Water, sanitation and schistosomiasis mansoni: a study based on the Brazilian National Prevalence Survey (2011-2015)

Poague, Kasandra Isabella Helouise Mingoti; Mingoti, Sueli Aparecida; Heller, Léo

doi:10.1590/1413-81232023282.09692022

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ARTIGO • Ciênc. saúde coletiva 28 (2) • Feb 2023 • https://doi.org/10.1590/1413-81232023282.09692022 copy

Water, sanitation and schistosomiasis mansoni: a study based on the Brazilian National Prevalence Survey (2011-2015)

Água, saneamento e esquistossomose mansoni: um estudo baseado no Inquérito Nacional de Prevalência do Brasil (2011-2015)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to explore the association between water, sanitation, and the prevalence of schistosomiasis mansoni in students aged 7 to 17 years from all 27 federative units in Brazil. It was a cross-sectional study conducted based on data on the prevalence of schistosomiasis mansoni referring to 197,567 students from 521 Brazilian municipalities, who participated in the National Survey on the Prevalence of Schistosomiasis Mansoni and Soil-transmitted Helminth Infections (2011-2015). Univariable and multivariable generalized linear models of the negative binomial type were adjusted using 25 and 5% significance levels, respectively, considering municipalities as the unit of analysis. While a protective association was found between access to filtered water in schools and schistosomiasis mansoni prevalence, sanitation in schools was indicated as a risk factor. The collection of wastewater through a network is not universal in Brazil, and even when present, it is not necessarily carried out by the treatment of collected effluents, thus often resulting in the direct discharge of raw sewage into water resources. Regarding septic tanks, only the presence of infrastructure alone does not guarantee its correct use by the population.

Keywords:
Drinking water; Sanitation; Schistosoma mansoni; Brazil

Variable	Variable type	Description	Period	Source
% Population served with adequate water supply at home	Explanatory	Population supplied with piped water in at least one of the rooms of their household from the following sources: general distribution network, well or spring water on or off the property	2013*	IBGE
% Population served with adequate sanitation at home	Explanatory	Population that disposes its sewage in a general sewerage system, rainwater drainage, or septic tank	2013*	IBGE
% Population served with household solid waste collection	Explanatory	Population served with direct and indirect household solid waste collection, regardless of location (urban or rural)	2013*	IBGE
¨% Schools with filtered water	Explanatory	Schools that provide their students with filtered water from filters, such as clay, crockery, plastic, or activated carbon filters, that typically has porous filter elements to retain impurities	2014	INEP
% Schools served with adequate water supply	Explanatory	Schools with adequate water supply, i.e., which are provided with public network, artesian well, and “cacimba” / well / cistern	2014	INEP
% Schools served with adequate sanitation	Explanatory	Schools that dispose their sewage into a public sewerage system or septic tank	2014	INEP
% Schools with proper solid waste disposal	Explanatory	Schools whose solid waste produced is periodically collected or recycled	2014	INEP
% Municipality’s urbanization	Confounding	Percentage of municipality’s inhabitants living in urban areas	2013*	IBGE
% Population served with Bolsa Família Program - BFP	Confounding	Percentage of municipality’s population served by BFP (used as a poverty and social inequality identifier). The BFP is a conditional direct cash transfer government program created in 2003. It serves families living in poverty and extreme poverty situation, namely: families with per capita income in Brazilian currency up to R$ 89.00 per month (about US$ 22); families with pregnant women, children or adolescents from 0 to 17 years old, with per capita income between R$ 89.00 and R$ 178.00 per month.	2013	MDS
% Population served by primary health care services	Confounding	Percentage of municipality’s population attended by Family Health Teams and Primary Care Teams	2013	MS
% Population employed in agricultural sector - 18 years and over	Confounding	Percentage of active population (18 years old and over) of each municipality employed in the agricultural sector	2013*	IBGE
Municipal Human Development Index: Education Component	Confounding	Proxy of municipality’s population access to education. Its value ranges from 0 to 1	2013*	IBGE
Presence of snail	Confounding	Represents whether there are historical records of the presence of one or more species of the genus Biomphalaria recognized in Brazil as naturally infected by S.mansoni (Biomphalaria glabrata, B.straminea, and B.tenagophila) within the territorial limits of each municipality (0 - No, 1 - Yes).	2008^&	Carvalho et al., 2008; Carvalho et al., 2018
Endemic level	Sampling	Non-endemic (0), Low (1) and High (2)	-	Katz 2018
Natural log of Population in 2010	Sampling	Population size of each municipality in 2010	2010	IBGE

Variable	Category	Intercept	Coefficient	P-value	RR	RR (75%CI)
Endemic level	Non-endemic (0)		Reference
	Low (1)	-6.230	0.93	0.001	2.536	1.825 - 3.523
	High (2)	-6.230	3.183	< 0.001	24.125	16.917 - 34.406
Natural log of population in 2010	Continuous	-2.061	-0.267	0.002	0.765	0.692 - 0.846
Presence of Snail	Dichotomous	-5.934	1.692	< 0.001	5.428	4.039 - 7.294
% Population served with adequate water supply at home	Continuous	-4.005	-0.009	0.348*	0.991	0.980 - 1.002
% Population served with adequate sanitation at home	Continuous	-4.592	-0.004	0.400*	0.996	0.990 - 1.002
% Population served with household solid waste collection	Continuous	-4.088	-0.010	0.138	0.991	0.983 - 0.998
% Schools with filtered water	Continuous	-3.276	-0.018	0.016	0.983	0.974 - 0.991
% Schools served with adequate water supply	Continuous	-4.244	-0.006	0.413*	0.994	0.986 - 1.002
% Schools with proper solid waste disposal	Continuous	-4.211	-0.009	0.062	0.991	0.986 - 0.997
% Schools served with adequate sanitation	Continuous	-7.606	0.030	0.067	1.030	1.011 - 1.049
% Municipality’s urbanization	Continuous	-3.585	-0.019	0.001	0.981	0.975 - 0.988
% Population served by Bolsa Família Program	Continuous	-6.438	0.037	< 0.001	1.038	1.029 - 1.047
% Population served by primary health care services	Continuous	-7.238	0.028	< 0.001	1.028	1.022 - 1.035
% Population employed in the agricultural sector - 18 years and over	Continuous	-5.184	0.013	0.056	1.014	1.005 - 1.022
Municipal Human Development Index: Education Component	Continuous	-0.987	-6.408	< 0.001	0.002	0.000 - 0.010

Variable	Category	Coefficient	P-value	RR	RR (95%CI)
Endemic level	Non-endemic (0)	Reference
	Low (1)	0.878	0.005	2.406	1.302 - 4.444
	High (2)	2.654	< 0.001	14.206	7.551 - 26.726
Natural log of population in 2010	Continuous	-0.071	0.552*	0.931	0.736 - 1.178
Presence of Snail	Dichotomous	1.287	< 0.001	3.622	2.171 - 6.043
% Schools served with adequate sanitation	Continuous	0.045	0.006	1,046	1.013 - 1.081
% Schools with filtered water	Continuous	-0.018	0.005	0.982	0.970 - 0.995
% Municipality’s urbanization	Continuous	0.021	0.022	1.021	1.003 - 1.039
% Population served by primary health care services	Continuous	0.013	0.042	1.013	1.000 - 1.026
Municipal Human Development Index: Education Component	Continuous	-6.741	0.002	0.001	0.000 - 0.076
Model’s constant (intercept)	Continuous	-7.538	< 0.001	0.001	0.000 - 0.036

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva