Abstract
The adjusted effect of the characteristics of sanitation companies on the provision of fluoridation into public water supply in Brazilian municipalities was evaluated. Cross-sectional and ecological study based on the 2010 Demographic Census, 2008 National Survey on Basic Sanitation (PNSB), and 2010 Atlas of Human Development. The independent variables were the characteristics of utilities and municipalities, and the outcome was the lack of provision of fluoridation. Prevalence ratio was estimated with Poisson regression with robust variance. 5,565 Brazilian municipalities were included. In the adjusted analysis, the outcome was independently and positively associated to municipalities in the North, Northeast, Central-West and Southeast macro-regions, with coverage rates for water and sewage services below the median value, with less than 10,000 inhabitants, medium and low/very low in human development. Regarding the independent effect of the utilities' characteristics, they were more likely not to provide fluoridation, all the companies that were not classified as indirect administration of the government or mixed-capital company or mixed-capital company of public character; municipal and intermunicipal (PR=1.21; 95%CI 1.19-1.23); and when the municipal government is the only provider (PR=1.22; 95%CI 1.20-1.25). The lack of provision of water fluoridation was greater when the service was mainly provided by municipal administrations and private companies associated or not to public entities, regardless of the characteristics of the municipalities.
Highlights
The adjusted effect of the characteristics of sanitation companies on the provision of fluoridation into public water supply in Brazilian municipalities was evaluated
The lack of provision of water fluoridation was greater when the service was mainly provided by municipal administrations and private companies associated or not to public entities, regardless of the characteristics of the municipalities
60.2% had fluoridation services, and those belonging to the South and Southeast macro-regions had greater provision of the service
Summary
The adjusted effect of the characteristics of sanitation companies on the provision of fluoridation into public water supply in Brazilian municipalities was evaluated. The outcome was independently and positively associated to municipalities in the North, Northeast, Central-West and Southeast macro-regions, with coverage rates for water and sewage services below the median value, with less than 10,000 inhabitants, medium and low/very low in human development. It can be assumed that these differences between regions of the same country are linked to the political-administrative complexity that the relative autonomy of national subunits brings to the provision of sanitation services Characteristics of municipalities, such as human development index, geographic location between macro-regions and population size seem to be linked to the benefit[4,6,7]. There is no scientific information on the independent effect of other variables, such as the characteristics of sanitation companies in the provision of public health technology
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Schedule a callMore From: Revista brasileira de epidemiologia = Brazilian journal of epidemiology
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