Shigellosis on Indian reserves in Manitoba, Canada: its relationship to crowded housing, lack of running water, and inadequate sewage disposal.

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Abstract
OBJECTIVES: This study compares incidence and hospitalization rates for shigellosis between Indians and the rest of the population in Manitoba, Canada. It examines the relationship between shigellosis and environmental conditions on reserves. METHODS: Rates were calculated with surveillance data and a survey of environmental infrastructure was done. RESULTS: Indians had shigellosis incidence and hospitalization rates that were 29 and 12 times as high, respectively, as those of the rest of the population. Household crowding, lack of piped water, and inadequate sewage disposal were significantly associated with an increased incidence of shigellosis on reserves. CONCLUSIONS: Many cases of shigellosis may be prevented by improving living conditions on Indian reserves.