ABSTRACT Given the dynamic nature of the ongoing pandemic, public knowledge and perceptions about... more ABSTRACT Given the dynamic nature of the ongoing pandemic, public knowledge and perceptions about COVID-19 are evolving. Limited transportation options, inconsistent healthcare resources, and lack of water and sanitation infrastructure in many remote Alaskan communities located off the road system have contributed to the experience of the COVID-19 pandemic in these areas. We used longitudinal surveys to evaluate remote Alaskan residents’ early vaccine acceptance, vaccine uptake and motivations, risk perceptions regarding COVID-19 vaccines, and likelihood of getting a booster. Slightly over half of respondents showed early vaccine acceptance (November/December 2020), with the highest rate among those over the age of 65 years. However, by March 2021, 80.7% of participants reported receiving the COVID-19 vaccine or planning to get one. Of the unvaccinated, reasons for not getting a vaccine included concerns about side effects and not trusting the vaccine. By September 2021, 88.5% of people had received two doses of a COVID-19 vaccine and 79.7% said they would get the booster (third dose) when it became available. There were misconceptions about vaccine recommendations for pregnant women and effects on fertility and DNA. Although initial vaccine concerns may have subsided, the booster rollout and forthcoming vaccines for youth under 12 years of age present new hurdles for vaccine communication efforts.
International Journal of Hygiene and Environmental Health, 2022
This paper presents estimates of the potential health-related economic benefits of providing univ... more This paper presents estimates of the potential health-related economic benefits of providing universal access to in-home water and sanitation services to households in rural Alaska. In particular, we use data on disease incidence rates, health care costs, and local estimates of the impact of piped water on disease reduction to estimate the potential health-related economic benefits of providing universal access to piped water in the Yukon Kuskokwim (Y.K.) Delta region of Alaska. We include estimates of avoided treatment and diagnosis costs as well as private benefits associated with reduced morbidity and mortality associated with improved access to in-home piped water. To our knowledge, these are the first estimates of the economic benefits of improved access to water and sanitation in rural Alaska and the Arctic. Our analysis suggests increased access to in-home piped water in the region may yield substantial reductions in direct medical expenses incurred by public agencies and families, as well as reductions in time and travel costs associated with improved health outcomes. These benefits, along with the array of health and non-health-related benefits not included in our analysis, may provide new impetus to expanding access to high-quality water and sanitation services in the region.
With its oil wealth and an environment of abundant rivers, lakes, and the largest coastline in th... more With its oil wealth and an environment of abundant rivers, lakes, and the largest coastline in the United States, Alaska is one of the last places one would expect to find water insecurity. Yet approximately one third of households in remote Alaska Native villages lack in-home piped water and suffer the health consequences of poor sanitation and inadequate treated water. This problem has become particularly acute in the wake of surging energy prices and a concomitant shift in policies that increasingly require demonstrated economic sustainability before funding will be allocated for village water and sanitation projects. In response to increasing costs of living and the failure of development projects to foster the conditions under which they would be able to provide for their needs, many Iñupiat assert the importance of traditional values, practices and values that from their view constitute a path out of insecurity and into self-sufficiency. These Iñupiat point to modern technology as the source of what they call the spoiling of their communities. In this dissertation, I explore the disjuncture between how the state and the Iñupiat signify historical and contemporary issues and solutions around water, energy, and development. I suggest that the unintended consequences of decades of interventions to improve Iñupiaq health and well-being have been manufactured insecurity that is exacerbated by weakened social networks of reciprocity (the Iñupiaq traditional value of sharing), and rendered invisible by sustainability policies. I argue that these multifaceted processes of domination and suffering are all part of what many Iñupiat describe spoiling. In other words, when the Iñupiat talk about being spoiled by technology, they are talking about the historical domination by the state over their social reproduction in ways that produce and exacerbate the insecurities characterizing daily life in these remote villages.Dissertation not available (per author's request)previously embargoed until May 2, 2013; restricted on June 3, 2013 per author's request; K
Abstract The relationship between human health and water quantity is less understood than that of... more Abstract The relationship between human health and water quantity is less understood than that of water quality. Based on earlier studies, the WHO has established a threshold of 13.2 gallons per person per day (gal/c/d) (50 L per person per day or l/c/d) of water as sufficient for health [26]. In remote and low income communities where piped water and sanitation systems do not exist, residents may seek water from multiple sources and use water for different purposes at multiple locations. In this paper, we aim to assess the quantity of water needed for different hygiene and physiologic needs and whether that water is required in the home and could be provided through a decentralized water and sanitation system or if it could be used at an alternate location. Using known appliance water flow rates and established or reasonable duration and frequency of use, we determine that the overall water need for a household of 5.5 persons assuming low-frequency use across categories (e.g. cooking, handwashing, laundry etc.) is 79.0 gallons/household (299 L/household), which equates to a total use of 14.4 gal/c/d (54.5 l/c/d). Assuming a functional centralized shower and laundry facility, 20.2 gallons (76.5 L) are needed in the home per day, equivalent to 3.7 gal/c/d (14 l/c/d). We conclude that, when combined with access to centralized laundry and shower facilities, decentralized in-home water and sanitation systems can facilitate sufficient water use to protect health.
