Health impact of drainage and sewerage in poor urban areas in Salvador, Brazil.

The lack of environmental sanitation measures is a worldwide problem, especially in developing countries, and greatly facilitates the spread of disease. This thesis aims to contribute towards a better understanding of the effect on diarrhoea, nutritional status and intestinal nematode infections of drainage and sewerage in an impoverished urban environment. After an extensive literature review of some relevant aspects of the health impact of environmental sanitation, field research was designed and conducted in nine poor urban areas of the city of Salvador (pop. approximately 2.3 million), capital of Bahia State, in northeast Brazil. The study was targeted to a sample of children under 15 years old living in the poor urban areas of the city at the time of the field work (August 1989-November 1990). An extensive questionnaire was applied to collect information on each child and on the conditions of the family and the household, three stool examinations of the children 5-14 years old were performed (to measure nematode infection and reinfection), diarrhoea was monitored fortnightly, in children under 5 years old for one year, and anthropometric measurements taken every two months. The results showed that among children in neighbourhoods with unimproved community sanitation the incidence of diarrhoea was consistently higher and the nutritional status, expressed by the mean height-for-age z-score, was significantly lower throughout the study period as compared to those with improved sanitation. Regarding intestinal nematode infections, as the level of community sanitation improves, the following trends were noted: prevalence and intensity of infection and reinfection declined, risk factors for infection became more numerous and more significant, clustering of cases by house­ hold became more significant, predisposition of individuals to reinfection and to heavy infection became more marked, and infections with different species were increasingly aggregated in the same individuals. These results suggest that sewerage and drainage can have a significant effect on diarrhoea, nutritional status and intestinal nematode infections and that the evidence of the health impact was strongest for intestinal nematode infections. The interpretation of these epidemiological findings in the light of the Brazilian health, urban and social policies contributes to a comprehensive framework for the control of nematode infections, diarrhoea and malnutrition in poor urban areas of Salvador and elsewhere

Reductions in the Prevalence and Incidence of Geohelminth Infections following a City-wide Sanitation Program in a Brazilian Urban Centre

In the city of Salvador, a large urban centre in Northeast Brazil, a city-wide sanitation intervention started in 1997, aiming to improve the sewerage coverage of households from 26% to 80%. Our aim was to study the impact of the intervention on the prevalence and incidence of geohelminths in the school-aged population. The longitudinal study comprised two cohorts: from the beginning of 1997 to 1998, where data was collected before the intervention, and at the end of 2003 to 2004, after the intervention. Copro-parasitological examinations were carried out on every individual from both cohorts, at the start and nine months later. Demographic, socio-economic, and environmental data were collected using semi-structured questionnaires. The variables utilized to demonstrate the effects of intervention, when utilized together in a multivariate model, accounted for a 100% observed reduction in the prevalence ratio (PR) and incidence ratio (IR). As well as proving that the variables associated with the effect of the program intervention were mediators in this reduction, the reduction in the PR and IR between these periods demonstrated that modifications to the urban environment, particularly those associated with sanitary sewage systems, affected the health of the population, significantly reducing the prevalence of geohelminths

Environmental interventions and the pattern of geohelminth infections in Salvador, Brazil.

This paper reports a longitudinal study, conducted in 1989/90, of 1893 children aged 5 to 14 years in 9 poor urban areas of the city of Salvador (population 2.44 million), capital of Bahia State in northeast Brazil. Stool examinations were performed to measure nematode infection and reinfection 9 months after treatment, and an extensive questionnaire was applied to collect information on each child and on the conditions of the household. Comparison of areas with different levels of infrastructure showed the following trends as the level of community sanitation improved: clustering of cases by household became more significant, predisposition of individuals to reinfection and to heavy infection became more marked, and infections with different species were increasingly aggregated in the same individuals. These results suggest that sewerage and drainage can significantly reduce transmission of intestinal nematode infections in the public domain, but that other measures are required to control transmission within the household

Impact of drainage and sewerage on intestinal nematode infections in poor urban areas in Salvador, Brazil.

