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Hamdan OHC, Libânio M, Costa VAF. Proposal of a regulatory index of quality of water supply services-RIQS. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:93564-93581. [PMID: 37505391 DOI: 10.1007/s11356-023-28880-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023]
Abstract
Among the challenges faced by regulatory authorities in the water sector, the large number of municipal supply services to be inspected and the cost of on-site inspections are prominent. To overcome these issues, decisions regarding the priority of inspections based on indicators is an alternative. Therefore, this research aims to propose and evaluate the Regulatory Index of Quality of Water Supply Service (RIQS) to triage on-site inspections of water supply systems in cities of the state of Minas Gerais. The study was conducted with information from the Regulatory Agency of Water Supply and Sanitation Services of Minas Gerais (Arsae-MG). The methodology followed seven steps: (i) selection of available indicators; (ii) grouping of indicators according to their typology; (iii) screening of indicators; (iv) establishment of standardized scale; (v) evaluation of the relative importance of typologies and indicators, through the adaptation of the analytic hierarchy process (AHP); (vi) determination of the RIQS; and (vii) analysis of results. As a result, we selected 12 indicators to compose the RIQS, which deal with efficiency, effectiveness, and customer relationship. We noticed that the indicator of water supply service coverage (17.2%) had the highest weight in the calculation of the RIQS, and the index of requests for an inspection of the water connection served on time (2.1%) had the lowest weight. In addition, 95.1% of the 591 municipalities evaluated presented excellent or good performance. Based on these results, we show that the RIQS can be used to identify cities with low performance and prioritize inspections in the most urgent water systems. Furthermore, these outcomes reveal the possibility of extending and adapting the methodology to other regulatory agencies around the world for identifying the priority of inspections in water supply systems at a municipal level.
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Affiliation(s)
| | - Marcelo Libânio
- Sanitary and Environmental Engineering Department, Engineering School, Federal University of Minas Gerais, 6627, Antonio Carlos Ave., Belo Horizonte, 31270-901, Brazil
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Machado LMG, Dos Santos ES, Cavaliero A, Steinmann P, Ignotti E. Spatio-temporal analysis of leprosy risks in a municipality in the state of Mato Grosso-Brazilian Amazon: results from the leprosy post-exposure prophylaxis program in Brazil. Infect Dis Poverty 2022; 11:21. [PMID: 35193684 PMCID: PMC8862266 DOI: 10.1186/s40249-022-00943-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/02/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Leprosy post-exposure prophylaxis (LPEP) with single dose rifampicin (SDR) can be integrated into different leprosy control program set-ups once contact tracing has been established. We analyzed the spatio-temporal changes in the distribution of index cases (IC) and co-prevalent cases among contacts of leprosy patients (CP) over the course of the LPEP program in one of the four study areas in Brazil, namely the municipality of Alta Floresta, state of Mato Grosso, in the Brazilian Amazon basin. METHODS Leprosy cases were mapped, and socioeconomic indicators were evaluated to explain the leprosy distribution of all leprosy cases diagnosed in the period 2016-2018. Data were obtained on new leprosy cases [Notifiable diseases information system (Sinan)], contacts traced by the LPEP program, and socioeconomic variables [Brazilian Institute of Geography and Statistics (IBGE)]. Kernel, SCAN, factor analysis and spatial regression were applied to analyze changes. RESULTS Overall, the new case detection rate (NCDR) was 20/10 000 inhabitants or 304 new cases, of which 55 were CP cases among the 2076 examined contacts. Changes over time were observed in the geographic distribution of cases. The highest concentration of cases was observed in the northeast of the study area, including one significant cluster (Relative risk = 2.24; population 27 427, P-value < 0.001) in an area characterized by different indicators associated with poverty as identified through spatial regression (Coefficient 3.34, P-value = 0.01). CONCLUSIONS The disease distribution was partly explained by poverty indicators. LPEP influences the spatial dynamic of the disease and results highlighted the relevance of systematic contact surveillance for leprosy elimination.
