Socioeconomic, hygienic, and sanitation factors in reducing diarrhea in the Amazon

Imada, Katiuscia Shirota; Araújo, Thiago Santos de; Muniz, Pascoal Torres; Pádua, Valter Lúcio de

doi:10.1590/S1518-8787.2016050006505

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Original Articles • Rev. Saúde Pública 50 • 2016 • https://doi.org/10.1590/S1518-8787.2016050006505 copy

Socioeconomic, hygienic, and sanitation factors in reducing diarrhea in the Amazon

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the contributions of the socioeconomic, hygienic, and sanitation improvements in reducing the prevalence of diarrhea in a city of the Amazon.

METHODS

In this population-based cross-sectional study, we analyzed data from surveys conducted in the city of Jordão, Acre. In 2005 and 2012, these surveys evaluated, respectively, 466 and 826 children under five years old. Questionnaires were applied on the socioeconomic conditions, construction of houses, food and hygienic habits, and environmental sanitation. We applied Pearson’s Chi-squared test and Poisson regression to verify the relationship between origin of water, construction of homes, age of introduction of cow’s milk in the diet, place of birth and the prevalence of diarrhea.

RESULTS

The prevalence of diarrhea was reduced from 45.1% to 35.4%. We identified higher probability of diarrhea in children who did not use water from the public network, in those receiving cow’s milk in the first month after birth, and in those living in houses made of paxiúba. Children born at home presented lower risk of diarrhea when compared to those who were born in hospital, with this difference reversing for the 2012 survey.

CONCLUSIONS

Sanitation conditions improved with the increase of bathrooms with toilets, implementation of the Programa de Saúde da Família (PSF – Family Health Program), and water treatment in the city. The multivariate regression model identified a statistically significant association between use of water from the public network, construction of houses, late introduction of cow’s milk, and access to health service with occurrence of diarrhea.

Child, Preschool. Diarrhea, epidemiology; Basic Sanitation; Water Supply; Domestic Effuents; Community Development; Socioeconomic Factors

Variable	2005 survey		2012 survey		p

	n	%	n	%
Electrical energy					0.304
Yes	160	35.2	303	38.3
No	295	64.8	489	61.7
Total	455	100	792	100
Family Allowance Program					< 0.001
Yes	110	23.9	437	53.9
No	351	76.1	373	46.1
Total	461	100	810	100
Mother’s education level					0.017
Illiterate	79	17.4	99	12.0
1-4 years	214	47.0	411	49.8
5-8 years	96	21.2	186	22.5
9-11 years	57	12.6	96	11.6
≥ 12 years	8	1.8	34	4.1
Total	454	100	826	100
Household income (minimum wages)					0.545
0-0.5	191	41.8	367	45.2
0.5-0.9	88	19.3	138	17.0
1-1.9	122	26.7	219	27.0
≥ 2	56	12.5	88	10.8
Total	457	100	812	100
Type of house					< 0.001
Masonry	10	2.3	46	5.6
Processed wood	221	50.1	537	65.7
Paxiúba	210	47.6	235	28.7
Total	441	100	818	100
Type of roof					< 0.001
Asbestos	55	12.2	26	3.2
Zinc or aluminum	126	28.1	334	41.1
Straw	268	59.7	452	55.7
Total	449	100	812	100
Type of floor					< 0.001
Wood	243	52.5	549	67.1
Ceramics or cement	2	0.4	13	1.6
Paxiúba	218	47.1	256	31.3
Total	463	100	818	100
Number of rooms					< 0.001
1	50	10.8	171	21.2
2	105	22.7	158	19.5
3	307	66.5	480	59.3
Total	462	100	809	100
Introduction of cow’s milk					< 0.001
1-29 days	188	43.0	202	24.8
30-730 days	74	16.9	570	69.9
Never drank cow’s milk	175	40.1	43	5.3
Total	437	100	815	100
Place of birth					0.001
House	298	35.5	442	55.1
Hospital	164	64.5	360	44.9
Total	462	100	802	100

Variable	Year of survey 2005		Year of survey 2012		p

	n	%	n	%
Toilet					< 0.001
Absence	169	36.5	284	34.8
Ceramic	99	21.4	276	33.8
Wood	195	42.1	257	31.4
Total	463	100	817	100
Origin of water
Rain	4	0.9	18	2.2	0.001
Public network	160	34.6	239	29.8
Well or spring	76	16.4	90	11.2
River	223	48.2	456	56.8
Total	463	100	803	100
Frequency of water shortage
Never	335	72.5	504	62.1	< 0.001
Rarely	73	15.8	166	20.4
Often	54	11.7	142	17.5
Total	462	100	812	100
Treatment of drinking water					< 0.001*
Boiled/Filtered and boiled	61	13.3	48	6.1
Filtered	20	4.4	32	4.1
Chlorinated at home	244	53.3	449	57.5
Mineral	2	0.4	9	1.2
Untreated	131	28.6	243	31.1
Total	458	100	781	100
Destination of trash					0.675
Collection	168	36.4	304	38.8
Buried/Burned/Thrown into river	163	35.4	273	34.8
Thrown in open area	130	28.2	207	26.4
Total	461	100	784	100
Destination of sewage					< 0.001
Septic tank	65	14.2	124	15.6
Cesspit	130	28.4	317	39.8
Open pit	210	46.0	276	34.7
Others	52	11.4	79	9.9
Total	457	100	796	100

Variable	Year of survey 2012

	n	%
Insects and rodents
Flies
Not present	103	12.9
Low	357	44.8
Average	114	14.3
High	223	28.0
Total	797	100
Cockroaches
Not present	84	10.3
Low	268	32.8
Average	115	14.1
High	349	42.8
Total	816	100
Rat
Not present	162	21.2
Low	269	35.2
Average	123	16.1
High	210	27.5
Total	764	100
Washes hands when handling food
Yes	708	88.7
No	90	11.3
Total	798	100
Care with raw fruits and vegetables
Washed (treated water)	163	23.8
Washed (untreated water)	297	43.4
Does not wash	173	25.3
Does not consume raw fruits and vegetables	51	7.5
Total	684	100

Variable	Year of survey 2005			Year of survey 2012

	n	%	RR^b	n	%	RR^c
Water			p = 0.025			p = 0.024
Public network^a	41	36.9	1	67	28.5	1
Well or river	114	51.1	1.38	14	60.9	1.6
Others	55	42.6	1.17	200	37.0	1.01
Type of house			p = 0.511			p = 0.081
Masonry or processed wood	107	43.7	1	187	32.1	1
Paxiúba	103	47.2	1.08	103	43.8	1.21
Age of introduction of cow’s milk			p = 0.022			p = 0.034
Never drank	71	40.6	1	10	23.3%	1
1-29 days	95	50.5	1.31	73	36.1	1.90
30-730 days	32	43.2	1.17	208	36.5	1.76
Place of birth			p = 0.031			p = 0.009
Hospital or maternity	83	50.6	1	101	28.1	1
House	126	42.3	0.78	185	41.9	1.40

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[1] Correspondence
: Katiuscia Shirota Imada. Centro de Ciência da Saúde e do Desporto. Curso de Bacharelado em Nutrição. Bloco Lúcia Kiyoko Ozaki Yuyama. Rodovia BR 364, km 04, s/n Distrito Industrial 69920-900 Rio Branco, AC, Brasil. E-mail: k_shirota@hotmail.com