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Impact of a city-wide sanitation intervention in a large urban centre on social, environmental and behavioural determinants of childhood diarrhoea: analysis of two cohort studies

Genser, B.; Strina, A.; Dos Santos, L.A.; Teles, C.A.; Prado, M.S.; Cairncross, S.; Barreto, M.L.
International Journal of Epidemiology, 2008; 37(4):831-840
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pub_id
18653513
pubmedid
18653513
ISI
257963500025
reference_type
Journal Article
author
Genser, B.; Strina, A.; Dos Santos, L.A.; Teles, C.A.; Prado, M.S.; Cairncross, S.; Barreto, M.L.
title
Impact of a city-wide sanitation intervention in a large urban centre on social, environmental and behavioural determinants of childhood diarrhoea: analysis of two cohort studies
secondary_title
International Journal of Epidemiology
ISBNISSN
0300-5771
volume
37
number
4
pages
831-840
year
2008
abstract
BACKGROUND: Poor socioeconomic status (SES) increases diarrhoea risk, mostly mediated by lack of sanitation, poor infrastructure and living conditions. The effectiveness of a city-wide sanitation intervention on diarrhoea in a large urban centre in Northeast Brazil has recently been demonstrated. This article aims to explore how this intervention altered the magnitude of relative and attributable risks of diarrhoea determinants and the pathways by which those factors affect diarrhoea risk. METHODS: We investigated determinants of prevalence of diarrhoea in two cohort studies conducted before and after the intervention. Each study enrolled pre-school children followed up for 8 months. For both cohorts, we calculated relative, attributable and mediated risks of diarrhoea determinants by a hierarchical effect decomposition strategy. RESULTS: The intervention reduced diarrhoea and also changed attributable and relative risks of diarrhoea determinants by altering the pathways of mediation. Before the intervention SES was a major distal diarrhoea determinant (attributable risk: 24%) with 90% of risk mediated by other factors, mostly by lack of sanitation and poor infrastructure (53%). After the intervention, only 13% of risk was attributed to SES, with only 42% mediated by other factors (18% by lack of sanitation and poor infrastructure). CONCLUSION: The intervention reduced diarrhoea risk by reducing direct exposure to unfavourable sanitation conditions. At the same time it altered the effect and mediation pathways of most distal diarrhoea determinants, especially SES. This finding corroborates the importance of public sanitation measures in reducing the impact of poverty on diarrhoea. It also underlines the value of studying the impact of public health interventions to improve our understanding of health determinants.
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secondary_author
place_published
publisher
number_of_volumes
tertiary_author
tertiary_title
edition
date
type_of_work
subsidiary_author
alternate_title
call_number
accession_number
18653513
custom_1
WOS OK
custom_2
Unknown
custom_3
custom_4
10.1093/ije/dyn101
custom_5
Free
custom_6
10
label
2016-10-18
notes
Times Cited: 1
url
://MEDLINE:18653513 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=18653513
author_address
library
dyn101 10.1093/ije/dyn101 18653513
date_accepted
date_online
created
2008-08-22 13:09:24
modified
2016-07-08 00:00:00
library

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<ArticleId IdType="doi">10.1093/ije/dyn101</ArticleId>
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