Evaluation of the Portable Alternative Sanitation System (PASS) on In-Home Water Use and Quality of Life

项目摘要(摘要) 水洗疾病(与供水不足和卫生条件差有关的感染)是可以预防的 公共卫生问题继续影响着美国140万人，他们仍然无法获得基本的水 和卫生设施。新冠肺炎的大流行提醒人们，美国原住民家庭 没有室内管道的可能性是白人家庭的19倍。从历史上看，一个拥有 家庭自来水和卫生服务比例较低的情况下， 呼吸道和皮肤感染与有管道的社区相比，这些感染率在 在一些社区安装家庭供水服务。资金不足，工程挑战， 可负担性，现在气候变化阻碍了集中式管道水的安装和维护 以及偏远阿拉斯加的下水道系统。因此，迫切需要评估新奇的、有针对性的 水、环境卫生和个人卫生(洗涤)干预措施减少了水洗疾病的差异。要解决这个问题 这项研究将评估专门为美国人开发的有针对性的洗涤干预的影响 印第安人/阿拉斯加原住民(AI/AN)社区，称为便携式替代卫生系统(PASS)，在 用水、废物管理、水洗疾病和福祉(由生物医学和当地定义-- 定义的类别)随时间在家庭中。我们将通过两个具体目标来实现这一点：1)描述 在偏远地区体验家庭水和卫生安全(HWSS)、健康和福祉 使用以社区为基础的措施和2)评估水和卫生服务领域的家庭 通行证对家庭用水储存和使用、生活质量、水安全和可靠性的影响，以及 水洗疾病的流行。通过这种混合的方法，纵向研究，我们将提供证据 这表明有针对性的洗涤干预措施如何影响水洗疾病、家庭用水和 废物管理，以及AIAN社区的整体福祉。这也将使部落、部落健康 阿拉斯加以外的组织和相关利益攸关方对PASS系统进行评估，以决定它是否合适 为了他们自己的社区。这项研究建立在我们之前在Kivalina社区所做的工作的基础上，具有更大的 样本量，管道和非管道家庭数据的比较，以及来自COVID后的纵向数据 时代。据我们所知，这是第一次对家庭使用点水处理如何进行纵向评估 无水厕所系统影响到北极地区家庭的水和卫生安全、健康和福祉， 原住民背景。

PROJECT SUMMARY (ABSTRACT) Water-washed diseases (infections related to inadequate water access and poor sanitation) are a preventable public health issue that continues to affect the 1.4 million people in the U.S. who still lack access to basic water and sanitation. The COVID-19 pandemic brought to the forefront a reminder that Native American households are 19 times more likely to lack indoor plumbing than White households. Historically, AN communities with a lower proportion of in-home piped water and sanitation services have disproportionately higher rates of respiratory and skin infections compared to plumbed communities, and these infection rates decreased after the installation of in-home water services in some communities. Inadequate funding, engineering challenges, affordability, and now climate change have hindered the installation and maintenance of centralized piped water and sewer systems in remote Alaska. There is therefore an urgent need to evaluate whether novel, targeted water, sanitation, and hygiene (WASH) interventions reduce water-wash disease disparities. To address this need, this study will evaluate the impact of a targeted WASH intervention developed specifically for American Indian/Alaska Native (AI/AN) communities, known as the Portable Alternative Sanitation System (PASS), on water use, waste management, water-wash disease and well-being (defined by both biomedical and locally- defined categories) over time in AN households. We will do this through two Specific Aims: 1) Characterize the lived experiences of household water- and sanitation security (HWSS), health, and well-being in remote AN households across the water and sanitation service spectrum using community-based measures and 2) Evaluate the impact of the PASS on in-home water storage and use, quality of life, water security and reliability, and prevalence of water-washed diseases. Through this mixed methods, longitudinal study, we will provide evidence that demonstrates how a targeted WASH intervention affects water-wash diseases, in-home water use and waste management, and overall well-being in AIAN communities. This will also enable tribes, tribal health organizations, and related stakeholders beyond Alaska to evaluate the PASS system to decide if it is appropriate for their own communities. This study builds on our previous work in the community of Kivalina with a greater sample size, comparison of data from piped and unpiped households, and longitudinal data from the post-COVID era. To our knowledge, this is the first longitudinal evaluation of how an in-home point-of-use water treatment and waterless toilet system affects household water and sanitation security, health, and well-being in an Arctic, Indigenous context.