Journal of Water, Sanitation and Hygiene for Development, 2021
Mid-tech water and sanitation infrastructure – interventions that make moderate use of resources,... more Mid-tech water and sanitation infrastructure – interventions that make moderate use of resources, materials, and technology while providing improvements in health and well-being – may serve an important intermediate role for communities that cannot immediately get high-tech piped infrastructure. However, such systems must be socially appropriate, technically functional, and sustainable. We determined the combinations of technical and social conditions that contribute to the success of household, mid-tech water, sanitation, and hygiene (WASH) systems using qualitative comparative analysis (QCA). We collected data on 32 household mid-tech Portable Alternative Sanitation Systems (PASS) installed in remote, rural Alaskan communities for 1 year. We then coded qualitative and quantitative data for each household ‘case’ into fuzzy-set values for four technical conditions and four social conditions. We conducted fuzzy-set QCA analyses to determine combinations of conditions (pathways) that ...
The novel coronavirus SARS-CoV-2, the causative agent of COVID-19, emerged in the human populatio... more The novel coronavirus SARS-CoV-2, the causative agent of COVID-19, emerged in the human population in December 2019 and spread worldwide within a few short months. Much of the public health focus for preventing and mitigating the spread of COVID-19 has been on individual and collective behaviors, such as social distancing, mask-wearing, and hygiene. Yet it is equally important to recognize that these behaviors and health outcomes occur within broader social and environmental contexts. Factors within local communities, regional policy, race, history, personal beliefs, and natural- and built environmental characteristics affect underlying population health and the spread of disease. For example, COVID-19 has renewed attention to secure water and sanitation services and their importance in protecting human health. Many remote Alaskan communities are particularly vulnerable because of inadequate water and sanitation systems. In this paper, we describe how inadequate water and sewer serv...
Abstract Variability of water sources and water consumption patterns throughout the year is an un... more Abstract Variability of water sources and water consumption patterns throughout the year is an under-explored characteristic of household water insecurity globally. In this paper, I examine how expected uncertainties in access and quality, as well as and cultural dimensions shape experiences of household water insecurity in a remote Alaska Native community detrimentally affected by climate change. I use ethnographic and quantitative data from Niugtaq (Newtok), Alaska, as a case study to explore how household water security is affected by sudden changes in water access and quality, water sources, and cultural dynamics. Under normal conditions, the community uses an average of 7.2 l per capita per day (lpcd, 1.9 Gal/c/d) of water from the central facility. However, individual households reported great variation in their water use patterns, from 1.1 to 16.2 l/c/d (0.3 to 4.23 Gal/c/d). The primary factors affecting per capita treated water consumption are those that affect reliable access to an improved water source throughout the year. Household consumption of natural sources is a strategy to increase water access, and reflects how concerns about quality and safety of treated water that are part of the water insecurity experience. At the same time, consumption of natural sources reflects their cultural importance. This case study suggests that providing reliable access at least one improved water source, and incorporating trusted (traditional) water sources into improved water source development may be an effective approach to improving household water security in Indigenous communities affected by climate change.
