Perceptions of bottled water consumers in three Brazilian municipalities

This study presents perceptions of consumers of bottled water in their households in three Brazilian municipalities. Data from interviews were analyzed using the Discourse Collective Subject method. Interviewees spent, on average, the equivalent of 40% of their water bill for the public water supply on the purchase of bottled water. The decision about water consumption in the household was predominantly made by women. Interviewees were particularly concerned with health risks and expressed a strong preference for the safety and organoleptic qualities of bottled water, particularly in cases where the tap water supply did not fully meet the regulated water quality standards. Interviewees were largely unaware of the origin, type, storage, and social and environmental impacts of bottled water. Results highlight the importance of water education efforts among the general population and the key role of women in the processes related to drinking water. The need for gender-specific interventions and the empowerment of women on water issues is noted. Results also strongly support the relevance of ensuring the provision of safe drinking water, from the source to the consumption point, with the trust of consumers.

Drinking water standards in South American countries: convergences and divergences

In this paper we present a comparative assessment of drinking-water standards from almost all South American countries, using the USA and the Canadian standards and the World Health Organization (WHO) Guidelines as references. Similarities and discrepancies between standards/guidelines were identified through descriptive analyses and, in the case of chemical standards, clustering techniques. In general, one or another of the four consecutive editions of the WHO Guidelines were shown to be quite influential in setting drinking-water standards in the region, but not so much the USA and the Canadian standards. Considerable discrepancies between South American drinking-water standards were found, mainly with respect to chemical substances. Questions are raised about their scientific basis and/or the practicalities for their enforcement. In conclusion, the paper highlights that many drinking-water regulations in South America need updating, taking on the approach of health-based targets in setting these standards, as well as that of a broader risk-based preventive management in the entire supply system to assure water safety.

Programa Nacional de Vigilância em Saúde Ambiental Relacionada à Qualidade da Água para Consumo Humano (Vigiagua): lacunas entre a formulação do programa e sua implantação na instância municipal

A avaliação e o acompanhamento das ações do Programa Nacional de Vigilância em Saúde Ambiental Relacionada à Qualidade da Água para Consumo Humano (Vigiagua) são importantes para validar o processo de trabalho, identificar nós e sugerir mudanças objetivando o avanço do Programa. Trabalhos sobre o Vigiagua geralmente exploram aspectos quantitativos e metas atingidas, inexistindo uma avaliação qualitativa sobre a sua implantação na instância municipal. Assim, práticas rotineiras preconizadas pelo Ministério da Saúde referentes à identificação e ao cadastramento das formas de abastecimento de água, à espacialização e ao compartilhamento de informações, intraorganizacional e intersetorialmente, são analisadas por meio de falas captadas em entrevistas com profissionais do Vigiagua em três municípios de diferentes portes populacionais. Recorreu-se ao método da análise de conteúdo de Bardin (1994) para o tratamento e a análise dos relatos, que revelou persistir dificuldades para cadastramento e vigilância a instalações de abastecimento de água, a não realização de séries temporais, a deficiência de instrumentos de georreferenciamento e a integração incipiente entre setores. Ainda, a integração entre a prática dos profissionais do Vigiagua e da Vigilância Epidemiológica é incipiente nos três municípios, restringindo-se basicamente a situações de surto. A implantação muito recente do Vigiagua aponta para a importância de avaliações visando, assim, seu aprimoramento.

Relationship (or its lack) between population and a water and sanitation service: a study of users' perception in Vitória (ES) Brazil

The objective of this paper is to identify and analyse the perception of groups of dwellers of Vitória, Espírito Santo, Brazil, regarding their relationship with the water and sanitation service and aspects of water handling. Participants living in four distinct urban districts of the capital city were interviewed in their own houses and the Discourse of the Collective Subject approach was employed to order the data so obtained. The testimonies revealed the health risk to which individuals were exposed by virtue of: (i) inadequate knowledge concerning the water supply offered, (ii) lack of stimulus to exert their citizens' rights and obligations in relation to the water provided for their consumption and (iii) poor channels of communication between the community, the water and sanitation service and the local public health authority. The study concluded that there is a need to rethink the forms of information provided to the population that are presently adopted by these institutions.

