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      Relações entre saneamento, saúde pública e meio ambiente: elementos para formulação de um modelo de planejamento em saneamento Translated title: Relationship between water supply, sanitation, public health, and environment: elements for the formulation of a sanitary infrastructure planning model

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          Abstract

          A compreensão das relações entre saneamento, saúde pública e meio ambiente revela-se um pressuposto fundamental para o planejamento de sistemas de saneamento em centros urbanos. Nesse sentido, o presente artigo objetiva propor elementos para o desenvolvimento de um modelo de planejamento em saneamento, a partir de um levantamento histórico das questões ambientais e de saúde incorporadas pelo setor, de uma análise dos marcos conceituais da relação saúde e saneamento, e de uma sistematização dos diversos efeitos da implementação de sistemas de abastecimento de água e de esgotamento sanitário no meio ambiente e na saúde pública. A avaliação desses efeitos deve garantir a análise correta das possíveis alternativas, tanto do ponto de vista dos objetivos ambientais, quanto dos de saúde pública (objeto primordial do saneamento), de modo a apontar o direcionamento mais adequado das ações. A proposta de sistematização dos efeitos das ações de saneamento em cada fase de sua implementação, realizada neste trabalho, constitui-se em um avanço, no sentido de reunir elementos fundamentais para a formulação de um modelo de planejamento em saneamento.

          Translated abstract

          The understanding of sanitation infrastructure, public health, and environmental relations is a fundamental assumption for planning sanitation infrastructure in urban areas. This article thus suggests elements for developing a planning model for sanitation infrastructure. The authors performed a historical survey of environmental and public health issues related to the sector, an analysis of the conceptual frameworks involving public health and sanitation systems, and a systematization of the various effects that water supply and sanitation have on public health and the environment. Evaluation of these effects should guarantee the correct analysis of possible alternatives, deal with environmental and public health objectives (the main purpose of sanitation infrastructure), and provide the most reasonable indication of actions. The suggested systematization of the sanitation systems effects in each step of their implementation is an advance considering the association between the fundamental elements for formulating a planning model for sanitation infrastructure.

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          Most cited references36

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          Water, waste, and well-being: a multicountry study.

          S Esrey (1996)
          Data collected in the late 1980s from eight countries in Sub-Saharan Africa (Burundi, Ghana, Togo, and Uganda), Asia/North Africa (Sri Lanka and Morocco), and the Americas (Bolivia and Guatemala) were combined and analyzed to test whether incremental health effects regarding diarrhea and nutritional status result from incremental improvements in water and sanitation conditions. Rural (n = 11,992) and urban (n = 4,888) samples were analyzed separately. Optimal (i.e., on the premises) and intermediate (improved public water) water supplies were compared with unimproved water conditions. Optimal (flush toilets or water-seal-latrines) and intermediate (latrines) sanitation levels were compared with unimproved sanitation. Nationally representative (random) samples of ever-married women age 15-49 years, with or without children, were interviewed in all countries, and children aged 3-36 months with available weight and height data were included in the analyses. Multiple linear regression controlled for household, maternal, and child-level variables; in addition, dummy variables were included for each country. Improvements in sanitation resulted in less diarrhea and in taller and heavier children with each of the three levels of water supply. Incremental benefits in sanitation were associated with less diarrhea and with additional increases in the weights and heights of children. The effects of improved sanitation were greater among urban dwellers than among rural dwellers. Health benefits from improved water were less pronounced than those for sanitation. Benefits from improved water occurred only when sanitation was improved and only when optimal water was present. These findings suggest that public health intervention should balance epidemiologic data with the cost of services and the demand for water. There should be efforts to develop compatible technologies so that incremental improvements in service can be made.
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            Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma.

            A total of 144 studies were analysed to examine the impact of improved water supply and sanitation facilities on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. These diseases were selected because they are widespread and illustrate the variety of mechanisms through which improved water and sanitation can protect people. Disease-specific median reduction levels were calculated for all studies, and separately for the more methodologically rigorous ones. For the latter studies, the median reduction in morbidity for diarrhoea, trachoma, and ascariasis induced by water supplies and/or sanitation was 26%, 27%, and 29%, respectively; the median reduction for schistosomiasis and dracunculiasis was higher, at 77% and 78%, respectively. All studies of hookworm infection were flawed apart from one, which reported a 4% reduction in incidence. For hookworm infection, ascariasis, and schistosomiasis, the reduction in disease severity, as measured in egg counts, was greater than that in incidence or prevalence. Child mortality fell by 55%, which suggests that water and sanitation have a substantial impact on child survival. Water for personal and domestic hygiene was important in reducing the rates of ascariasis, diarrhoea, schistosomiasis, and trachoma. Sanitation facilities decreased diarrhoea morbidity and mortality and the severity of hookworm infection. Better water quality reduced the incidence of dracunculiasis, but its role in diarrhoeal disease control was less important than that of sanitation and hygiene.
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              Environmental interventions in developing countries: interactions and their implications.

              This study assesses the effect of drinking water quality on diarrheal disease in good and poor sanitary conditions using a random sample of 2,355 Filipino infants over the first year of life. The study provides powerful confirmation of the importance of environmental factors on diarrhea: The effects of water quality, household sanitation, and community sanitation are strong, consistent, and statistically significant. The positive impact of improved water quality is greatest for families living under good sanitary conditions, with the effect statistically significant when sanitation is measured at the community level but not significant when sanitation is measured at the household level. Improving drinking water quality would have no effect in neighborhoods with very poor environmental sanitation; however, in areas with better community sanitation, reducing the concentration of fecal coliforms by two orders of magnitude would lead to a 40 percent reduction in diarrhea. Providing private excreta disposal would be expected to reduce diarrhea by 42 percent, while eliminating excreta around the house would lead to a 30 percent reduction in diarrhea. The findings suggest that improvements in both water supply and sanitation are necessary if infant health in developing countries is to be improved. They also imply that it is not epidemiologic but behavioral, institutional, and economic factors that should correctly determine the priority of interventions.
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                Author and article information

                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                0102-311X
                1678-4464
                December 2002
                : 18
                : 6
                : 1713-1724
                Affiliations
                [01] Brasília DF orgnameUniversidade de Brasília orgdiv1Faculdade de Tecnologia orgdiv2Departamento de Engenharia Civil e Ambiental Brasil
                Article
                S0102-311X2002000600026 S0102-311X(02)01800626
                62139bef-ca2e-4c39-ae62-467c022fc9ee

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 11 April 2002
                : 11 January 2002
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 12
                Product

                SciELO Brazil

                Self URI: Texto completo somente em PDF (PT)
                Categories
                Artigos

                Saneamento,Environment and Public Health,Planning,Sanitation,Meio Ambiente e Saúde Pública,Planejamento

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