Abstract
This study aimed to analyze the association between the contextual determinants related to basic sanitation and self-reported health in Brazilian capitals. The sample consisted of 27,017 adults (≥18 years) residing in the 27 Brazilian capitals in 2013, from the National Health Survey (PNS). The association between self-reported health and sanitation (sewage system, water supply and garbage collection) was analyzed using Bayesian multilevel models, controlling for individual factors (first level of the model) and area-level socioeconomic characteristics (second level). We found a consistent association between better self-reported health and better sanitation levels, even after controlling for individual and contextual characteristics. At the contextual level, lower odds of poor self-reported health was observed among those living in areas with medium (OR = 0.59, 95%CI 0.57 - 0.61) or high (OR = 0.61, 95%CI 0.57 - 0.66) sewage system level; medium (OR = 0.77, 95%CI 0.71 - 0.83) coverage of water supply; and high (OR = 0.78, 95%CI 0.69 - 0.89) garbage collection level. The positive association between better sanitation conditions and health, independently of the individual factors and the socioeconomic characteristics of the place of residence, confirms the need to consider sanitation in the planning of health policies.
Highlights
Basic sanitation is a major public health concern, especially in low- and middle-income countries[1]
We found a consistent association between better self-reported health and better sanitation levels, even after controlling for individual and contextual characteristics
The sample consisted of 27,017 individuals at least 18 years old, of both sexes, residing in one of the 27 Brazilian capitals, including the Federal District, in 2013
Summary
Basic sanitation is a major public health concern, especially in low- and middle-income countries[1]. Related to services for drinking water availability and sewage and solid waste management services, sanitation problems are aggravated by the unplanned growth of urban centers[3], currently affecting an important part of the total disease burden in the world[4]. In this context, it is estimated that about 10% of all diseases can be prevented by improving sanitation conditions[4]. Another factor that can influence the coverage of sanitation services is unsustainable urbanization, which results in increased housing in places without adequate infrastructure[6]
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