SummaryBackgroundA city-wide sanitation intervention was started in Salvador, Brazil, in 1997 to improve sewerage coverage from 26% of households to 80%. Our aim was to investigate the epidemiological effect of this city-wide sanitation programme on diarrhoea morbidity in children less than 3 years of age.MethodsThe investigation was composed of two longitudinal studies done in 1997–98 before the intervention (the sanitation programme) and in 2003–04 after the intervention had been completed. Each study consisted of a cohort of children (841 in the preintervention study and 1007 in the postintervention study; age 0–36 months at baseline) who were followed up for a maximum of 8 months. Children were sampled from 24 sentinel areas that were randomly chosen to represent the range of environmental conditions in the study site. At the start of each study an individual or household questionnaire was applied by trained fieldworkers; an environmental survey was done in each area before and after introduction of the sanitation programme to assess basic neighbourhood and household sanitation conditions. Daily diarrhoea data were obtained during home visits twice per week. The effect of the intervention was estimated by a hierarchical modelling approach fitting a sequence of multivariate regression models.FindingsDiarrhoea prevalence fell by 21% (95% CI 18–25%)—from 9·2 (9·0–9·5) days per child-year before the intervention to 7·3 (7·0–7·5) days per child-year afterwards. After adjustment for baseline sewerage coverage and potential confounding variables, we estimated an overall prevalence reduction of 22% (19–26%).InterpretationOur results show that urban sanitation is a highly effective health measure that can no longer be ignored, and they provide a timely support for the launch of 2008 as the International Year of Sanitation.

BackgroundSanitation affects health, especially that of young children. Residents of Salvador, in Northeast Brazil, have had a high prevalence of intestinal parasites. A citywide sanitation intervention started in 1996 aimed to raise the level of sewer coverage from 26% to 80% of households.ObjectivesWe evaluated the impact of this intervention on the prevalence of Ascaris lumbricoides, Trichuris trichuria, and Giardia duodenalis infections in preschool children.MethodsThe evaluation was composed of two cross-sectional studies (1998 and 2003–2004), each of a sample of 681 and 976 children 1–4 years of age, respectively. Children were sampled from 24 sentinel areas chosen to represent the range of environmental conditions in the study site. Data were collected using an individual/household questionnaire, and an environmental survey was conducted in each area before and after the intervention to assess basic household and neighborhood sanitation conditions. Stool samples were examined for the presence of intestinal parasites. The effect of the intervention was estimated by hierarchical modeling, fitting a sequence of multivariate regression models.FindingsThe prevalence of A. lumbricoides infection was reduced from 24.4% to 12.0%, T. trichuria from 18.0% to 5.0%, and G. duodenalis from 14.1% to 5.3%. Most of this reduction appeared to be explained by the increased coverage in each neighborhood by the sewage system constructed during the intervention. The key explanatory variable was thus an ecological measure of exposure and not household-based, suggesting that the parasite transmission prevented by the program was mainly in the public (vs. the domestic) domain.ConclusionThis study, using advanced statistical modeling to control for individual and ecological potential confounders, demonstrates the impact on intestinal parasites of sanitation improvements implemented at the scale of a large population.

This study was conducted in an arti

ArtigoPor uma política para a saúde do trabalhador não assalariado: o caso dos pescadores artesanais e das marisqueiras Todos os autores declaram que não possuem interesses pessoal, comercial, acadêmico, político ou financeiro neste manuscrito e que todo o apoio financeiro e material para esta pesquisa e trabalho estão claramente identificados no manuscrito.

