prevent, control, limit, and abate pollution from local to global scales. Indigenous peoples experience large burdens of environmental pollution linked to the expansion of commodity frontiers and industrial development, including agricultural, mining, and extractive industries, as well as urban growth, waste dumping, and infrastructure and energy development. Nevertheless, IPs are contributing to limit pollution in different ways, including through environmental monitoring and global policy advocacy, as well as through local resistance toward polluting activities. This work adds to growing evidence of the breadth and depth of environmental injustices faced by IPs worldwide, and we conclude by highlighting the need to increase IPs' engagement in environmental decision-making regarding pollution control. Integr Environ Assess Manag 2020;16:324-341. © 2019 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Source Water Characteristics and Building-specific Factors Influence Corrosion and Point of Use Water Quality in a Decentralized Arctic Drinking Water System

Access to clean and safe drinking water is a perpetual concern in Arctic communities because of challenging climatic conditions, limited options for the transportation of equipment and process chemicals, and the ongoing effects of colonialism. Water samples were gathered from multiple locations in a decentralized trucked drinking water system in Nunavut, Canada, over the course of one year. The results indicate that point of use drinking water quality was impacted by conditions in the source water and in individual buildings and strongly suggest that lead and copper measured at the tap were related to corrosion of onsite premise plumbing components. Humic-like substances were the dominant organic fraction in all samples, as determined by regional integration of fluorescence data. Iron and manganese levels in the source water and throughout the water system were higher in the winter and lower in the summer months. Elevated concentrations of copper (>2000 μg L^-1) and lead (>5 μg L^-1) were detected in tap water from some buildings. Field flow fractionation coupled with inductively coupled plasma mass spectrometry and ultraviolet-visible spectrometry was used to demonstrate the link between source water characteristics (high organics, iron and manganese) and lead and copper in point of use drinking water.

Municipal Solid Waste Disposal Operational Performance in Wa Municipality, Ghana

BACKGROUND

The generation and management of solid waste pose potential adverse impacts on human health and the environment.

OBJECTIVE

The present study examines the operational performance of municipal solid waste (MSW) disposal in the Wa Municipality, Ghana.

METHODS

The study applied both qualitative and quantitative research methods and modelled the Wa Municipality's MSW disposal system using the municipal solid waste decision support tool (MSW DST). Acid gases (sulphur oxides and nitrogen oxides) and total particulate matter that have a direct impact on human health were set as the objective functions for modelling five MSW disposal scenarios. The modelled scenarios were: 1) landfill disposal only; 2) composting and landfill disposal; 3) composting, incineration, refuse derived fuels (RDF) and landfill disposal; 4) separation, composting, incineration, RDF and landfill disposal; and 5) separation, transfer, material recovery, composting, incineration, RDF and landfill disposal. The pollutants chosen as indicators for substance flow analysis included lead, cadmium, arsenic, mercury, copper, chromium, and zinc.

RESULTS

Scenarios 4 and 5 produced the least engineering cost of 1 150 000 US $/year for the entire MSW disposal system, whereas scenario 2 produced the highest cost of 1 340 000 US $/year. Scenario 5 produced the least average health impacts of -5.812E-04 lbs/year, while scenario 2 generated the highest engineering cost and produced the highest average health impact of 9.358E-05 lbs/year. Scenarios 5 and 4, which included waste-to-energy conversion in the systems, produced the lowest average health impacts (-5.812E-04 lbs/year and -5.611E-04 lbs/year, respectively).

CONCLUSIONS

The adoption of an integrated solid waste management concept, including waste-to-energy technologies, will not only help to lessen MSW disposal hazards, but also to produce alternative sources of energy for Ghana and other developing countries.

COMPETING INTERESTS

The authors declare no competing financial interests.