Objective:To assess whether a community water service is associated with the frequency of sugar-s... more Objective:To assess whether a community water service is associated with the frequency of sugar-sweetened beverages (SSB) consumption, obesity, or perceived health status in rural Alaska.Design:We examined the cross-sectional associations between community water access and frequency of SSB consumption, body mass index categories, and perceived health status using data from the 2013 and 2015 Alaska Behavioral Risk Factor Surveillance System (BRFSS). Participants were categorized by zip code to ‘in-home piped water service’ or ‘no in-home piped water service’ based on water utility data. We evaluated the univariable and multivariable (adjusting for age, household income and education) associations between water service and outcomes using log-linear survey-weighted generalized linear models.Setting:Rural Alaska, USA.Subjects:Eight hundred and eighty-seven adults, aged 25 years and older.Results:In unadjusted models, participants without in-home water reported consuming SSB more often t...
This paper critically examines sustainability as an ideology that gives meaning to processes of d... more This paper critically examines sustainability as an ideology that gives meaning to processes of domination occurring through the operations of treated water systems in Iñupiaq villages in Alaska's Northwest. The implementation of neoliberal sustainability policies shapes social relations around water, establishes particular forms of 'expert' knowledge, erases experiences of water insecurity, and renders moot local opposition to charging for water. Throughout, treated 'safe water' is signified as a scarce commodity; its production requiring full cost recovery through practices of calculation that discipline Iñupiaq citizens as consumers. This paper provides a case study for understanding some of the processes of domination through which the commodification of water occurs, and how local people who otherwise oppose these processes may nonetheless become drawn into practices of calculation and domination in an attempt to meet state-defined sustainability requirement...
Household water insecurity has serious implications for the health, livelihoods and wellbeing of ... more Household water insecurity has serious implications for the health, livelihoods and wellbeing of people around the world. Existing methods to assess the state of household water insecurity focus largely on water quality, quantity or adequacy, source or reliability, and affordability. These methods have significant advantages in terms of their simplicity and comparability, but are widely recognized to oversimplify and underestimate the global burden of household water insecurity. In contrast, a broader definition of household water insecurity should include entitlements and human capabilities, sociocultural dynamics, and political institutions and processes. This paper proposes a mix of qualitative and quantitative methods that can be widely adopted across cultural, geographic, and demographic contexts to assess hard-to-measure dimensions of household water insecurity. In doing so, it critically evaluates existing methods for assessing household water insecurity and suggests ways in ...
Environmental Science and Pollution Research, 2017
Using a relational approach, I examine several cultural dimensions involved in household water ac... more Using a relational approach, I examine several cultural dimensions involved in household water access and use in Newtok, Alaska. I describe the patterns that emerge around domestic water access and use, as well as the subjective lived experiences of water insecurity including risk perceptions, and the daily work and hydro-social relationships involved in accessing water from various sources. I found that Newtok residents haul water in limited amounts from a multitude of sources, both treated and untreated, throughout the year. Household water access is tied to hydro-social relationships predicated on sharing and reciprocity, particularly when the primary treated water access point is unavailable. Older boys and young men are primarily responsible for hauling water, and this role appears to be important to male Yupik identity. Many interviewees described preferring to drink untreated water, a practice that appears related to cultural constructions of natural water sources as pure and self-purifying, as well as concerns about the safety of treated water. Concerns related to the health consequences of low water access appear to differ by gender and age, with women and elders expressing greater concern than men. These preliminary results point to the importance of understanding the cultural dimensions involved in household water access and use. I argue that institutional responses to water insecurity need to incorporate such cultural dimensions into solutions aimed at increasing household access to and use of water.
Gastric cancer (GC) is the world's fifth most common cancer, and the third leading cause of c... more Gastric cancer (GC) is the world's fifth most common cancer, and the third leading cause of cancer-related death. Over 70% of incident cases and deaths occur in developing countries. We explored whether disparities in access to improved drinking water sources were associated with GC risk in the Golestan Gastric Cancer Case Control Study. 306 cases and 605 controls were matched on age, gender, and place of residence. We conducted unconditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CI), adjusted for age, gender, ethnicity, marital status, education, head of household education, place of birth and residence, homeownership, home size, wealth score, vegetable consumption, and H. pylori seropositivity. Fully-adjusted ORs were 0.23 (95% CI: 0.05-1.04) for chlorinated well water, 4.58 (95% CI: 2.07-10.16) for unchlorinated well water, 4.26 (95% CI: 1.81-10.04) for surface water, 1.11 (95% CI: 0.61-2.03) for water from cisterns, and 1.79 (95% CI...
