The Science of the total environment · 2023
Sewerage as a protective factor for prevalence of hookworm infection in schoolchildren in Brazil: A multilevel ecological analysis of national prevalence surveys (1950-2018).
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Santos Mariana Cristina Silva, Oliveira Guilherme Lopes de, Mingoti Sueli Aparecida, Heller Léo
Аннотация
INTRODUCTION: The prevalence of hookworm infection in Brazil has decreased considerably in recent decades. However, there is no definitive consensus as to which changes have contributed to this reduction. A hypothesis is that improvements in environmental factors have contributed to lowering the parasite load and the level of host-parasite contact.
METHODS: This is an ecological study using unbalanced panel data from two Brazilian surveys (1947-1953 and 2010-2015), with municipalities as the analysis unit. The sample comprised 1428 municipalities, in which a total of 745,983 schoolchildren aged 7 to 14 were examined. Zero-inflated Poisson regression models, with fixed and random effects were estimated to evaluate the association of potential explanatory variables with the prevalence of hookworm infection at a significance level of 5 %.
RESULTS: We identified a significant decrease in the prevalence between the first and last analyzed periods (RR 0.096; CI 0.086-0.107); The following variables were found to have a protective effect: access to sanitary sewage systems (RR 0.984, CI 0.982-0.986), urbanization (RR 0.995, CI 0.993-0.997), and gross domestic product (RR 0.929, CI 0.912-0.945).
CONCLUSION: The findings of this study show a decrease in the prevalence of hookworm infections over six decades in schoolchildren in the Brazilian municipalities. Environmental, demographic, and economic factors were associated with this trend. A historical analysis indicates that interventions aimed at improving sanitation contributed to reducing the disease prevalence.
METHODS: This is an ecological study using unbalanced panel data from two Brazilian surveys (1947-1953 and 2010-2015), with municipalities as the analysis unit. The sample comprised 1428 municipalities, in which a total of 745,983 schoolchildren aged 7 to 14 were examined. Zero-inflated Poisson regression models, with fixed and random effects were estimated to evaluate the association of potential explanatory variables with the prevalence of hookworm infection at a significance level of 5 %.
RESULTS: We identified a significant decrease in the prevalence between the first and last analyzed periods (RR 0.096; CI 0.086-0.107); The following variables were found to have a protective effect: access to sanitary sewage systems (RR 0.984, CI 0.982-0.986), urbanization (RR 0.995, CI 0.993-0.997), and gross domestic product (RR 0.929, CI 0.912-0.945).
CONCLUSION: The findings of this study show a decrease in the prevalence of hookworm infections over six decades in schoolchildren in the Brazilian municipalities. Environmental, demographic, and economic factors were associated with this trend. A historical analysis indicates that interventions aimed at improving sanitation contributed to reducing the disease prevalence.