Socioeconomic, hygienic, and sanitation factors in reducing diarrhea in the Amazon

ABSTRACT OBJECTIVE To analyze the contributions of the socioeconomic, hygienic, and sanitation improvements in reducing the prevalence of diarrhea in a city of the Amazon. METHODS In this population-based cross-sectional study, we analyzed data from surveys conducted in the city of Jordão, Acre. In 2005 and 2012, these surveys evaluated, respectively, 466 and 826 children under five years old. Questionnaires were applied on the socioeconomic conditions, construction of houses, food and hygienic habits, and environmental sanitation. We applied Pearson’s Chi-squared test and Poisson regression to verify the relationship between origin of water, construction of homes, age of introduction of cow’s milk in the diet, place of birth and the prevalence of diarrhea. RESULTS The prevalence of diarrhea was reduced from 45.1% to 35.4%. We identified higher probability of diarrhea in children who did not use water from the public network, in those receiving cow’s milk in the first month after birth, and in those living in houses made of paxiúba. Children born at home presented lower risk of diarrhea when compared to those who were born in hospital, with this difference reversing for the 2012 survey. CONCLUSIONS Sanitation conditions improved with the increase of bathrooms with toilets, implementation of the Programa de Saúde da Família (PSF – Family Health Program), and water treatment in the city. The multivariate regression model identified a statistically significant association between use of water from the public network, construction of houses, late introduction of cow’s milk, and access to health service with occurrence of diarrhea.

摘要
目的：分析亚马孙地区某城市的社会经济、卫生及环卫改善措施对降低腹泻患病率的贡献。
方法：本研究为基于人群的横断面研究，分析了巴西阿克雷州若当市（Jordão, Acre）的调查数据。2005年与2012年分别对466名和826名五岁以下儿童开展调查。问卷内容涵盖社会经济状况、住宅建造情况、饮食与卫生习惯以及环境卫生状况。采用皮尔逊卡方检验（Pearson’s Chi-squared test）与泊松回归（Poisson regression），验证饮用水来源、住宅建造类型、膳食中牛乳引入年龄、出生地点与腹泻患病率之间的关联。
结果：腹泻患病率从45.1%降至35.4%。研究发现，未使用公共供水网络的儿童、出生后首月即摄入牛乳的儿童，以及居住在paxiúba材质房屋中的儿童，其腹泻发生概率更高。相较于医院分娩的儿童，居家分娩儿童的腹泻风险更低，但这一差异在2012年的调查中发生逆转。
结论：随着带冲水马桶的卫生间数量增加、家庭健康计划（Family Health Program，简称PSF）的实施以及城市饮用水处理工作的推进，当地环卫条件得到改善。多变量回归模型显示，公共供水网络使用情况、住宅建造类型、牛乳较晚引入膳食以及医疗服务可及性与腹泻发生存在具有统计学意义的关联。