Análise da correlação de ocorrência da doença diarreica aguda com a qualidade da água para consumo humano no município de Vitória-ES

Buscou-se traçar possíveis associações da qualidade da água para consumo humano com a ocorrência de casos de diarreia utilizando o Programa de Monitorização da Doença Diarreica Aguda, no ano de 2004, no município de Vitória, capital do Estado do Espírito Santo, Brasil. Para a análise da qualidade da água, foram utilizados os dados do Programa de Controle da Qualidade da Água, realizado pelo serviço de abastecimento público, e da Vigilância da Qualidade da Água, realizada pela Prefeitura local. O delineamento epidemiológico adotado foi o estudo do tipo ecológico. Foram utilizadas ferramentas de georreferenciamento para representação das amostras estudadas e análises estatísticas de regressão linear univariada e multivariada. Foram encontradas associações com significância estatística para a ocorrência de diarreia com os parâmetros de turbidez, coliformes totais e termotolerantes. Os resultados apontam para a necessidade de maior cuidado na rede de distribuição de água. Entretanto, como a doença diarreica pode ser causa de várias enfermidades, são necessárias ações com o objetivo principal de caracterizar o agravo e definir sua fonte de infecção, de modo a propor medidas que interrompam a cadeia de transmissão.

A method for prioritization of areas for pesticides surveillance on surface waters: a study in Minas Gerais, Brazil

The occurrence of pesticides in drinking water is a matter of growing concern in several parts of the world, mainly in developing countries, due the possible adverse effects on human health. Pesticides applied in the agriculture are an important source of contamination and are rarely monitored in surface water in developing countries, either by water supply operators or health authorities, often not accomplishing the legal issues regarding the quality control of raw waters. The paper discusses a method for prioritization of surveillance actions of pesticides in surface waters, through multicriteria analysis. Five criteria were defined and a range of weight was established for each criterion. For validation of the method, it was applied in five sub-basins of Grande River Basin - MG. This application allowed ordering priority sub-basins for pesticides surveillance, suggesting two sub-basins as priorities. The validation performed enabled the evaluation and adjustment of the method, mainly regarding the availability of information. The method showed a practical alternative for the environmental surveillance, targeting priority areas. Moreover, its structure allows the application in other different areas and for other pollutants.

Giardia duodenalis infection: risk factors for children living in sub-standard settlements in Brazil

The objective of the present study was to characterize Giardia duodenalis infection among children living in sub-standard settlement areas in the municipality of Juiz de Fora, Minas Gerais State, Brazil. The cross-sectional epidemiological study included 590 children from 1 to 5 years of age. Data were collected from one child per selected family through home interviews with the parent or guardian and parasitological examination of stool samples. Thirty-one putative risk factors concerning family structure, socioeconomic status, and environmental factors were analyzed by multivariate logistic regression. Prevalence of G. duodenalis infection was 18% (106 children). Four potential risk factors were heavily associated with G. duodenalis infection: number of under-five children in the same household, index child's birth order, existence of a bathroom in the home, and drinking water source.

Bacillus anthracis virulent plasmid pX02 genes found in large plasmids of two other Bacillus species

In order to cause the disease anthrax, Bacillus anthracis requires two plasmids, pX01 and pX02, which carry toxin and capsule genes, respectively, that are used as genetic targets in the laboratory detection of the bacterium. Clinical, forensic, and environmental samples that test positive by PCR protocols established by the Centers for Disease Control and Prevention for B. anthracis are considered to be potentially B. anthracis until confirmed by culture and a secondary battery of tests. We report the presence of 10 genes (acpA, capA, capB, capC, capR, capD, IS1627, ORF 48, ORF 61, and repA) and the sequence for the capsule promoter normally found on pX02 in Bacillus circulans and a Bacillus species closely related to Bacillus luciferensis. Tests revealed these sequences to be present on a large plasmid in each isolate. The 11 sequences consistently matched to B. anthracis plasmid pX02, GenBank accession numbers AF188935.1, AE011191.1, and AE017335.3. The percent nucleotide identities for capD and the capsule promoter were 99.9% and 99.7%, respectively, and for the remaining nine genes, the nucleotide identity was 100% for both isolates. The presence of these genes, which are usually associated with the pX02 plasmid, in two soil Bacillus species unrelated to B. anthracis alerts us to the necessity of identifying additional sequences that will signal the presence of B. anthracis in clinical, forensic, and environmental samples.

Endemic Cryptosporidium infection and drinking water source: a systematic review and meta-analyses

Cryptosporidium is a well-known cause of diarrhoea in humans. Little is known about risk factors associated with endemic cryptosporidiosis, which constitutes the majority of cases. We carried out meta-analyses to verify if drinking water is also associated with endemic infection and to assess the magnitude of the associations. The global meta-analysis suggests that there is an increased risk of Cryptosporidium infection among unsafe water users (OR 1.40 [1.15, 1.72]). Studies were stratified, according to the exposure to different sources of safe drinking water, due to the heterogeneity presented. The consumption of non-well and unboiled water was associated with an increased chance of endemic cryptosporidiosis, though only the latter was significant (OR 1.45 [0.95, 2.20]; OR 1.61 [1.09, 2.38]). Drinking non-bottled water did not present a risk factor associated with endemic cryptosporidiosis (OR 0.87 [0.72, 1.05]). These meta-analyses present results that could be useful to clarify the epidemiology of Cryptosporidium. We recommend that other risk factors could also be studied by this approach.

