TY - JOUR
T1 - Evidence of waste management impacting severe diarrhea prevalence more than WASH : An exhaustive analysis with Brazilian municipal-level data
AU - Juvakoski, Anni
AU - Rantanen, Henrik
AU - Mulas, Michela
AU - Corona, Francesco
AU - Vahala, Riku
AU - Varis, Olli
AU - Mellin, Ilkka
N1 - Funding Information:
This study was financially supported by Maa- ja vesitekniikan tuki ry. (MVTT) and Aalto University. The authors also thank Laboratorio Nacional de Ciencias de La Sostenibilidad (LANCIS), Instituto de Ecología (UNAM), for hosting Anni Juvakoski for a research stay at the time of finalizing this manuscript.
Publisher Copyright:
© 2023
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Adequate housing protects from diarrhea, which is a substantial health concern in low- and middle-income countries. The purpose of this study was to quantify the relationship between severe diarrhea and housing features at the municipal level to help in public health planning. Regression analyses were performed on annual (2000–2012) datasets on Brazilian municipalities (5570) in six household feature categories (e.g., waste management) and four severe diarrhea outcomes (e.g., diarrhea deaths of under-5 children). Household data were not available elsewhere of this magnitude and granularity, highlighting the scientific value-add of this study. Municipalities were clustered prior to regression analysis because of data heterogeneity. The compositional household feature data were also subjected to principal component analysis to diminish feature variable multicollinearity. The highest explanatory power was found for diarrhea deaths of under-5 children (R2 = 10–22 %), while those in the over-5 population were the least best explained (R2 = 0.3–7 %). Household features predicted diarrhea outcomes more accurately in the “advanced” housing municipality cluster (R2 = 16–22 %) than in the “mid-level” (R2 = 7–20 %) and “basic” (R2 = 6–12 %) ones (over-5 diarrhea deaths excluded). Under-5 children's diarrhea death prevalence was three times higher in the “basic” cluster than in the “advanced” cluster. Importantly, the impact of waste management was overall the largest of all household features, even larger than those of WASH, i.e., water supply, sanitation, and household drinking water treatment. This is surprising in the context of existing literature because WASH is generally regarded as the most important household factor affecting gastrointestinal health. In conclusion, public health interventions could benefit from customizing interventions for diarrhea outcomes, municipality types, and household features. Waste management's identified stronger association with diarrhea compared to WASH may have important implications beyond the water field and Brazil.
AB - Adequate housing protects from diarrhea, which is a substantial health concern in low- and middle-income countries. The purpose of this study was to quantify the relationship between severe diarrhea and housing features at the municipal level to help in public health planning. Regression analyses were performed on annual (2000–2012) datasets on Brazilian municipalities (5570) in six household feature categories (e.g., waste management) and four severe diarrhea outcomes (e.g., diarrhea deaths of under-5 children). Household data were not available elsewhere of this magnitude and granularity, highlighting the scientific value-add of this study. Municipalities were clustered prior to regression analysis because of data heterogeneity. The compositional household feature data were also subjected to principal component analysis to diminish feature variable multicollinearity. The highest explanatory power was found for diarrhea deaths of under-5 children (R2 = 10–22 %), while those in the over-5 population were the least best explained (R2 = 0.3–7 %). Household features predicted diarrhea outcomes more accurately in the “advanced” housing municipality cluster (R2 = 16–22 %) than in the “mid-level” (R2 = 7–20 %) and “basic” (R2 = 6–12 %) ones (over-5 diarrhea deaths excluded). Under-5 children's diarrhea death prevalence was three times higher in the “basic” cluster than in the “advanced” cluster. Importantly, the impact of waste management was overall the largest of all household features, even larger than those of WASH, i.e., water supply, sanitation, and household drinking water treatment. This is surprising in the context of existing literature because WASH is generally regarded as the most important household factor affecting gastrointestinal health. In conclusion, public health interventions could benefit from customizing interventions for diarrhea outcomes, municipality types, and household features. Waste management's identified stronger association with diarrhea compared to WASH may have important implications beyond the water field and Brazil.
KW - Housing
KW - Low- and middle-income countries (LMIC)
KW - Municipalities
KW - Public health
KW - Waste management
KW - Water, sanitation, and hygiene (WASH)
UR - http://www.scopus.com/inward/record.url?scp=85176935649&partnerID=8YFLogxK
U2 - 10.1016/j.watres.2023.120805
DO - 10.1016/j.watres.2023.120805
M3 - Article
C2 - 37976622
AN - SCOPUS:85176935649
SN - 0043-1354
VL - 247
JO - Water Research
JF - Water Research
M1 - 120805
ER -