Electrocoagulation of wastewater using aluminum, iron, and magnesium electrodes

Primary influent from a municipal wastewater treatment plant was electrochemically treated with sacrificial aluminum, iron, and magnesium electrodes. The influence of sacrificial anodes on the removal of chemical oxygen demand, total nitrogen, total phosphorus, and orthophosphate during sedimentation was investigated. Nitrification kinetics were assessed on treated supernatant and biogas production was monitored on settled solids. Changes in alkalinity, conductivity, and pH were also recorded. Aluminum and iron electrodes provided high rates of orthophosphate removal (i.e., 6.8 mg-P/mmol-e). Aluminum and iron electrodes also provided similar treatment to equivalent doses of alum and ferric salts (i.e., 38-68% chemical oxygen demand, 10-13% total nitrogen, and 67-93% total phosphorus). The estimated stochiometric ratio of aluminum and iron dosed to orthophosphate removed was approximately 1.3:1 and 4.1:1, respectively. Magnesium electrodes, on the other hand, removed orthophosphate at rates 8-9 times slower than aluminum and iron (i.e., 0.9 mg-P/mmol-e). Magnesium had to be dosed at a ratio of 13.5:1 orthophosphate for phosphorus removal. Orthophosphate removal by magnesium electrodes was most likely limited by electrolysis reactions responsible for increases in pH (i.e., 0.52 pH units/mmol-e). Magnesium electrodes removed 49% chemical oxygen demand and 21% total nitrogen at the high molar ratios required for orthophosphate removal.

Screening-level microbial risk assessment of acute gastrointestinal illness attributable to wastewater treatment systems in Nunavut, Canada

Most arctic communities use primary wastewater treatment systems that are capable of only low levels of pathogen removal. Effluent potentially containing fecally derived microorganisms is released into wetlands and marine waters that may simultaneously serve as recreation or food harvesting locations for local populations. The purpose of this study is to provide the first estimates of acute gastrointestinal illness (AGI) attributable to wastewater treatment systems in Arctic Canada. A screening-level, point estimate quantitative microbial risk assessment model was developed to evaluate worst-case scenarios across an array of exposure pathways in five case study locations. A high annual AGI incidence rate of 5.0 cases per person is estimated in Pangnirtung, where a mechanical treatment plant discharges directly to marine waters, with all cases occurring during low tide conditions. The probability of AGI per person per single exposure during this period ranges between 1.0 × 10^-1 (shore recreation) and 6.0 × 10^-1 (shellfish consumption). A moderate incidence rate of 1.2 episodes of AGI per person is estimated in Naujaat, where a treatment system consisting of a pond and tundra wetland is used, with the majority of cases occurring during spring. The pathway with the highest individual probability of AGI per single exposure event is wetland travel at 6.0 × 10^-1. All other risk probabilities per single exposure are <1.0 × 10^-1. The AGI incidence rates estimated for the other three case study locations are <0.1. These findings suggest that wastewater treatment sites may be contributing to elevated rates of AGI in some arctic Canadian communities. Absolute risk values, however, should be weighed with caution based on the exploratory nature of this study design. These results can be used to inform future risk assessment and epidemiological research as well as support public health and sanitation decisions in the region.

Weather, environmental conditions, and waterborne Giardia and Cryptosporidium in Iqaluit, Nunavut

Indigenous communities in the Arctic often face unique drinking water quality challenges related to inadequate infrastructure and environmental contamination; however, limited research exists on waterborne parasites in these communities. This study examined Giardia and Cryptosporidium in untreated surface water used for drinking in Iqaluit, Canada. Water samples (n = 55) were collected weekly from June to September 2016 and tested for the presence of Giardia and Cryptosporidium using microscopy and polymerase chain reaction (PCR). Exact logistic regressions were used to examine associations between parasite presence and environmental exposure variables. Using microscopy, 20.0% of samples tested positive for Giardia (n = 11) and 1.8% of samples tested positive for Cryptosporidium (n = 1). Low water temperatures (1.1 to 6.7 °C) and low air temperatures (-0.1 to 4.5 °C) were significantly associated with an increased odds of parasite presence (p = 0.047, p = 0.041, respectively). These results suggest that surface water contamination with Giardia and Cryptosporidium may be lower in Iqaluit than in other Canadian regions; however, further research should examine the molecular characterization of waterborne parasites to evaluate the potential human health implications in Northern Canada.