ABSTRACT Given the dynamic nature of the ongoing pandemic, public knowledge and perceptions about... more ABSTRACT Given the dynamic nature of the ongoing pandemic, public knowledge and perceptions about COVID-19 are evolving. Limited transportation options, inconsistent healthcare resources, and lack of water and sanitation infrastructure in many remote Alaskan communities located off the road system have contributed to the experience of the COVID-19 pandemic in these areas. We used longitudinal surveys to evaluate remote Alaskan residents’ early vaccine acceptance, vaccine uptake and motivations, risk perceptions regarding COVID-19 vaccines, and likelihood of getting a booster. Slightly over half of respondents showed early vaccine acceptance (November/December 2020), with the highest rate among those over the age of 65 years. However, by March 2021, 80.7% of participants reported receiving the COVID-19 vaccine or planning to get one. Of the unvaccinated, reasons for not getting a vaccine included concerns about side effects and not trusting the vaccine. By September 2021, 88.5% of people had received two doses of a COVID-19 vaccine and 79.7% said they would get the booster (third dose) when it became available. There were misconceptions about vaccine recommendations for pregnant women and effects on fertility and DNA. Although initial vaccine concerns may have subsided, the booster rollout and forthcoming vaccines for youth under 12 years of age present new hurdles for vaccine communication efforts.
International Journal of Hygiene and Environmental Health, 2022
This paper presents estimates of the potential health-related economic benefits of providing univ... more This paper presents estimates of the potential health-related economic benefits of providing universal access to in-home water and sanitation services to households in rural Alaska. In particular, we use data on disease incidence rates, health care costs, and local estimates of the impact of piped water on disease reduction to estimate the potential health-related economic benefits of providing universal access to piped water in the Yukon Kuskokwim (Y.K.) Delta region of Alaska. We include estimates of avoided treatment and diagnosis costs as well as private benefits associated with reduced morbidity and mortality associated with improved access to in-home piped water. To our knowledge, these are the first estimates of the economic benefits of improved access to water and sanitation in rural Alaska and the Arctic. Our analysis suggests increased access to in-home piped water in the region may yield substantial reductions in direct medical expenses incurred by public agencies and families, as well as reductions in time and travel costs associated with improved health outcomes. These benefits, along with the array of health and non-health-related benefits not included in our analysis, may provide new impetus to expanding access to high-quality water and sanitation services in the region.
With its oil wealth and an environment of abundant rivers, lakes, and the largest coastline in th... more With its oil wealth and an environment of abundant rivers, lakes, and the largest coastline in the United States, Alaska is one of the last places one would expect to find water insecurity. Yet approximately one third of households in remote Alaska Native villages lack in-home piped water and suffer the health consequences of poor sanitation and inadequate treated water. This problem has become particularly acute in the wake of surging energy prices and a concomitant shift in policies that increasingly require demonstrated economic sustainability before funding will be allocated for village water and sanitation projects. In response to increasing costs of living and the failure of development projects to foster the conditions under which they would be able to provide for their needs, many Iñupiat assert the importance of traditional values, practices and values that from their view constitute a path out of insecurity and into self-sufficiency. These Iñupiat point to modern technology as the source of what they call the spoiling of their communities. In this dissertation, I explore the disjuncture between how the state and the Iñupiat signify historical and contemporary issues and solutions around water, energy, and development. I suggest that the unintended consequences of decades of interventions to improve Iñupiaq health and well-being have been manufactured insecurity that is exacerbated by weakened social networks of reciprocity (the Iñupiaq traditional value of sharing), and rendered invisible by sustainability policies. I argue that these multifaceted processes of domination and suffering are all part of what many Iñupiat describe spoiling. In other words, when the Iñupiat talk about being spoiled by technology, they are talking about the historical domination by the state over their social reproduction in ways that produce and exacerbate the insecurities characterizing daily life in these remote villages.Dissertation not available (per author's request)previously embargoed until May 2, 2013; restricted on June 3, 2013 per author's request; K
Abstract The relationship between human health and water quantity is less understood than that of... more Abstract The relationship between human health and water quantity is less understood than that of water quality. Based on earlier studies, the WHO has established a threshold of 13.2 gallons per person per day (gal/c/d) (50 L per person per day or l/c/d) of water as sufficient for health [26]. In remote and low income communities where piped water and sanitation systems do not exist, residents may seek water from multiple sources and use water for different purposes at multiple locations. In this paper, we aim to assess the quantity of water needed for different hygiene and physiologic needs and whether that water is required in the home and could be provided through a decentralized water and sanitation system or if it could be used at an alternate location. Using known appliance water flow rates and established or reasonable duration and frequency of use, we determine that the overall water need for a household of 5.5 persons assuming low-frequency use across categories (e.g. cooking, handwashing, laundry etc.) is 79.0 gallons/household (299 L/household), which equates to a total use of 14.4 gal/c/d (54.5 l/c/d). Assuming a functional centralized shower and laundry facility, 20.2 gallons (76.5 L) are needed in the home per day, equivalent to 3.7 gal/c/d (14 l/c/d). We conclude that, when combined with access to centralized laundry and shower facilities, decentralized in-home water and sanitation systems can facilitate sufficient water use to protect health.
