Deprived areas and community water fluoridation in Brazil: a multilevel approach for refocusing public policy

Abstract

OBJECTIVES: The aim of this study was to determine whether geographic location, socioeconomic status, infant mortality, and mortality from diarrheal disease in health regions are associated with the provision of community water fluoridation (CWF) in Brazilian municipalities.METHODS: A multilevel ecological study was conducted based on data from the National Survey of Basic Sanitation and Human Development Atlas. A multilevel analysis was carried out considering Brazilian municipalities as the first level and health regions as the second level, comprising sanitation, demographic, socioeconomic, and health characteristics.RESULTS: The observation units comprised 5,565 municipalities clustered in 438 health regions in Brazil. The lack of CWF provision was positively associated with the following municipal characteristics: a below-median proportion of inhabitants covered by the sewage network, medium to very low human development index, below-median per capita gross domestic product, and an above-median percentage of expenditures on sanitation. In relation to the health regions, the likelihood of a lack of CWF provision was greater in the municipalities belonging to the health regions located in the Northern and Northeastern areas of Brazil and in those where child mortality due to acute diarrheal disease and the proportion of people with low income were higher when adjusted by municipal indicators.CONCLUSIONS: Information on the characteristics associated with CWF provision constitutes important input for refocusing public policy to reduce inequalities among Brazilian municipalities and health regions. These findings may help policy-makers to understand the challenges facing CWF expansion in low-, middle-, and high-income countries.

Influence of sociodemographic factors and Family Health Strategy coverage on oral health promotion procedures: an analysis of Brazilian municipalities in 2019

“…For this study, Gini index was dichotomized into ≤ 0.50 and > 0.50 ( 11 ). Population size was categorized according to number of inhabitants: < 5,001; from 5,001 to 10,000; from 10,001 to 50,000; from 50,001 to 100,000; from 100,001 to 500,000; and > 500,000 ( 12 ). HDI was ranged from 0 to 1 (the higher the value, the better the social conditions).…”

“…HDI was ranged from 0 to 1 (the higher the value, the better the social conditions). Values were categorized as low (≤ 0.50); medium (0.51 to 0.79); and high (> 0.80) ( 12 ).…”