Critical elements for local Indigenous water security in Canada: a narrative review

Indigenous communities in Canada are over-represented with respect to poor water quality and water advisories. To date, approaches to solve this water crisis have been founded in the Western Science (WS) context with little to no consultation or dialogue with those communities most impacted, and without regard for culture. A literature review was undertaken to: (i) document Indigenous Knowledge (IK), and perspectives regarding water and (ii) to identify current local water security tools utilized by Indigenous communities. The aim is to provide sound evidence regarding the value of ownership and leadership by Indigenous communities in the context of current and appropriate resources available to (re)claim these roles. Solutions must remain consistent with, and founded upon, traditional Indigenous worldviews and cultural values to ensure sustainable water security. Literature reviewed from the past ten years revealed one overarching creation theme with three water-specific themes in Indigenous communities; namely, water from natural sources, water as a life-giving entity, and water and gender. Ultimately, there needs to be a new framing of local water security with the development of tools which engage IK and WS in order to assess local water security and appropriately inform interventions, policies, regulations and legislation.

Fate of antibiotic resistance genes in two Arctic tundra wetlands impacted by municipal wastewater

In the Canadian Arctic, it is common practice to discharge municipal wastewater into tundra wetlands. Antibiotic resistant bacteria and the antibiotic resistance genes (ARGs) they contain can be present in municipal wastewater and there is a scarcity of knowledge on ARGs in wastewater in Arctic environments. This study was initiated on the fate of ARGs in tundra wetland ecosystems impacted by anthropogenic wastewater sources in Arctic communities. In the summer season of 2016, two wetlands were studied in the Inuit communities of Sanikiluaq and Naujaat in Nunavut, Canada. Genomic DNA was extracted from both soil and water during the spring freshet and late summer in the wetlands, and a suite of nine clinically relevant ARGs (sul1, sul2, mecA, vanA, qnrS, ermB, tetO, bla_TEM, bla_CTX-M), and an integron gene (int1) were analyzed using quantitative polymerase chain reaction (qPCR). Hydrological and water quality measurements were conducted in conjunction with the microbiological sampling. Gene targets were consistently present in the wastewater, and throughout both wetlands, except for vanA and mecA. Concentrations of ARGs were greater during the spring freshet, due to short hydraulic retention times (<2 days), which coincided with decreased treatment performance. The environmental resistome in un-impacted wetlands had above detection limit concentrations of int1, sul1, sul2, bla_CTX-M in water in Naujaat, and sul1, qnrS and tetO in soil in Sanikiluaq. First-order rate constants were widely variable and specific to the gene target. ARGs were present in concentrations elevated above baseline reference sites in tundra wetlands influenced by municipal wastewater, and hydrological conditions had a large impact on their spatial distribution and levels.

Wastewater treatment and public health in Nunavut: a microbial risk assessment framework for the Canadian Arctic

Wastewater management in Canadian Arctic communities is influenced by several geographical factors including climate, remoteness, population size, and local food-harvesting practices. Most communities use trucked collection services and basic treatment systems, which are capable of only low-level pathogen removal. These systems are typically reliant solely on natural environmental processes for treatment and make use of existing lagoons, wetlands, and bays. They are operated in a manner such that partially treated wastewater still containing potentially hazardous microorganisms is released into the terrestrial and aquatic environment at random times. Northern communities rely heavily on their local surroundings as a source of food, drinking water, and recreation, thus creating the possibility of human exposure to wastewater effluent. Human exposure to microbial hazards present in municipal wastewater can lead to acute gastrointestinal illness or more severe disease. Although estimating the actual disease burdens associated with wastewater exposures in Arctic communities is challenging, waterborne- and sanitation-related illness is believed to be comparatively higher than in other parts of Canada. This review offers a conceptual framework and evaluation of current knowledge to enable the first microbial risk assessment of exposure scenarios associated with food-harvesting and recreational activities in Arctic communities, where simplified wastewater systems are being operated.