The association of infantile diarrhoea with the presence of garbage in the environment was investigated in Canabrava, a peripheral neighbourhood of Salvador, northeast of Brazil. A cross-sectional study was conducted with all the 184 children aged less than two years residing in Canabrava, which is located close to the city garbage dump. Variables selected for study included the method used for the disposal of excrement, type of floor, mother's education, unemployment of the head of the family, regularity of the water supply, presence of toilet, storage of garbage inside the house, age, gender, duration of breastfeeding, and the number of people per room. The estimated prevalence of diarrhoea was 21.2%. Exposure to garbage in the environment was found to be the most important factor associated with diarrhoea (adjusted odds ratio [AOR] = 3.98, 95% CI 1.56-10.13). Other important variables were the mother's education (AOR = 2.79, 95% CI 1.09-7.13), maternal breastfeeding (AOR = 2.30, 95% CI 1.05-5.04), and unemployment of the head of the family (AOR = 2.09, 95% CI 0.93-4.69). These findings indicate the necessity of adopting solutions in the public domain and of intersectorial policies for the reduction of diarrhoea.

A crude oil spill was first identified on the Brazilian coast on August 30, 2019, and has reached 4,334 km of coastline in 11 states of the Northeast and Southeast, with 120 municipalities (counties) and 724 locations, as of November 22, 2019 1. The disaster is considered the worst oil spill in Brazil's history and one of the largest on record in the world. The sequence of the phenomena cannot be attributed to chance, rather expressing probabilities that increase as a function of an unsustainable development model, environmental crisis, institutional unpreparedness for the prevention of expanded social and technical events, with obsolete legal frameworks that rarely punish the large conglomerates responsible for them, and discriminatory policies against vulnerable populations, among other weaknesses 2. The scale of the government's response, particularly that of the health sector, must be assessed in order to minimize the population's health problems and organize effective responses, given the potential occurrence of similar phenomena. Brazil has been stage to major environmental disasters of global proportions in the last five years. In 2015, the collapse of the Samarco company's Fundão mine tailings dam in Mariana, state of Minas Gerais, considered the largest of its kind on record, contaminated approximately 650 km of riverine and marine territories, with material and health damage that will persist for years. In 2018, involving the same mining conglomerate, the Córrego do Feijão tailings dam collapsed in Brumadinho, also in the state of Minas Gerais, resulting in 254 deaths to date 2. This represents the largest fatal work accident on record in Brazil. In the mining tragedies, the health sector at the three levels of government played a secondary role, without demonstrating the capacity to ensure quality healthcare for the affected communities. In this same spectrum, the frequency of non-natural tragedies has increased around the globe, revealing the hazardous unpreparedness of the public health sector to deal with large-scale disasters. Bhopal (1984), in India, with more than 200,000 deaths, Chernobyl (1986), in Ukraine, and Fukushima (2011), in Japan, are examples of such expanded risks. Accidents of similar magnitude to that of the oil spill on the Brazilian coast have increased, underlining the severity of health impacts and the need for organized responses to events characterized as public health emergencies 3. Examples of crude oil disasters of a global scale include Deepwater Horizon in 2010, which spilled 200 million gallons of oil into the Gulf of Mexico, considered the largest on record,

Domestic solid waste is cause for current environmental concern in large cities around the world. Little is known about the human health consequences of solid waste disposal in open-air dumps. In addition, there are few studies on people's health practices in relation to solid waste. As the initial step in epidemiological research on the relationship between solid waste and diarrhea, this study describes women's perception of the definition of garbage and the popular understanding of the relationships between garbage and disease, and between garbage and the environment. The study used a qualitative approach in a slum neighborhood in Salvador, Bahia. A total of 13 women were interviewed using a semi-structured questionnaire in 1999. The FileMaker "diaricamp" application was used for data analysis. Interviewees defined garbage as anything useless and considered it a problem whenever it accumulated in the surroundings producing a bad smell or visual pollution, attracted animals, caused disease in children or adults, or was shifted from the individual to the collective/institutional sphere of action to solve the problem.

Por um diálogo de saberes entre pescadores artesanais, marisqueiras e o direito ambiental do trabalhoTowards a dialogue of knowledge between subsistence fishermen, shellfish gatherers and environmental labor law