Journal of Water, Sanitation and Hygiene for Development, 2021
Mid-tech water and sanitation infrastructure – interventions that make moderate use of resources,... more Mid-tech water and sanitation infrastructure – interventions that make moderate use of resources, materials, and technology while providing improvements in health and well-being – may serve an important intermediate role for communities that cannot immediately get high-tech piped infrastructure. However, such systems must be socially appropriate, technically functional, and sustainable. We determined the combinations of technical and social conditions that contribute to the success of household, mid-tech water, sanitation, and hygiene (WASH) systems using qualitative comparative analysis (QCA). We collected data on 32 household mid-tech Portable Alternative Sanitation Systems (PASS) installed in remote, rural Alaskan communities for 1 year. We then coded qualitative and quantitative data for each household ‘case’ into fuzzy-set values for four technical conditions and four social conditions. We conducted fuzzy-set QCA analyses to determine combinations of conditions (pathways) that ...
The novel coronavirus SARS-CoV-2, the causative agent of COVID-19, emerged in the human populatio... more The novel coronavirus SARS-CoV-2, the causative agent of COVID-19, emerged in the human population in December 2019 and spread worldwide within a few short months. Much of the public health focus for preventing and mitigating the spread of COVID-19 has been on individual and collective behaviors, such as social distancing, mask-wearing, and hygiene. Yet it is equally important to recognize that these behaviors and health outcomes occur within broader social and environmental contexts. Factors within local communities, regional policy, race, history, personal beliefs, and natural- and built environmental characteristics affect underlying population health and the spread of disease. For example, COVID-19 has renewed attention to secure water and sanitation services and their importance in protecting human health. Many remote Alaskan communities are particularly vulnerable because of inadequate water and sanitation systems. In this paper, we describe how inadequate water and sewer serv...
Abstract Variability of water sources and water consumption patterns throughout the year is an un... more Abstract Variability of water sources and water consumption patterns throughout the year is an under-explored characteristic of household water insecurity globally. In this paper, I examine how expected uncertainties in access and quality, as well as and cultural dimensions shape experiences of household water insecurity in a remote Alaska Native community detrimentally affected by climate change. I use ethnographic and quantitative data from Niugtaq (Newtok), Alaska, as a case study to explore how household water security is affected by sudden changes in water access and quality, water sources, and cultural dynamics. Under normal conditions, the community uses an average of 7.2 l per capita per day (lpcd, 1.9 Gal/c/d) of water from the central facility. However, individual households reported great variation in their water use patterns, from 1.1 to 16.2 l/c/d (0.3 to 4.23 Gal/c/d). The primary factors affecting per capita treated water consumption are those that affect reliable access to an improved water source throughout the year. Household consumption of natural sources is a strategy to increase water access, and reflects how concerns about quality and safety of treated water that are part of the water insecurity experience. At the same time, consumption of natural sources reflects their cultural importance. This case study suggests that providing reliable access at least one improved water source, and incorporating trusted (traditional) water sources into improved water source development may be an effective approach to improving household water security in Indigenous communities affected by climate change.