Total staphylococci as performance surrogate for greywater treatment

Faecal indicator bacteria (FIB) are commonly used as water quality indicators; implying faecal contamination and therefore the potential presence of pathogenic enteric bacteria, viruses, and protozoa. Hence in wastewater treatment, the most commonly used treatment process measures (surrogates) are total coliforms, faecal coliforms, Escherichia coli (E. coli), and enterococci. However, greywater potentially contains skin pathogens unrelated to faecal load, and E. coli and other FIB may grow within greywater unrelated to pathogens. Overall, FIB occurs at fluctuating and relatively low concentrations compared to other endogenous greywater bacteria affecting their ability as surrogates for pathogen reduction. Therefore, unlike municipal sewage, FIB provides a very limited and unreliable log-reduction surrogate measure for on-site greywater treatment systems. Based on our recent metagenomic study of laundry greywater, skin-associated bacteria such as Staphylococcus, Corynebacterium, and Propionibacterium spp. dominate and may result in more consistent treatment surrogates than traditional FIB. Here, we investigated various Staphylococcus spp. as potential surrogates to reliably assay over 4-log10 reduction by the final-stage UV disinfection step commonly used for on-site greywater reuse, and compare them to various FIB/phage surrogates. A collimated UV beam was used to determine the efficacy of UV inactivation (255, 265 and 285 nm) against E. coli, Enterococcus faecalis, E. faecium, E. casseliflavus, Staphylococcus aureus, and S. epidermidis. Staphylococcus spp. was estimated by combining the bi-linear dose-response curves for S. aureus and S. epidermidis and was shown to be less resistant to UV irradiation than the other surrogates examined. Hence, a relative inactivation credit is suggested; whereas, the doses required to achieve a 4 and 5-log10 reduction of Staphylococcus spp. (13.0 and 20.9 mJ cm-2, respectively) were used to determine the relative inactivation of the other microorganisms investigated. The doses required to achieve a 4 and 5-log10 reduction of Staphylococcus spp. resulted in a log10 reduction of 1.4 and 4.1 for E. coli, 0.8 and 2.8 for E. faecalis, 0.8 and 3.6 for E. casseliflavus and 0.8 and 1.2 for MS2 coliphage, respectively. Given the concentration difference of Staphylococcus spp. and FIB (3 to 5-log10 higher), we propose the use of Staphylococcus spp. as a novel endogenous performance surrogate to demonstrate greywater treatment performance given its relatively high and consistent concentration and therefore ability to demonstrate over 5-log10 reductions.

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

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_{transfer device} = 3.4, 95% CI 1.2-11.7; OR_dipper = 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.

Co-design of water services and infrastructure for Indigenous Canada: A scoping review

There is movement in engineering fields and in Indigenous communities for enhancement of local participation in the design of community infrastructure. Inclusion of community priorities and unique cultural, spiritual, and traditional values harmonize the appearance, location, and functionality of developments with the social and cultural context in which they are built and contribute to holistic wellness. However, co-design processes that align community values and the technical needs of water facilities are difficult to find. A scoping review was conducted to explore the state of knowledge on co-design of water infrastructure in Indigenous Canada to build a knowledge base from which practices and processes could emerge. The scoping results revealed that articles and reports emerged only in recent years, contained case studies and meta-reviews with primary (qualitative) data, and involved community members in various capacities. Overall, 13 articles were reviewed that contributed to understanding co-design for water infrastructure in Indigenous Canada. Barriers to co-design included funding models for Indigenous community infrastructure, difficulties in engineers and designers understanding Indigenous worldviews and paradigms, and a lack of cooperation among stakeholders that contribute to ongoing design failures. A working definition of co-design for Indigenous water infrastructure is presented.