This cross-sectional study was conducted in 1989 among children aged between 5 and 14 years old living in nine poor urban areas of the city of Salvador (pop. 2.44 million), capital of Bahia State, in Northeast Brazil. Three of these areas had benefited from both drainage and sewerage, 3 from improved drainage only, and 3 from neither. The children studied thus belonged to 3 exposure groups regarding their level of sanitation infrastructure. An extensive questionnaire was applied to collect information on each child and on the conditions of the household, and stool examinations of the children 5-14 years old were performed to measure nematode infection. Comparison of the sewerage group with the drainage-only group and the latter with the control (no sewerage or drainage) group showed that, when the level of community sanitation was better, the prevalence of infection among children was less, but risk factors identified for infection were more numerous and more significant. Intensity of infection with Trichuris, but not with Ascaris or hookworm, was also less. The results suggest that sewerage and drainage can have a significant effect on intestinal nematode infections, by reducing transmission occurring in the public domain

Fatores ambientais associados à diarréia infantil em áreas de assentamento subnormal em Juiz de Fora, Minas Gerais Childhood diarrhea-related to environmental factors in subnormal settlements in Juiz de Fora, Minas Gerais

OBJETIVOS: caracterizar a prevalência de diarréia e identificar os fatores associados à essa doença em crianças residentes em áreas de assentamento subnormal. MÉTODOS: utilizou-se um delineamento transversal de base populacional. A amostra estudada totalizou 655 crianças. A coleta de dados foi feita mediante entrevistas domiciliares com a mãe ou com o responsável pela criança. Foram usados modelos de regressão logística para identificar fatores associados à diarréia. RESULTADOS: a prevalência da diarréia foi 17,5%. Os fatores associados à doença incluíram internação da criança no primeiro mês de vida; ser cuidado por terceiros, que não a mãe; maior nível de escolaridade do responsável; e maior tempo de residência, como fatores de proteção. Como fatores de risco individuais, a existência de outra doença; e baixa idade. Como fatores de risco coletivos, o consumo de água de mina; a disposição dos esgotos na rua ou no terreno; o acondicionamento inadequado do lixo; e presença de moscas. CONCLUSÕES: para o combate à diarréia sugere-se atenção especial à saúde e à alimentação de crianças com idade abaixo de cinco anos, incluindo adequadas cobertura e qualidade nos serviços de saneamento ambiental.<br>OBJECTIVES: to determine diarrhea prevalence and to identify factors associated to the condition in children living in subnormal settlement areas. METHODS: a cross-sectional population-based study was used. The sample studied totaled 655 children. Data collection was performed through home interviews with the mother or caretaker. Logistic regression models were used to identify diarrhea associated factors. RESULTS: diarrhea prevalence was of 17.5%. Condition associated factors included child hospitalization during the first month of life; children looked after by others and not the mother; higher education level of the caretaker and longer residency period, as protection factors and as individual risk factors associated diseases and young age and as factors for collective risk, mine water consumption; sewage disposal on the streets or in the yard; inadequate garbage disposal and flies. CONCLUSIONS: to fight diarrhea special care should be given to health and nutrition of children under five years old, including adequate and quality environmental sanitation services

Acondicionamento e coleta de resíduos sólidos domiciliares e impactos na saúde de crianças residentes em assentamentos periurbanos de Salvador, Bahia, Brasil Household solid waste bagging and collection and their health implications for children living in outlying urban settlements in Salvador, Bahia State, Brazil

O artigo apresenta estudo do acondicionamento e coleta de resíduos sólidos domiciliares e o impacto na saúde de crianças, por meio de pesquisa realizada em nove assentamentos humanos localizados em área periurbana da cidade de Salvador, Bahia, Brasil. Como indicadores epidemiológicos foram utilizados, em 1.893 crianças entre 5 e 14 anos, a infecção por nematóides intestinais, expressa pela prevalência de Ascaris lumbricoides, Trichuris trichiura e ancilostomídeos, e em 1.204 crianças menores de cinco anos, a incidência de diarréia e o estado nutricional, este expresso por indicadores antropométricos. Os resultados apresentam a maior prevalência dos três nematóides nas crianças dos domicílios que não dispõem de acondicionamento adequado e de coleta de resíduos sólidos que naquelas de domicílios com acondicionamento adequado e coleta regular, sendo a diferença encontrada estatisticamente significante, mesmo quando outros fatores de risco sócio-econômicos, culturais, demográficos e ambientais são considerados. Resultado semelhante é também observado com relação aos indicadores epidemiológicos, incidência de diarréia e estado nutricional.<br>This paper presents a study on the bagging and collection of household solid waste and the health implications for children. The research was conducted in nine human settlements on the outskirts of Salvador, Bahia State, Brazil. Intestinal nematode infection, predominantly involving Ascaris lumbricoides, Trichuris trichiura, and hookworms, was used as an epidemiological indicator in 1,893 children from 5 to 14 years of age. The study also included diarrhea incidence and nutritional status as shown by anthropometric indicators in 1,204 children less than 5 years of age. There was a higher prevalence of the three nematodes in children living in households without proper bagging/isolation and collection of household solid waste as compared to those in areas with regular garbage collection and adequate isolation of solid waste. The differences were statistically significant when other socioeconomic, cultural, demographic, and environmental risks factors were considered in the analysis. Similar results were also observed for epidemiological indicators, diarrhea incidence, and nutritional status