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Affiliation(s)
- Lúbia Maieles Gomes Machado
- Institute of Public Heath, Post-Graduation Program in Public Health, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Emerson Soares Dos Santos
- Institute of Public Heath, Post-Graduation Program in Public Health, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,Department of Geography, Post-Graduation Program of Geography, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Eliane Ignotti
- School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,School of Health Sciences, Post-Graduation Program in Environment Sciences, State University of Mato Grosso, Cáceres, Mato Grosso, Brazil
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do Nascimento RS, Baia KLN, de Souza SB, Fontoura GMG, Nunes PF, Machado LFA, Kupek E, Fischer B, Martins LC, Oliveira-Filho AB. Hepatitis E Virus in People Who Use Crack-Cocaine: A Cross-Sectional Study in a Remote Region of Northern Brazil. Viruses 2021; 13:926. [PMID: 34067873 PMCID: PMC8156048 DOI: 10.3390/v13050926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/19/2022] Open
Abstract
People who use crack-cocaine (PWUCC) have numerous vulnerabilities and pose a challenge to health and social assistance services. The exposure to pathogens and risk situations occur differently according to each individual, region and social group. This study identified the presence, genotypes and factors associated with hepatitis E virus (HEV) exposure among a community-recruited cohort of 437 PWUCC in northern Brazil. Epidemiological information was collected through community-based assessments and interviews. Thereafter, blood and fecal samples were collected and tested for HEV using an immunoenzymatic assay, and the genotype was identified by PCR. Logistic regressions were used to identify the risk factors independently associated with exposure to HEV. In total, 79 (18.1%) PWUCC were exposed to HEV: 73 (16.7%) for IgG and six for IgG + IgM. HEV RNA was detected in six fecal samples and in two blood samples from PWUCC with IgM + IgG. Subtype 3c was identified in all of the samples. The factors associated with exposure to HEV were low monthly income, unstable housing (e.g., homelessness), crack-cocaine use ≥40 months, and the shared use of crack-cocaine equipment. The current study provides unique initial insights into HEV status and risk factors among PWUCC in a remote area in Brazil, with diverse implications for urgently improved diagnosis, prevention, and treatment intervention needs.
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Affiliation(s)
- Raquel Silva do Nascimento
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil; (R.S.d.N.); (K.L.N.B.); (S.B.d.S.); (G.M.G.F.)
- Programa de Pós-Graduação em Biologia Ambiental, Universidade Federal do Pará, Bragança 68600-000, Brazil
| | - Karen Lorena N. Baia
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil; (R.S.d.N.); (K.L.N.B.); (S.B.d.S.); (G.M.G.F.)
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66055-240, Brazil; (P.F.N.); (L.C.M.)
| | - Samara Borges de Souza
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil; (R.S.d.N.); (K.L.N.B.); (S.B.d.S.); (G.M.G.F.)
- Programa de Pós-Graduação em Linguagens e Saberes na Amazônia, Bragança 68600-000, Brazil
| | - Guilherme Martins G. Fontoura
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil; (R.S.d.N.); (K.L.N.B.); (S.B.d.S.); (G.M.G.F.)
| | - Patrícia Ferreira Nunes
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66055-240, Brazil; (P.F.N.); (L.C.M.)
| | - Luiz Fernando A. Machado
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
| | - Emil Kupek
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis 88040-900, Brazil;
| | - Benedikt Fischer
- Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand;
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo 04038-000, Brazil
| | - Luísa Caricio Martins
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66055-240, Brazil; (P.F.N.); (L.C.M.)
| | - Aldemir B. Oliveira-Filho
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil; (R.S.d.N.); (K.L.N.B.); (S.B.d.S.); (G.M.G.F.)
- Programa de Pós-Graduação em Biologia Ambiental, Universidade Federal do Pará, Bragança 68600-000, Brazil
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66055-240, Brazil; (P.F.N.); (L.C.M.)
