Evidence of waste management impacting severe diarrhea prevalence more than WASH: An exhaustive analysis with Brazilian municipal-level data

Anni Juvakoski; Henrik Rantanen; Michela Mulas; Francesco Corona; Riku Vahala; Olli Varis; Ilkka Mellin

doi:10.1016/j.watres.2023.120805

Evidence of waste management impacting severe diarrhea prevalence more than WASH: An exhaustive analysis with Brazilian municipal-level data

Water Res. 2023 Dec 1:247:120805. doi: 10.1016/j.watres.2023.120805. Epub 2023 Oct 28.

Authors

Anni Juvakoski¹, Henrik Rantanen², Michela Mulas³, Francesco Corona⁴, Riku Vahala⁵, Olli Varis⁵, Ilkka Mellin⁶

Affiliations

¹ Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland. Electronic address: anni.juvakoski@aalto.fi.
² Independent.
³ Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland; Department of Teleinformatics Engineering, Federal University of Ceará, Campus do Pici, Fortaleza, Brazil.
⁴ Department of Chemical and Metallurgical Engineering, Aalto University, PO Box 16100, Espoo, FI-00076, Aalto, Finland.
⁵ Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland.
⁶ Department of Mathematics and Systems Analysis, Aalto University, PO Box 11100, FI-00076, Aalto, Finland.

PMID: 37976622
DOI: 10.1016/j.watres.2023.120805

Abstract

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.

Keywords: Housing; Low- and middle-income countries (LMIC); Municipalities; Public health; Waste management; Water, sanitation, and hygiene (WASH).

MeSH terms

Brazil / epidemiology
Child
Diarrhea / epidemiology
Humans
Hygiene*
Prevalence
Sanitation
Waste Management*
Water Supply