Objective:To assess whether a community water service is associated with the frequency of sugar-s... more Objective:To assess whether a community water service is associated with the frequency of sugar-sweetened beverages (SSB) consumption, obesity, or perceived health status in rural Alaska.Design:We examined the cross-sectional associations between community water access and frequency of SSB consumption, body mass index categories, and perceived health status using data from the 2013 and 2015 Alaska Behavioral Risk Factor Surveillance System (BRFSS). Participants were categorized by zip code to ‘in-home piped water service’ or ‘no in-home piped water service’ based on water utility data. We evaluated the univariable and multivariable (adjusting for age, household income and education) associations between water service and outcomes using log-linear survey-weighted generalized linear models.Setting:Rural Alaska, USA.Subjects:Eight hundred and eighty-seven adults, aged 25 years and older.Results:In unadjusted models, participants without in-home water reported consuming SSB more often t...
This paper critically examines sustainability as an ideology that gives meaning to processes of d... more This paper critically examines sustainability as an ideology that gives meaning to processes of domination occurring through the operations of treated water systems in Iñupiaq villages in Alaska's Northwest. The implementation of neoliberal sustainability policies shapes social relations around water, establishes particular forms of 'expert' knowledge, erases experiences of water insecurity, and renders moot local opposition to charging for water. Throughout, treated 'safe water' is signified as a scarce commodity; its production requiring full cost recovery through practices of calculation that discipline Iñupiaq citizens as consumers. This paper provides a case study for understanding some of the processes of domination through which the commodification of water occurs, and how local people who otherwise oppose these processes may nonetheless become drawn into practices of calculation and domination in an attempt to meet state-defined sustainability requirement...
Household water insecurity has serious implications for the health, livelihoods and wellbeing of ... more Household water insecurity has serious implications for the health, livelihoods and wellbeing of people around the world. Existing methods to assess the state of household water insecurity focus largely on water quality, quantity or adequacy, source or reliability, and affordability. These methods have significant advantages in terms of their simplicity and comparability, but are widely recognized to oversimplify and underestimate the global burden of household water insecurity. In contrast, a broader definition of household water insecurity should include entitlements and human capabilities, sociocultural dynamics, and political institutions and processes. This paper proposes a mix of qualitative and quantitative methods that can be widely adopted across cultural, geographic, and demographic contexts to assess hard-to-measure dimensions of household water insecurity. In doing so, it critically evaluates existing methods for assessing household water insecurity and suggests ways in ...
Environmental Science and Pollution Research, 2017
Using a relational approach, I examine several cultural dimensions involved in household water ac... more Using a relational approach, I examine several cultural dimensions involved in household water access and use in Newtok, Alaska. I describe the patterns that emerge around domestic water access and use, as well as the subjective lived experiences of water insecurity including risk perceptions, and the daily work and hydro-social relationships involved in accessing water from various sources. I found that Newtok residents haul water in limited amounts from a multitude of sources, both treated and untreated, throughout the year. Household water access is tied to hydro-social relationships predicated on sharing and reciprocity, particularly when the primary treated water access point is unavailable. Older boys and young men are primarily responsible for hauling water, and this role appears to be important to male Yupik identity. Many interviewees described preferring to drink untreated water, a practice that appears related to cultural constructions of natural water sources as pure and self-purifying, as well as concerns about the safety of treated water. Concerns related to the health consequences of low water access appear to differ by gender and age, with women and elders expressing greater concern than men. These preliminary results point to the importance of understanding the cultural dimensions involved in household water access and use. I argue that institutional responses to water insecurity need to incorporate such cultural dimensions into solutions aimed at increasing household access to and use of water.
Gastric cancer (GC) is the world's fifth most common cancer, and the third leading cause of c... more Gastric cancer (GC) is the world's fifth most common cancer, and the third leading cause of cancer-related death. Over 70% of incident cases and deaths occur in developing countries. We explored whether disparities in access to improved drinking water sources were associated with GC risk in the Golestan Gastric Cancer Case Control Study. 306 cases and 605 controls were matched on age, gender, and place of residence. We conducted unconditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CI), adjusted for age, gender, ethnicity, marital status, education, head of household education, place of birth and residence, homeownership, home size, wealth score, vegetable consumption, and H. pylori seropositivity. Fully-adjusted ORs were 0.23 (95% CI: 0.05-1.04) for chlorinated well water, 4.58 (95% CI: 2.07-10.16) for unchlorinated well water, 4.26 (95% CI: 1.81-10.04) for surface water, 1.11 (95% CI: 0.61-2.03) for water from cisterns, and 1.79 (95% CI...
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