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Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies

Barreto, M.L.; Genser, B.; Strina, A.; Teixeira, M.G.; Assis, A.M.O.; Rego, R.F.; Teles, C.A.; Prado, M.S.; Matos, S.M.A.; Santos, D.N.; Dos Santos, L.A.; Cairncross, S.
Lancet, 2007; 370(9599):1622-1628
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pub_id
17993362
pubmedid
17993362
ISI
250883400021
reference_type
Journal Article
author
Barreto, M.L.; Genser, B.; Strina, A.; Teixeira, M.G.; Assis, A.M.O.; Rego, R.F.; Teles, C.A.; Prado, M.S.; Matos, S.M.A.; Santos, D.N.; Dos Santos, L.A.; Cairncross, S.
title
Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies
secondary_title
Lancet
ISBNISSN
0140-6736
volume
370
number
9599
pages
1622-1628
year
2007
abstract
Background A 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. Methods The 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. Findings Diarrhoea 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%). Interpretation Our 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.
keywords
; Brazil; epidemiology; Child, Preschool; Diarrhea, Infantile; epidemiology; prevention & control; Housing; Humans; Infant; Infant, Newborn; Longitudinal Studies; Prevalence; Regression Analysis; Sanitation; economics; trends; Sentinel Surveillance;
secondary_author
place_published
publisher
number_of_volumes
tertiary_author
tertiary_title
edition
date
Nov
type_of_work
subsidiary_author
alternate_title
call_number
accession_number
17993362
custom_1
WOS OK
custom_2
Unknown
custom_3
custom_4
10.1016/S0140-6736(07)61638-9
custom_5
PMC
custom_6
10
label
2016-10-18
notes
url
://000250883400021 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=17993362
author_address
library
S0140-6736(07)61638-9 10.1016/S0140-6736(07)61638-9 17993362
date_accepted
date_online
created
2007-12-07 12:40:02
modified
2016-07-08 00:00:00
library
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<ArticleId IdType="doi">10.1016/S0140-6736(07)61638-9</ArticleId>
<ArticleId IdType="pubmed">17993362</ArticleId>