Impact of water supply, domiciliary water reservoirs and sewage on faeco-orally transmitted parasitic diseases in children residing in poor areas in Juiz de Fora, Brazil

The objectives of this study were to characterize faeco-orally transmitted parasitic diseases and to identify the factors associated with these diseases, with emphasis on environmental factors, in children ranging from 1 up to 5 years old residing in substandard settlement areas. A population-based cross-sectional epidemiological design was used in a non-random selection of 29 out of the 78 substandard settlement areas in the municipality of Juiz de Fora, Brazil. A sample of 753 children were assessed from the target population consisting of all children of the appropriate age range residing in the selected areas. Data were collected by means of domiciliary interviews with their mothers or with the person responsible for them. The Hoffmann-Pons-Janer method was used in the parasitological examination of faeces. Binary logistic regression models were used to identify the factors associated with the diseases. A total of 319 sample children presented faeco-orally transmitted parasitic diseases. The factors associated with these parasitic diseases included the children's age, family income, number of dwellers in the domicile, consumption of water from shallow wells, consumption of water from natural sources, absence of covered domiciliary water reservoirs, and the presence of sewage flowing in the street.

Fatores ambientais associados à diarréia infantil em áreas de assentamento subnormal em Juiz de Fora, Minas Gerais

OBJETIVOS: caracterizar a prevalência de diarréia e identificar os fatores associados à essa doença em crianças residentes em áreas de assentamento subnormal. MÉTODOS: utilizou-se um delineamento transversal de base populacional. A amostra estudada totalizou 655 crianças. A coleta de dados foi feita mediante entrevistas domiciliares com a mãe ou com o responsável pela criança. Foram usados modelos de regressão logística para identificar fatores associados à diarréia. RESULTADOS: a prevalência da diarréia foi 17,5%. Os fatores associados à doença incluíram internação da criança no primeiro mês de vida; ser cuidado por terceiros, que não a mãe; maior nível de escolaridade do responsável; e maior tempo de residência, como fatores de proteção. Como fatores de risco individuais, a existência de outra doença; e baixa idade. Como fatores de risco coletivos, o consumo de água de mina; a disposição dos esgotos na rua ou no terreno; o acondicionamento inadequado do lixo; e presença de moscas. CONCLUSÕES: para o combate à diarréia sugere-se atenção especial à saúde e à alimentação de crianças com idade abaixo de cinco anos, incluindo adequadas cobertura e qualidade nos serviços de saneamento ambiental.

Setting priorities for environmental sanitation interventions based on epidemiological criteria: a Brazilian study

The present study addresses the use of analytical epidemiologic approaches to subsidize the establishment of priorities in environmental sanitation interventions. An epidemiological investigation was carried out in 1993 in the urban area of Betim, a southeast Brazilian City of 160,000 inhabitants. The case-control 'inclusive' (or case-cohort) design, with a sample of 997 cases and 999 controls, was employed. Cases were defined as children of less than five years of age presenting diarrhoea episodes, while controls were randomly selected among children of the same age, living in the study area. After logistic regression adjustment, 11 of several exposure variables analysed were significantly associated with diarrhoea. Four different criteria, using as risk measures the relative risk, the attributable risk, the standardized coefficient of the logistic regression and the cost standardized coefficient, were used in order to define intervention priorities.

Fatores ambientais associados à desnutrição infantil em áreas de invasão, Juiz de Fora, MG

O objetivo deste estudo foi caracterizar a morbidade por desnutrição crônica e por desnutrição aguda, além de identificar os fatores associados a estas doenças, com ênfase para os fatores ambientais, em crianças com idade entre um ano completo e cinco anos completos, residentes em áreas de invasão. Utilizou-se um delineamento transversal de base populacional em áreas de invasão em Juiz de Fora - MG. O critério de inclusão na amostra foi de uma criança por família, por sorteio. A amostra totalizou 659 crianças. A coleta de dados foi feita mediante entrevistas domiciliares. Foram usados modelos de regressão logística para identificar fatores associados às enfermidades. Da amostra, 74 (11,23%) crianças apresentaram desnutrição crônica e 40 (6,07%) apresentaram desnutrição aguda. Os fatores ambientais associados à desnutrição crônica incluíram intermitência no fornecimento de água (OR = 2,44), higiene precária da criança antes da alimentação (OR = 2,05) e lançamento das fezes das fraldas das crianças no peridomicílio (OR = 2,60). Nenhuma variável relacionada ao saneamento e à higiene mostrou-se associada a desnutrição aguda.