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

Concerns regarding the safety and aesthetic qualities of one's municipal drinking water supply are important factors influencing drinking water perceptions and consumption patterns (i.e. sources used and daily volume of consumption). In northern Canada, Inuit communities face challenges with drinking water quality, and many Inuit have reported concerns regarding the safety of their drinking water. The objectives of this research were to describe perceptions of municipal tap water, examine use of water sources and changes following the installation of a potable water dispensing unit (PWDU) in 2014, and identify factors associated with water consumption in the Inuit community of Rigolet. This study used data from three cross-sectional census surveys conducted between 2012 and 2014. Principal component analysis (PCA) was used to aggregate data from multiple variables related to perceptions of water, and logistic regressions were used to identify variables associated with water consumption patterns. Three quarters of residents reported using the PWDU after its installation, with concomitant declines reported in consumption of bottled, tap, and brook water. Negative perceptions of tap water were associated with lower odds of consuming tap water (OR_{PCAcomponent1}=0.73, 95% CI 0.56-0.94; OR_{PCAcomponent2}=0.67, 95% CI 0.49-0.93); women had higher odds of drinking purchased water compared to men (OR=1.90, 95% CI 1.11-3.26). The median amount of water consumed per day was 1L. Using brook water (OR=2.60, 95% CI 1.22-5.56) and living in a household where no one had full-time employment (OR=2.94, 95% CI 1.35-6.39) were associated with consuming >2L of water per day. Results of this study may inform drinking water interventions, risk assessments, and public health messaging in Rigolet and other Indigenous communities.

Antibiotic resistance genes in municipal wastewater treatment systems and receiving waters in Arctic Canada

Domestic wastewater discharges may adversely impact arctic ecosystems and local indigenous people, who rely on being able to hunt and harvest food from their local environment. Therefore, there is a need to develop efficient wastewater treatment plants (WWTPs), which can be operated in remote communities under extreme climatic conditions. WWTPs have been identified as reservoirs of antibiotic resistance genes (ARGs). The objective of this work was to quantify the presence of nine different ARG markers (int1, sul1, sul2, tet(O), erm(B), mecA, bla_CTX-M, bla_TEM, and qnr(S)) in two passive systems (waste stabilization ponds [WSPs]) and one mechanical filtration plant operating in two smaller and one large community, respectively, in Nunavut, Canada. Measurement of water quality parameters (carbonaceous oxygen demand, ammonia, total suspended solids, Escherichia coli and total coliforms) showed that the WWTPs provided only primary treatment. Low levels of the ARGs (2logcopies/mL) were observed in the effluent, demonstrating that bacteria residing in three northern WWTPs harbour ARGs conferring resistance to multiple clinically-relevant classes of antibiotics. Our results indicate that long-term storage in WSPs benefitted removal of organic material and some ARGs. However, one WSP system showed evidence of the enrichment of sul1, sul2, mecA, tet(O) and qnr(S). Further research is needed to fully understand if these ARG releases pose a risk to human health, especially in the context of traditional hunting and fishing activities.

Self-reported Effects of Water on Health in First Nations Communities in Saskatchewan, Canada: Results From Community-Based Participatory Research

Water-related health challenges on First Nations reserves in Canada have been previously documented. Our objective was to describe factors associated with self-reported health effects from tap water in 8 First Nations reserve communities in Saskatchewan, Canada. Community-based participatory approaches were used in designing and implementing cross-sectional household surveys. Individual, household, community, and contextual effects were considered in multilevel analysis. Negative health effects from tap water were reported by 28% of households (n = 579). Concerns about environmental factors affecting water quality (odds ratio [OR] = 3.4, 95% confidence interval [CI] = 1.8-6.7), rarely or never drinking tap water (OR = 2.9, 95% CI = 1.3-6.6), insufficient tap water (OR = 3.0, 95% CI = 1.4-6.3), paying for bottled water (OR = 3.2, 95% CI = 1.2-8.7), and dissatisfaction with tap water were associated with self-reported health effects (n = 393); however, the effect of dissatisfaction was modified by respondent age (P = .03). Quality and availability were associated with perceptions of health effects from drinking water, providing additional information on how ongoing concerns about drinking water influence self-reported health in some First Nations.