- Programa de Pós-Graduação em Linguagens e Saberes na Amazônia, Bragança 68600-000, Brazil
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de Souza AA, Mingoti SA, Paes-Sousa R, Heller L. Combined effects of conditional cash transfer program and environmental health interventions on diarrhea and malnutrition morbidity in children less than five years of age in Brazil, 2006-2016. PLoS One 2021; 16:e0248676. [PMID: 33784331 PMCID: PMC8009376 DOI: 10.1371/journal.pone.0248676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/03/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Governmental measures aiming at social protection, with components of disease control, have potential positive impacts in the nutritional and health outcomes of the beneficiaries. The concomitant presence of these measures with environmental sanitation interventions may increase their positive effect. The context of simultaneous improvement of social protection and environmental sanitation is found in Brazil since 2007 and an assessment of the combined effects of both programs has not been performed so far. OBJECTIVE To evaluate whether interaction effects between improvement of access to water, sanitation and solid waste collection with the Bolsa Família Program [PBF] were related to better responses in the reduction of morbidity due to diarrhea and malnutrition in children less than five years of age, acknowledging the positive results of these improved conditions and the PBF separately in coping with these diseases. METHODS Descriptive and inferential analyses were performed through Generalized Linear Models of the Negative Binomial type of fixed effects, with and without addition of zeros. Interaction models were inserted in order to evaluate the outcomes when the two public policies of interest in the current study were present simultaneously in the municipalities. RESULTS Interaction with negative effect when a concomitantly high municipal coverage of the Bolsa Família Program and adequate access to sanitation and solid waste collection were present. In contrast, regardless of municipal coverage by the PBF, the simultaneous presence of water and sanitation (0.028% / 0.019%); water and solid waste collection (0.033% / 0.014%); sanitation and solid waste collection (0.018% / 0.021%), all resulted in a positive effect, with a decrease in the average morbidity rates for both diseases. CONCLUSION Investments aimed at universalizing water, sanitation and solid waste collection services should be priorities, aiming at reducing the incidence of morbidity due to malnutrition and diarrhea and preventing deaths from these poverty-related diseases.
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Affiliation(s)
| | - Sueli Aparecida Mingoti
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rômulo Paes-Sousa
- Instituto René Rachou, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil
| | - Léo Heller
- Instituto René Rachou, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil
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Localizing Sustainable Development Goal 6: An Assessment of Equitable Access to Sanitation in a Brazilian Metropolitan Region. SUSTAINABILITY 2020. [DOI: 10.3390/su12176776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In order for the goals and targets of the 2030 Agenda to be achieved, it is essential to “localize” the Sustainable Development Goals (SDGs), since it is only at the local level that it is possible to move towards their effective implementation. This article seeks to contribute to the development of evaluation and monitoring strategies for target 6.2 at the local level, adapting the official SDG indicator 6.2.1a and the international criteria established by the Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (coordinated by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF)) at the municipal scale. Using the Belo Horizonte Metropolitan Region (RMBH) as a case study, a series of methodological procedures is proposed to assess and monitor equitable access to sanitation services. Inequalities in access to services between different population subgroups and between the municipalities that make up the RMBH are explored in different ways, including the evaluation of intersecting forms of inequality, the mapping of a synthetic index of inequality based on multiple criteria and the projection of the time needed to achieve universal access to services according to international criteria. The procedures applied demonstrated the existence of significant inequalities among the municipalities and population subgroups of the RMBH, which are not evident in the analysis of the aggregated data by municipality.
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New Approaches to Monitor Inequalities in Access to Water and Sanitation: The SDGs in Latin America and the Caribbean. WATER 2020. [DOI: 10.3390/w12040931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the 2030 Agenda for Sustainable Development, Targets 6.1 and 6.2 show, in their formulation, some alignment with the normative content of the human rights to water and sanitation (HRWS). However, the principle of equality and non-discrimination, which applies to all human rights, was not clearly incorporated into the indicators adopted to assess and monitor these targets. This paper contributes to bridging this gap by proposing two methodological strategies to address inequalities in analyses of access to water and sanitation services. The first consists in adjusting the indicators of access to these services according to inequality. The second proposes an assessment of intersecting forms of inequality. An application of these methods in Latin America and the Caribbean highlights significant regional heterogeneity and elevated inequality in access to services in the countries of this region. The methods demonstrate their potential in contributing to assessment and monitoring of the SDGs, but outdated or lacking data are obstacles to more in-depth analyses.
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