Sanitation utilities and fluoridation of water supply systems: an ecological study in Brazilian municipalities, 2008-2010

Silva, Franklin Barbosa da; Frazão, Paulo

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 27 (4) • 2018 • https://doi.org/10.5123/S1679-49742018000400003 copy

Sanitation utilities and fluoridation of water supply systems: an ecological study in Brazilian municipalities, 2008-2010^* * This article is derived from the Doctoral thesis entitled 'Contextual characteristics associated with public water supply system fluoridation in Brazil, 2008', defended in 2018 by Franklin Barbosa da Silva at the Postgraduate Program in Public Health, University of São Paulo. The author Franklin Barbosa da Silva received a doctoral scholarship from the Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM): Process No. 062.03159/2014-4. The author Paulo Frazão received a scholarship from CNPq: Process No. 303681/2016-0.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to describe the characteristics of Brazilian sanitation utilities and municipalities according to the water supply system fluoridation situation.

Methods:

this was an ecological study using data from the National Survey of Basic Sanitation 2008, the Demographic Census 2010 and the Atlas of Human Development 2010.

Results:

of the 5,565 Brazilian municipalities, 60% had a fluoridation service; there was variation in fluoridation provision depending on the characteristics of the service providers and the municipality; the greater the coverage of water supply and sewerage and the higher the level of human development, the greater the provision of fluoridation (p<0.001); fluoridation provision was higher in municipalities where the sanitation utilities were mixed-capital companies (75%) and lower when the companies were private (27%) and also when the service was provided only by the municipal government (40%).

Conclusion:

there was an important dependence relationship between the characteristics of the companies and the provision of water fluoridation in Brazilian municipalities.

Keywords:
Fluoridation; Sanitation; Sanitation Utilities; Public Health Policy; Ecological Studies

Variables	Municipalities
Variables	N	%
Water supply system fluoridation^a
Yes	3,351	60
No	2,214	40
Population size (1,000 inhabitants)^b
<5	1,301	23
5-10	1,212	22
10-20	1,401	25
20-50	1,043	19
50-100	325	6
100-500	245	4
>500	38	1
Municipal Human Development Index 2010^c
Very low (0-0.499)	32	1
Low (0.500;-0.599)	1,367	24
Medium (0.600-0.699)	2,233	40
High (0.700;-0.799)	1,889	34
Very high (0.800-1.000)	44	1
Legal nature^a
Exclusive direct government administration	924	17
Exclusive indirect government administration	494	9
Mixed-capital companies only	2,056	37
Private administration only	209	4
Public mixed-capital company	974	17
Private mixed-capital company	309	6
Direct government administration combined with any type of indirect government administration	113	2
Direct government administration combined with private administration	186	3
Mixed-capital companies, combined with direct or indirect government administration and private administration	266	5
Administrative sphere^a
Total exclusive state and federal entities	2,125	38
Total exclusive municipal and intermunicipal entities	1,383	25
Private entities only	208	4
Association between public entities	1,067	19
Association between public and private entities	748	14
Form of service provision	3.220	58
Municipal Government is the only provider	943	17
Other entities provide the service	3,220	58
Municipal Government and other entities provide the service	1,368	25

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Franklin Barbosa da Silva - Rua 3, No. 81, Conjunto Castelo Branco, Parque 10 de Novembro, Manaus, AM, Brazil. CEP: 69055-210 E-mail: frank_barbosa@usp.br