Surveillance of public water supply fluoridation and municipal indicators: an analysis in the state of Espirito Santo, Brazil

Ariane Mendonça,Lorrayne Belotti,Karina Tonini Dos Santos Pacheco,Carolina Dutra Degli Esposti,Katrini Guidolini Martinelli

doi:10.4136/ambi-agua.2693

Abstract

This study investigated the demographic, socioeconomic, and municipal health indicators related to the quality of water fluoridation. An ecological study was carried out in Espirito Santo state (ES), based on data from the Drinking Water Quality Surveillance Information, from 2014 to 2017. The non-parametric Mann-Whitney and Spearman tests were applied to compare municipal indicators with the availability of information and the quality of fluoridation, respectively. Fluoridation quality was calculated to define the percentage of fluoride concentration values in each municipality within the range of the optimal level corresponding to the maximum benefit for preventing dental caries and minimum risk for the occurrence of dental fluorosis. The proportion of 80% or more samples were defined as a compliance criterion. In 2014, 62.8% of the municipalities had information available, and 16.7% performed analyses of fluoride concentration. The percentage of available data increased about 30%, in 2017, with 3.8% referring to fluoride. The quality of fluoridation remained high (> 80%) in ES in almost every year, except in 2014. The municipalities with the largest population, the highest GDP per capita, and the lowest coverage of the oral health team exhibited a greater availability of information about fluoride (p <0.05). The child mortality rate showed a strong negative correlation with the quality of fluoridation. The findings reinforce the importance of directing public policies that ensure the correct practices for monitoring and maintaining the quality of fluoridation.

Highlights

The fluoridation of public water supply is one of the most important measures of comprehensive coverage in public health, being recognized and recommended by the main World Health Organizations (Petersen, 2003)
Analyzing the availability of information regarding the external control of public water supply in 2014, of the 78 municipalities that make up the state of Espirito Santo (ES), only 49 (62.8%) recorded data related to the analysis of public water supply in the Sisagua, of which only 13 (16.7%) had data on the fluoride parameter
Among the samples with analysis of the fluoride concentration, in all the state, the percentage of the samples with content considered: (a) “adequate” - ranged from 70.7% to 87.6%; (b) “inadequate” - below ranged from 5.1% to 23.6%; and (c) “inadequate” - above ranged from 1.0% to 7.3% (Table 1)

Summary

Introduction

The fluoridation of public water supply is one of the most important measures of comprehensive coverage in public health, being recognized and recommended by the main World Health Organizations (Petersen, 2003). In Brazil, water quality control for human consumption was made a public responsibility action in 1977 by the passage of Federal Decree no 79.367, through Ordinance no 56 of the Ministry of Health. It was only at the end of the 1990s that the National Water Quality Surveillance Program for Human Consumption (Vigiagua) was created, which consists of the set of actions adopted to ensure the control and quality of the water consumed by the population. In order to assist in the management of information, the Drinking Water Quality Surveillance Information System (Sisagua) was developed, systematizing the data routinely generated by professionals in the health sector and those responsible for water supply services (Brasil, 2018)

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Results

Conclusion